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Research Bulletin

Phi Delta Kappa Center for Evaluation, Development, and Research
December 1997, No. 19

Building Effective Drug Education Programs
By Alice Evans and Kris Bosworth

None of us wants to see the lives of young people irreparably damaged by drugs, and schools are a logical place to try to prevent this from happening. But research indicates that, for a variety of reasons, schools are largely ineffective in their prevention efforts.

The most popular drug abuse prevention program in the country, Drug Abuse Resistance Education or Project D.A.R.E., has shown disappointing results, while other, more promising programs have not been widely used. Moreover, there is no one program, curriculum, or strategy that meets the needs of all students in all settings.

The good news is that 20 years of research on drug abuse prevention has yielded effective strategies and a broad range of curricula. There are also curricula guides, such as Drug Information and Decision Support Assessment (DIADS), to help educators choose the most effective curriculum for their situation.

THE PROBLEM

The statistics are alarming. Self-reports by students who have graduated from high school indicate that 29% are regular smokers, 44% have tried marijuana, 90% have tried alcohol, and 33% have been recent heavy drinkers.(1) Health problems associated with adolescent drug use impact four major areas of a student's life: physical, psychological, social, and spiritual. Alcohol use and drug use are strongly correlated with suicide, homicide, and accidental death. Experts consider most adolescents to be at risk, both for drug use and drug abuse. "Few, if any, are invulnerable," writes Nancy Tobler.(2)

The first prevention programs, started in the 1970s, targeted tobacco use but gradually expanded to include alcohol and other drugs. The primary strategy of these programs was to provide information, which was found to be ineffective. The next wave of programs shifted to building self-esteem and clarifying values, but researchers found that these strategies were no more effective in changing behavior. Indeed, one researcher found that self-esteem actually increased among some teens when they started using alcohol.(3)

FACTORS THAT WORK

Most successful prevention programs grew out of research conducted in the late 1980s by Richard Evans at the University of Houston. Based upon the assumption that smoking is primarily a social act, he developed several programs that target the attitudes and behaviors associated with the social aspects of smoking.

To be effective, adolescent prevention programs must address environmental, personality, and behavioral risk factors identified through research in social psychology. Findings on the antecedents of drug use indicate that it serves specific functions for young people, including the opportunity to challenge parental and societal authorities. The use of tobacco, alcohol, and other drugs allows adolescents to demonstrate autonomy and independence, signals entry into a peer group, and relieves the stresses of growing up. Researchers conclude that all these factors need to be considered in building drug education programs.

In a longitudinal study commissioned by the U.S. Department of Education (USDOE), researchers examined school-based prevention programs in 19 school districts that received funding through the Drug-Free Schools and Communities Act. The following factors were found to be important elements in effective programs.(4)

1) Prevention programs need to be tailored to the age of the student. Drug use behaviors, attitudes, perceptions, and general views about drug use are sensitive to small (one-year) changes in age.

2) Attitudes toward drugs and perceptions of drug use by others change rapidly with increasing age. Programs need to deal aggressively and proactively with students' changing views. "[S]uch target measures as refusal skills and feelings of self-esteem do not change very much after fifth grade and do not appear to be very amenable to change after that age. These may not be useful targets for prevention programs or they may need to be targeted at a younger age."(5)

3) Strategies designed to challenge influences and misperceptions regarding peers show the best chance of changing attitudes and improving outcomes for drug use among students. Experts say the use of peer leaders in program delivery adds credibility to the message and increases a program's effectiveness, because their presence helps alter perceived norms in regard to drug use and social acceptability. Another strategy believed to increase the likelihood of effectiveness and to promote longer-lasting results is the involvement of families and the community in drug prevention programs.

The USDOE study emphasizes that program extensiveness and program stability are the two aspects found to be most linked to positive outcomes for students, but they are dependent upon level and continuity of funding. To be well implemented and to have a chance to make an impact on students, the study recommends that, regardless of size, school districts commit the resources to hire a prevention coordinator at least half time.

EFFECTIVE PROGRAMS

Some commercial programs with significant potential for prevention, based on results of rigorous evaluations are described below.

*Life Skills Training (LST). Designed for seventh-graders, LST is a cognitive-behavioral model that focuses on social influences related to smoking and alcohol and drug use. A combination of interactive and engaging teaching techniques is used to build skills. A study by Gilbert Botvin and his associates indicates significant prevention effects for marijuana use, cigarette smoking, and immoderate use of alcohol.(6) LST has been evaluated over a period of 15 years.

*Alcohol Misuse Prevention Study (AMPS). Developed at the University of Michigan, the AMPS curriculum is designed for grades six through eight and emphasizes social pressure resistance training, peer support, and setting norms. Evaluations of both an initial curriculum for fifth- and sixth-grade students and an expanded curriculum indicated an increase in students' knowledge of curriculum content as well as a reduced rate of increase in alcohol misuse among a subgroup of students who had previous unsupervised drinking experiences.(7) The expanded curriculum included more sessions, role playing, refutation of common expectations for alcohol use, and using knowledge and experience to guide problem solving and decision making about alcohol use.

*Project ALERT. This program, which includes videos and participatory classroom lessons, is designed to build motivation and skills in middle school students to resist pressures to use drugs. Results of a six-year evaluation of the program's effects in diverse school environments indicated that exposure to the curriculum reduced or delayed cigarette and marijuana use with equal effectiveness in schools with high and low percentages of minority enrollment and with adolescents at high and low risk of using substances.(8) The program was less effective in influencing alcohol use and beliefs about alcohol, and what effects there were eroded rapidly. The program's effects on cognitive risk factors, such as perceived consequences of drug use and normative perceptions, lasted longer than its effect on drug use. The findings suggest that "prevention programs work best for children who have limited prior experience with drugs and for substances (e.g., cigarettes and marijuana) that are spurned by most adults."(9) Researchers concluded that continued and strong reinforcement to resist drugs and other high-risk behavior is necessary during high school.

*Project Northland. This is a communitywide multilevel intervention program aimed at reducing alcohol use in sixth through eighth grades. The program involves peers in organizing and promoting alcohol-free social activities, such as movies, open gym, dances, ski trips, and roller skating. Other aspects include a social-behavioral curriculum in the schools, peer leadership, parental involvement and education, and communitywide task force activities. A three-year study by researchers at the University of Minnesota indicated the program was effective in reducing alcohol use and the tendency to use alcohol, reducing the combination of cigarette and alcohol use, changing the functional meanings of alcohol use, reducing peer norms and peer influence to use alcohol, introducing skills to resist peer influences, and increasing parent-child communication about the consequences of drinking.(10)

PROJECT D.A.R.E

It is likely that every public school teacher in America has heard about the Drug Abuse Resistance Education program, commonly known as Project D.A.R.E. Developed in 1983 as a joint project of the Los Angeles Unified School District and the Los Angeles Police Department, it is the most visible and widely used drug abuse prevention program in the United States. Project D.A.R.E. is also being implemented in 49 foreign countries. It is popular with police departments, parents, educators, and government officials. In 1993 Project D.A.R.E was administered to a reported 6 million U.S. students at a cost of $750 million dollars. About 25,000 officers nationwise have been trained to deliver the curriculum at a cost of nearly $50,000 per year per officer. In spite of all this, evaluations of the program's long-term impact on students' drug use have shown it to be ineffective.

Project D.A.R.E.'s main audience is fifth- and sixth-graders, who are taught a standardized curriculum by a uniformed police officer one hour per week for 17 weeks. The program is designed to build self-esteem and resistance to peer pressure and to increase institutional bonding in order to delay the onset of experimentation with tobacco, alcohol, and other drugs. Students learn about the consequences of drugs and alternatives to drugs and practice decision-making skills. The basic curriculum is used by 81% of the districts that implement Project D.A.R.E. Also available are 10-week junior high and high school programs, visitation lessons for students in grades K-4, programs for after-school recreation for middle school students (D.A.R.E. + PLUS), and programs for parents and special education populations.

In response to negative evaluations, the Project D.A.R.E. curriculum was revised in 1993 to include a single lesson on reducing violence, replacing one on building a support system. However, only 9 of 17 lessons contain instruction on social competency development, considered an essential component of an effective curriculum. In addition, the program has infrequent interactive teaching techniques, and it uses uniformed officers rather than trained teachers.

The program consists of a curriculum, informal contact with students, a graduation program, and the distribution of program memorabilia; but researchers find that it is the curriculum itself, rather than the extracurricular elements of Project D.A.R.E., that is likely to be the key to its failure. William Hansen and Ralph McNeal, Jr., report that the "D.A.R.E. program yielded only one effect that, by itself, had the potential to consistently alter substance use onset: building a personal commitment to not use substances. The magnitude of relationship between the program and commitment, while encouraging, still falls within the weak range of interpretation."(11)

The first assessment of the long-term effects of the program was commissioned by school officials in Kokomo, Indiana. Researchers from Indiana University compared the drug-use rates of the 1991 senior class, which had never been exposed to Project D.A.R.E., with the 1992 senior class, which was exposed to Project D.A.R.E. in the seventh grade, using the D.A.R.E. SCALE. The researchers found no significant differences between the two groups regarding self-reports of lifetime usage, how recently they had used drugs, how often they used drugs, or the grade in which they started using drugs.(12) One exception was that the D.A.R.E. seniors reported significantly higher rates of use of hallucinogens over the 30 days prior to answering the questionnaire. The researchers also found no significant long-term effects on students' ability to resist peer pressure or their self-esteem as a result of exposure to Project D.A.R.E.

In an evaluation of Project D.A.R.E. in 36 Illinois schools, researchers from the Research Triangle Institute in North Carolina and the University of Illinois at Chicago found "only limited support for D.A.R.E.'s impact on students' drug use immediately following the intervention, and no support for either continued or emerging impact on drug use once subjects have made the transition to middle school."(13) Cigarette smoking was the only behavior that was significantly affected by exposure to the D.A.R.E. program, in that immediately following exposure to D.A.R.E. students were less likely to report increased cigarette smoking. A year later, however, the effect had disappeared.

In a study that examined the impact of Project D.A.R.E. on potential mediators of substance use and the degree to which such effects account for behavioral outcomes of the program, researchers found that the program had a weak effect on only one of 12 mediators, building personal commitment not to use substances. The researchers concluded that prevention approaches such as Project D.A.R.E. "need significant curriculum enhancement. In the case of the tested D.A.R.E. curriculum, it may need to be replaced by a curriculum that has the potential to target and alter variables that truly mediate substance use and other problem behaviors."(14)

Finally, it is important to note that other programs that are delivered primarily by an expert rather than a teacher, that focus on self-esteem and other affective outcomes, and that emphasize imparting knowledge about drugs are no more effective than Project D.A.R.E.

CURRICULUM SELECTION

The most prevalent method schools use to educate students about substance abuse is to expose them to a particular curriculum. A critical consideration in selecting the appropriate curriculum is making sure there is an effective match between what is available and the particular needs of students. Experts advise schools to include someone in the selection process who is specifically trained in substance abuse prevention theory and practice and who has kept abreast of the literature. Educators can consult local universities, their state departments of education, or prevention resource centers such as the Center for Substance Abuse Prevention (CSAP), accessible via the World Wide Web [http://www.samhsa.gov/csap/index.shtml].

Those responsible for daily implementation need to be trained not only in the principles of prevention, but also in delivering lessons. Lectures and other forms of one-way communication are ineffective. Interactive techniques, such as role plays, Socratic questioning, small-group activities, brainstorming, simulations, cooperative learning, class discussions, and service-learning projects, engage students in self-examination and learning. The six areas of content discussed below also need to be included in a curriculum for it to be effective.

Normative education helps students understand that using alcohol, tobacco, and other drugs is not the norm for adolescents. Student surveys and opinion polls can be used to give students an understanding of actual rates of use and to aid them in setting norms.

Social skills help students increase their verbal skills to expand their ability to handle social situations, particularly at the onset of and during puberty. Skill-building exercises need to focus on decision making, communication, and assertiveness.

Social influences help students recognize outside pressures to use substances that come from messages in advertising, role models, and peers. Information that helps students develop the cognitive skills to resist these pressures is essential.

Perceived harm helps students understand the consequences and risks of substance use. Short- and long-term effects and consequences are messages that need to be reinforced in multiple settings and from credible sources.

Protective factors help students by challenging them to live up to their potential. Material should facilitate connections with positive peers and support and encourage the development of positive aspects of life, such as caring, helping, and setting goals.

Refusal skills help students learn ways to refuse substances effectively and still maintain friendships. Recent research reveals this to be most relevant in supporting teens who do not want to use drugs. This is best carried out in conjunction with other activities such as normative education and social influences.

The following two resources can assist a school in selecting the most appropriate curriculum for their particular circumstances:

*Making the Grade: A Guide to School Drug Prevention Programs covers 47 curricula and offers educators a means to evaluate and compare the quality of curricula.(15) In order to be included in this guide, curricula must be available nationally, have adequate content in alcohol and/or other drug prevention, and have publishers or distributors willing to provide review copies of materials.

*Drug Information and Decision Support Assessment (DIADS), available on the World Wide Web [http://education.indiana.edu/cas/diads/diads.html], is an interactive interview designed to help a school evaluate its current prevention program and explore options for improvement. The interview queries users about curriculum, school policy, staff training, community norms and programs, and alternative activities. Finally, DIADS identifies strengths and weaknesses in the current situation, makes suggestions for improvements, and provides links to other resources on the Web.

CONCLUSION

School and classroom climates and teacher attitudes that reflect the message of prevention reinforce and support a school's efforts, but education alone has a limited impact. What is taught in school must be reinforced outside the school to be effective. Most teen use of alcohol, tobacco, and other drugs occurs in the community, not the school. Therefore, schools need to be involved actively in communitywide planning and coordination of activities that will strengthen and develop antidrug norms. There are many curricula available that integrate suggestions for parent activities and information sharing.

Every day adolescents are exposed to alcohol, tobacco, and other drugs, and they are saturated by media exposure that makes it seem okay or cool to use drugs. Educators are often on the frontline in what has become an ongoing battle; while there are no easy answers to this problem, prevention programs, strategies, and curricula are becoming more sophisticated, effective, and available as a result of ongoing research and evaluation. Educators are not alone in their concern and dedication. Indeed, it is important that they see themselves as part of a team of caring adults. Prevention can only occur if educators, parents, and the community join together in efforts to train and protect our young people.

ENDNOTES

1. Cheryl L. Perry and Steven H. Kelder, "Models for Effective Prevention," Journal of Adolescent Health 13 (1992): 355.

2. Nancy S. Tobler, "Drug Prevention Programs Can Work: Research Findings," Journal of Addictive Disease 11, no. 3 (1992): 2.

3. Stewart I. Donaldson et al., "Drug Abuse Prevention Programming: Do We Know What Content Works?" American Behavioral Scientist 39 (1996): 868-83.

4. E. Suyapa Silvia and Judy Thorne, School-Based Drug Prevention Programs: A Longitudinal Study in Selected School Districts, Final Report (Research Triangle Park, NC: Research Triangle Institute, 1997).

5. Ibid, E-27.

6. Gilbert J. Botvin et al., "Preventing Adolescent Drug Abuse Through a Multimodal Cognitive-Behavioral Approach: Results of a Three-Year Study," Journal of Consulting and Clinical Psychology 58 (1990): 437-46.

7. Jean Shope et al., "Longitudinal Evaluation of an Enhanced Alcohol Misuse Prevention Study (AMPS) Curriculum for Grades Six-Eight," Journal of School Health 64 (1994): 160-66.

8. Phyllis L. Ellickson, Robert M. Bell, and Kimberly McGuigan, "Preventing Adolescent Drug Use: Long-Term Results of a Junior High Program," American Journal of Public Health 83 (1993): 856-61.

9. Ibid, 858.

10. Cheryl L. Perry et al., "Project Northland: Outcomes of a Communitywide Alcohol Use Prevention Program During Early Adolescence," American Journal of Public Health 86 (1996): 956-65.

11. William B. Hansen and Ralph B. McNeal, Jr., "How D.A.R.E. Works: An Examination of Program Effects on Mediating Variables," Health Education and Behavior 24 (1997): 173.

12. Earl Wysong, Richard Aniskiewicz, and David Wright, "Truth and DARE: Tracking Drug Education to Graduation and as Symbolic Politics," Social Problems 41: 448-72.

13. Susan T. Ennett et al., "Long-Term Evaluation of Drug Abuse Resistance Education," Addictive Behaviors 19 (1994): 121.

14. Hansen and McNeal, 175.

15. This publication is available from Drug Strategies, 2445 M Street, NW, Washington, DC 20037 (202/663-6090).