Middle School Interventions Reduce Rates of Alcohol Use Disorder at High School Graduation

Early initiation of alcohol use is associated with an increased risk of alcohol use disorder (AUD) later in life. Prevention programs delivered in middle school may be able to disrupt this relationship, although most studies examine immediate outcomes and intermediary markers. In this study, Mexican-American adolescents who participated in a randomized controlled trial of an alcohol prevention program in middle school were re-surveyed as high school seniors.

• Compared with controls, students who were randomized to the preventive intervention were 2.5 times less likely to have had an AUD by senior year of high school.
• Among students who had initiated alcohol use in middle school, students randomized to the intervention group reported less frequent alcohol use and “drunkenness”* in twelfth grade compared with those randomized to the control group.
• There were no differences in frequency of alcohol use or “drunkenness” among students who initiated alcohol use after middle school.

* Based on responses to the 2001 Youth Risk Behavior Survey question: “During the past year, on how many days did you drink enough to feel pretty high/drunk?”

Comments: Adolescence is a developmental window during which children are particularly vulnerable to the development of substance use disorder. Interventions that reduce use during this critical period may reduce lifetime risk for substance use disorder, and thus may have benefits that compound over time.

Sharon Levy, MD, MPH

Reference: Gonzales NA, Jensen M, Tein JY, et al. Effect of middle school interventions on alcohol misuse and abuse in Mexican American high school adolescents: five-year follow-up of a randomized clinical trial. JAMA Psychiatry. 2018;75(5):429–443.