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Chapter 17

Preventing Substance Abuse

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Possible aims:

Prevent all drug use including alcohol use?

Prevent drug abuse and its associated harms?

Drugs have always been a part of our society

The relative number of people who have problems with legal drugs is small

Because prevention efforts are focused on teaching people how to coexist with these drugs

Can we do the same with illegal drugs?

What are We Trying to Prevent?

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Traditional approach

Presentation of negative information about drugs in schools

Goal of approach

Prevention of drug use

Evaluation of effectiveness

How many students used drugs in the future?

Until the early 1970s, most drug prevention programs were not evaluated

Defining Goals and Evaluating Outcomes

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Primary prevention

Aimed at young people who have not yet tried drugs

May encourage abstinence but may arouse curiosity

Secondary prevention

Aimed at people who have experimented with drugs

Goal: prevention of use of more dangerous drugs

Example: colleges encouraging responsible use of alcohol

Tertiary prevention

Aimed at people have been through drug treatment

Goal: relapse prevention

Prevention: Public Health Model

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Efforts are categorized based on target population:

Universal prevention

The entire population

Example: community, school

Selective prevention

High-risk groups within a population

Example: students doing poorly in school

Indicated prevention

Individuals who show signs of developing problems

Example: adult arrested for a first DUI offense

Prevention: Continuum of Care

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Knowledge-attitudes-behavior model

Affective education

Anti-drug norms

Social influence model

DARE

Prevention Programs in Schools

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Programs typically involved presentations by police, former drug users, or pharmacologists

Often included traditional scare tactics and/or pharmacological information

Assumptions of the approach

Increasing student knowledge about drugs will…

Change their attitudes and these changed attitudes will…

ecrease drug-using behavior

Knowledge-Attitudes-Behavior Model

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1970s: model began to be questioned

Research findings

Students with more knowledge about drugs tend to have more positive attitudes about drug use

Early prevention efforts were:

Effective in increasing knowledge about drugs

Ineffective in altering attitudes or behavior

Concerns raised that drug education programs were increasing drug use

By teaching students about drugs that they otherwise wouldn’t have been exposed to

Knowledge-Attitudes-Behavior Model

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Affective domain focuses on emotions and attitudes, which may underlie some drug use

Examples:

Students may use drugs for excitement or relaxation

For feelings of power or control

In response to peer pressure

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 Education

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Values clarification

Teaching students to recognize and express feelings and beliefs

Assumes students have factual information about drugs

Emphasis placed on generic decision-making skills

Alternatives to drugs

Assumes students might take drugs for the experience

Emphasis on alternative nondrug activities that give “natural highs”

Personal and social skills

Assumes drug use is in response to personal or social failure

Emphasis on communicating with others and providing success experiences

Affective Education: Concepts

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In the 1980s, there were growing concerns about affective education approaches

Not enough emphasis on acquisition of skills needed to resist interpersonal pressures to start using drugs

Two new approaches were developed in response to these criticisms

Refusal skills

Drug-free schools

AntiDrug Norms

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Refusal skills

Focus on teaching students to respond to peer pressure to use drugs

“Just say no”

Drug-free schools

1986: Federal government began providing direct aid for drug-prevention

Anti-Drug Norms

School policies were designed to demonstrate that the school did not condone drug use

Examples: locker searches, no tobacco use on school grounds

Many of these policies remain in place even though a “drug-free” society is probably unrealistic

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Image source: © Corbis Images (Image Ch17_12SmokingRefusal)

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Social Influence Model

A prevention model adopted from successful smoking programs

Advantages of education research on smoking prevention programs directed at adolescents

Large enough proportion of adolescents smoke so that measurable behavior change is possible

Health consequences of smoking are so clear that there is consensus that preventing smoking is an appropriate goal

Social Influence Model

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Training in refusal skills

Demonstrating the kinds of social pressures that peers might use to encourage smoking

Modeling a variety of appropriate responses

Normative education

Students tend to overestimate peer smoking

Presenting factual information about smoking trends

Reducing “everybody is doing it” attitude

Social Influence Model: Key Elements

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Use of teen leaders

Using older students as role models

Public commitment

Standing before peers and promising not to smoke

Countering advertising

Teaching students to analyze and discover the hidden messages in ads

Teaching how these messages differ from the actual effects of smoking

Social Influence Model: Key Elements

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DARE = Drug Abuse Resistance Education

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

DARE

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Studies on effectiveness:

1994:

Increased self-esteem

No evidence for long-term reduction in drug use

1994:

Increased knowledge about drugs and social skills

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

DARE

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Some programs based on the social influence model

Demonstrated to have beneficial effects on actual drug use

ALERT

Cigarette experimenters were more likely to quit or to maintain low rates of smoking

Initiation of marijuana smoking among nonusers reduced

Level of marijuana smoking among users reduced

Life Skills Training

Teaches resistance skills, normative education, media influences, and general self-management and social skills

Programs That Work

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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

Peer participation programs

Emphasize becoming participating members of society

Often focuses on youth in high-risk areas

May involve activities such as paid community service

Data on effectiveness are not yet available or are inconclusive

Peer Programs

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Informational programs

Provide basic information about alcohol and drugs and their use and effects

Rationale for these programs is that well-informed parents

Can teach appropriate attitudes

Can recognize potential problems

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

Parent and Family Programs

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Parenting skills programs

Focuses 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 Program

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Several 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

Programs that involve many groups can receive more widespread community support

Community Programs

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Community-based programs can involve many resources, including local businesses and the public media

Communities Mobilizing for Change on Alcohol

One of SAMHSA’s model prevention programs

Community Programs

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All companies and organizations that obtain federal funding have to adopt a “drug-free workplace” plan

Most consistent feature of workplace programs

Random urine screening

Ultimate goal:

Prevent drug use by making it clear through policies and actions that it is not condoned

Workplace Programs

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What needs to be done in a situation depends on the motivations for doing it

Example 1: State requirement for drug education

Most appropriate approach might be a balanced combination of factual information and social skills training

Important to avoid inadvertent demonstration of things you don’t want students to do

Example 2: Widespread concern about a local “epidemic” of drug and alcohol use

Goal would be to organize a community planning effort

Important to avoid negative approaches shown to be ineffective

What Should We Be Doing?

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