School-based psychological interventions reduce risk of alcohol misuse, finds new study

 
Targeted psychological interventions aimed at teenagers at risk of emotional and behavioural problems significantly reduce their drinking behaviour, and that of their schoolmates, according to the results from a large randomised controlled trial published today in JAMA Psychiatry. The authors argue that the intervention could be administered in schools throughout the UK to help prevent teenage alcohol abuse.

The ‘Adventure Trial‘ is led by Dr Patricia Conrod, King’s College London’s Institute of Psychiatry, in collaboration with the University of Montreal and Sainte-Justine University Hospital Center (Canada) and was commissioned by Action on Addiction.

The trial involved 21 schools in London that were randomly allocated to either receive the intervention, or the UK statutory drug and alcohol education curriculum. A total of 2,548 year-10 students (average age 13.8 years) were classed as high or low-risk of developing future alcohol dependency. Those classed as high-risk fit one of four personality risk profiles: anxiety, hopelessness, impulsivity or sensation seeking. All students were monitored for their drinking behaviour over two years. Four members of staff in each intervention school were trained to deliver group workshops targeting the different personality profiles. 11 schools received the intervention where 709 high-risk teenagers were invited to attend two workshops that guided them in learning cognitive-behavioural strategies for coping with their particular personality profiles.

Dr Patricia Conrod, from King’s Institute of Psychiatry and lead author of the paper, says: “Through the workshops, the teenagers learn to better manage their personality traits and individual tendencies, helping them to make good decisions for themselves. Depending on their personality profiles, they might learn cognitive-behavioural strategies to better manage high levels of anxiety, to manage their tendency to have pessimistic reactions to certain situations or to control their tendency to react impulsively or aggressively. Our study shows that this mental health approach to alcohol prevention is much more successful in reducing drinking behaviour than giving teenagers general information on the dangers of alcohol.”

After two years, high-risk students in intervention schools were at a 29% reduced risk of drinking, 43% reduced risk of binge drinking and 29% reduced risk of problem drinking compared to high-risk students in control schools. The intervention also significantly delayed the natural progression to more risky drinking behaviour (such as frequent binge drinking, greater quantity of drinking, and severity of problem drinking) in the high-risk students over the two years.

Additionally, over the two year period, low-risk teenagers in the intervention schools, who did not receive the intervention, were at a 29% reduced risk of taking up drinking and 35% reduced risk of binge drinking compared to the low-risk group in the non-intervention schools, indicating a possible ‘herd effect’ in this population.

Dr Conrod adds: “Not only does the intervention have a significant effect on the teenagers most at risk of developing problematic drinking behaviour, there was also a significant positive effect on those who did not receive the intervention, but who attended schools where interventions were delivered to high-risk students. This ‘herd effect’ is very important from a public health perspective as it suggests that the benefits of mental health interventions on drinking behaviour also extend to the general population, possibly by reducing the number of drinking occasions young people are exposed to in early adolescence.”

Dr Conrod concludes: “This intervention could be widely administered to schools: it is successful from a public health perspective, appreciated by students and staff, and because we train school staff rather than professional psychologists, the intervention remains relatively inexpensive to roll-out.”

Approximately 6 out of 10 people aged 11-15 in England report drinking, and in the UK approximately 5,000 teenagers are admitted to hospital every year for alcohol related reasons. Across the developed world, alcohol accounts for approximately 9% of all deaths of people aged 15-29, and so far, universal community or school-based interventions have proven difficult to implement and shown limited success.

Nick Barton, Chief Executive of Action on Addiction says: “Dr Conrod’s study which helps young people reduce their chances of developing an addiction to alcohol and/or drugs in the future is an exciting development for prevention work in the UK. This is generally recognised as inadequate, and as we see regularly in the media, currently fails to address binge drinking and drug taking among young people. We treat a large number of people who began misusing substances in their school years, and we welcome any evidence-based research which may help to reverse this trend.”

ᔥKing’s College London

Out lesbians, gays, and bisexuals are in better mental and physical health than others

Coming out is no longer a matter of popular debate but a matter of public health

– lead author Robert-Paul Juster

Lesbians, gays and bisexuals (LGBs) who are out to others have lower stress hormone levels and fewer symptoms of anxiety, depression, and burnout, according to researchers at the Centre for Studies on Human Stress (CSHS) at Louis H. Lafontaine Hospital, affiliated with the University of Montreal. Cortisol is a stress hormone in our body. When chronically strained, cortisol contributes to the ‘wear and tear’ exerted on multiple biological systems. Taken together, this strain is called “allostatic load”. “Our goals were to determine if the mental and physical health of lesbians, gay men and bisexuals differs from heterosexuals and, if so, whether being out of the closet makes a difference. We used measures of psychiatric symptoms, cortisol levels throughout the day, and a battery of over twenty biological markers to assess allostatic load,” explained lead author Robert-Paul Juster. “Contrary to our expectations, gay and bisexual men had lower depressive symptoms and allostatic load levels than heterosexual men. Lesbians, gay men, and bisexuals who were out to family and friends had lower levels of psychiatric symptoms and lower morning cortisol levels than those who were still in the closet.”

Montrealers of diverse sexual orientations were invited to the laboratory of Dr. Sonia Lupien, Director of the CSHS. Lupien’s team recruited eighty-seven men and women, all of whom were around twenty-five years of age. Over the course of several visits, the researchers collected psychological questionnaires, asked participants to provide saliva samples to measure cortisol over two days, and calculated allostatic load indices using results from blood, saliva, and urine samples. “Chronic stress and misbalanced cortisol levels can exert a kind of domino effect on connected biological systems,” Lupien said. “By looking at biomarkers like insulin, sugar, cholesterol, blood pressure, adrenalin, and inflammation together, an allostatic load index can be constructed and then used to detect health problems before they occur.”

Stigma-related stress might force LGBs to develop coping strategies that make them more effective at managing future stressors. “Coming out of the closet is a major milestone in lives of LGBs that has not been studied extensively using interdisciplinary approaches that assess stress biomarkers” said co-author Dr. Nathan Grant Smith. These exciting findings underline the role self-acceptance and disclosure has on the positive health and wellbeing of LGBs. In turn, this has important implications for ongoing political debates. “Coming out might only be beneficial for health when there are tolerant social policies that facilitate the disclosure process” said Juster. “Societal intolerance during the disclosure process impairs one’s self-acceptance that generates increased distress and contributes to mental and physical health problems.”

“As the participants of this study enjoy progressive Canadian rights, they may be inherently healthier and hardier,” Juster said. “Coming out is no longer a matter of popular debate but a matter of public health. Internationally, societies must endeavour to facilitate this self-acceptance by promoting tolerance, progressing policy, and dispelling stigma for all minorities.”

ᔥThe research was published in Psychosomatic Medicine on January 29, 2013. The University of Montreal

The “empty nest” of past generations, in which the kids are grown up and middle-aged adults have more time to themselves, has been replaced in the United States by a nest that’s full – kids who can’t leave, can’t find a job and aging parents who need more help than ever before.

According to a new study by researchers at Oregon State University, what was once a life stage of new freedoms, options and opportunities has largely disappeared.

An economic recession and tough job market has made it hard on young adults to start their careers and families. At the same time, many older people are living longer, which adds new and unanticipated needs that their children often must step up to assist with.

The end result, researchers suggest, are “empty nest” plans that often have to be put on hold, and a mixed bag of emotions, ranging from joy and “happy-to-help” to uncertainty, frustration and exhaustion.

“We mostly found very positive feelings about adults helping their children in the emerging adulthood stage of life, from around ages 18 to 30,” said Karen Hooker, director of the OSU Center for Healthy Aging Research.

“Feelings about helping parents weren’t so much negative as just filled with more angst and uncertainty,” Hooker said. “As a society we still don’t socialize people to expect to be taking on a parent-caring role, even though most of us will at some point in our lives. The average middle-aged couple has more parents than children.”

The findings of this research were just published in the Journal of Aging Studies, and were based on data from six focus groups during 2009-10. It was one of the first studies of its type to look at how middle-aged adults actually feel about these changing trends.

Various social, economic, and cultural forces have combined to radically challenge the traditional concept of an empty nest, the scientists said. The recession that began in 2008 yielded record unemployment, substantial stock market losses, lower home values and increased demand for higher levels of education.

Around the same time, advances in health care and life expectancy have made it possible for many adults to live far longer than they used to – although not always in good health, and often needing extensive care or assistance.

This study concluded that most middle-aged parents with young adult children are fairly happy to help them out, and they understand that getting started in life is simply more difficult now. Some research has suggested that age 25 is the new 22; that substantially more parents now don’t even expect their kids to be financially independent in their early 20s, and don’t mind helping them through some difficult times.

But the response to helping adult parents who, at the same time, need increasing amounts of assistance is not as uniformly positive, the study found – it can be seen as both a joy and a burden, and in any case was not something most middle-aged adults anticipated.

“With the kids, it’s easy,” is a general purpose reaction. With aging parents, it isn’t.

“My grandparents died younger, so my parents didn’t cope with another generation,” one study participant said.

Many middle-aged people said it was difficult to make any plans, due to disruptions and uncertainty about a parent’s health at any point in time. And most said they we’re willing to help their aging parents, but a sense of being time-starved was a frequent theme.

“It brings my heart joy to be able to provide for my mom this way,” one study participant said. “There are times when it’s a burden and I feel resentful.”

The dual demands of children still transitioning to independence, and aging parents who need increasing amounts of care is causing many of the study participants to re-evaluate their own lives. Some say they want to make better plans for their future so they don’t pose such a burden to their children, and begin researching long-term care insurance. Soul-searching is apparent.

“I don’t care if I get old,” a participant said. “I just don’t want to become debilitated. So I would rather have a shorter life and a healthy life than a long life like my mom, where she doesn’t have a life. She doesn’t have memories. Our memories are what make us who we are.”

An increasing awareness of the challenges produced by these new life stages may cause more individuals to anticipate their own needs, make more concrete plans for the future, reduce ambivalent approaches and have more conversations with families about their own late-life care, the researchers said in their study.

ᔥOregon State University