Lect 15 - Ch17: Drug Prevention

Most Teen Smokers

• Most teen smokers believe they can quit, but after six years, $75\%$ still smoke.

Limiting Drug Availability

• As long as there is a market for drugs, there will be people to supply them.
• To attack the source of the problem, the demand for drugs must be eliminated.
• Drugs will never disappear, so people need to learn to live in a world that includes them.
• Society has accepted the continued existence of tobacco and alcohol despite the harm they cause.
• Is it possible to teach people to coexist with legal and illegal substances that can impair their health?

Defining Goals and Evaluating Outcomes

• Programs should be evaluated according to how many students in the program later tried drugs.
• Until the early 1970s, most drug prevention programs were not evaluated.
• The goal of presenting negative information about drugs in schools was for prevention of use.

Types of Prevention

• Public health model: primary, secondary, and tertiary prevention.
• Primary prevention
  • Aimed at young people who have not yet tried the substances in question.
  • May encourage abstinence and help teach people how to view the potential influence of drugs on their lives, emotions, and social relationships.
  • Must avoid giving information in ways that arouses children’s curiosity and encourages them to try the substances in question.

Prevention Goals

• Prevention of use of other, more dangerous substances.
• Prevention of more dangerous forms of use.
  • Example: College programs encouraging responsible use of alcohol.
• Secondary prevention
  • Aimed at people who have experimented with drugs but who typically aren’t suffering serious consequences from drug use.
  • Many college students fall into this category.
• Tertiary prevention
  • Aimed at people who have been through substance abuse treatment or who stopped using a drug on their own.
  • Goal is relapse prevention.

Institute of Medicine’s “Continuum of Care”

• Prevention
• Treatment
• Maintenance
• Classification scheme for prevention efforts
  • Universal prevention
  • Selective prevention
  • Indicated prevention

Types of Prevention Examples

• Universal prevention: for an entire population (e.g., community, school).
• Selective prevention: for high-risk groups within a population.
• Indicated prevention: For individuals who show signs of developing problems.
  • Example: students doing poorly in school.
  • Example: adult arrested for a first offense of driving under the influence of alcohol.

Prevention Programs in Schools

• Knowledge-Attitudes-Behavior Model
• Affective Education
• Anti-Drug Norms
• Social Influence Model
• DARE and other programs in use.

Knowledge-Attitudes-Behavior Model

• Programs typically involve presentations by police and former users.
• Often include traditional scare tactics and/or pharmacological information.
• Approach assumes that increasing student knowledge about drugs will change their attitudes and that these changed attitudes will be reflected in decreased drug-using behavior.

Knowledge-Attitudes-Behavior Model - Research Findings

• Model questioned by research findings.
• Students with more knowledge about drugs tend to have more positive attitudes about drug use.
• All early prevention approaches.
  • Effective in increasing knowledge about drugs.
  • Ineffective in altering attitudes or behavior.
• Concerns raised that drug education programs were actually teaching students about drugs that they otherwise wouldn’t have been exposed to.

Knowledge-Attitudes-Behavior Model - Evaluation

• Evaluation of effectiveness depends on program goals.
• Possible goals
  • No experimentation with drugs by students.
  • Rational decisions about drugs by students.
• Research on early drug prevention education efforts.
  • Students more likely to experiment with drugs.
  • Students less likely to develop abuse problems.
  • Does society view this as an appropriate goal?
  • Teaching students to make rational decision about their own drug use with the goal of reducing the overall harm produced by misuse and abuse.

Affective Education

• Drug use may be reduced by helping children:
  • To know and express their feelings.
  • To achieve altered emotional states without drugs.
  • To feel valued and accepted.
• Affective domain focuses on emotions and attitudes, which may underlie some drug use.
• Students may use drugs for excitement or relaxation, for feelings of power or control, or in response to peer pressure.

Affective Education - Values Clarification

• Values clarification: Teach students to recognize and express their own feelings and beliefs.
• Assumes students have factual information about drugs.
  • What they lack is the ability to make appropriate decisions based on that information.
• Programs that teach generic decision-making skills may be appropriate in this approach.
• Students are taught to analyze and clarify their own values.
• Parents may not understand this approach as it may run contrary to the particular set of values that parents want their children to learn.

Affective Education - Alternatives to Drugs

• Alternatives to drugs.
  • Assumes that one reason young people take drugs is for the experience of altered states of consciousness.
  • Teaches students other ways of obtaining a “high” such as relaxation exercises, meditation, vigorous exercise, or sports.
  • Alternatives need to be realistic and tailored to particular audiences.

Selected Suggested Alternatives to Drug Use

• Physical
  • Relaxation: Relaxation exercises
  • Increased energy: Athletics, dancing
• Sensory
  • Stimulation: Skydiving
  • Magnify senses: Sensory awareness training
• Interpersonal
  • Gain acceptance: Learn about social norms, find a group that “fits”
• Spiritual/mystical
  • Develop spiritual insight: Meditation

Affective Education - Personal and Social Skills

• Personal and social skills.
  • Assumes that personal and social problems are causes of drug use.
  • Based on the known association of drug use with poor academic performance and lack of involvement in school activities.
  • Teaches students communication skills and provides opportunities for successful interpersonal interaction.
  • Examples
    • A group of students operates a school store.
    • Older students tutor younger students.

Drug Abuse Resistance Education (DARE)

• Developed in 1983 in Los Angeles; spread to all states by the early 1990s.
• Widely accepted initially despite lack of studies supporting its effectiveness.
• Contains many components of earlier prevention models.
• Delivered by trained, uniformed police officers.
• Includes elements of social influence model.
  • Refusal skills, teen leaders, and public commitment.
• Includes elements of affective education.
  • Self-esteem building, alternatives to drug use, decision making.

Drug Abuse Resistance Education (DARE) - Effectiveness Studies

• Studies on effectiveness of DARE
  • 1994: Program shown to affect self-esteem but no evidence for long-term reduction in drug use.
  • 1994: Program shown to increase knowledge about drugs and knowledge about social skills, but the effects on drug use were marginal.
  • 2004: Review of earlier studies showed program effect is small and not statistically significant.
• Despite failure to demonstrate a significant impact of the DARE program on drug use, it continues to be widely used.

Programs That Work

• Some programs have been demonstrated to have beneficial effects on actual drug use.
• ALERT: Based on social influence model
  • Cigarette experimenters were more likely to quit or to maintain low rates of smoking.
  • Initiation of marijuana smoking among nonusers was reduced.
  • Level of marijuana smoking among users was reduced.
• Life Skills Training: Based on social influence model
  • Teaches resistance skills, normative education, media influences, and general self-management and social skills.

Peer Programs

• Peer influence approaches.
  • Based on open discussion among a group of children or adolescents.
  • Underlying assumption is that the opinions of an adolescent’s peers are significant influences on behavior.

Parent and Family Programs

• Informational programs for parents.
  • Provide basic information about alcohol and drugs and their use and effects.
  • Also may aim to make parents aware of their own alcohol and drug use.
  • Rationale for these programs is that well-informed parents:
    • Can teach appropriate attitudes.
    • Can recognize potential problems.

Parent and Family Programs - Skills and Support

• Parenting skills programs
  • Focus on communication, decision-making, setting goals and limits, and when and how to say no to a child.
• Parent support groups
  • Key adjuncts to skills training or in planning community efforts.

Parent and Family Programs - Family Interaction

• Family interaction approaches
  • Families work as a unit to examine, discuss, and confront issues relating to drug use.
  • Programs can improve family communication and strengthen knowledge and skills.
  • Example: Strengthening Families program
    • Targets children of substance abusers.
    • Goals are improving parenting skills and family relationships and increasing children’s skills.
    • Evaluations indicate it reduces tobacco and alcohol use in children and reduces substance abuse and other problems in parents.

Community Programs

• Reasons for organizing prevention programs on the community level.
  • Coordinated approach at different levels can have a greater impact.
  • Drug education and prevention can be controversial, and programs that involve many groups can receive more widespread community support.

Community Programs - Resources

• Community-based programs can involve other resources, including local businesses and the public media.
• Communities Mobilizing for Change on Alcohol is one of SAMHSA’s model prevention programs.
  • Works for community policy changes and encourages participation of many community organizations and businesses.

Workplace Programs

• Most consistent feature of workplace programs is random urine screening.
• All companies and organizations that obtain grants or contracts from the federal government have to adopt a “drug-free workplace” plan.
• Ultimate goal is to prevent drug use by making it clear through policies and actions that it is not condoned.