gram effects were initially observed for alcohol use, but they too eroded by 8th grade, by which time the higher-risk participants actually reported more statistically significant alcohol use than the control group. The follow-up studies showed that once the lessons stop, so did the program’s effects on drug use.

Programs for High-Risk Populations

These examples suggest (but by no means are sufficient to establish) that universal prevention programs designed to prevent initiation in the general population may either increase use or have no effect on use for the most at-risk segment of the population. In contrast are programs that are specifically designed for high-risk populations. Relatively few studies have assessed the effects of such programs on substance use, but Lochman’s anger-coping program is one example.

This program targets boys in 4th through 6th grades who are identified as highly aggressive and disruptive by their teachers; these are risk factors for later serious and chronic substance use. In this intervention, a school counselor and a mental health professional provide intensive training and coaching in behavioral and cognitive skills necessary for self-control. The intervention is delivered to small groups of boys over a 12- to 18-week period.

The effectiveness of this intervention was investigated in a series of studies that systematically varied features of the program to learn more about its essential elements. These studies in general found that the intervention was effective for reducing disruptive behavior in the short run. A three-year follow-up study, conducted when boys from several of the studies were 15 years old, found that the intervention had a statistically significant effect on self-reported alcohol and substance abuse (Lochman, 1992).

This study suggests that programs carefully designed to reduce known risk factors for use in high-risk populations may be effective for reducing drug use, even if they are not about drugs per se. No research has examined potential diffusion effects of prevention efforts. It is well known that peer groups have large effects on individual substance use; it stands to reason that if members of one’s peer group are positively affected by a preventive intervention, this effect will spread to the “untreated” members of the peer group.

To the extent that such diffusion of effects occurs, prevention effects are underestimated. This may be an important side-effect of prevention, and it may be that the diffusion effect obtained from an intensive preventive intervention targeting a small group of high-risk youths is larger than

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