HLSC641 Report: Critical Analysis of Alcohol Abuse Research Studies

This report critically analyzes two research papers related to adolescent alcohol abuse. The first paper, a quantitative study, investigates the effectiveness of personality-targeted interventions in preventing alcohol misuse among adolescents, employing a cluster randomized controlled trial design. The analysis meticulously evaluates the study's methodology, including participant recruitment, follow-up procedures, and the blinding of participants, while also addressing potential biases. The second paper, a qualitative study, explores the relationship between family dynamics, parental attitudes, and adolescent drinking behaviors. Both papers are critically appraised using the CASP tool to assess their validity, reliability, and applicability. The report discusses the strengths and weaknesses of each study, considering factors such as sample size, research design, and potential limitations, providing a comprehensive overview of the research landscape in adolescent alcohol abuse. The report concludes with a discussion on the clinical significance and broader implications of the findings.

Running head: CRITIQUE
Critique
Name of the Student
Name of the university
Author’s note

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Introduction
Alcohol is the most commonly used abused drug worldwide and the highest level of
alcohol is consumed by the adolescent group of people. Excessive use of alcohol has both
physiological and psychological effects that increases the risk of several health condition.
Consumption of alcohol not only increases the burden of health but also affects a person
economically. Indiscriminate use of alcohol by the adolescents has become a major concern for
the government as illness due to alcohol accounts for huge financial burden on government
(Mares et al., 2015). This paper would critically analyses a qualitative paper relating family
dynamics and alcohol abuse among the adolescents and the quantitative paper would describe
about the effectiveness of the personality targeted intervention in the programs for the
adolescents. The critical appraisal should be conducted by using the CASP tool analysis.
Critical appraisal
Quantitative Study: Randomised Control Trial
Paper
Conrod, P. J., O’Leary-Barrett, M., Newton, N., Topper, L., Castellanos-Ryan, N., Mackie, C., &
Girard, A. (2013). Effectiveness of a selective, personality-targeted prevention program
for adolescent alcohol use and misuse: a cluster randomized controlled trial. JAMA
psychiatry, 70(3), 334-342. https://doi.org/10.1001/jamapsychiatry.2013.651

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Answer 1
According to Banducci, Hoffman, Lejuez and Koenen (2014), the risk factor which
makes the young adults or the adolescent susceptible for alcohol misuse is behavioural
difficulties, emotional challenges, personality factors and other family related consequences. The
aim of the research article mainly encompass implementation of the personality target approach
over the secondary school students who are vulnerable in getting affected in substance abuse like
the students suffering from anxiety sensitivity, impulsivity, hopelessness and sensation seeking.
The authors also undertook Teacher-Delivered Personality-Target Interventions for Substance
Misuse Trial over the low-risk population in order to check the effect of the projected
intervention over the herd community.
Answer: 2
The recruitment of the patients to the study was completely randomised. 149 secondary
schools, which are proximal to the research centre, were invited for the study of them, the first 21
schools who signed up for study were recruited and this constitutes 14% of the schools in
comparison to the overall schools which were initially approached. The sample of each school
was diverse with 41% from the ethnic background. The eligibility for the projected interventions
upon the target population was determined via identification of youth who suffer from anxiety,
sensitivity, impulsivity, hopelessness and have a tendency of sensation seeking (Conrod et al.,
2013). According to Donovan, Paramasivan, de Salis and Toerien (2014), selection of the focus
group of the study via randomised recruitment of the population in the focus group helps to
increase the quality of the RCT study along with the reduction in the biased outcomes. Conrod et
al., 2013 also conducted the recruitment process via masking and that too in a highly confidential

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manner. This concealing from the participants (focus group and the target group) further
increased the quality of this RCT study (Donovan, Paramasivan, de Salis and Toerien, 2014).
Answer: 3
It was a 24 month follow-up study. All the high risk (HR) and low risk (LR) patients (N=
2643) were invited to participate in the follow-up assessment during their school time under a
periodic interval of 6, 12, 18 and 24 months after the interventions have been provided.
However, one placebo school, the follow-up rates were hampered as they failed to arrange the
same at 6-month interval. Another school experienced difficulty for a 24 month follow-up. In
some schools follow-up was arranged through telephonic interview as the students were unable
for face-to-face interview (Conrod et al., 2013). This lack of stringent follow up session
hampered the overall outcome of the study. In RCT study, loss of follow-up or increase in the
dropout rates cause the generation of biased outcomes (Brannen, 2017). However, the patients
were analysed in different groups based on the different students with complete blinding of the
students (Conrod et al., 2013).
Answer: 4
The students who participated in the RCT and were provided interventions were not
informed about the various other types of interventions that were being offered in their schools to
their friends. They were also not aware which of their friends were called on to take a part in
these other types of interventions. However, the teachers who were asked to access the outcome
of the interventions via a periodic follow-up were aware of the reason of the interventions
(Conrod et al., 2013). Thus the study was single blind and not double-blinded trial. According to
Misra (2012) randomised double blinded study are the gold standards for the RCTs. The
condition where the reviewer is aware of the projected outcomes and the nature of interventions

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applied in the study, is suppose to suffer from the interviewer bias, response bias and reporting
bias. The presence of this kind of bias leads to the generation of the erroneous results.
Answer: 5
The groups were similar at the initiation of the study. During the initiation of the study,
the main target group of the students mostly constitute pupils who suffered from certain
behavioural disorders which can make them prone to victims of the alcohol abuse in bear future.
The behavioural or mental traits which were selected for the study include anxiety disorder,
sensitivity disorder; suffer from hopelessness, impulsivity, sensation seeking (Conrod et al.,
2013). Taking the similar focus group both for the placebo and the target group, helps in the
generation of the unbiased results. Moroever the age bracket of the students was not large as all
the secondary school students from grade 9 were selected for the study and this might increase
the quality of the overall results. According to Brannen (2017), the groups which were similar
both the initiation and after the follow up of the RCT study help in the achievement of the
desired outcomes.
Answer: 6
The students of the selected secondary schools were randomised in order to provide a
short personality targeted interventions to the high risk youth or treatment as usual for the
statutory education in the domain of drug intake. Apart from the education and the interventions
provided at school the students were set free at while at the home thus overall treatment
occurring as the chosen zone of the research was equal for all the selected group of school
students (Conrod et al., 2013). However, the rate of drinking or binge drinking might vary from
students to students as the drinking study not only depends on the behavioural responses but also
on the family influence (Banducci, Hoffman, Lejuez & Koenen, 2014). This lack of proper

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monitoring while the students are in their home might lead to the generation so biased response
(Brannen, 2017).
Answer: 7
The treatment effect that was measure during the study was the rate of drinking, rate of
binge drinking and the problem of drinking. These outcomes are in sync with the scope of the
study. The primary outcome of the study was mainly projected over the long-term benefits of this
intervention on the drinking outcomes over the high risk patients who were selected and then
randomised to receive a brief section of the personality-targeted interventions. The primary
outcome mainly showed that the drinking tendency was reduced among high risk youth along
with delay in the natural progression towards more risky drinking behaviour like frequent binge
drinking (Conrod et al., 2013). According to Moore et al. (2015), discussing the primary
outcome of the study in a succinct manner helps to increase the quality of the RCT study.
Answer: 8
The confidence interval of the study was selected as 95% while conducting the statistical
analysis. According to Moore et al. (2015) Confidence interval is the interval estimate of the
computed statistical data. 95% of the confidence interval significance the 95% of interval was
computed for each sample and thus there is 0.95% probability of containing population mean. It
other words it can be said that the 95% of the population distribution is selected under the
confidence interval (Brannen, 2017). Having high confidence interval signifies standard
statistical outcome and thereby increasing the overall strength of the results (Brannen, 2017).

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Answer: 9
The results cannot be applied to the local population and as the projected focus group of
the study were secondary school children who were in their 9 standards. The mindsets of the
young adults like those who are in college are different from the school level children and hence
the results cannot be same when the same intervention was applied to the college youth
population. However, the projected interventions can surely be applied in over other population
in order to ascertain outcome. Moreover, the selected group of population is composed children
who are with behavioural complications like anxiety and hopelessness (Conrod et al., 2013). This
has further segregated the children population making the selected focus group very specific.
Answer: 10
All the clinically important outcomes like the drinking rates, binge drinking, growth in
the binge drinking and problem drinking. All these outcomes were considered on the basis of the
statistical analysis. The drinking quality was also accessed after the procurement of the
interventions that is after the 24 months. However, the author could have access the mental status
of the disease like the anxiety level and depression (Conrod et al., 2013).Via doing this, the
authors might have ascertained the affect of the intervention on the mental health of the school
students.
Answer: 11
Yes the benefits are worth the harm and cost. This is because, it helped to get a ascertain
the benefits of the selective school-based alcohol prevention programs, Teacher-Delivered
Personality-Targeted Interventions over the control of the tendency of developing alcohol abuse
over the vulnerable group of school student (Conrod et al., 2013). However, further studies are
required to be undertaken in order to the effectiveness of the slected program over other diverse

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group of population. The selected intervention helped in the achieving a statistically significant
outcome, the study is worth of costs and benefits. Moreover, none of the participants were
harmed in the study and the study provided a clear view of the effectiveness of the school based
interventions.
References (Quantitative)
Banducci, A. N., Hoffman, E. M., Lejuez, C. W., & Koenen, K. C. (2014). The impact of
childhood abuse on inpatient substance users: Specific links with risky sex, aggression,
and emotion dysregulation. Child abuse & neglect, 38(5), 928-938.
https://doi.org/10.1016/j.chiabu.2013.12.007
Brannen, J. (2017). Mixing methods: Qualitative and quantitative research. Routledge.
https://www.taylorfrancis.com/books/9781351917186
Conrod, P. J., O’Leary-Barrett, M., Newton, N., Topper, L., Castellanos-Ryan, N., Mackie, C., &
Girard, A. (2013). Effectiveness of a selective, personality-targeted prevention program
for adolescent alcohol use and misuse: a cluster randomized controlled trial. JAMA
psychiatry, 70(3), 334-342. https://doi.org/10.1001/jamapsychiatry.2013.651
Donovan, J. L., Paramasivan, S., de Salis, I., & Toerien, M. (2014). Clear obstacles and hidden
challenges: understanding recruiter perspectives in six pragmatic randomised controlled
trials. Trials, 15(1), 5. https://doi.org/10.1186/1745-6215-15-5

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Misra, S. (2012). Randomized double blind placebo control studies, the “Gold Standard” in
intervention based studies. Indian journal of sexually transmitted diseases, 33(2), 131.
doi: 10.4103/0253-7184.102130
Moher, D., Schulz, K. F., Altman, D. G., & Consort Group. (2001). The CONSORT statement:
revised recommendations for improving the quality of reports of parallel-group
randomised trials. https://doi.org/10.1016/S0140-6736(00)04337-3
Moore, G. F., Audrey, S., Barker, M., Bond, L., Bonell, C., Hardeman, W., ... & Baird, J. (2015).
Process evaluation of complex interventions: Medical Research Council
guidance. bmj, 350, h1258. doi: https://doi.org/10.1136/bmj.h1258

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Qualitative paper
Paper: Gilligan, C., & Kypri, K. (2012). Parent attitudes, family dynamics and adolescent
drinking: qualitative study of the Australian parenting guidelines for adolescent alcohol
use. BMC Public Health, 12(1),
491.https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-12-491
The aim of this paper is to understand the perception of the parents, the family dynamics
and the alcohol drinking among the adolescents group of people. The extent to which the
parental behavior follow the recommendations that has been made in the guidelines and the
parental approach towards adolescents’ alcohol drinking and alcohol initiation. The aim of this
research study is valid as family perceptions and dynamics can be the important precipitating
factor for the alcohol addiction among the adolescents. According to Carvajal & Lerma-Cabrera,
(2015), parents often introduced their children to social drinking with an aim to safe drinking
which ultimately turns against them. A study by (Van den Eijnden, Van De Mheen, Vet &
Vermulst, 2011), have proved that parental introduction of alcohol to their children have a high
rate addiction development among the adolescents. Again, according to Ryan et al., (2010),
parental introduction to alcohol has been found to have no relation with alcohol addiction. Ryan
et al. (2010), have stated that there are certain predictors of the alcohol consumption, which
included parental model of the drinking, norms about the usage of the alcohol, child-parent
relationship, parental support and family conflict. Australian National Health and Medical
Research Council (NHMRC) have designed specific guidelines to help the parent stop the use of

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alcohol among the adolescents (National Health and Medical Research Council., 2009). There
are legislations that states that recommends the delaying of the alcohol initiation for the
adolescents, but the information is not readily followed by most of the parents rather in most of
the cases the information is not disseminated to the parents. In spite of the strict legislation
followed by the Australian jurisdiction, most of the parents are unable to follow the guidelines,
which provides the actual rationale for this paper.
2. This study is a qualitative research, where one on-one interviews has been conducted with the
parents for capturing their opinions and perceptions. Individual interviews were preferred over
focus group as parents might not feel comfortable to open up in group discussions due to the
associated stigma related to alcohol in the society. Interview also allow the participants to move
deeper due to the privacy and the confidentiality maintained (Larimer, 2013). Again focus group
requires all the participants at the same time, which can be difficult in times.
3. Qualitative research helps in observations, which can be used to develop the hypothesis for the
further testing, understand the feeling, perceptions, value and beliefs that influence the behavior
(Moretti et al., 2015). This would ultimately help to understand how the parents are really being
impacted by the guidelines. It provides the data on the basis of which statistical data analysis can
be done. In general qualitative studies do not offer any statistical validation.
4. The recruitment strategy has been appropriate. The participants have been chosen by
displaying posters in the local cafes and in the premises of the University of Newcastle, and
through University of Newcastle staff networks. Parents were given the opportunity to choose
their time o their own thus giving them the authority. They are also allowed to disseminate the
information in order to get more participants or to disseminate the aim of this study. Parents of

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child between 13-17 years were included in the selection criteria as most of the alcohol addiction
has been found in the adolescents between this age group (Spear, 2015).
5. Twenty two face to face interviews were conducted for about an hour. The time was enough to
discuss all the parameters in details. The perception of the parents regarding the parenting
guidelines were recorded. It has been mindful that the parent were not asked about their
knowledge regarding the guidelines could have restricted their answers. The characteristics that
has been taken into consideration were the gender, marital status, the education of the parents,
employment and the ethnicity. The behaviors of the parents were made in relation to the
guidelines on the basis of three categories- Those who relatively followed the guidelines, those
who often followed the guidelines and those who follow less often. The recordings were tallied
with the guidelines to understand the percentage of adherence. Sampling was done as per the
convenience which could have limited the representativeness of the sample and the
generalizability of the results. Furthermore the parent could have been more aware while
discussing their family dynamics or the attitudes of their children (Carvajal & Lerma-Cabrera,
2015). Self-data can be biased. Furthermore the viewpoint of the parents over the behavior of the
adolescents, the rules of the household and their impact on adolescent drinking has not been
explicitly explored. Another limitation is that this study has been conducted based on the
viewpoints of the parents and not of the adolescents itself, which may actually vary with the
situation.