Engs, Ruth C. [Ed.], Controversies in the Addiction's Field. Stuart Fors, Ph. D. "CHAPTER 20: School-based alcohol and drug education programs can be effective."
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CHAPTER 20 School-based alcohol and drug education programs can be effective Stuart Fors, Ph. D.
The availability of all kinds of drugs (Johnston, O'Malley, and Bachman, 1987) makes it a virtual certainty that young people will be put in a position of deciding whether or not to use them. For the purpose of this paper, drugs include psychoactive substances that are available either legally or illegally. For the most part, drugs that are generally considered to be medicines are excluded. For example, within this framework we find legal drugs such as alcohol and nicotine that are illegal for some age groups, as well as marijuana, the simple possession of which has been decriminalized (de factor or de jure) in most states, and cocaine/crack and heroin which are not legal under any circumstances.
The issue to be discussed in this chapter is the extent to which schools can be justifiably promoted as a primary site for drug education efforts. Do schools have a clear role (beyond the "3 R's") in education about health/ social issues? If schools have a role, how should it be described or defined? What are the limits of involvement and the expectations?
More specifically, this paper will:
Many of the thoughts in this paper reflect empirical and anecdotal evidence from the drug education literature as well as my personal views that have developed in my 25 years as a teacher of health/drug education at the middle, secondary, and university levels.
1) Clarify the role, goals, and scope of school-based drug education;
2) Argue that school-based drug education can, and does, work; and
3) Present suggestions for strengthening programs.
The Schools and Drug Education
Schools have a mandate from society to contribute to the physical, social, emotional, moral, and intellectual development of young people.
How moral issues are to be approached has not been resolved. Some say schools should be more involved, with specific moral directives; others say moral education should be left to the family and church. Nonetheless, schools are faced with major challenges, and education about drugs is just one of many that requires a commitment of time, money, and expertise. The federal government views the school as a major site where the "war" on drugs can be waged. Hundreds of millions of dollars are being pumped into the educational pipeline through direct grants and allocations to each state. Someone, somewhere, believes that drug education works.
The role of the school has been clarified and expanded in the last 5-10 years (see, for example: Lohrmann and Fors,1986; U.S. Department of Education [USDOE]—1986, 1988; Goodstadt, 1989). While there is no consensus on the specifics, the general areas of involvement include the following:
1. School drug policies—issues such as smoke-free schools, penalties
for use, possession, sale, or under the influence of drugs, first aid for drug emergencies;
2. Primary intervention—drug education that may be offered in a myriad of ways; and
3. Secondary intervention—programs for high risk students (those exhibiting problem behavior directly related to drugs or predictive of drug abuse).
Evidence That School-Based Drug Education Works
Interpretation of Evidence/Effectiveness
One of the major roadblocks to evaluating drug education programs is the inability of program planners to agree on the basic goals and objectives of drug education. For example, if a goal is "drug free youth" (USDOE, 1988), our standard for effectiveness will be a decrease toward zero in the consumption of all drugs. On the other hand, if "responsible use" (Engs and Fors, 1988) is a goal, success occurs if moderate drinking prevails and/or if there is a significant decrease in driving after drinking (or an increase in the use of designated drivers).
Over the past 25 years we have witnessed a decrease of 25-30 percent in the prevalence of smoking in adults (Surgeon General, 1989). This has resulted in over 750,000 smoking-related deaths that were either avoided or postponed. Additionally, the percentage of high school seniors who smoke daily has been reduced by 35-40 percent (28.8-18.7) (Johnston et al., 1987). Drug taking by middle and high school students, with the exception of alcohol, has decreased in the past ten years. Lloyd Johnston of the Institute for Social Research at the University of Michigan who coordinates the
annual drug use survey of high school seniors was quoted as saying, "The continued decline in drug use suggests that anti-drug campaigns educating the young about drug use are being heard." (Staff, 1989). Another newspaper article said this: "Prevention programs are generally credited for a marked drop nationwide in casual drug use. . . " (Straus, 1989). The following section will provide what I believe is specific evidence that some programs, in some places, are working for some people.
That school-based drug education has a positive effect on knowledge is well recognized. For some, this would be satisfactory evidence of success and we need go no further. But not for most! Bangert-Drowns (1988) concluded on the basis of his meta-analysis of 33 programs that were evaluated between 1968 and 1986 that, "alcohol and drug education successfully increased drug-related knowledge, but was less successful in changing attitudes, and least successful in changing the drug-related behaviors of students" (p.254). He continues, ". . . the public record shows that substance abuse education has, for the most part, failed to achieve its primary goal, the prevention of drug and alcohol abuse." (p. 260). Something else is needed! This is not new. Health behavior scholar, Godfrey Hochbaum admonished us in 1969 that ". . .we must pay much more attention to how a child can apply his health knowledge and overcome the difficulties he may encounter" (Hochbaum, 1969, p. 18).
Botvin (1986) summarized his view of the "state of the art" by saying, "The progress made in the past few years provides considerable cause for optimism" (p.369). "More than 20 research studies testing programs based on these two prevention models (social influences, personal and social skills) have demonstrated significant reductions in substance use (typically cigarette smoking)" (p. 373). He recognized some methodological limitations, and he stressed the potential of these strategies for use with programs that focus on multiple drug behaviors.
An expert Advisory Panel convened by the National Cancer Institute in December, 1987, concluded that, ". . . school-based smoking prevention programs in the U.S. have had consistently positive effects, though these effects have been modest and limited in scope" (cited in Glynn, 1989,p. 183).
Connell, Turner, and Mason (1985) reported the results of the School Health Education Evaluation project. This project looked at the effects four health curriculums (these were not limited to substance abuse prevention) had on approximately 30,000 students in more than 20 states over a period of three years. The authors concluded that knowledge, attitudes, health-related skills (i.e., decision-making skills) and selected behaviors were significantly different
in the experimental groups. Self-report behavioral data indudedcigarette smoking. Three times as many comparison group students began smoking during the first half of the 7th grade as experimental group students. A strong argument is made for the establishment of coordinated health education programs that continue "through several grades" (p. 317).
Pentz, et al. (1989) reported on a large scale substance abuse prevention project in the Kansas City, Kansas/Missouri metropolitan area. Over 22,O00 6th and 7th grade students received a school-based educational program that is being introduced sequentially into different schools over a six-year period. One-year follow-up data indicate significantly lower use prevalence rates for alcohol, cigarettes, and marijuana in the intervention schools when compared with delayed intervention schools. The net increase in prevalence in the intervention schools was half that of the comparison schools. This project also included parental involvement and media coverage.
Walter, Vaughan, and Wynder (1989) reported on their evaluation of a six year sequential health curriculum titled, "Know Your Body" that focused on cigarette smoking and diet as cancer risk factors. They followed a cohort beginning in the 4th grade in 1979 and continuing through the 9th grade. Of the 911 original subjects, 593 had data collected at both baseline and termination points. Of interest for this review was the significantly lower prevlance of current smokers (3.5%) in the intervention schools compared with the non-intervention schools (13.1%). The study results are limited in their external validity by the nature of the study subjects. The location was in Westchester County, New York, which is one of the most affluent areas of the United States.
Hard-core researchers, raise your warning flags! Reports that write of good feelings, lots of smiles, intuition, and other miscellaneous subjective "data" provide good reason to pause, but there are other good reasons to read further. Just because the project was not the idea of a funded researcher end therefore it does not include a sophisticated evaluation is no reason to discard it out-of-hand. The challenge is to sort through the numerous glowing reports and determine whether or not to accept the "results" at face value. Given the usual limitations, I am here with submitting examples of "testimonials" that have appeared in two publications (National Institute on Alcohol Abuse and Alcoholism [NIAAA] and National Institute on Drug Abuse [NIDA], 1986; Southeast Regional Center for Drug-Free Schools and Communities [SERC], 1988).
"The results of the analyses of the first post-test data for this project indicate early treatment effects on the awareness of curriculum content and the frequency of alcohol use." (NIAAA and NIDA, 1986, p. 22).
"A study conducted in 1984 to determine differences in the frequency and early onset of drug use in communities with Project Charlie compared to those not using a prevention program, showed significant differences." (NIAAA and NIDA, 1986, p. 26).
". . .the overall conclusion has been that when high team activity schools are compared to low or no team activity schools at each of the three grade levels (elementary, junior, and senior high), the high team activity schools average considerably more positive impact on substance use, attitudes, and knowledge." (NIAAA and NIDA, 1986, p.29).
"Self-report survey data, an increase in the number of students participating in organizations actively promoting the no-use message, official arrest data, and a decline in the number of students suspended or expelled from school all point to success." (SERC, 1988, p. 12).
"Statistics show that there were no alcohol or other drug use-related offenses in the two years, 198~86 and 1986-87." (SERC, 1988,p. 14).
"A repeat of PRIDE Survey in 1986 showed that student use of alcohol and other drugs had decreased in every category." (SERC, 1988, p. 16).
All of the programs from which a quote was taken regarding effectiveness included a school-based drug use/abuse prevention curriculum as part of a comprehensive community/school program. Should these results be taken "with a grain of salt?" My opinion is no. While many, if not most of the programs may not have incorporated an of the basic theoretical, educational, and behavior change principles such as those advocated by Botvin(1986)and Goodstadt (1986), they are stillworthy of our inclusion on the side of programs that "work." That is, by some pre-established standard, whether it is knowledge gain, attitude change, drug use reduction, arrest reduction, lower DUI behaviors, or emergency room visits, program directors/evaluators have concluded that to varying degrees school-based drug education works for them.
It would be a serious mistake to make a blanket statement that drug education works, without some caveats. To me that would be akin to saying that 500 mg of penicillin in capsules four times a day will work for an people for an health problems in all circumstances. We understand that is nonsense and certainly for some people, downright dangerous Goodstadt (1989) wrote of inconsistencies in effects:
Assuming Goodstadt's conclusions are accurate, we should avoid "throwing the baby out with the bathwater."That is, discarding potentially strong programs out-of-hand because in one evaluation they do not measure up to a pre-selected standard.
1. Program effects vary among sub-groups of students;
2. Program impact is inconsistent across outcome measures; and
3. Individual program have produced both positive and negative
outcomes. (p. 247).
Evidence has been presented that school-based drug education has worked as measured by knowledge, attitude, skill and/or behavioral effects. This is particularly true for cigarettes where a clear and consistent message from all parts of our society supports the educational effort. There is plenty of evidence that some programs have not worked, but rasher then dwell on what did not work, I suggest we carefully scrutinize those programs that have been successful.
When we analyze drug education programs, we need to look not just at the results, but at three possible factors that can determine success or failure (Green and Lewis, 1986):
While school-based drug education seems to be working in some situations (and we should celebrate those successes), programs still seem to be missing the youth at higher risk. Ten percent of those people who drink, consume 50 percent of the alcohol (Secretary of Health and Human Services, 1987), and this seems to be the trend with other drugs. There is relatively widespread experimentation (primarily with marijuana) that results in a small percentage of hard core users experiencing the majority of the problems that accompany abuse.
1. Theoretical basis—for scope and sequence, for educational strategies, for specific content;
2. Implementation process—the theoretical basis may be adequate, but if teachers do not teach the program the way it was designed, how can the program have a chance to succeed? This argues strongly for well designed teacher in-service and committed teachers; and
3. Evaluation strategy—if instrumentation and design are weak or faulty, then we must be concerned with a Type I or Type II statistical error. In either case, the "true" results are not uncovered.
Unfortunately, school-based drug education may only be a "band aid" for high risk youth. Peele (1987) expressed the dilemma this way, "Our inability to engage many youngsters in meaningful achievement activity or to provide a large
number with a minimal degree of social integration vitiates our drug education programs for the groups we are most concerned to reach." (p. 425). And finally, Representative Charles Rangel (D-NY) was quoted as saying, "Until we solve the problems of joblessness, homelessness, family instability, lack of education, and poverty, we will never end the despair that is the root cause. . . for many in the first place" (Thomas, 1989).
Bangert-Drowns, R. (1988). The effects of school-based substance abuse education—a meta-analysis. Journal of Drug Education, 18 243-264.
Botvin, G. (1986). Substance abuse prevention research: Recent developments and future directions. Journal of School Health, 56 369-374.
Connell, D., Tumer, R., and Mason, E. (1985). Summary of findings of School Health Education Evaluation: Health promotion effectiveness, implementation, and costs. Journal of School Health, 55 316-321.
Engs, R. and Fors, S. (1988). Drug abuse hysteria: The challenge of keeping perspective. Journal of School Health, 55 26-28.
Glynn, T. (1989). Essential elements of school-based smoking prevention programs. Journal of School Health, 59 181-188.
Goodstadt, M. (1986). Alcohol education research and practice: a logical analysis of the two realities. Journal of Drug Education, 16 349-365.
Goodstadt, M. (1989). Substance abuse curricula vs. school drug policies. Journal of School Health, 59 246-250.
Green, L. and Lewis, F. (1986). Measurement and evaluation in health education and health promotion. Mayfield: Palo Alto.
Hochbaum, G. (1969). Changing health behavior in youth. School Health Review, 1 (September) 15-19.
Johnston, L., O'Malley, P., and Bachman, J. (1987). National trends in drug use and related factors among American high school students and young adults, 1975-1986. NIDA: Rockville, MD.
Lohrmann, D. and Fors, S. (1986). Can school-based educational programs really be expected to solve the adolescent drug abuse problem? Journal of Drug Education, 16 327-339.
National institute on Alcohol Abuse and Alcoholism and National Institute on Drug abuse (1986). Proceedings of the 1st National Conference on Alcohol and Drug Abuse Prevention. NIAAA and NIDA: Rockville, MD.
Peele, S. (1987). Running scared: We're too frightened to deal with the real issues in adolescent substance abuse. Health Education Research,2 423-432.
Pentz, M., Dwyer, J., MacKinnon, D., Flay, D., Hansen, W., Wang, E., and Johnson, C.A. (1989). A multi-community trial for primary prevention of adolescent drug abuse—Effects on drug use prevalence. Journal of the American Medical Association, 261 3259-3266.
Secretary of Health and Human Services (1987). Sixth special report to the U.S. Congress on alcohol and health. DHHS: Washington, D.C.
Southeast Regional Center for Drug-Fee Schools and Communities (1988). Note worthy programs and practices: Summaries of programs and strategies in support of drug-free youth in the southeast. Atlanta. Southeast Regional Center for Drug-Free Schools and Communities.
Staff(1989, March 1). Teen drug use down sharply in class of '89. Atlanta Constitution.
Straus, H. (1989, September 5). "No" is easier said than done. Atlanta Constitution.
Surgeon General (1989). Reducing the health consequences of smoking: 25 years of progress. Executive summary. Rockville, MD: Thomas, K.,U.S. Dept. of H&H.S., ( 1989, June 22). Anti-drug campaigns' effectiveness debated. Atlanta Journal and Constitution. p. D-4.
U.S. Department of Education (1986). What works: Schools without drugs. USDOE: Washington, D.C.
U.S. Department of Education(1988). Drug prevention curricula: A guide to selection and implementation. USDOE: Washington, D.C.
Walter, H., Vaughan, R., and Wynder, E. (1989). Primary prevention of Cancer among children: Changes in cigarette smoking and diet after six years of intervention. Journal of the National Cancer Institute, 81 995-999.
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