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BACKGROUND While it is well known that adolescents frequently turn to their friends for support around mental health and substance use problems, there are currently no evidence-based digital programs to support them to do this. OBJECTIVE To evaluate the efficacy of the Mind your Mate program, a digital peer support program, in improving mental health symptoms, reducing the uptake of substance use, and increasing help-seeking. The Mind your Mate program consists of an online 40-minute classroom lesson and a companion smartphone mobile application (app). The active control group received school-based health education as usual. METHODS A cluster randomized controlled trial (RCT) was conducted with 12 secondary schools and 166 students (mean age=15.3 years, SD=0.41, 46% female, 80% born in Australia). Participants completed self-reported questionnaires assessing symptoms of mental health (depression, anxiety, and psychological distress), substance use (alcohol and other drug use) and help-seeking measures at baseline, 6- and 12-month follow-up. RESULTS Students who received the Mind your Mate program had reduced growth in depressive symptoms over a 12-month period, compared to controls (b=-1.86, 95% CI=3.73 – 0.02). Promisingly, anxiety symptoms decreased among students in the intervention group; however, these reductions did not meet statistical significance thresholds. No significant differences were observed in relation to psychological distress or help-seeking. CONCLUSIONS A novel digital health intervention, the Mind your Mate program, reduced depression symptoms in adolescents over 12-months compared to a control condition. While the current results are encouraging there is a need to continue to refine, develop and evaluate innovative applied approaches to the prevention of mental disorders in real-world settings. CLINICALTRIAL The study was prospectively registered on the Australian New Zealand Clinical Trials Registry (#ACTRN12620000753954). https://www.anzctr.org.au/ INTERNATIONAL REGISTERED REPORT RR2-10.2196/26796

ImportanceAlcohol consumption is one of the leading preventable causes of burden of disease worldwide. Selective prevention of alcohol use can be effective in delaying the uptake and reducing harmful use of alcohol during the school years; however, little is known about the durability of these effects across the significant transition from early adolescence into late adolescence and early adulthood.ObjectiveTo examine the sustained effects of a selective personality-targeted alcohol use prevention program on alcohol outcomes among adolescents who report high levels of 1 of 4 personality traits associated with substance use.Design, Setting, and ParticipantsA cluster randomized clinical trial was conducted to assess the effectiveness of the selective personality-targeted PreVenture program on reducing the growth of risky alcohol use and related harms from early to late adolescence and early adulthood. Participants included grade 8 students attending 14 secondary schools across New South Wales and Victoria, Australia, in 2012 who screened as having high levels of anxiety sensitivity, negative thinking, impulsivity, and/or sensation seeking. Schools were block randomized to either the PreVenture group (7 schools) or the control group (7 schools). The primary end point of the original trial was 2 years post baseline; the present study extends the follow-up period from July 1, 2017, to December 1, 2019, 7 years post baseline. Data were analyzed from July 22, 2021, to August 2, 2022.InterventionsThe PreVenture program is a 2-session, personality-targeted intervention designed to upskill adolescents to better cope with their emotions and behaviors.Main Outcomes and MeasuresSelf-reported monthly binge drinking, alcohol-related harms, and hazardous alcohol use measured by the Alcohol Use Disorders Identification Test–Concise consumption screener.ResultsOf 438 participants (249 male [56.8%]; mean [SD] age, 13.4 [0.5] years) from 14 schools, 377 (86.2%) provided follow-up data on at least 2 occasions, and among those eligible, 216 (54.0%) participated in the long-term follow-up. Compared with the control condition, the PreVenture intervention was associated with reduced odds of any alcohol-related harm (odds ratio [OR], 0.81 [95% CI, 0.70-0.94]) and a greater mean reduction in the frequency of alcohol-related harms (β = −0.22 [95% CI, −0.44 to −0.003]) at the 7.0-year follow-up. There were no differences in the odds of monthly binge drinking (OR, 0.80 [95% CI, 0.56-1.13]) or hazardous alcohol use (OR, 0.87 [95% CI, 0.59-1.27]) at the 7.0-year follow-up. Exploratory analyses at the 5.5-year follow-up showed that compared with the control condition, the PreVenture intervention was also associated with reduced odds of monthly binge drinking (OR, 0.87, [95% CI, 0.77-0.99]) and hazardous alcohol use (OR, 0.91 [95% CI, 0.84-0.99]), but this was not sustained.Conclusions and RelevanceThis study demonstrated that a brief selective personality-targeted alcohol use prevention intervention delivered in the middle school years can have sustained effects into early adulthood.Trial Registrationanzctr.org.au Identifier: ACTRN12612000026820

IntroductionAdolescent onset substance use is associated with neurodevelopmental, social and psychological harms. Thus, alcohol and other drug prevention programmes are essential to promote health and well-being during this period. Schools are uniquely positioned to deliver such prevention programmes. The last decade has seen a large expansion of school-based alcohol and drug prevention programmes in Australia, warranting an update of the comprehensive review conducted by Teessonet alin 2012. This proposed review aims to (1) identify school-based substance use prevention programmes that have been trialled in Australia since 2011, (2) evaluate their efficacy and (3) identify intervention components associated with effectiveness. This will assist schools in identifying and adopting effective evidence-based programmes and inform future programme development, evaluation and policy.Methods and analysisStudies published from 2011 will be identified by searching the electronic databases PubMed, PsycINFO, Medline, Embase, ProQuest and Cochrane Library in addition to grey literature searches. Eligible studies will be controlled trials (including randomised controlled trials, cluster randomised controlled trials and quasi-experimental trials) of programmes measuring drug and alcohol related outcomes that are conducted in a school setting and have been trialled within Australia. Records will be independently screened for eligibility by two review authors, with disagreements being resolved by consensus or a third review author where necessary. Data extraction, risk of bias and study quality will also be completed independently by two review authors. A qualitative synthesis of all eligible studies will be presented. In addition, if there are sufficient data to combine studies, a random-effects meta-analysis will be conducted.Ethics and disseminationThis research is exempt from ethics approval as no primary data are collected, with work instead being carried out on published documents. The findings of this proposed review will be disseminated in a peer-reviewed journal and at conferences.PROSPERO registration numberCRD42021272959.

To assess the efficacy of a selective, personality-targeted intervention for reducing suicidal ideation in adolescents.Post hoc analysis of survey data collected in the Climate and Preventure (CAP) study, a cluster randomised controlled trial that compared strategies for reducing alcohol misuse by adolescents, 2012-2015.Year 8 students at 16 New South Wales non-government schools and one Victorian non-government school.Preventure, a selective, personality-targeted intervention designed to help adolescents with personality risk factors for alcohol misuse, comprising two 90-minute sessions, one week apart. For our post hoc analysis, we combined data from the two CAP trial groups in which Preventure was offered (the Preventure and the Preventure/Climate Schools [a non-selective prevention strategy] groups) as the intervention group; and data from the two groups in which Preventure was not offered (usual health education only [control] and Climate Schools groups) as the control group.Difference between post hoc control and intervention groups in the change in proportions of students reporting suicidal ideation during the preceding six months (single item of Brief Symptom Inventory depression subscale) over three years.A total of 1636 students (mean age at baseline, 13.3 years; standard deviation, 0.5 years) were included in our analysis, of whom 1087 (66%) completed the suicidal ideation item in the three-year follow-up assessment. The post hoc control group included 755 students (nine schools), the intervention group 881 students (eight schools). After adjusting for nesting of students in schools and sex, reporting of suicidal ideation by students who had received Preventure had declined over three years, compared with the control group (per year: adjusted odds ratio, 0.80; 95% CI, 0.66-0.97).Personality-targeted selective prevention during early secondary school can have a lasting impact on suicidal ideation during adolescence.Australian and New Zealand Clinical Trials Registry, ACTRN12612000026820 (prospective).

BACKGROUND Digital technologies and mobile interventions are possible tools for prevention initiatives to target the substantial social and economic impacts that anxiety, mood, and substance use disorders have on young people. OBJECTIVE This paper described the design and development of the Mind your Mate program, a smartphone app and introductory classroom lesson enhancing peer support around the topics of anxiety, depression, and substance use for adolescents. METHODS The development of Mind your Mate was an iterative process conducted in collaboration with adolescents (n=23), experts, school staff, and software developers. The development process consisted of 3 stages: scoping; end-user consultations, including a web-based survey and 2 focus groups with 23 adolescents (mean age 15.9, SD 0.6 years); and app development and beta-testing. RESULTS This process resulted in a smartphone peer support app and introductory classroom lesson aimed at empowering adolescents to access evidence-based information and tools to better support peers regarding mental health and substance use–related issues. The program contains links to external support services and encourages adolescents to reach out for help if they are concerned about themselves or a friend. CONCLUSIONS The Mind your Mate program was developed in collaboration with a number of key stakeholders in youth mental health, including adolescents. The resulting program has the potential to be taken to scale to aid prevention efforts for youth mental health and substance use. The next step is to conduct a randomized controlled trial testing the feasibility, acceptability, and efficacy of the program.

Alcohol and cannabis are the most commonly used substances during adolescence and are typically initiated during this sensitive neurodevelopmental period. The aim of this review is to provide a comprehensive overview of the most recent literature focused on understanding how these substances affect the developing brain.Articles included in this review were identified by entering 30 search terms focused on substance use, adolescence, and neurodevelopment into MEDLINE, Embase, PsycINFO, ProQuest Central, and Web of Science. Studies were eligible for inclusion if they longitudinally examined the effect of adolescent alcohol and/or cannabis use on structural or functional outcomes in 50 or more participants.More than 700 articles were captured by the search, and 43 longitudinal studies met inclusion criteria, including 18 studies focused on alcohol use, 13 on cannabis use, and 12 on alcohol and cannabis co-use.Existing studies suggest heavy alcohol and cannabis use during adolescence are related to small to moderate disruptions in brain structure and function, as well as neurocognitive impairment. The effects of alcohol use include widespread decreases in gray matter volume and cortical thickness across time; slowed white matter growth and poorer integrity; disrupted network efficiency; and poorer impulse and attentional control, learning, memory, visuospatial processing, and psychomotor speed. The severity of some effects is dependent on dose. Heavy to very heavy cannabis use is associated with decreased subcortical volume and increased frontoparietal cortical thickness, disrupted functional development, and decreased executive functioning and IQ compared to non-using controls. Overall, co-use findings suggest more pronounced effects related to alcohol use than to cannabis use. Several limitations exist in the literature. Sample sizes are relatively small and demographically homogenous, with significant heterogeneity in substance use patterns and methodologies across studies. More research is needed to clarify how substance dosing and interactions between substances, as well as sociodemographic and environmental factors, affect outcomes. Larger longitudinal studies, already underway, will help clarify the relationship between brain development and substance use.

Older adolescence represents a critical period of brain development whereby the prefrontal cortex, responsible for higher level thinking and emotional regulation, is under construction. During this period, the brain is wired to underestimate risk and overestimate pleasure, which primes young people towards risky, pleasure-oriented experiences. Substance use during this time can hinder brain maturation and lead to development related disorders. However, young people are the most likely to drink at risky quantities, use cannabis, MDMA and cocaine in the previous 12 months than any other age group. Despite this, there are no validated, age-appropriate prevention programs targeting school leavers, which leaves a group of young people to navigate a landscape where drug use is the most common, without formal support. Drug and alcohol prevention programs should be developed for this age group that combine features of universal prevention programs and targeted intervention programs to support the wider range of drug use behaviours relevant to this older audience. This article outlines potential evidence-based strategies that programs could focus on in the future.

The prevention of risky adolescent substance use is critical. Limited age-appropriate, school-based programs target adolescents aged 16–19 years, despite this representing the age of initiation and escalation of substance use. The Illicit Project is a neuroscience-based, harm reduction program targeting late adolescents, designed to address this gap. The current study aims to evaluate the program’s effectiveness in reducing risky substance use and related harms among late adolescents. A cluster randomised controlled trial was conducted involving 950 students (Mage = 15.9 years SD = 0.68; 60% Female) from eight secondary schools in Australia. Five schools received The Illicit Project program, and three schools were randomised into the active control group (health education as usual). All students completed a self-report survey at baseline and 6-months post-baseline and intervention students completed a program evaluation survey. Outcomes include alcohol and substance use, alcohol related harms and drug literacy levels (knowledge and skills). At 6-months post baseline, individuals in the intervention group were less likely to engage in weekly binge drinking (OR = 0.56), high monthly alcohol consumption (OR = 0.56), early onset cannabis use (OR = 0.35), risky single occasion cannabis use (OR = 0.48), MDMA use (OR = 0.16) or nicotine product use (OR = 0.59) compared to the control group. Students in the intervention group were less likely to have experience alcohol related harms (OR = 0.57) and more likely to have higher drug literacy scores (β = 2.44) at follow-up. These preliminary results support the effectiveness of The Illicit Project. Further follow-up is required to determine the durability of the results over time.

Alcohol use is a leading cause of burden of disease among young people. Prevention strategies can be effective in the short-term; however little is known about their longer-term effectiveness. The aim of this study was to examine the sustainability of universal, selective, and combined alcohol use prevention across the critical transition period from adolescence into early adulthood.In 2012, a total of 2190 students (mean age, 13.3 years) from 26 Australian high schools participated in a cluster randomized controlled trial and were followed up for 3 years post baseline. Schools were randomly assigned to deliver the following: (1) universal Web-based prevention for all students (Climate Schools); (2) selective prevention for high-risk students (Preventure); (3) combined universal and selective prevention (Climate Schools and Preventure [CAP]); or (4) health education as usual (control). This study extends the follow-up period to 7-years post baseline. Primary outcomes were self-reported frequency of alcohol consumption and binge drinking, alcohol-related harms, and hazardous alcohol use, at the 7-year follow-up.At 7-year follow-up, students in all 3 intervention groups reported reduced odds of alcohol-related harms compared to the control group (odds ratios [ORs] = 0.13-0.33), and the Climate (OR = 0.04) and Preventure (OR = 0.17) groups reported lower odds of hazardous alcohol use. The Preventure group also reported lower odds of weekly alcohol use compared to the control group (OR = 0.17), and the Climate group reported lower odds of binge drinking (OR = 0.12), holding mean baseline levels constant.This study demonstrated that both universal and selective preventive interventions delivered in schools can have long-lasting effects and reduce risky drinking and related harms into adulthood. No added benefit was observed by delivering the combined interventions.The CAP Study: Evaluating a Comprehensive Universal and Targeted Intervention Designed to Prevent Substance Use and Related Harms in Australian Adolescents; https://www.anzctr.org.au/; ACTRN12612000026820.

Issue Reducing substance use harm in young people is a major public health priority however health promotion messages often struggle to achieve meaningful engagement. Neuroscience-based teachings may provide an innovative new way to engage young people in credible harm minimisation health promotion. This study aims to evaluate the acceptability and credibility of a series of neuroscience-based drug education animations and investigate neuroscience literacy in young people. Methods Three animations were developed around the impact of alcohol, MDMA and cannabis use on the growing brain, labelled the 'Respect Your Brain' video series. Sixty young people (mean age 21.9 years; 48% female) viewed the animations and completed a 20-minute web-based, self-report survey to provide feedback on the animations and a 19-item neuroscience literacy survey, assessing knowledge and attitudes towards the brain. Results The Alcohol, Cannabis and MDMA videos were rated as good or very good by the majority of participants (82%, 89% and 85% respectively) and all participants wanted to see more 'Respect your Brain' videos. On average the Alcohol, Cannabis and MDMA videos were rated as containing the right level of detail and being interesting, relevant and engaging by the majority of participants (80%, 81% and 83% respectively). Participants scored an average of 74% in the neuroscience literacy questionnaire, demonstrating some knowledge of brain functioning and positive attitudes towards the brain. Conclusion This study provides evidence that age-appropriate, neuroscience-based resources on alcohol, Cannabis and MDMA are engaging and relevant to young people and offer a potential new avenue to reduce alcohol and other drug related harm and promote healthy lifestyle choices in young people.

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Purpose Alcohol and cannabis are the most commonly used substances during adolescence and are typically initiated during this sensitive neurodevelopmental period. The aim of this review is to provide a comprehensive overview of the most recent literature focused on understanding how these substances affect the developing brain. Search methods Articles included in this review were identified by entering 30 search terms focused on substance use, adolescence, and neurodevelopment into MEDLINE, Embase, PsycINFO, ProQuest Central, and Web of Science. Studies were eligible for inclusion if they longitudinally examined the effect of adolescent alcohol and/or cannabis use on structural or functional outcomes in 50 or more participants. Search results More than 700 articles were captured by the search, and 43 longitudinal studies met inclusion criteria, including 18 studies focused on alcohol use, 13 on cannabis use, and 12 on alcohol and cannabis co-use. Discussion and conclusions Existing studies suggest heavy alcohol and cannabis use during adolescence are related to small to moderate disruptions in brain structure and function, as well as neurocognitive impairment. The effects of alcohol use include widespread decreases in gray matter volume and cortical thickness across time; slowed white matter growth and poorer integrity; disrupted network efficiency; and poorer impulse and attentional control, learning, memory, visuospatial processing, and psychomotor speed. The severity of some effects is dependent on dose. Heavy to very heavy cannabis use is associated with decreased subcortical volume and increased frontoparietal cortical thickness, disrupted functional development, and decreased executive functioning and IQ compared to non-using controls. Overall, co-use findings suggest more pronounced effects related to alcohol use than to cannabis use. Several limitations exist in the literature. Sample sizes are relatively small and demographically homogenous, with significant heterogeneity in substance use patterns and methodologies across studies. More research is needed to clarify how substance dosing and interactions between substances, as well as sociodemographic and environmental factors, affect outcomes. Larger longitudinal studies, already underway, will help clarify the relationship between brain development and substance use.

Adolescence and early adulthood are crucial periods of neurodevelopment characterised by functional, structural, and cognitive maturation, which helps prepare young people for adulthood. This systematic review of longitudinal studies aims to delineate neural predictors from neural consequences of cannabis and illicit substance use, as well as investigate the potential for the developing brain (at ages 10-25 years) to recover after damage. Five databases were searched to yield a total of 38 eligible studies, with some assessing multiple outcome techniques, including 22 neuroimaging, two neurophysiological, and 22 neuropsychological findings. High-quality evidence suggested that delayed or irregular neurodevelopment in executive functioning, particularly emotional perception, might predispose young people to higher frequency substance use. There was evidence of functional, structural, and cognitive deficits proceeding substance use, with harm potentially dependent on the frequency of use and recovery potentially dependent on the duration of use. Identifying aberrant neurodevelopment in young people is crucial for preventing substance use-related harm.

Crystal methamphetamine attracts an elevated level of negative attention in Australia and internationally, however there is a paucity of research into stigma and discrimination surrounding this drug. This study aimed to investigate and compare levels of public stigma, self-stigma and discrimination surrounding crystal methamphetamine use in a large sample of Australian residents.A cross-sectional online survey, open to all Australian residents aged 18 years and over, was conducted from November 2018 to March 2019 examining stigmatising attitudes towards people who use crystal methamphetamine. Respondents also reported any personal history of crystal methamphetamine use and experiences of discrimination. Multiple linear regression examined whether prior crystal methamphetamine use was associated with holding stigmatising attitudes. Covariates included in the analysis were presence of a family member or friend who uses crystal methamphetamine, knowledge about crystal methamphetamine, gender, age and region.A total of 2108 Australian participants completed the study (mean age = 36.3 years; 59% females; 27% had used crystal methamphetamine). Many participants reported being discriminated against because of their crystal methamphetamine use. Stigmatising attitudes were prevalent, particularly among those who hadn't used crystal methamphetamine (p.001). Others more likely to endorse stigmatising attitudes included females (p=.004 vs. males), individuals with less knowledge about crystal methamphetamine (p.001) and those living in regional (p.001) and rural/remote locations (p.001) compared to metropolitan areas.Stigma and discrimination surrounding crystal methamphetamine use was common in this sample of Australian residents, with public stigma more prevalent than self-stigma. This highlights a need for stigma reduction initiatives. Given higher levels of knowledge were associated with less stigmatising attitudes, public education campaigns providing accurate, evidence-based information about crystal methamphetamine along with guidelines and support for accurate media reporting, present promising approaches to stigma reduction. Exploration of other stigma reduction initiatives is also vital to ensuring people who use crystal methamphetamine feel supported in seeking help.

Background High rates of cannabis and illicit drug use are experienced by young people during the final stages of neurodevelopment (aged 15-24 years), a period characterized by high neuroplasticity. Frequent drug use during this time may interfere with neurophysiological and neuropsychological development pathways, potentially leading to ongoing unfavorable neuroadaptations. The dose-response relationship between illicit drug use, exposure, and individual neurodevelopmental variation is unknown but salient with global shifts in the legal landscape and increasingly liberal attitudes and perceptions of the harm caused by cannabis and illicit drugs. Objective This systematic review aims to synthesize longitudinal studies that investigate the effects of illicit drug use on structural, functional, and cognitive brain domains in individuals under the neural age of adulthood (25 years). This protocol outlines prospective methods that will facilitate an exhaustive review of the literature exploring pre- and post-drug use brain abnormalities arising during neurodevelopment. Methods Five electronic databases (Medline, Embase, PsycINFO, ProQuest Central, and Web of Science) will be systematically searched between 1990 and 2019. The search terms will be a combination of MeSH (Medical Subject Headings), with keywords adapted to each database. Study reporting will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and if relevant, study quality will be assessed using the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) approach. Eligible studies are those that sampled youth exposed to cannabis or illicit drugs and employed neurophysiological or neuropsychological assessment techniques. Studies will be excluded if participants had been clinically diagnosed with any psychiatric, neurological, or pharmacological condition. Results This is an ongoing review. As of February 2020, papers are in full-text screening, with results predicted to be complete by July 2020. Conclusions Integrating data collected on the three brain domains will enable an assessment of the links between structural, functional, and cognitive brain health across individuals and may support the early detection and prevention of neurodevelopmental harm. Trial Registration PROSPERO CRD42020151442; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=151442 International Registered Report Identifier (IRRID) PRR1-10.2196/18349

BACKGROUND High rates of cannabis and illicit drug use are experienced by young people during the final stages of neurodevelopment (aged 15-24 years), a period characterized by high neuroplasticity. Frequent drug use during this time may interfere with neurophysiological and neuropsychological development pathways, potentially leading to ongoing unfavorable neuroadaptations. The dose-response relationship between illicit drug use, exposure, and individual neurodevelopmental variation is unknown but salient with global shifts in the legal landscape and increasingly liberal attitudes and perceptions of the harm caused by cannabis and illicit drugs. OBJECTIVE This systematic review aims to synthesize longitudinal studies that investigate the effects of illicit drug use on structural, functional, and cognitive brain domains in individuals under the neural age of adulthood (25 years). This protocol outlines prospective methods that will facilitate an exhaustive review of the literature exploring pre- and post-drug use brain abnormalities arising during neurodevelopment. METHODS Five electronic databases (Medline, Embase, PsycINFO, ProQuest Central, and Web of Science) will be systematically searched between 1990 and 2019. The search terms will be a combination of MeSH (Medical Subject Headings), with keywords adapted to each database. Study reporting will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and if relevant, study quality will be assessed using the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) approach. Eligible studies are those that sampled youth exposed to cannabis or illicit drugs and employed neurophysiological or neuropsychological assessment techniques. Studies will be excluded if participants had been clinically diagnosed with any psychiatric, neurological, or pharmacological condition. RESULTS This is an ongoing review. As of February 2020, papers are in full-text screening, with results predicted to be complete by July 2020. CONCLUSIONS Integrating data collected on the three brain domains will enable an assessment of the links between structural, functional, and cognitive brain health across individuals and may support the early detection and prevention of neurodevelopmental harm. CLINICALTRIAL PROSPERO CRD42020151442; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=151442 INTERNATIONAL REGISTERED REPORT PRR1-10.2196/18349

This is the first study to investigate the effectiveness of Preventure, a selective personality-targeted prevention program, in reducing the uptake of tobacco smoking over a three-year period in adolescence. A cluster randomised controlled trial was conducted to assess the effectiveness of Preventure. Schools were block randomised to either the Preventure group (n = 7 schools) or the Control group (n = 7 schools) and students were assessed at five time points (baseline, 6-, 12-, 24- and 36-months post-baseline) on measures of tobacco use, intentions to use and self-efficacy to resist peer pressure to smoke tobacco. Intervention effects were estimated using mixed models to account for the hierarchical data structure. Exploratory analyses assessed intervention effects among internalising and externalising personality traits. This trial is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12612000026820; www.anzctr.org.au ). A total of 1005 adolescents (mean age: 13.4 years, SD = 0.47) attending 14 Australian schools in February 2012 were recruited to the study. Relative to students in Control schools, students in Preventure schools were less likely to report recent tobacco use (OR = 0.66 95% CI = 0.50, 0.87) and intentions to use tobacco in the future (OR = 0.77 95% CI = 0.60, 0.97) over the three-year follow-up. Students in Preventure schools with internalising personality traits had a greater increase in their likelihood to report high self-efficacy to resist peer pressure to smoke sustained three-years post program delivery (OR = 1.85 95% CI = 1.0, 3.4). Findings from this study support the use of selective personality-targeted preventive interventions in reducing tobacco smoking during adolescence.

Older adolescence (16–19 years) is characterised by an increase in alcohol and illicit substance use, however limited age-appropriate prevention programs exist to target this critical group. Schools are increasingly opting for web-based programs to deliver health education due to their effectiveness, accessibility and scalability. This study outlines the web-based adaptation of a neuroscience-based harm reduction program targeting older adolescents known as, The Illicit Project, and the study protocol to evaluate its effectiveness. A cluster randomised controlled trial will be conducted with Year 10, 11 and/or 12 students (aged 16–19 years) from 8 secondary schools across New South Wales, Australia. Participating schools will be randomised into the control group (health education as usual) or the intervention group (The Illicit Project program; a three-lesson, web-based program delivered fortnightly over 6 weeks) and will complete four web-based assessments at baseline, 6-, 12- and 24-months post baseline. Primary outcomes are the quantity and frequency of substance use, alcohol-related harms and drug literacy levels, with the 12-month follow-up, the primary end point. Secondary outcomes include intentions to use alcohol and other drugs in the future and risk perceptions. This trial has been registered with Australia and New Zealand Clinical Trials Registry (ACTRN12620000805976). Intervention effects will be estimated using multilevel mixed effects models with an intention-to-treat sample. This is the first evaluation of a web-based, age-appropriate neuroscience-based prevention program for substance use targeting older adolescents.

Substance use often begins, and noticeably escalates, during adolescence. Identifying predictive neurobehavioral vulnerability markers of substance use and related problems may improve targeted prevention and early intervention initiatives. This review synthesizes 44 longitudinal studies and explores the utility of developmental imbalance models and neurobehavioral addiction frameworks in predicting neural and cognitive patterns that are associated with prospective substance use initiation and escalation among young people. A total of 234 effect sizes were calculated and compared. Findings suggest that aberrant neural structure and function of regions implicated in reward processing, cognitive control, and impulsivity can predate substance use initiation, escalation, and disorder. Functional vulnerability markers of substance use include hyperactivation during reward feedback and risk evaluation in prefrontal and ventral striatal regions, fronto-parietal hypoactivation during working memory, distinctive neural patterns during successful (fronto-parietal hyperactivation) and failed response inhibition (frontal hypoactivation), and related cognitive deficits. Structurally, smaller fronto-parietal and amygdala volume and larger ventral striatal volume predicts prospective substance misuse. Taken together, the findings of this review suggest that neurobehavioral data can be useful in predicting future substance use behaviors. Notably, little to no research has empirically tested the underlying assumptions of widely used theoretical frameworks. To improve the reliability and utility of neurobehavioral data in predicting future substance use behaviors, recommendations for future research are provided. This article is part of the special issue on 'Vulnerabilities to Substance Abuse.'

ObjectivesThe primary aim is to evaluate the feasibility of a newly developed, neuroscience-based, alcohol and other drug (AOD) use prevention programme, ‘The Illicit Project’, in Australian older adolescents. The secondary aim is to investigate the impact of the programme on students’ drug literacy levels (a combination of knowledge, attitudes and skills).DesignA pilot study examining the feasibility of The Illicit Project in Australian schools was conducted.ParticipantsStudents aged 15–19 years from two secondary schools and a youth centre and 11 teachers and health professionals from various organisations in Sydney were recruited.InterventionThe intervention consisted of three 90 min workshops delivered by trained facilitators within a month.Primary and secondary measuresStudents completed a drug literacy questionnaire before and after intervention. All participants (students, teachers and health professionals) completed an evaluation questionnaire postprogramme delivery. A paired-sample t-test and descriptive analytics were performed.ResultsStudents (n=169) demonstrated a significant increase in drug literacy levels from preintervention to postintervention (t(169) = −13.22, pThe Illicit Project was good or very good (76%), that the neuroscience content was interesting (76%) and relevant (81%), and that they plan to apply the concepts learnt to their own lives (80%). In addition, all teachers and health professionals (n=11) agreed that the programme was feasible and valid for schools and perceived the programme to be effective in reducing the harms and use of AOD.ConclusionsThere is evidence to suggest that The Illicit Project is credible and feasible in the school environment and there are preliminary data to suggest it may help to improve drug literacy levels in young people. A large-scale evaluation trial of the intervention will be conducted to determine the programme’s effectiveness in minimising the harms of AOD in older adolescents.