{"id":9306,"date":"2014-03-25T17:11:45","date_gmt":"2014-03-25T17:11:45","guid":{"rendered":"https:\/\/drugprevent.org.uk\/ppp\/?p=9306"},"modified":"2016-10-03T19:55:31","modified_gmt":"2016-10-03T19:55:31","slug":"effective-programmes-for-drug-prevention-in-youth","status":"publish","type":"post","link":"https:\/\/drugprevent.org.uk\/ppp\/2014\/03\/effective-programmes-for-drug-prevention-in-youth\/","title":{"rendered":"Effective Programmes for Drug Prevention in Youth"},"content":{"rendered":"

CND 52ND<\/sup> Session \u2013 Vienna International Centre<\/b><\/span><\/p>\n

Side Event \u2013 18th<\/sup> March 2009<\/b><\/span><\/p>\n

 <\/p>\n

Effective Programmes for Drug Prevention in Youth<\/b><\/span><\/p>\n

by Peter Stoker \u2013 Director, National Drug Prevention Alliance, UK.<\/span><\/p>\n

This paper is written in the context of education for Universal Prevention, rather than for Indicated or Selective Prevention processes.<\/span><\/p>\n

Drug education, as we on the prevention side of the house understand it, is part of the process of producing drug-free lifestyles for all. But our opponents characterise and condemn this as part of a so-called \u2018war on drugs\u2019.<\/span><\/p>\n

Well, if what we have here is indeed a \u2018war\u2019, should Obama pull the troops out? More realistically, this is a \u2018war\u2019 that has never been fought for real. And sadly those whom you might think of as \u2018our\u2019 troops too often turn out to be collaborators. With the benefit of hindsight we can see that the term \u2018war on drugs\u2019 is a finely conceived and executed meme<\/b> (Ref 1<\/b> – a paper by my NDPA colleague Brian Heywood – will tell you more about what a meme is) \u2013 this particular meme engenders a feeling that we who are opposed to drug abuse are aggressors, whilst our opponents, the libertarians, are cast as peace-seekers. Their high priests, such as Arnold Trebach, exploit this meme by pleading that \u2018\u2026 we have had enough \u2018drug war\u2019 \u2013 what we want now is a little \u2018drug peace\u2019\u2019. As Mel Brooks might have put it:<\/span><\/p>\n

\u201cA little piece of heroin, a little piece of dope,<\/i><\/span><\/p>\n

A little piece of cocaine, brings us peace – we hope.\u201d<\/i><\/span><\/p>\n

<\/i>Whether you seek a drug-free society, or the kind of drug-laden \u2018peace\u2019 Arnold Trebach proposes, both camps see a key role for drug education. Surely this means that if we serve up more education than they do, we will reach our goal \u2013 right? Wrong. This is the kind of over-simplifying that has typified too much of what has been done in the name of drug education in the past \u2013 it is like serving yourself chicken soup at home \u2013 it gives you a warm feeling, but nobody else notices.<\/span><\/p>\n

After nearly twenty years of PRIDE conferences I can recall several drug education programmes which would have \u2018warmed the soup\u2019 for the teacher \u2013 but done little else.<\/span><\/p>\n

Taking the title of this paper \u2013 \u2018Effective Drug Education for Youth\u2019 \u2013 let me start by de-constructing the title \u2013 in reverse order:<\/span><\/p>\n

\u2018Youth \u2026\u2019<\/b><\/span><\/p>\n

<\/b>There are not a few people around \u2013 present company excepted \u2013 who see drug education with youth as the Silver Bullet. Get this youthful generation \u2018educated\u2019 and we are home and dry (and clean and sober). I take issue with this \u2013 youth are not an island, even though they are as vulnerable as any, and more vulnerable than many, to external influences \u2013 what the professionals call \u2018mediating variables\u2019. And youth have an inexhaustible knack of grabbing the wrong end of the stick; I still relish the words of one American mentor, several years ago:<\/span><\/p>\n

\u2018There\u2019s nothing wrong with a teenager that reasoning with him\u00a0<\/i>won\u2019t aggravate\u2019.<\/i><\/span><\/p>\n

<\/i>Just to remind us all that youth are not the be-all and end-all, I draw your attention to a report on evidence-based prevention with \u2018older adults\u2019 \u2013 published under the auspices of SAMHSA (Substance Abuse and Mental Health Services Administration) by the \u2018Older Americans Substance Abuse and Mental Health Technical Assistance Center\u2019. The problem of substance abuse amongst senior citizens is recognised to be such as to require prevention to be \u2018a national priority\u2019. (Ref 2<\/b>)<\/span><\/p>\n

\u2018Drug Education \u2026\u2019<\/b><\/span><\/p>\n

<\/b>I am astonished to note that there are still teachers around who think the transfer of factual knowledge is the key to drug prevention success. One may comfort oneself on the excellence of one\u2019s knowledge transfer, and be warmed by a few positive feedbacks; the acid test is \u2018have you influenced the majority?\u2019 \u2013 the acid answer is \u2018probably not\u2019. Of course facts on their own will be seminal for a few receiving them \u2013 we have all, in our time, been touched by a single fact \u2013 but one cannot in all seriousness extend this to a generality.<\/span><\/p>\n

We need to recognise that drug education is not an end in itself, it is a tool of prevention, and as such it must help must mediate behaviour. You can deliver a programme of education which satisfies process criteria within itself \u2013 but it has long been known that transmitting knowledge does not automatically change behaviour.<\/span><\/p>\n

A valuable and occasionally seminal tool, maybe, but unless it is delivered skilfully, and in the right setting, unless it is properly sharpened, it won\u2019t cut it.<\/span><\/p>\n

\u2018Effective \u2026\u2019<\/b><\/span><\/p>\n

<\/b>My contention, from the review above, is that concentrating on \u2018youth\u2019 and \u2018drug education\u2019 in isolation cannot (for most recipients) be effective in terms of drug prevention. If we are looking for effective lifestyle change, then we have to look much wider and more rationally.<\/span><\/p>\n

The current US-based point of reference for effective processes of prevention is NIDA. (National Institute on Drug Abuse). Their most recent summary on the subject is \u2018Preventing Drug Use \u2013 A Research Based Guide \u2013 second edition\u2019 – 2003. (Ref 3<\/b>) It is interesting to note that this reference work is now more than six years old. Does this mean it cannot yet be improved upon? Have fashions changed? Or is it simply a shortage of funding for prevention research?<\/span><\/p>\n

The Guide starts by setting out the Principles of Prevention, under sixteen main headings. Of these, Principles 7 and 8 – reproduced here as Table 1 – focus on education, saying:<\/span><\/p>\n

Principle 7- Elementary Schools \u2013 \u2018\u2026 programs should target improving academic and social-emotional learning\u2019.<\/i><\/span><\/p>\n

<\/i>Principle 8 \u2013 Middle, Junior and High schools \u2013 \u2018\u2026programs should increase academic and social competence\u2019<\/i><\/span><\/p>\n

<\/i>The Guide does give a useful reference list of the components of effective preventive education, but this does not seem to take us much further than the earlier work (Ref <\/b>3) by Bonnie Benard, when she was a specialist with Illinois Teen Institute in the 1980s. Benards\u2019 recommendations are shown in Table 2.<\/span><\/p>\n

What neither NIDA nor Benard do not mention is the single factor which can be said to encompass all other factors in influencing (mediating) behaviour. That factor is culture<\/b>.<\/span><\/p>\n

This means the culture in which decisions about drugs are made; the culture in which teachers, police, media, legislators, governments, medics, youth workers, parents, partners (and many more besides) operate in this society of ours. The culture impinging on the decision-making person and their interaction with the culture of all other people around them is a major part of this. The age of all concerned is also relevant \u2013 as is the \u2018education\u2019 they have received. We sometimes forget that teachers in drug education have often received little or no education on the subject themselves, or in some cases, may have been exposed to influence from teacher trainers who have a drug education axe to grind. (Indeed some of these teachers may be current or past users of drugs themselves).<\/span><\/p>\n

So, what influences the culture around decisions? It \u00a0includes, in no particular order:<\/span><\/p>\n

– Peer Group Influence<\/span><\/p>\n

– Personal perceptions<\/span><\/p>\n

– Income v Cost of any action<\/span><\/p>\n

– Health Issues<\/span><\/p>\n

– Moral Structure<\/span><\/p>\n

– Spiritual structure<\/span><\/p>\n

– Family values<\/span><\/p>\n

– The attraction of risk-taking<\/span><\/p>\n

– The media, music, movies, tv, fashion, humour etc.<\/span><\/p>\n

– Mental condition, – depressed, elated, in-between, and<\/span><\/p>\n

– Legislation, including Conventions<\/span><\/p>\n

This primacy of culture resonates with the work of one of my earliest mentors, Bill Lofquist, (Ref 5<\/b>) who hails from Tucson, Arizona and who said:<\/span><\/p>\n

\u201cWe need to get beyond the notion that prevention is stopping\u00a0<\/i>something happening, to a more positive approach which\u00a0<\/i>creates conditions<\/b> which promote the well-being of people.\u201d<\/i><\/span><\/p>\n

<\/i>Addressing culture through education is \u2018creating conditions\u2019<\/b> \u2013 no more and no less.<\/span><\/p>\n

If you are going to tackle the culture in a community, you would do well to first measure whether your seeds will fall on stony ground, or will bear fruit. The NIDA Guide usefully assists this by giving a check list \u2018Nine Stages of Readiness in a Community\u2019 \u2013 reproduced here in Table 3.<\/span><\/p>\n

Specifics of Effective Drug Education for Youth<\/b><\/span><\/p>\n

<\/b>Too often, it seems, the approach to drug education takes for granted that the educators understand and buy into the intended goals, know what they are doing, and will operate a Systems Approach \u2013 such as that described in another invaluable reference tool \u2013 \u2018The Future by Design\u2019. Published by the USDHHS, Department of Health and Human Services, in 1991. The core of a systemised approach is a \u2018spiral\u2019 of revisiting process stages \u2013 plan\/implement\/evaluate\/decide\/then plan again.<\/span><\/p>\n

Another gem from this valuable reference work is a table showing a \u2018Contrast of Paradigms\u2019 in empowering a community \u2013 whether this be an education community or some other part of society. Reproduced herein as Table 4, it will almost certainly have a salutary effect on all of us, whatever our professional discipline !<\/span><\/p>\n

As a very recent example of effective prevention programmes. I cite the \u2018Good Behavior Game\u2019 developed and tested in Baltimore City Public Schools, and reported in 2008 ( Ref 7<\/b> and Ref 8<\/b>). Addressing multiple targets \u2013 anti-social disorders, violent and criminal behaviour, disruptiveness, as well as drug abuse and other factors, the \u2018GBG\u2019 program applied classroom management techniques with more than 2300 pupils, and helped them to significantly adjust to the role of successful student. A positive impact on drug\/alcohol abuse was but one of the measured positive outcomes.<\/span><\/p>\n

How Does Effective Education Fit In?<\/b><\/span><\/p>\n

America\u2019s CSAP (Centre for Substance Abuse Prevention) \u2013 was excited as long ago as 1991 (Ref 6 \u2013 see Chapter 1, Overview<\/b>) <\/b>by the finding that the best prevention results come through \u2018\u2026.co-ordinated prevention efforts that offer multiple strategies, provide multiple points of access, and coordinate and expand citizen participation in community activity.\u2019<\/span><\/p>\n

Such an approach , whether in drug prevention or drug education, requires a certain relinquishing of self-authority; to get the best out of a wide range of disciplines and sectors, it is expedient to get on to their level \u2013 whatever that is. Prevention expert Bill Lofquist spells this out clearly by defining a spectrum of approaches \u2013 you can treat youth as dumb \u2018Objects\u2019, as \u2018Recipients\u2019 \u2013 albeit under your control, or as \u2018Resources\u2019 sharing the policy and practice. Hard way or easy way \u2013 your choice. It is also important to recognise that you cannot \u2018do\u2019 prevention \u2018to\u2019 people, you must rather engender a condition in which prevention will be the obvious choice for people.<\/span><\/p>\n

This is also to a significant extent true of drug education \u2013 and certainly of affective education.<\/span><\/p>\n

Equally important is an understanding of how the drug education which you are delivering interacts and harmonises with the whole societal system, and the goals of each sector. An example of this is given in Table 5 herein, which was presented by NDPA to the UK Shadow Home Secretary\u2019s Office last November (2008) as part of a dialogue on national drug policy.<\/span><\/p>\n

Specific examples of Effective Prevention<\/b><\/span><\/p>\n

The technical references called up in this paper give several specific examples, covering various approaches. NDPA can give extended details (on request) on its own Peer-led drug education and prevention process \u2013 Teenex ( Ref 9<\/b> )\u2013 which was successfully adopted by other countries.<\/span><\/p>\n

If you are looking for support for prevention, your first place to look would probably not be The Economist, and yet their issue on 5th<\/sup> March this year gave just that. Their Article entitled \u2018In America, lessons learned\u2019 ( Ref 10<\/b>) says:<\/span><\/p>\n

\u2018By far the best way of reducing the harm that drugs do is to convince\u00a0<\/i>people not to use them\u2019<\/i><\/span><\/p>\n

The Economist article gives several further encouragements to preventive drug education. It takes the usual swipes at the DARE (Drug Abuse Resistance Education) programme, and does so on the usual incorrect and outdated basis, but it finds itself compelled to move to a more complimentary stance when it describes the latest remodelling, including DARE\u2019s much wider scope of linked subjects \u2013 from drugs to internet bullying.<\/span><\/p>\n

As the Economist observes, DARE (Drug Abuse Resistance Education) programme has learnt this lesson the hard way. DARE\u2019s current strapline is \u2018Dare to resist drugs, and violence\u2019 and despite the hostile attitude of some on both sides of the drug education house towards it, DARE continues to succeed, witness the fact that it has been taken up by another 220 communities in the three years to its latest published report (2007).<\/span><\/p>\n

Another project lauded by the Economist for a multi-topic motivational approach started in Montana and other western states in tackling the resurgent problem of methamphetamine abuse. Instead of trotting out the usual array of medical harm facts, the organisers elected to highlight that meth users often get rotten teeth. This turned out to be a very telling message.<\/span><\/p>\n

The Economist concludes its article by referring to the anti-tobacco campaigns, which have made big inroads into prevalence. They suggest several reasons for this success; I would suggest they can all be grouped under the heading of culture change<\/b>.<\/span><\/p>\n

Elsewhere, an interestingly different example is given in the NIDA research-based guide. It is called PATHS \u2013 Promoting Alternative Thinking Strategies, and it is a programme for \u2018promoting emotional, health and social competencies, and reducing aggression and behaviour problems in elementary school children, while enhancing the educational process in the classroom\u2019. Although primarily targeted at school classrooms, it also includes information and activities for parents. I draw your attention to this programme not so much for its particular excellence as much as its example of how diverse one\u2019s drug education approach can and should be. Diversity in a programme may produce vital dividends in this time of scarce funding. If the programme you intend using has other benefits over and above drug education, then this could open the door to other funding sources. Diverse outcomes equals diverse incomes!<\/span><\/p>\n

Conclusions<\/b><\/span><\/p>\n

With the aim of \u2018Effective Drug Education for Youth\u2019 we need to understand that what makes a programme effective will range well beyond the programme itself. Taking an extreme example, if , as has been asserted, drug abuse is a reaction to an unsatisfactory society, then the solution is simple \u2013 improve society!<\/span><\/p>\n

This paper has attempted to take drug education out of its comfort zone, and in the process, to identify ways of improving effectiveness. \u00a0\u00a0One way to concentrate one\u2019s thinking about drug education is to consider it as a business venture. Metaphorically speaking, what are the parameters we should address in this business?<\/span><\/p>\n

– What is our product, our USP?<\/span><\/p>\n

– What can we sell it for, and to whom?<\/span><\/p>\n

– What can the competition sell theirs for and to whom?<\/span><\/p>\n

– Where can we best sell it?<\/span><\/p>\n

– Who, besides us, can influence the market?<\/span><\/p>\n

– Who has the best toys? And can we partner with them?<\/span><\/p>\n

– What is the shelf life of our product?<\/span><\/p>\n

– What is our human resource? and<\/span><\/p>\n

– How are we going to measure sales?<\/span><\/p>\n

I wish you every good fortune, as you draw up your Business Plan!<\/span><\/p>\n

********** <\/b><\/span><\/p>\n

 <\/p>\n

REFERENCES<\/b><\/span><\/p>\n

1. Heywood, B.<\/b> \u2018Assaying Information in the Substance Misuse World\u2019 Published NDPA, 2004<\/span><\/p>\n

2. Blow, C. F. et al<\/b> \u2018Evidence-Based Practices for Preventing Substance Abuse and Mental Health Problems in Older Adults\u2019 Published: Older American Substance Abuse & Mental Health Technical Assistance Center, 2005.<\/span><\/p>\n

3. National Institute on Drug Abuse.<\/b> \u2018Preventing Drug Use Among Children and Adolescents \u2013 A Research- Based Guide\u2019 Published NIDA, Second Edition 2003.<\/span><\/p>\n

4. Benard, B.<\/b> \u2018Characteristics of Effective Prevention\u2019 Published Project Snowball training manuals, Illinois Teen Institutes, 1987.<\/span><\/p>\n

5. Lofquist, W.A.<\/b> \u2018Discovering the Meaning of Prevention \u2013 A Practical Approach to Positive Change\u2019, Published: AYD Publications, Tucson, Arizona l983. Fifth Printing, 1991.<\/span><\/p>\n

6. OSAP, DHHS.<\/b> \u2018The Future by Design \u2013 A Community Framework for Preventing Alcohol and Other Drug Problems Through a Systems Approach. Published: DHSS No. (ADM) 91-1760; l991<\/span><\/p>\n

7. Petras, H. et al.<\/b> \u2018Developmental Epidemiological Courses Leading to Antisocial Personality Disorder and Violent and Criminal Behavior; Effects by Young Adulthood of a Universal Preventive Intervention in first-and second-grade Classrooms\u2019 Published: Drug and Alcohol Dependency, 95S1 \u2013 pp.S45-S59, 2008<\/span><\/p>\n

8. Poduska, J. et al.<\/b> \u2018Impact of the Good Behavior Game, A Universal Classroom-based Behavior Intervention, on Young Adult Service Users for Problems with Emotions, Behavior, or Drugs or Alcohol. Published: Drug and Alcohol Dependency, 95S1 \u2013 pp.S29-S44, 2008<\/span><\/p>\n

9. Stoker, S. A.<\/b> \u2018Teenex – \u2018A Peer Education and Drug Prevention Programme\u2019 Published National Drug Prevention Alliance, 1988 and subsequent editions.<\/span><\/p>\n

10. Economist,<\/b>print edition. <\/b>\u2018In America, lessons learned \u2013 but efforts to warn people off drugs are still too timid\u2019. \u2013 March 5th<\/sup> 2009<\/span><\/p>\n

 <\/p>\n

Table 1.<\/b><\/span><\/p>\n

NIDA: \u2018Preventing Drug Use, Research-based Guide\u2019 – 2nd<\/sup> Edition, 2003.<\/b><\/span><\/p>\n

Prevention Principles \u2013 Extract for Education<\/b><\/span><\/p>\n

Principle 7:<\/b><\/span><\/p>\n

Prevention programs for elementary school children<\/i> should target improving academic and social-emotional learning to address risk factors for drug abuse, such as early aggression, academic failure, and school dropout. Education should focus on the following skills (Ialongo et al. 2001; Conduct Problems Prevention Work Group 2002b):<\/b><\/span><\/p>\n

 <\/p>\n