Curbing young adolescents' alcohol abuse: Time to revisit the prevention paradox?

Abstract

The central theme of this thesis is alcohol prevention in adolescence. In the last decades, various prevention programmes have been developed to prevent young adolescents from initiating alcohol use at an early age, and to prevent them from developing unhealthy drinking patterns once they have initiated drinking. Until today, efforts to control adolescents drinking behaviour mainly fall under universal prevention, which means prevention for the group of adolescents in general. Far fewer efforts have been done for adolescents who are at higher risk for initiating alcohol misuse at an early age and developing alcohol related problems at a later age; the so-called selective and indicated prevention (targeted prevention). A discussion that is often held in the field of substance use prevention is what is most effective, focusing on the entire group of young adolescents, or focusing on the group of young adolescents that is most at risk of alcohol abuse. The current thesis contributes to finding an answer to this question, as well as discussing the results of an effectiveness study on a selective alcohol prevention programme. General conclusion The results of this dissertation provide indications that targeted prevention (selective and indicated prevention) is more effective than universal prevention in preventing or reducing alcohol abuse among young adolescents. Investing in relatively small high-risk groups can yield profit at the population level of young adolescents, and can be complimenting to universal prevention efforts; the so called second order prevention paradox. One of the selective alcohol prevention approaches with potential is the Preventure programme. The results of the effectiveness study provided prudent indications that Preventure is effective in reducing binge drinking in young adolescents with a high-risk personality profile, and among the group of lower educated young adolescents. Relevance The results from this dissertation show that selective alcohol prevention is a good supplement to universal prevention. The availability of evidence-based alcohol prevention programs for high-risk adolescents in the Netherlands is scarce. The Preventure programme can have an added value for the prevention field in The Netherlands. This on personality traits driven approach can fill the gap of the availability of evidence based alcohol prevention programs for high-risk groups. The Preventure approach could also be suitable for vulnerable groups for which little to no evidence-based interventions are available, such as youngsters with a mild intellectual disability, and students in practical education and secondary special education. It is recommended to further develop this prevention programme for these target groups and to invest in effectiveness research.