The follow-up results of a six-year study by the Institute for Prevention Research at Cornell University Medical College provide important new evidence that drug abuse prevention programs conducted in school classrooms work. In a large-scale study involving nearly 6,000 students from 58 schools in New York state, students who received a skills-based prevention program in junior high school were found to have significantly lower odds of smoking, drinking, and using marijuana at the end of high school. This is the first scientifically rigorous study to show conclusively that a school-based drug abuse prevention program can produce meaningful reductions in drug use lasting over the critical junior and senior high school years.
The study was conducted by researchers at Cornell University Medical College’s Institute for Prevention Research with funding from the National Institute on Drug Abuse. The research team was led by Dr. Gilbert J. Botvin, professor public health and psychiatry. Schools were first grouped according to their rates of drug use and then randomly assigned to either receive the prevention program or to serve as controls. The prevention program, called Life Skills Training, taught students self-management skills and general social skills as well as information and skills for resisting pro-drug use influences. Students received the prevention program during the 7th, 8th, and 9th grades. Final follow-up data were collected at the end of the 12th grade.
Students receiving the prevention program had less tobacco, alcohol, and drug use at the end of the study than control students who did not receive the prevention program. The odds of smoking, drinking immoderately, or using marijuana were significantly lower for the students who received the prevention program during grades seven, eight, and nine. For these students, the odds of smoking, drinking, or using marijuana were up to 40 percent lower than for controls. Not surprisingly, the prevention program was less effective for students whose teachers taught only part of the program. On the other hand the strongest prevention effects were found for students who received at least 60 per cent of the drug abuse prevention program.
In addition to assessing the long-term impact of the prevention program on the use of individual substances, the effectiveness of the program was also assessed in terms of polydrug use (defined as the use of two or more drugs by the same individual.) A criticism of previous prevention studies is that they have only demonstrated an impact on relatively low levels of drug involvement – for example, the occasional use of cigarettes. This study directly deals with this issue by looking at the impact of the prevention program on the regular (weekly or more) use of cigarettes, alcohol, and marijuana. The odds of using all three substances on a regular basis were up to 60 percent lower for the students who received the prevention program than for controls.
Two forms of the prevention program were tested. One involved providing teachers conducting the program with special training and feedback by project staff. The other gave teachers a videotaped version of the training and no feedback. All teachers assigned to teach the prevention program were given a teacher’s manual and student guides for each year of the program. The teacher’s manual contained 12 units designed to be taught in 15 class periods. Each unit included an overall goal and specific student objectives as well as detailed lesson plans spelling out the material that should be covered with step-by-step instructions. The student guide contained information related to each of the program units and classroom activities along with workbook assignments intended to supplement classroom material.
Teachers in the schools assigned to receive training and feedback attended a one-day workshop that taught them about the causes of drug abuse and the reasons for using this particular prevention method. They were also taught how each of the classroom sessions should be conducted. During the time they were teaching the prevention program, members of the project staff periodically watched the teachers conducting the program in the classroom and whenever necessary gave them feedback and advice on how to teach the prevention program more effectively. The teachers in the other group received the same prevention materials and videotapes for each year of the program offering the same material as the training workshops. Although teachers in this group were also periodically observed while teaching the prevention program, they did not receive any feedback or advice.
Both prevention groups had significantly lower odds of using drugs by the end of the study. However, when results were examined with respect to the most serious patterns of drug use – using two or three drugs once a week or more – as expected, the prevention program was more effective for the students whose teachers received the training workshop and ongoing support from the Cornell researchers.
The results of this study have several practical implications for developing more effective drug abuse prevention programs:
Prevention programs should contain components that make students aware of the actual rates of drug use and the fact that only a small percentage of adolescents use drugs in order to correct the misperception that “everybody’s doing it.”
Prevention programs should teach skills for resisting pro-drug use social influences.
They should also teach a variety of general life skills for helping adolescents deal with the challenges of adolescent life. These include self-improvement skills such as goal-setting and self-reinforcement, skills for making decisions and solving problems, skills for thinking critically and analyzing media messages, skills for coping with anxiety, skills for communicating effectively, skills for meeting people and making friends, and general assertiveness skills.
Even if a prevention program previously found to be effective is being taught, it will only be effective if it is properly implemented. Because there are many competing demands on the school schedule, it is sometimes difficult to teach drug abuse prevention programs in their entirety. However, this and other studies show that there is a direct relationship between how much of the prevention program is implemented and its effectiveness. If prevention programs are only partially implemented, they are not likely to reduce drug use or drug use risk. Similarly, changing a prevention program known to be effective by modifying program components or adding new ones that have not yet been tested can render the prevention program ineffective.
Drug abuse prevention programs must be taught over a prolonged period of time. Prevention programs that are only one year long or do not contain two or more years of booster sessions are not likely to produce lasting reductions in a drug use. In fact, evaluations of prevention programs not including booster sessions have shown that initial reductions in drug use decrease after about a year and disappear totally after about two or three years.
In order to have maximum effectiveness, training and support from prevention experts should be obtained whenever possible.
The prevention program tested in the Cornell study was effective whether teachers received a formal training workshop and ongoing consultation and support or only received a training videotape. However, with respect to more serious drug use, it was most effective when teachers received formal training and periodic consultation and support.
Researchers have been searching for effective prevention programs for more than two decades now. The goal of a prevention program that could actually produce measurable reductions in drug use behavior has been elusive. Prevention approaches that relied on teaching factual information about the dangers of drug use have consistently been shown to be ineffective, as have a variety of other prevention approaches. Prevention programs that teach students how to resist social influences to use drugs have produced short-term reductions in cigarette smoking and, to a lesser extent, alcohol and marijuana use. Several long-term follow-up studies have raised questions about the ability of these approaches to pro duce lasting reductions in drug use.
The results of the Cornell study provide important new information that prevention works. The right kind of program, when properly implemented with junior high school students and with four years of booster sessions, can produce prevention effects that last at least until the end of high school. A prevention program that teaches general skills for dealing with life as well as skills and information for resisting social influences to use drugs can significantly reduce the chances that junior high school students will experiment with drugs. It can also reduce the likelihood that these same students will develop more serious patterns of drug use by the end of high school . With this study, it is clear that drug abuse prevention has come of age.
Source: Western Center News – June 1994 – Western Regional Center for Drug-Free Schools and Communities – published in ‘The Challenge’ vol. 6 No.1.
