Characteristics Of Effective Prevention

Written by Bonnie Benard, NIDA, USA.(Originally in training manuals for Project Snowball, Illinois Teen Institutes, 1987)

Published in Britain in ‘Drug Prevention – Just say Now’ by Peter Stoker, pub. David Fulton Publishers,London, 1992.

Programme comprehensiveness/intensity

A.        Multiplicity: the causes of drug/alcohol abuse are multiple: personality, environmental, behavioural (Kandel, Logan, 1984; Hawkins et al, 1951).  Programmes tackling only one area usually fail.  You should target multiple systems (youth, families, schools, community, workplace, media, etc).  Also use multiple strategies (information, lifestyles, positive alternatives, community policies) (Botvin, 1982).

B.         Target whole community.  School-based programmes achieve less than community-based approaches.

C.         Target all youth for prevention – not just “high risk”.  Adolescence is seen to be a high-risk time for all youth in terms of health-compromising behaviour.  Labelling “high risk” youth can provoke stigmatisation and lead to self-fulfilling prophecies.  There is however an argument for defining “high risk” communities where an additional resource over and above the general prevention effort could be justified.

D.        Build drug prevention into general health promotion.  Drug abuse has been found by several (Lofquist, 1993) to be part of a complex pattern of interrelated factors – e.g. delinquency, truancy, school failure, precocious sexuality, which share common antecedents.

E.         Start at an early age and keep going!  Even in infancy there are influences in later behaviour.  Developmental difficulties by age 3 are difficult to overcome (Burton, White).  Here, it is of course relevant to mention Trevor Williams, Noreen Wetton and Alysoun Moon of the Southampton University team who have demonstrated so graphically in their “Jugs and Herrings” research papers that primary age children are not blissfully ignorant of drugs and alcohol.  Prevention programmes starting from what children actually know are essential.  Many secondary schools still seem to regard years 11 and 12 as the age at which discussion of drugs (or indeed sexuality) should be facilitated.  Don’t wait until the horse has run away before you lock the stable doors!

F.         Adequate quantity.  ‘One-shot prevention efforts do not work” (Kumpfer, 1988) there must be a substantial number of interventions, each of a substantial duration.  Project D.A.R.E. (Drug Abuse Resistance Education) initiated by Los Angeles Police and now in several countries, delivers no less than seventeen one-hour lessons to any given year and this is only part of the school programme.

G.        Integrate family/classroom/school/community life.  This is easier to say than do, but where it has happened results have been enhanced.

H.        Supportive environment, empowerment.  Where young people are encouraged to participate and take responsibility their behavioural outcomes are improved.  In Britain now peer-education methods which have been proven elsewhere have been applied to good effect.

Programme strategies

J.          ‘KAB’ – Knowledge/Attitudes/Behaviour.  Address these as a set, i.e. each must be directly tackled rather than assuming one will flow from another.  The behavioural component is in part addressed by social skills development, but also supported by positive reinforcement activities – drug free social/sporting events, commendations (preferably with something for everyone), media coverage, etc.  Research suggests that social learning theory (Bandura, 1977) produces some of the most profound improvements.

K.         Drug specific curriculum.  Affective education programmes that had not specifically covered drugs (including alcohol) were found unsuccessful, even though they addressed knowledge, attitudes and lifeskills.

L.         Gateway drugs.  So-called because people now using heavy-end drugs almost always started on these.  Gateway drugs can be tobacco, alcohol and cannabis or, these days inBritain, even heroin!  Concentration on prevention of these is therefore likely to prevent all substances.  British research by PaT (Parents against Tobacco, 1990), showed that of youth who smoked tobacco 50% had also tried an illegal drug compared with only 2% of those who did not smoke tobacco.  It should be particularly noted that cannabis is far from harmless; physical, mental and social damage is now being increasingly accepted as a reality.

M.        Salient material.  Whatever is used needs to identify with the audience, including:

•          ethnic/cultural sensitivity

•          appeal to youth’s interests

•          short term outcomes to be emphasised as important to youth as well as long term

•          appropriate language, readability

•          appealing graphics

•          appropriate to real age/reading age – a key factor

In a survey of 3, 700, 000 young American children, 25% of 9 year olds felt “some” to “a lot” of peer pressure to try drugs or alcohol (Weekly Reader, 1987).

N.        Alternatives.  Activities have to be plausible, be more highly valued than the health-compromising behaviour.  Too often these alternatives are poorly thought through. ( ‘Ping-pong = prevention’? No!)

P.         Lifeskills.      Development of these will be of wider benefit than drug prevention.  Included will be

communication, problem solving, decision-making, critical thinking, assertiveness, peer pressure reversal, peer selection, low-risk choice making, self-improvement, stress reduction and consumer awareness (Botvin, 1985).

Choosing your friends has been found in some research to be more effective than resisting the peer pressure of said friends.  Consumer awareness is a “companion” to resisting peer pressure, i.e. resisting media pressure.

Q.        Training prevention workers.  For the school setting the greater emphasis on experiential and interactive work requires teacher training to extend into youth work skills.  Community development skills are valuable in taking school initiatives into the community.  Imported “prestige” role models are all very well, but good results have been achieved with parents, peers, teachers, or outside agency workers.

R.         Community norms.  Consistency of policies throughout schools, families and communities can greatly enhance impact.

S.         Alcohol norms.  Because of its dual status as a beverage and as a culturally accepted drug, alcohol is problematic for prevention.  However, heart disease and tobacco prevention programmes have shown that societal norms can be changed.

T.         Improve schooling!  Listed here as a target because of its important correlation with healthy lifestyle.  Within the current British economic and academic climate one realistic hope may lie with co-operative learning, see the ‘Tribes’ programme, for example.

U.        Change society.  Don’t just stop with improving schools; add your voices to pressure for improvement in employment, housing, recreation and self-development; it is naïve to suppose that prevention can take place in a political vacuum.  Jessor recognises that failing to acknowledge the need for macro-environmental improvement while at the same time placing the responsibility for health solely with the individual is tantamount to “blaming the victim”.

The planning process

V.         Design, implementation, evaluation.  Evaluations have generally concentrated on outcomes rather than the quality of design.  However, implementation is as much dependent on engaging all sectors of the community (be it a school, a workplace, or a town) as it is on quality of design.  Evaluation should therefore measure process as well as outcome.

W.        Goal-setting.  Unrealistic or immeasurable goals help no-one.  It is important to set not only long-term outcome goals (for prevention is long-term) but also “process goals” such as increased involvement of parents and community, academic success, increased student-teacher interaction, and so on.

X.         Evaluation and amendment.  Prevention workers have been criticized for giving too little attention to this area, the crushing shortage of funds has much to do with it (inAmerica the ratio of funding between interdiction-policy and prevention is about 200:1).  This lack of emphasis on evaluation has been the Achilles heel that pro-drug campaigners have gleefully attacked.  Effective evaluations have been those including longitudinal design, multiple measures of process as well as outcome (Tobler, 1986), and cost-benefit analysis (CBA).  CBA is perhaps the greatest marketing tool prevention has; where CBA has been applied substantial cost effectiveness has been demonstrated.

Source: Quoted in book Drug Prevention Just Say Now (1992) by Peter Stoker.  Contact NDPA

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