Informing America's Policy on Illegal Drugs What We Don't Know Keeps Hurting Us (2001) / Chapter Skim
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7 Preventing Drug Use
7 Preventing Drug Use
Pages 208-240
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From page 208... ...
It is important to note at the outset that although this report concerns itself with illegal drug use, the notion that the use of tobacco, alcohol, and marijuana increases the probability of later illegal drug use, which is generally accepted in the prevention field, requires that these other substances be considered in this chapter. It is also the case that almost all of the available research in this area deals with what are called "gateway" substances, rather then cocaine, crack, heroin, and the other illegal drugs that are the focus of the other chapters of this report.
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From page 209... ...
Media avenues might include the use of billboards, newspapers, radio, and television, as well as collaborations with the entertainment industry, music videos, and interactive media. The ongoing National Youth Anti-Drug Campaign of the Office of National Drug Control Policy is an example of such a media campaign implemented at the national level.
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program and Life Skills Training. The most effective of these instructional programs use what are called cognitivebehavioral or behavioral instructional methods, which rely on modeling, providing rehearsal, and coaching in the display of new skills (Gottfredson, 2001~.
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and Comer's School Development Process (Comer, 1985; Cook et al., 1998~. Often these interventions also include efforts to establish or clarify school rules or discipline codes and mechanisms for the enforcement of school rules strategies discussed in more detail in Chapter 6.
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Although little is known about the extent to which these different prevention strategies are used in local communities, a recent national study of school-based prevention attempted to describe the prevalence of prevention strategies used in schools (Gottfredson et al., 2000~. The investigators asked school principals to report which of 14 types of discretionary prevention activities instruction, counseling, norm change, recreation, etc.
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At least 20 reviews and meta-analyses of drug prevention programs were published during the 1980s and 1990s. The most recent of these generally conclude that substance abuse prevention efforts are "effective" for preventing substance use, in the sense that the studies reviewed report statistically significant differences between subjects receiving and not receiving the preventive intervention on some measure of substance use, at least immediately following the termination of the prevention activity, and in rare cases months or years beyond that point (Botvin, 1990; Botvin et al., 1995; Dryfoos, 1990; Durlak, 1995; Ennett et al., 1994a, 1994b; Gerstein and Green, 1993; Gorman, 1995; Gottfredson, 1997; Gottfredson et al., forthcoming; Hansen, 1992; Hansen and O'Malley, 1996; Hawkins et al., 1995; Institute of Medicine, 1993, 1994; Norman and Turner, 1993; Tobler, 1992; Tobler and Stratton, 1997~.
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This selection renders the groups nonequivalent in ways that have not been measured and cannot be controlled. Most reviews of drug prevention programs have also focused on statistical significance rather than the magnitude of effects as the sole criterion for determining effectiveness.
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Likewise, small effect sizes on measures of very serious crimes are worthy of note because preventing even a small number of such crimes is important. Only a handful of reviews of prevention programs have reported ESs.
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documents effect sizes slightly smaller than those from previous meta-analyses.2 This study found that across 88 relevant published treatment-control comparisons, the mean effect size for school-based prevention activities on measures of alcohol and other drug use (but not tobacco use) is statistically significantly different from zero.
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as well as research evidence of a statistical link between age at first use of drugs and later more frequent or problematic use (Brunswick and Boyle, 1979; O'Donnell and Clayton, 1979; Robins and Przybeck, 1985; Anthony and Petronis, 1991) Findings such as these and subsequent analyses of sequences of drug use patterns over time led to a developmental stage theory of adolescent involvement in legal and illegal drugs (Kandel, 1975; Kandel and Faust, 1975~.
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They argue that the more substantial effects on potential users are diluted in studies that report findings for the entire population. For example, suppose that 98 percent of a population targeted for universal prevention programming will never use heroin, and that the
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, only 7 of the 88 studies for which effect sizes could be computed targeted populations that were at elevated risk for developing problem use. A handful of studies have compared the effectiveness of universal prevention activities for groups that differed according to their level of use at baseline.
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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.
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sit may be possible to infer something about the size of the diffusion effect by comparing the effect sizes of studies that randomly assign subjects within a social unit, such as a school, with studies that randomly assign the social units. Diffusion effects should weaken the effect in the within-unit design more than in the between-unit design.
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They had to estimate this effect indirectly in a two-stage process (from the National Household Survey of Drug Abuse) , by combining estimates from evaluations of prevention program effects on the age of marijuana initiation and the correlation between the age of marijuana initiation and the quantity of cocaine later consumed.
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From page 223... ...
summary of the effectiveness of different kinds of prevention programs has become influential in the prevention field. According to Botvin, four general approaches are largely ineffective for reducing substance use: "information dissemination" approaches, which teach primarily about drugs and their effects; "fear arousal" approaches, which emphasize the risks associated with tobacco, alcohol, and drug use; "moral appeal" approaches, which teach students about the evils of use; and "affective education" programs, which focus on building self-esteem, responsible decision making, and interpersonal growth.
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In addition to showing effect sizes for the major modalities listed above for which more than one study was available, it also shows a separate breakout for the Drug Abuse Resistance Education (D.A.R.E.) program, which is of special interest to policy makers because it is the most widely used classroom instructional programin 1998 it was used in 48 percent of the nation's elementary schools and because it enjoys substantial federal support (Gottfredson et al., 2000~.
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-0.44 0.37 30 Skill-building instruction without cognitive-behavioral or behavioral instructional methods 0.03 -0.22 0.29 25 D.A.R.E. 0.03 -0.22 0.25 12 Other instructional programs 0.07 -0.26 0.54 5 Cognitive behavioral, behavioral modeling, or behavior modification 0.23 -0.21 0.44 3 Other counseling, social work, and therapeutic -0.19 -0.39 0.00 2 Mentoring, tutoring, and work study -0.11 -0.21 0.00 2 All environmentally focused interventions 0.13*
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Thus, it is likely that the eventual results of the evaluation will be ambiguous. Content As reviews of drug prevention have suggested and the results in Table 7.1 document, among instructional programs, those that teach students about social influences to engage in substance use and provide specific skills for effectively resisting these pressures alone or in combination with broader-based life-skills training reduce substance use, particularly when these skills are taught using cognitive-behavioral methods.
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The committee recommends additional research to assess the effectiveness of social competency skill development and normative education approaches, which emphasize conveying correct information about the prevalence of drug use and its harmful effects. This research should also assess the interaction between the content of the prevention activity and the risk level of the population targeted, because it is likely that provision of correct information may be especially effective for the subset of the population that is most at risk for higher levels of use.
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From page 228... ...
was an elementary school intervention that reduced substance abuse during adolescence. The Good Behavior Game is another example of a successful early preventive intervention studies using a randomized control group design (Dolan et al., 1993; Kellam et al., 1994; Kellam and Anthony, 1998~.
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Although these examples provide evidence that early prevention may work to reduce substance use, little is known about the ideal time or times to deliver preventive interventions, how preventive interventions can be most effectively sequenced over the life course, or how the timing of prevention activities may matter relative to the timing of drug epidemics. Presumably, the effects of cumulative prevention efforts delivered over the entire life course are considerably larger than the relatively short-term efforts that have been studied, and presumably the effects of certain types of prevention are greater during the early stages of an epidemic than when it is in full swing.
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Brief messages delivered closer in time to the situation in which an opportunity to use drugs is likely to arise, or small doses delivered continually over the life span, may be more effective than long messages delivered within a short time frame, as is most often the case in drug prevention classes as they are offered today. Mass media campaigns television and radio advertisements, billboards, and posters offer this potential advantage over classroom-based messages.
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Each of the potential moderator variables must be systematically varied in rigorous prevention trials. Needed Research Much remains to be learned about the potential of prevention activities for reducing illegal drug use.
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That is, combinations may increase the magnitude of effects through the additive effects of each component, but they may also have a multiplicative effect, so that certain strategies are more or less effective in combination with another than they are by themselves. For example, a drug prevention curriculum with a "no use" message may be counterproductive when delivered in a school environment in which norms favor use, or one in which the rules related to the possession of substances are lax or inconsistently applied.
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effects of drug prevention programs implemented under conditions of normal practice, outside the boundaries of the initial tightly controlled experimental tests of program efficacy under optimal conditions; (3) effects of different combinations of prevention programs, for example, how they complement each other or detract from one another when used in combination, as they most often are; and (4)
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Center for Substance Abuse Prevention 1999 Here's Proof Prevention Works. DHHS Publication No.
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Nicholas, and B.G. Dicker 1994 Preventing adolescent drug abuse and high school dropout through an intensive school-based social network development program.
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I, eds., 1992 School-based substance abuse prevention: A review of the state of the art in curriculum: 1980-1990. Health Education Research 7:403430.
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Flay, and E.Y. Wang 1991 Mediating mechanisms in a school-based drug prevention program: First-year effects of the Midwestern prevention project.
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1986 Meta-analysis of 143 adolescent drug prevention programs: Quantitative outcome results of program participants compared to a control or comparison group. Journal of Drug Issues 16~4~:537-567.
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Report prepared for the National Institute on Drug Abuse. http:/www.Whitehousedrugpolic.ov/pdf/ nida/pdf.
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