Escape Addict, a playful school-based program to prevent psychoactive substances use in students from Normandy

Plain English summary of protocol

Background and study aims
Early psychoactive substances consumption (PSC) in youth impairs psychosocial and neurocognitive development with with short- and long-term consequences (Hamidullah et al., 2020; Castellanos-Ryan et al., 2017). Among French teenagers, lifetime use (experimentation) of tobacco and alcohol, and to a lesser extent cannabis, still begins in the early years of middle school, with an increase and installation of consumption in the transition to high school (Kopp, 2023 ; Obradovic, 2022).
Few prevention of PSC programs are evaluated, and heterogeneous effects of actions, with rare or limited replication are found (Santé Publique France, 2019, Tremblay et al., 2020). This lack of replicability is consistent with the low quality of theoretical implementation (Michie, 2014). The COM-B (Michie et al., 2011) appears as a key theoretical framework for understanding and supporting behavior change, and for designing and informing interventions, by choosing appropriate behavior change techniques (BCT, Michie et al., 2013). The use of technology, and in particular gaming, can enhance students interest in learning (Virvou et al., 2005) with interventions build on immersive, enjoyable, problem-based principles, and strategies that encourage health behavior change (Stapinski et al., 2018).
Escape Addict (EA) was first implemented in Switzerland, and designed as an escape game. Evaluations (Bezençon et al, 2022 ; Bezençon et al., 2023) reported that the one hour and a half experience was not sufficient to lead to significant change in PSC representations and behaviors. A french association, in collbaoration with actors in the field and researchers, adapted EA to its cultural context, and developed supplementary sessions to complete the game and foster behavior change basing the intervention on the COM-B model, integrating relevant BCT and using relevant prevention tools to communicate about PSC.

Who can participate?
8th grade students from high schools in deprived background of Rouen Metropolis (Normandy, France) are eligible to participate.

What does the study involve?
The first objective of the pilot study is to evaluate the feasibility (acceptability, implementation, fidelity) of EA program ; The second objective of the study is to estimate the pilot effect-size of EA on the retardation of first experience and on the decrease of recent PSC. The PSC targeted by EA are alcohol, cannabis, tobacco and chicha ; outcomes are assessed by questionnaire at two study endpoints (baseline-post). The primary outcome is the proportion of adolescents who did not experience psychoactive substances. The secondary outcome is the proportion of adolescents who decreased their recent PSC (last month consumption). Other outcomes are motivational variables determining behavior change, assessed by COM-B questionnaire.
The study will include secondary schools from disadvantaged backgrounds in the Rouen metropolitan area. 4 secondary schools 8th grade classes (around n = 300 students) will benefit from EA program. To investigate feasibility, a mixed method study, with quantitative indicators, and qualitative study based on process analysis and FIC model (Key Functions/Implementation/Context, Villeval, 2015) will be used, the latter allowing, in particular, to analyze the effects of the intervention in terms of social inequalities. Interviews and focus group will involve various actors engaged in the intervention (schoolchildren, school nurses, teachers, prevention staff, research and field team).

What are the possible benefits and risks of participating?
The expected impacts are to develop a theoretically anchored, playful public health program in high school, targeting PCS, that is acceptable, easily implemented and adapted to students’ social backgrounds. The benefits for participants are, with a decrease or delay of PSC use, also the improvement of psychosocial skills (i.e. psychosocial variables influencing behaviour, targeted by the model).

Where is the study run from?
1. Epidaure Institute of Cancer - Montpellier (France)
2.University Paul Valéry Montpellier III (France)

When is the study starting and how long is it expected to run for?
January 2023 to December 2025

Who is funding the study?
Institut National Du Cancer (France)

Who is the main contact?
Florence Cousson-Gélie, florence.cousson-gelie@univ-montp3.fr

Contact information

Prof Florence Cousson-Gélie
Public, Scientific, Principal investigator

Lab EPSYLON, University Paul Valéry Montpellier, site St-Charles, rue du Pr. Henri Serre.
Montpellier
34090
France

ORCID ID	0000-0002-8195-9170
Phone	+33 (0)4 11 75 70 65
Email	florence.cousson-gelie@univ-montp3.fr

Dr Marie CHOLLEY-GOMEZ
Scientific

Lab EPSYLON, University Paul Valéry Montpellier, site St-Charles, rue du Pr. Henri Serre.
Montpellier
34090
France

ORCID ID	0000-0001-7555-6079
Phone	+33 (0)4 11 75 70 65
Email	marie.cholley-gomez@univ-montp3.fr

Study information

Eligibility

Locations

Countries of recruitment

• France

Study participating centres

Results and Publications

Study outputs

Editorial Notes

03/12/2025: The study design was updated from 'Interventional feasibility and pilot pre-post effectiveness single-center study' to 'Pilot pre-post effectiveness single-center study & process analysis (acceptability, implementation, impact on social health inequalities)'. Final enrolment number added.
20/03/2025: Trial's existence confirmed by Institut National Du Cancer.