The Difference is Research Can we really prevent alcohol and drug harms?

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1 The Difference is Research Can we really prevent alcohol and drug harms? Maree Teesson, Director, Centre of Research Excellence in Mental Health and Substance Use, CREMS

2 Prevention Team & Contributors Academic Dr Nicola Newton Prof Maree Teesson Dr Lexine Stapinski Dr Cath Chapman A/Prof Tim Slade Dr Frances Kay-Lambkin Prof Steve Allsop Dr Nyanda McBride Dr Wendy Swift Dr Emma Barrett Prof Gavin Andrews Research Team Katrina Champion Daniel Rodriguez Zoe Tonks Bill Reda Erin Kelly Katrina Champion Natasha Nair Louise Birrell Netfront web designers 2and2 game developers

3 Funders include National Health and Medical Research Council Centre of Research Excellence, Project Grants, Fellowships Australian Government Department of Health NSW Department of Health Rotary PhD Scholarships and Fellowships Society for Mental Health Research Fellowships Declaration Maree Teesson and Nicola Newton are the directors of CLIMATESCHOOLS PTYLTD. An Australian company set up to deliver the online CLIMATESCHOOLS programs.

4 Outline 1. Who gets into trouble with drugs and alcohol, and why does it matter? 2. Can we prevent the problems? 3. How do we help schools and parents access evidence-based resources?

5 Alcohol and drugs in Australia 80% of Australians (aged 14 & over) drink alcohol More than 1 in 3 (38%) consumed alcohol at a level that put themselves at risk of harm or injury, (26% did this monthly) 35% have tried cannabis 11% have tried ecstasy 1.2% had used synthetic cannabis 0.4% other emerging psychoactive substances

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7 Recent Trends: Illicit Drugs Rates of illicit drug use are fairly stable month use of any illicit substance by Australians yrs < 20% Source: National Drug Strategy Household Survey

8 Recent Trends: Alcohol Young people are delaying onset of drinking 16 Age of drinking initiation among Australians aged yrs yrs yrs However, rates of very high risk binge drinking (11+ drinks) among year olds have not shifted from 2010 to 2013 Source: National Drug Strategy Household Survey

9 Risk Factors for Teenage drinking Many! Recent study by Mattick et al (2014) examined a range of individual, family and peer factors on teenage drinking The most important risk factors when all were considered were: Peer use of alcohol The perception of alcohol use as normative ( everyone is doing it ) Behavioural problems Parental supply of alcohol Mattick, Wadolowski, Aiken, Najman, Kypri, Slade, Hutchinson, Bruno & McBride, 2014

10 Outline 1. Who gets into trouble with drugs and alcohol, and why does it matter? 2. Can we prevent the problems? 3. How do we help schools and parents access evidence-based resources?

11 Types of prevention 1. Universal: delivered to an entire population regardless of level of risk 2. Selective: targeted to groups at greatest risk of developing problems 3. Indicated: targeted to those experiencing early symptoms of a disorder

12 Prevention needs to occur early School is the ideal location Practical - spend > 25% waking lives Time when first start to experiment Tailor messages at developmental levels Educate prior to harmful exposure

13 Effective principles of school-based drug prevention Evidence-based and theory driven Developmentally appropriate & immediately relevant to students Implemented prior to harmful patterns of use Be part of a comprehensive health education curriculum Use peer leadership but keep teacher as the central role Employ interactive teaching approaches Adopt a social influence or comprehensive approach (Newton et al., 2013, Botvin & Griffin, 2007, Midford et al., 2001; 2002, Tobler et al., 1999; 2000, Foxcroft, & Tsertsvadze, 2011, Faggiano et al., 2008, Dusenbury, L., & Falco, 1995)

14 Universal school-based drug prevention Evidence-based programs do exist: Life Skills Training program (Botvin et al) School Health and Alcohol Harm Reduction Project (SHAHRP) (Midford & McBride) EU-DAP Study Unplugged program (Faggiano et al) Get Ready program (DEVS Study) (Cahill & Midford) Dissemination of evidence-based programs is low 14% schools use programs with correct content and delivery Due to barriers & obstacles that arise when implementing programs in the school environment

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16 Innovative new prevention model Clearly a new approach was needed that was: 1. Evidence-based: adheres to effective principles of drug prevention 2. Overcame barriers to implementation to increase fidelity & outcomes

17 Climate Schools programs Universal prevention programs which aim to prevent substance use and related harms in adolescents Social influence approach Harm-minimisation goal Internet-based Easy to implement Embedded in curriculum Age and context appropriate Interactive cartoons & activities Reinforcement - booster

18 Climate Schools programs Four modules for Australian high school students 1. Alcohol module (Yr 8: 13-14yr olds) 2. Alcohol & Cannabis module (Yr 8/9: 13-15yr olds) 3. Cannabis & Psychostimulant module (Yr 9/10: 14-16yr olds) 4. Ecstasy and New Psychoactive Substances (Yr 10)

19 Climate Schools components Extensive development process Focus groups & interviews teachers, students and health prof. Developed by the user group for the user group Module = 6 lessons of Part 1: 15 min online Part 2: 25 min class activities Assertion skills Calling for assistance Recovery position Decision making Group discussions Covering Alcohol guidelines and laws Normative use Short & long term risks Influences of media & peers Drug refusal & harm minimisation skills Staying safe & first aid

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21 Part 1: Online component

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34 Part 1: Online component

35 Lesson summaries

36 Part 2: Class activities

37 Does Climate Schools reduce harms? 6 cluster RCTs in Australia (4 complete, 2 ongoing) and a pilot in UK 157 schools and > 14,000 students have participated across NSW, WA, VIC, ACT, QLD and London 14 papers reporting their effectiveness

38 Climate Schools: Alcohol & Cannabis module Newton, N. C., Teesson, M., Vogl, L. E. & Andrews, G. (2010). Internet-based prevention for alcohol and cannabis use: Final results of the Climate Schools course. Addiction, 105, Newton, N. et al. (2009). Delivering school-based prevention for alcohol and cannabis using the internet: A cluster randomised controlled trial. Preventive Medicine, 48, Champion KE; Newton NC; Stapinski L; Slade T; Barrett EL; Teesson M. (2016) 'A cross-validation trial of an Internet-based prevention program for alcohol and cannabis: Preliminary results from a cluster randomised controlled trial.', ANZJP, 50, 64-73, Two independent RCTs Summary of results: Increased alcohol and cannabis knowledge Decreased frequency of cannabis use Decreased average alcohol consumption Decreased binge drinking Reduced truancy, psychological distress & moral disengagement

39 Our latest trial results. * Newton N, Teesson M, Barrett E, Slade T, Conrod P CAP study, evaluation of integrated universal and selective prevention strategies for youth alcohol misuse: Study protocol of a cluster randomized controlled trial BMC Psychiatry (2012)

40 1. Target universal risk factors Climate Schools Series of online 6-session courses Aligned with health curriculum Cartoon-based teenage drama, followed by interactive class activities Based on social influence model with harm minimisation focus

41 Preventure individual risk All adolescents screened using the SURPS High-risk adolescents take part in two 90-minute coping skills workshops: manualised facilitator-led content differs depending on personality based on motivational interviewing (MI) and cognitive behaviour therapy (CBT) principles

42 Study Design Schools recruited 27 schools (18 private, 9 public) Total students: 3,361 Parental consent/return 2,608 students (77.6%) No consent / return No consent: 94 (2.8%) No return: 659 (19.6%) CONTROL 7 schools Students: 612 CLIMATE 6 schools* Students: 708 PREVENTURE 7 schools Students: 615 CAP 6 schools Students: 673 Student consent / present at baseline 2,190 students * One school dropped out due to insufficient time and was not included in the intention to treat sample

43 Binge drinking Binge drinking - total sample* 21% 15% ~5% Baseline Post 12M F/U 24M F/U Control CAP Climate *N=2189

44 Outline 1. Who gets into trouble with drugs and alcohol, and why does it matter? 2. Can we prevent the problems? 3. How do we help schools and parents access evidence-based resources?

45 Positive Choices: Improving dissemination Funded by the Australian Government Department of Health Dissemination project to improve access to evidence-based drug prevention resources for schools across Australia Two phases: 1. Distribution of a resource package to every secondary school 2. Development of an online portal

46 1. Positive Choices Drug Prevention Resource Package 186,000 resource packages delivered to 3,072 secondary schools across Australia Wide interest, with requests for 4,172 additional booklets from Primary & High Schools Drug and Alcohol support services Indigenous health services Medical Centres Youth-oriented organisations & Youth Centres Government departments Victoria Police Rehabilitation Centres Community events Booklets available for free download from: positivechoices.org.au To request hard copies, with postal address.

47 1. Positive Choices Illegal Drugs Resource Package Pure Rush: Online Game How do we make drug education interesting, interactive and engaging? How do we provide factual information about drug harms in a context that is relevant for young people? Educational games are a promising alternative to traditional drug education s/pure-rush-online-drugeducation-game

48 Pure Rush Online drug education game Factual info about drugs effects Interactive learning: colliding with drugs results in impaired performance effects Avoid drugs to succeed in game

49 2. Positive Choices: Online Portal Central access point for school-based drug prevention A focus on resources and prevention programs that are engaging, interactive, evidence-based Developed in consultation with teachers, parents, students Helps users find resources according to their specific needs, lesson planning Ongoing engagement, discussion, resource sharing through subscriber newsletters, twitter & facebook

50 Launch of Positive Choices portal: 6 th Dec Broad interest already with 9,942 users nationally and internationally

51 Summing up Earlier initiation of drug and alcohol use is associated with long-term negative outcomes Prevention needs to occur early School-based prevention approaches have proven effective in reducing alcohol/drug use and related harms, e.g. Climate Schools Broad dissemination of evidence-based approaches is critical

52 Thank-you To find out more, visit: