Effect of selective and family-based prevention on addiction susceptibility, affiliation with deviant peers, risk-taking, and risk and protective factors of substance use in high-risk adolescents: A randomized clinical trial

Abstract

BACKGROUND:

Adolescents with a background in families affected by substance use exhibit an increased susceptibility to developing individual substance-related or other mental disorders. Consequently, they represent a crucial demographic for targeted preventive interventions. The current study examined the impact of selective prevention (SP) and family-based prevention (F-BP) measures on addiction susceptibility, affiliation with deviant peers (ADP), risk-taking, and risk and protective factors (RPFs) related to substance use among high-risk adolescents.

MATERIALS AND METHODS:

The study employed an experimental design incorporating pretest, posttest, and 6-month follow-up. A sample of 60 adolescents, meeting the study criteria, was selected and assigned to two intervention groups and one control group using a simple randomization method (with 20 individuals in each group). Measures encompassed the Risk and Protective Factors Inventory (RAPI), Addiction Susceptibility Questionnaire-Adolescents Version (ASQ-AV), Adolescent Affiliation with Deviant Peers Scale (AADPS), and Iranian Adolescents Risk-taking Scale (IARS). The data were analyzed with repeated measures analysis of variance (ANOVA) using Statistical Package for the Social Sciences (SPSS) version 24 software.

RESULTS:

The results revealed significant differences only between the SP and F-BP groups in the variables of adolescent risk-taking and addiction susceptibility. However, for the other study variables, no significant differences were observed between the SP and F-BP groups. Furthermore, notable differences were identified between the control group and F-BP, as well as between the control group and SP, across all study variables (P value < 0.05).

CONCLUSIONS:

The outcomes of our investigation reinforce the importance of adopting multifaceted approaches in substance abuse prevention, emphasizing the need to target various aspects of individuals’ lives. Regarding data generalization, it is noteworthy that the sample comprised adolescents predominantly from middle- or low-income groups, suggesting caution in extending findings to the entire adolescent population. Finally, we recommend that future studies assess interventions that involve both adolescents and parents in sessions.

Introduction

Substance abuse is a widespread and significant social challenge, often associated with mental health issues among users.[1,2,3] Moreover, substance use disorder (SUD) is correlated with a higher mortality rate in the population.[4,5] Substance use problems not only impact the individual consumer but also give rise to challenges in the health and well-being of their children and family members.[6,7,8] Children within families where individuals grapple with substance abuse face an increased risk of developing SUDs and other mental health issues. Therefore, they are considered a particularly crucial target group for preventive interventions.[9] Children and adolescents influenced by parental substance abuse exhibit a higher prevalence of externalizing[10,11] and internalizing symptoms, such as antisocial behaviors, emotional difficulties, social isolation, attention deficits, and attempts to escape from home.[10] The presence of academic difficulties, anxiety, depression, conduct problems, oppositional behavior, and similar challenges engages the children of substance-abusing individuals to a greater extent compared to their peers.[12,13,14,15] Parental SUD exposure during adolescence significantly heightens the risk of SUD development in offspring.[16] Studies suggest that 33 to 40 percent of children with substance-abusing parents are at risk of developing a SUD.[17] Children raised by parents with a substance-dependent parenting style were observed to adopt substance use as a coping mechanism in challenging and stressful situations.[18,19] Young people who engage in continuous substance use before the age of 15 are at risk of subsequent addiction and an increased likelihood of developing problems and diseases associated with their lifestyle, including type 2 diabetes, obesity, liver disorders, human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS), cancer, heart attacks, and mortality.[20] A systematic review and meta-analysis showed that the prevalence of substance use among Iranian male adolescents is high, so it is necessary for researchers to pay special attention to this issue.[21] Another study underscores a significant issue of drug abuse among high school students in Iran, potentially originating from parental modeling, particularly by fathers, and the cultural acceptance of specific substances. Given the widespread occurrence of drug abuse in Iranian high school students, it is imperative to develop and execute drug prevention programs to protect them.[22]

Early intervention can lead to distancing individuals from substance abuse and the risk of developing SUDs.[23] Selective prevention (SP) interventions are provided for specific communities, families, or children who are at risk of substance abuse problems due to exposure to risk factors.[24] SP may be implemented within a universal prevention framework, such as in healthcare or school environments, while also being administered directly to the specific group it intends to address, either through face-to-face interactions or digital platforms.[25,26,27,28] These interventions typically offer specialized prevention services with the goal of reducing identified risk factors, enhancing protective factors, or both.[24] Research also validates a correlation between the quality of parent-adolescent relationships and adolescent substance use.[29,30,31] Consistently, research has established associations between family-related factors and the onset and progression of substance use during adolescence. For instance, proficient parental supervision of adolescent engagements and peer affiliations can mitigate the likelihood of substance use.[30,32,33]

The family-based prevention (F-BP) intervention is another type of substance abuse prevention intervention in adolescents.[34] F-BP programs strive to enhance positive youth outcomes by addressing risk factors and strengthening protective factors. These programs focus on educating families about proper parenting, relational skills, and reinforcing behaviors such as effective monitoring, discipline, and communication. Therefore, a multitude of F-BP programs have been devised to address substance use among adolescents.[35] Study findings indicate that F-BP interventions emerge as the most effective methods for preventing and treating adolescent substance abuse. F-BP interventions are beneficial for both the child or adolescent and all family members, including parents, siblings, and others living in the family with the adolescent. In addition to addressing substance abuse, F-BP interventions have proven effective in improving school performance, mental health, reducing delinquency, and achieving meaningful goals.[20] In an Iranian study, a family-based model was introduced to prevent student substance abuse, identifying factors such as family control, educational commitments, religious beliefs, family disputes, disunity, and socioeconomic status as linked to addiction tendencies.[36] Various risk and protective factors (RPFs) impacting alcohol, tobacco, and substance use in Iranian adolescents were identified across individual (e.g., high sensation-seeking, lack of assertiveness, positive attitudes toward drug use, negative moods, and negative self-concept), family (including poor bonding and high family conflicts), and social/academic (involving peer pressure, poor school commitment, and a negative school psychosocial climate) domains. These findings highlight the importance of comprehensive prevention programs addressing multiple domains and stress the need for psychosocial education among parents, school staff, and adolescents.[37] Positive family functioning acts as a protective factor against adolescent substance use, risky behaviors, and mental health problems.[38] Aligning with these goals, prevention efforts have shown significant impacts on individuals, families, and communities, leading to improvements in academic performance, reduced tobacco use, decreased addiction, violence, mental health problems, and other adverse outcome.[39] Mehri et al.[40] conducted a study exploring the influence of a web-based family empowerment program, based on the health promotion model, in mitigating substance abuse risk factors among parents of students. After the educational intervention, a notable difference was observed in preventive behaviors associated with substance abuse, along with significant changes in average scores for perceived barriers to action, interpersonal influences, perceived self-efficacy, and role modeling among parents in the experimental group compared to the control group.[40] Sparks et al.[41] carried out a study with the goal of assessing the effectiveness of a family-based program aimed at disrupting the cycle of addiction by bolstering protective factors and mitigating risk factors. The findings of their study showed that family skills program such as Celebrating Families! (CF!) led to significant behavioral changes in parents as well as a proper understanding of youth about SUDs.

As adolescents face a growing demand to navigate daily challenges and transition into adulthood with informed, healthy choices, there is an expanding need to equip them with essential life skills. Most study is focused on evaluating the effectiveness of life skill interventions, particularly in terms of their impact on various aspects of individuals, such as cognitive and psychological factors.[42,43,44] Nevertheless, despite these remarkable successes, preventive strategies are not consistently implemented. This reality may be due to the lack of public awareness, both among the general public and some policymakers, regarding the importance of study findings in preventive sciences. Although any intervention has costs, the real costs are the real burden on society when we do not treat what can be fixed. Since none of the family interventions are designed for all family needs and to respond to a wider range of adolescent ages and family risks, program developers have developed other versions such as SP programs for different types of family pathology, risks, culture, and ages. These efforts, which combine multiple levels of intervention, can do more to reduce the burden of suffering that exists in socioeconomically disadvantaged families.[45] To the authors’ knowledge, no published studies have directly compared SP and F-BP intervention in adolescents. Therefore, the current study aims to compare the effectiveness of SP and F-BP on RPFs related to substance use in high-risk adolescents.

Materials and Methods

Study design and setting

The study employed an experimental design incorporating a pretest, posttest, and a six-month follow-up. With random assignment into the following three groups (two interventions and a control), the first group had ten sessions of the SP protocol, the second group followed eight sessions of an F-BP protocol, and the control group did not receive any treatment.

Inclusion criteria involved informed consent, residence in Tehran province, ages 13–16 for adolescents, parents who have abstained from SUD for at least 3 months, no intellectual disability, psychotic symptoms or diagnosable psychotic illness, bipolar disorder, or illnesses that prevent participants from cooperating (according to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR)). Exclusion criteria included receiving psychological counseling or psychiatric medications during the intervention and experiencing active suicidal thoughts.

Study participants and sampling

After meeting the study requirements and obtaining the necessary approvals from the research Vice-chancellor of Shahid Beheshti University of Medical Sciences, the researcher visited two addiction treatment centers in the west of Tehran province with the available method. At first, a recruitment advertisement was published for intervention in two addiction treatment centers in West Tehran. The place where the treatment sessions were held was at the psychiatric clinic of Shahid Beheshti University of Medical Sciences. Individuals interested in participating were contacted by the research evaluation team to participate in the initial screening by the researcher. Among the people who participated in the first screening (N = 91), finally, 60 participants were selected with inclusion and exclusion criteria. Individuals meeting the study criteria were selectively chosen through available sampling and randomly assigned to three conditions [see Figure 1]. The randomization into the control and experimental groups was achieved through a simple randomization process, with each individual serving as a unit of randomization. The participants were assigned to different groups using a table of random numbers. Each participant’s name was associated with a number, and these numbers were used to categorize the participants into their respective groups. The participants were divided into three groups. People with even numbers were in the first intervention group (SP) and people with odd numbers were in the second intervention group (F-BP) and the remaining people were in the control group. The study objective was communicated to the parents of at-risk adolescents. The therapist was a Ph.D. student of clinical psychology with 4–5 years of experience. The statistical analyst remained blind to ensure unbiased data analysis. Power analysis was conducted for a repeated measures analysis with three groups (Control, Group A, Group B), using a general power analysis program (G*Power 3.1),[46] each consisting of 20 participants, totaling 60 participants. The analysis used a significance level (α) of 0.05 and an effect size (d) of 0.30, considered a medium effect size. With four scales included in the analysis, the total number of measurements was 240. The desired power (1 - β) was set at 0.80. The power analysis results indicated that the study had sufficient statistical power to detect the specified effect size with the chosen sample size and significance level. Ethically, the control group received preventive intervention at the end, along with an office supplies package gifted to each adolescent after the interventions.

Figure 1.

Participants’ Flowchart

Data collection tool and technique

Before starting the intervention, participants were informed about the study objective, providing written consent emphasizing voluntary participation and the option to withdraw at any time. Confidentiality was assured for all collected information, with questionnaires processed using numerical codes instead of names, and only one researcher having access to individuals’ identities corresponding to the assigned codes. People’s characteristics were defined as codes and access to the list of main codes or key codes was limited. The research assistants were trained on the confidentiality of information to manage and store the data of the research samples. Profile files were password-protected during data transfer, and a sample of research data was securely stored in a password-protected file. Contact lists, informed consent forms, and profiles or other relevant information were destroyed when no longer needed for the research. Then, the participants completed questionnaires on risk and protective factors inventory (RAPI), ADP, risk-taking, and addiction susceptibility. These assessments were conducted by an independent evaluator, distinct from the therapist, in the pretest, posttest, and follow-up.

Ethical consideration

The study was approved by the ethics committee and received an ethics code (IR.SBMU.MSP.REC.1400.669). Then, the study was recorded in the Iranian Registry of Clinical Trials (IRCT20211223053494N1).

Study protocol

The present study had two protocols, which included SP and F-BP protocols.

SP intervention

This protocol, as our first intervention group, consisted of ten 120-min sessions weekly [Table 1]. This intervention aimed to enhance the health of adolescents based on the “Multidimensional Preventive Planning” program, designed from the most defensible patterns of preventive programs against social harms. The primary target group for this intervention is adolescents who are at risk. Since adolescents are usually curious beings who may seek to discover new events when faced with them, they should increase their skills and awareness, because the true beliefs about phenomena are different, and the experience of some of this curiosity is so destructive that it is very rare and difficult to return. Substance use is one of these curiosities that can be helped to prevent them from using drugs in the future by identifying misconceptions about drug and alcohol use and increasing awareness of the effects of drug and alcohol use.[47]

Table 1.

Treatment protocol based on SP

Sessions	Content	Structure
First	Facts about drug use	An assessment to identify misconceptions about substance and alcohol use in adolescents, familiarization with the stages of substance use in adolescents, determining risk factors for substance use, recognizing potential signs of substance use in adolescents, and completing assigned readings.
Second	Motivating a substance-free life	Creating motivation for a substance-free life, and identifying problematic issues.
Third	How to make the right decisions	Becoming familiar with problem-solving and decision-making components, understanding the importance of thinking before acting to make more informed decisions for at-risk adolescents, identifying factors influencing logical decision-making, assisting the target adolescent group in defining a problem, identifying possible solutions, evaluating consequences, and choosing an appropriate solution with reasons discussed.
Fourth	Assertiveness and the skill of refusing to use drugs in adolescents	Discussing adolescents’ familiarity with vulnerability factors for engaging in risky behaviors, explaining the meaning of assertiveness and distinguishing it from aggression and passivity, emphasizing the role of peer pressure in engaging in risky behavior, acquainting adolescents with the necessary steps for adopting courageous behavior, and practicing courageous behavior through role-playing activities.
Fifth	Dealing with unpleasant emotions	Becoming acquainted with emotions and their significant role in adolescent health, understanding the importance of utilizing emotion regulation strategies for at-risk adolescents, identifying effective and ineffective strategies for moderating adolescents’ emotions, assisting adolescents in recognizing effective emotion regulation strategies, and discussing the stages of implementing these strategies.
Sixth	Stress management	Focused on stress management in at-risk adolescents. Identification of stress and its types. Knowing the common causes of stress in teenagers, identifying ways to deal with stress, recognizing the symptoms of stress, identifying common situations that cause stress, teaching simple and effective ways to deal with stress such as healthy lifestyle, and everyday routine. Tips for exercise, a healthy diet, and systematic walking. Learning of diaphragmatic breathing and progressive muscle relaxation and recommendation to apply relaxation techniques twice a day (morning and evening).
Seventh	Anger management	Identifying the difference between anger and aggression, getting to know the methods of dealing with anger, recognizing the signs of anger, helping teenagers at risk to deal with anger using appropriate methods.
Eighth	Delved into coping with sexual misuse in adolescents exposed to substance abuse	Sufficient awareness regarding the relationship between drug use and sexual abuse, teaching methods and strategies used in the community and family to prevent sexual abuse, identifying risk situations in terms of sexual abuse, and predicting strategies to deal with these situations. To help teenagers identify protective factors that prevent sexual abuse of target group teenagers and apply them.
Ninth	Promotion of positive and healthy personal and social life (1)	Introduced the concept of positive living and its impact on promoting the health of at-risk adolescents. It involved identifying relationships, institutions, and social networks related to the social health of adolescents in a community, learning general principles of establishing effective communication, and providing education on creating and maintaining positive social relationships with non-substance-using peers and social groups.
Tenth	Promotion of positive and healthy personal and social life (2)	Covered the concept of goal-setting in various life domains, emphasizing the importance of goal-setting in different areas such as education and sports, and planning based on goals in constructing a healthy life for adolescents. It also included education on designing an action plan for at-risk adolescents to achieve their goals.

SP=Selective prevention

F-BP

In the present study, an F-BP intervention was implemented in the experimental group over eight sessions of 90 min each per week [Table 2]. The skills taught in this program, referred to as “preventive parenting skills,” encompass abilities that, irrespective of addiction prevention, contribute generally to the strength and stability of the family, appropriate interpersonal connections among family members, and the healthy growth and development of children.[48] The primary target group for this intervention was families and parents.

Table 2.

Treatment protocol based on F-BP

Sessions	Content	Structure
First	Parenting	Introducing the participants and how to conduct the session, familiarizing them with the program, conveying the concept of parenting, discussing various parenting styles, and presenting assignments and exercises.
Second	Smart and effective parenting skills	A quick review of the first session, revisiting the assignments from the first session, introducing and demonstrating intelligent and effective parenting techniques, engaging in practical exercises applying these techniques, and assigning new tasks.
Third	Proper communication with the teenager, presence in the teenager’s life	A brief review of the topics covered in the second session, revisiting the assignments from the second session, discussing the characteristics of healthy relationships, imparting techniques for fostering healthy connections with adolescents, and assigning new tasks.
Fourth	Legislation and how to monitor teenagers and families	A review was conducted summarizing the topics and assignments of the third session. The discussion included defining legislation, introducing legislative strategies, and presenting the assignment.
Fifth	Attention to the relationship with friends	Reviewing the topics and assignments from the fourth session, introducing the role of friends in the life of adolescents, empowering parents to nurture confident adolescents, transferring decision-making skills, and presenting the assignment.
Sixth	Parents as the most important role model	A review of the topics and assignments from the fifth session, understanding the characteristics of a good role model for adolescents, introducing stress management techniques, and presenting the assignment.
Seventh	Family meetings	A review of the topics and assignments from the sixth session, as well as the introduction and discussion of family sessions.
Eighth	Informing and talking to adolescents about substances	A review of the topics and assignments from the seventh session, introducing risk and protective factors, presenting protective measures for adolescents, introducing ways to talk to adolescents about substances and alcohol, and identifying signs of substance use in adolescents.

F-BP=Family-based prevention

Measures

Structured clinical interview for DSM-5 disorders, research version (SCID-5-RV)

The SCID-5-RV[49] serves as a guide for semi-structured interviews, encompassing major DSM-5 diagnoses. It is administered by a knowledgeable clinician in a 45–90-min session.[50] The Research Version encompasses a broader range of disorders compared to the Clinician Version.[51] Various studies confirm the reliability and validity of SCID-5-RV.[49] The Persian version demonstrates acceptable test-retest reliability (0.60–0.79), internal consistency (0.95–0.99), and kappa reliability (0.57–0.72).[52]

RAPI

The RAPI, developed by Mohammadkhani,[53] serves as a screening tool for assessing RPFs related to the consumption of cigarettes, alcohol, and other substances among adolescents. The scoring is based on a five-point Likert scale. The test’s validity and reliability have been examined and confirmed by Mohammadkhani. In the Iranian community, the total reliability of the questionnaire has been reported as 0.90.[53] In this study, the Cronbach’s alpha for the RAPI was 0.74.

Addiction susceptibility questionnaire-adolescents version (ASQ-AV)

Zeinali[54] designed a 50-item questionnaire with 10 subscales, covering aspects like risk behaviors, inner dissatisfaction, positive thoughts about substance, non-reliability, dissatisfaction with family, deviation from the norm, show off, low faith and spirituality, risky relationships with friends, and self-centered. Responses are assessed as yes = 1 and no = 0. The ASQ-AV demonstrated a suitable factor structure and internal consistency reliability. Its reliability ranged from. 68 to. 83. In this study, the Cronbach’s alpha for the ASQ-AV was 0.83.

Adolescent affiliation with deviant peers scale (AADPS)

The AADPS, developed by Paschall et al.,[55] comprises eight questions. Adolescents respond to each question on a five-point Likert scale, ranging from “none of them (0)” to “all of them (4).” The questions address adolescents’ relationships with their peers, reflecting behaviors such as alcohol and drug use, carrying knives or guns, and engaging in physical fights. A total response score is computed for each adolescent, with a higher score indicating greater affiliation with deviant peers (ADP). In the Iranian community, a Cronbach’s alpha of 0.82 has been obtained for this questionnaire.[56]

Iranian adolescents risk-taking scale (IARS)

The IARS, developed by Zadeh Mohammadi et al.[57] is a 38-item assessment that measures risky behaviors across seven subscales using a five-point Likert scale (1 to 5). Scores range from 38 to 190, with higher scores indicating increased risky behaviors. The Cronbach’s alpha value for the overall scale was 0.94.

Data analysis

The data were analyzed with repeated measures analysis of variance (ANOVA) using Statistical Package for the Social Sciences (SPSS) version 24 software. Three independent 2 × 3 repeated measures ANOVA were used to pairwise compare groups to find further significant differences. ANOVAs were used to discover the main effects and interactions between Group and Time, and post hoc analyses included pairwise comparisons and t-tests with Bonferroni correction.

Results

To assess the normality of the data, the Shapiro–Wilk test was employed. The significance level of the Shapiro–Wilk test for all variables was greater than 0.05 (P value < 0.05), thus confirming the normality of the data. Furthermore, the significance level of Levene’s test was greater than 0.05 (P value < 0.05), hence confirming the homogeneity of variances. The subsequent results related to the demographic characteristics of the participants (educational status and age) are reported in Table 3. The results of Table 3 indicated that there was no significant difference between the three groups (control, SP, and F-BP) in terms of the educational status of the participants (P > 0.05, F = 0.06). Similarly, the results of the Chi-square test regarding the age of the participants in the three groups (control, SP, and F-BP) showed no significant difference among them (P > 0.05, χ² = 94.2). The demographic characteristics of the participants, including education level and age are detailed in Table 3.

Table 3.

The demographic characteristics of participants

Measure	SP n, %, M, SD	F-BP n, %, M, SD	Control n, %, M, SD	F	P
Education
Eighth grade	7.35%,	6.30%	6.30%,	0/06	0/93
Ninth grade	6.30%	8.40%	8.40%
Tenth grade	5.25%	5.25%	3.15%
Eleventh grade	2.10%	1.5%	3.15%
Age	15/15, 0/98	15/20, 0/78	15/10, 0/91

SP=Selective prevention, F-BP=Family-based prevention

Descriptive statistics (mean and standard deviation) of the research variables are reported in Table 4.

Table 4.

Mean (M), standard deviation (SD) for all variables in the groups

Variable	Group	Pretest		Posttest		Follow-up
		M	SD	M	SD	M	SD
Risk and Protective factors	SP	202.95	4.673	197.90	4.266	201.60	5.771
	Control	201.40	5.051	206.80	6.818	214.30	9.879
	F-BP	202.65	6.515	198.85	4.804	200.15	6.089
Adolescents Risk-taking	SP	119.75	7.018	100.95	3.137	103.10	3.959
	Control	116.90	4.166	122.30	4.497	121.85	4.880
	F-BP	118.00	2.753	105.45	2.523	107.80	4.572
Addiction Susceptibility	SP	33.05	2.089	20.45	4.763	17.95	5.375
	Control	33.20	1.881	32.20	2.167	32.15	2.300
	F-BP	33.80	2.419	24.45	6.817	21.50	7.459
Affiliation with Deviant Peers	SP	19.60	1.465	13.35	1.814	11.25	1.446
	Control	17.20	1.196	17.20	1.473	15.95	1.317
	F-BP	18.50	1.318	13.65	1.631	11.75	1.410

SP=Selective prevention, F-BP=Family-based prevention

RPFs

The mean and standard deviation related to the variable of RPF are reported in Table 4. The results regarding the main effect of group in the repeated measures ANOVA (3 Group × 3 Time) for the variable of RPF were significant (F (2,57) = 10.34, P < 0.001, ηp² = 0.27), indicating a significant difference among the three groups at the pretest, posttest, and follow-up.

To compare the three groups of SP, F-BP, and control in the variable of RPF, two separate 2 × 3 ANOVA tests were conducted. The results of the 2 × 3 ANOVA (2 Group × 3 Time) for the variable of RPF between the two groups of F-BP and control showed that the main effect of group was significant (F (1,38) = 13.824, P < 0.001, ηp² = 0.267). Therefore, it can be concluded that there is a significant difference in the variable of RPF between the two groups of F-BP and control. Similarly, the results of the 2 × 3 ANOVA for the variable of RPF between the two groups of SP and control showed that the main effect of the group was significant (F (1,38) = 14.666, P < 0.001, ηp² =0.278). Therefore, it can be concluded that there is a significant difference in the variable of RPF between the two groups of SP and control.

Adolescents risk-taking

The mean and standard deviation related to the variable of risk-taking are reported in Table 4. The results regarding the main effect of group in the repeated measures ANOVA (3 Group × 3 Time) for the variable of risk-taking were significant (F (2,57) = 65.85, P < 0.001, ηp² = 0.70), indicating a significant difference among the three groups at the pretest, posttest, and follow-up.

Two separate 2 × 3 ANOVA tests (2 Group × 3 Time) were conducted to compare the three groups of SP, F-BP, and control in the variable of risk-taking. The results of the 2 × 3 ANOVA (2 Group × 3 Time) for the variable of risk-taking between the two groups of F-BP and control showed that the main effect of group was significant (F (1,38) = 244.85, P < 0.001, ηp² = 0.692). Therefore, it can be concluded that there is a significant difference in the variable of risk-taking between the two groups of F-BP and control. The results of the 2 × 3 ANOVA (2 Group × 3 Time) for the variable of risk-taking between the two groups of SP and control showed that the main effect of the group was significant (F (1,38) = 750.90, P < 0.001, ηp² = 0.705). Therefore, it can be concluded that there is a significant difference in the variable of risk-taking between the two groups of SP and control.

Addiction susceptibility

The mean and standard deviation related to the variable of addiction susceptibility are reported in Table 4. The results regarding the main effect of group in the repeated measures ANOVA (3 Group × 3 Time) for the variable of addiction susceptibility were significant (F (2,57) = 27.26, P < 0.001, ηp² = 0.49), indicating a significant difference among the three groups at the pretest, posttest, and follow-up.

Two separate 2 × 3 ANOVA tests (2 Group × 3 Time) were conducted to compare the three groups of SP, F-BP, and control in the variable of addiction susceptibility. The results of the 2 × 3 ANOVA (2 Group × 3 Time) for the variable of addiction susceptibility between the two groups of F-BP and control showed that the main effect of the group was significant (F (1,38) = 763.23, P < 0.001, ηp² = 0.385). Therefore, it can be concluded that there is a significant difference in the variable of addiction susceptibility between the two groups of F-BP and control. The results of the 2 × 3 ANOVA (2 Group × 3 Time) for the variable of addiction susceptibility between the two groups of SP and control showed that the main effect of the group was significant (F (1,38) = 117.86, P < 0.001, ηp² = 0.694). Therefore, it can be concluded that there is a significant difference in the variable of addiction susceptibility between the two groups of SP and control.

ADP

The mean and standard deviation related to the variable of ADP are reported in Table 4. The results regarding the main effect of group in the repeated measures ANOVA (3 Group × 3 Time) for the variable of ADP were significant (F (2,57) = 23.54, P < 0.001, ηp² = 0.45), indicating a significant difference among the three groups at the pretest, posttest, and follow-up. Two separate 2 × 3 ANOVA tests (2 Group × 3 Time) were conducted to compare the three groups of SP, F-BP, and control in the variable of ADP. The results of the 2 × 3 ANOVA (2 Group × 3 Time) for the variable of ADP between the two groups of F-BP and control showed that the main effect of group was significant (F (1,38) = 642.34, P < 0.001, ηp² = 0.477). Therefore, it can be concluded that there is a significant difference in the variable of ADP between the two groups of F-BP and control. The results of the 2 × 3 ANOVA (2 Group × 3 Time) for the variable of ADP between the two groups of SP and control showed that the main effect of the group was significant (F (1,38) = 847.37, P < 0.001, ηp² = 0.499). Therefore, it can be concluded that there is a significant difference in the variable of ADP between the two groups of SP and control.

The results regarding within-group differences for the research variables in three stages, pretest-posttest, posttest-follow-up, and pretest-follow-up, are reported in Table 5. Additionally, the follow-up tests’ outcomes are documented in Table 6.

Table 5.

Within-subject differences for each measure (Pairwise Comparisons)

Groups	Variables	Levels of the study	Mean Diff.	Sig*	95% Confidence Inter-val for Difference		ES (ηp2)
					Lower Bound	Upper Bound
SP	RPF	Pre-to-post	5.05	0.001	2.18	7.91	0.25
		Pre-to-follow-up	-1.35	0.421	-4.71	2.01	0.01
		Post-to-follow-up	-3.70	0.027	-6.94	-0.45	0.12
	ADP	Pre-to-post	6.25	0.00	5.19	7.30	0.79
		Pre-to-follow-up	-8.35	0.00	-9.28	-7.41	0.89
		Post-to-follow-up	-7.80	0.41	-27.02	11.42	0.01
	Risk-taking	Pre-to-post	18.80	0.00	15.32	22.28	0.75
		Pre-to-follow-up	-2.15	0.00	-20.29	-13	0.69
		Post-to-follow-up	-16.65	0.06	-4.43	0.13	0.08
	Addiction Susceptibility	Pre-to-post	12.35	0.55	-29.05	53.75	0.01
		Pre-to-follow-up	-13.15	0.53	-55.53	29.23	0.01
		Post-to-follow-up	2.15	0.91	-40.45	44.75	0.00
F-BP	RPF	Pre-to-post	3.80	0.04	0.13	7.46	0.10
		Pre-to-follow-up	-2.50	0.21	-4.81	2.21	0.04
		Post-to-follow-up	-1.30	0.45	-6.53	1.53	0.01
	ADP	Pre-to-post	4.85	0.00	3.90	5.79	0.73
		Pre-to-follow-up	-6.75	0.00	-7.62	-5.87	0.86
		Post-to-follow-up	0.65	0.56	-1.59	2.89	0.009
	Risk-taking	Pre-to-post	12.55	0.00	10.86	14.24	0.85
		Pre-to-follow-up	-1.20	0.00	-12.61	-7.78	0.65
		Post-to-follow-up	-235	0.051	-4.71	0.01	0.09
	Addiction Susceptibility	Pre-to-post	9.35	0.00	6.07	12.62	0.46
		Pre-to-follow-up	-12.30	0.00	-15.84	-8.75	0.56
		Post-to-follow-up	2.95	0.20	-1.62	7.52	0.04
Control	RPF	Pre-to-post	-5.40	0.007	-9.24	-1.55	0.17
		Pre-to-follow-up	7.50	0.008	2.06	12.93	0.17
		Post-to-follow-up	-7.50	0.008	-12.93	-2.06	0.17
	ADP	Pre-to-post	0	1	-0.085	0.85	0.00
		Pre-to-follow-up	-1.25	0.003	-2.05	-0.44	0.20
		Post-to-follow-up	1.25	0.007	0.35	2.14	0.17
	Risk-taking	Pre-to-post	-5.40	0.00	-8.17	-2.62	0.29
		Pre-to-follow-up	4.95	0.001	2.04	7.85	0.23
		Post-to-follow-up	0.45	0.76	-2.55	3.45	0.002
	Addiction Susceptibility	Pre-to-post	1	0.12	-0.29	2.29	0.06
		Pre-to-follow-up	-1.05	0.12	-2.39	0.29	0.06
		Post-to-follow-up	0.05	0.94	-1.38	1.48	0.00

RPF: Risk and Protective factors, ADP: Affiliation with Deviant Peers, SP=Selective prevention, F-BP=Family-based prevention

Table 6.

Post hoc analyses (t-tests) of between-group differences across times and measures

Variable	Time	Groug 1. to	Group 2	Df	t	P	ES (ηp2)
Risk and Protective factors	Posttreatment	SP	F-BP	38	-0.66	0.51	0.01
			Control	38	-4.94	0.00	0.39
		F-BP	Control	38	-4.26	0.00	0.32
	Follow-up	SP	F-BP	38	0.77	0.44	0.01
			Control	38	-4.96	0.00	0.39
		F-BP	Control	38	-5.45	0.00	0.43
Addiction Susceptibility	Posttreatment	SP	F-BP	38	-2.15	0.03	0.10
			Control	38	-10.04	0.00	0.72
		F-BP	Control	38	-4.84	0.00	0.38
	Follow-up	SP	F-BP	38	-1.72	0.09	0.07
			Control	38	-10.06	0.00	0.75
		F-BP	Control	38	-6.10	0.00	0.49
Affiliation with Deviant Peers	Posttreatment	SP	F-BP	38	-0.55	0.58	0.008
			Control	38	-7.36	0.00	0.58
		F-BP	Control	38	-7.22	0.00	0.57
	Follow-up	SP	F-BP	38	-1.10	0.27	0.03
			Control	38	-10.74	0.00	0.75
		F-BP	Control	38	-9.73	0.00	0.71
Risk-taking	Posttreatment	SP	F-BP	38	-4.99	0.00	0.39
			Control	38	-17.41	0.00	0.88
		F-BP	Control	38	-14.61	0.00	0.84
	Follow-up	SP	F-BP	38	-3.47	0.001	0.24
			Control	38	-13.34	0.00	0.82
		F-BP	Control	38	-9.39	0.00	0.69

Note: RPF: SP=Selective prevention, F-BP=Family-based prevention

Discussion

This study aimed to test whether two types of prevention intervention, SP, and F-BP training could reduce adolescents’ addiction susceptibility, RPFs, ADP, and risk-taking. We examined the short- and long-term effects of prevention interventions on adolescents’ addiction susceptibility, ADP, risk-taking, and RPFs and compared the effects of SP and F-BP interventions on a control group.

Both F-BP and SP group interventions for the Prevention of Substance Abuse have demonstrated efficacy in addressing RPFs, risk-taking, addiction susceptibility, and affiliation with delinquent peers. Also, the results of this study indicated that SP group interventions for the Prevention of Substance Abuse have a greater impact on addiction susceptibility and risk-taking compared to F-BP group Interventions for the Prevention of Substance Abuse.

The protocol of F-BP interventions for the Prevention of Substance Abuse includes parenting training. Petrie, Bunn, and Byrne (2007) studied the impact of parenting programs on preventing substance abuse. They systematically reviewed 20 studies, and the results were consistent with our findings, showing that the parenting program can prevent substance abuse.[58] Another systematic review indicated that parenting interventions effectively reduce or prevent adolescent substance use, with protective effects lasting for multiple years.[59] This intervention improves children’s RPFs and behaviors.[60] Another study suggested that parenting style can predict addiction susceptibility through self-regulation.[61] Therefore, we can infer that F-BP interventions can reduce addiction susceptibility through self-regulation. War (2005) pointed out that family supervision affects the delinquent friendships of children.[62] We presume that juvenile and family legislation, supervision, and attention to adolescent relationships can impact affiliation with delinquent peers; establishing appropriate rules can restrict dangerous adolescent relationships. During F-BP interventions for the Prevention of Substance Abuse, we teach parents how to communicate with their adolescents and make them aware of substance abuse.

In our study, SP group intervention for the Prevention of Substance Abuse includes motivating individuals to live without drugs, decision-making skills, assertiveness training, emotion regulation, and stress management. A prior study by Sussman, Earleywine, and colleagues (2004) investigated the MSD model, which stands for motivation, skills, and decision-making. The skills in this model include communication skills, assertiveness skills, and self-control. This model demonstrated sufficient efficacy in preventing substance abuse.[63] Another study revealed that the decision-making perspective can be applied to analyzing risky behavior.[64] Therefore, we assume that training decision-making can reduce risk-taking.

The results have shown that SP group interventions for the Prevention of Substance Abuse have a priority over F-BP group interventions for the Prevention of Substance Abuse. Several studies have indicated that individual therapy has more effect on adolescent’s psychological problems compared to family therapy.[65,66] The findings of the primary study indicate that distortions may arise in the transmission of information from parents to adolescents. Moreover, when adolescents undergo individual therapy, they tend to attribute their well-being to personal coping skills. Also, for this reason, the SP group may be more helpful for the adolescent than the F-BP group to the adolescent’s skill learning because the adolescent receives the treatment alone and in interaction with his peers and can attribute success to his coping skills. The number of F-BP group sessions compared to the SP group, as well as F-BP group sessions in general, may not be sufficient to fully address the majority of adolescent issues. For the F-BP group, the participants were fathers who probably had problems due to substance dependence. Because the father’s role may be important in reducing some adolescent issues, including anxiety, this may negatively affect the effectiveness of family approaches. Furthermore, in instances where parents report psychological issues, individual therapy for children proves more efficacious than family therapy in addressing the identified problem.[65]

Limitations and recommendation

Limitations were evident in this study, particularly concerning the inherent reliance on self-reported data collection, leading to the potential for inaccuracies in form completion. Nevertheless, the researcher endeavored to mitigate this limitation through regular monitoring and providing detailed instructions for form completion. Regarding data generalization, it is noteworthy that the sample comprised adolescents predominantly from middle- or low-income groups, suggesting caution in extending findings to the entire adolescent population.

As we move forward, these insights can inform the development of more nuanced and targeted prevention initiatives, providing valuable direction for policymakers, practitioners, and researchers alike in the ongoing efforts to curb substance abuse and promote overall well-being. Longer follow-up analyses may give insight into long-term efficacy differences. Finally, we recommend that future studies assess interventions that involve both adolescents and parents, with three control groups, the active control condition with relaxation training, the control group with the self-help training package, and a waitlist control group in sessions.

Conclusion

In conclusion, the outcomes of our investigation highlight the notable effectiveness of both F-BP group interventions for the Prevention of Substance Abuse and SP group interventions for the Prevention of Substance Abuse. The comprehensive nature of these interventions is evident in their success in addressing a spectrum of critical factors, including risk and protective elements, risk-taking tendencies, addiction susceptibility, and affiliation with delinquent peers. These findings reinforce the importance of adopting multifaceted approaches in substance abuse prevention, emphasizing the need to target various aspects of individuals’ lives. The positive impact observed across a range of domains, from enhancing social skills to reducing addiction susceptibility, underscores the potential of these interventions to contribute significantly to comprehensive substance abuse prevention strategies. The success of F-BP and SP group interventions suggests that tailored programs can effectively address the diverse needs of individuals at risk.

Financial support and sponsorship

This study was supported by the School of Medicine, Shahid Beheshti University of Medical Sciences (Grant No: 31574) and the Presidential Drug Control Headquarters (DCHQ), Department for Research and Education.

Conflicts of interest

There are no conflicts of interest.