(c) McGraw-Hill 2011

1. Chapter 17
Preventing
Substance Abuse
© 2011 McGraw-Hill Higher Education. All rights reserved.

2. Society’s Attempts to Limit
Drug Availability
 Key facts
 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
 Our 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?
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3. Defining Goals and Evaluating
Outcomes
 Goal of presenting negative information about
drugs in schools = prevention of use
 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
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4. 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
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5. Types of Prevention
 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
 Goals
 Prevention of use of other, more dangerous
substances
 Prevention of more dangerous forms of use
 Example = college programs
encouraging responsible use of alcohol
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6. Types of Prevention
 Tertiary prevention
 Aimed at people have been through
substance abuse treatment or who stopped
using a drug on their own
 Goal is relapse prevention
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7. Types of Prevention
 Institute of Medicine’s “continuum of care”
 Prevention
 Treatment
 Maintenance
 Classification scheme for prevention efforts
 Universal prevention
 Selective prevention
 Indicated prevention
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8. Types of Prevention
 Universal prevention = for an entire population
 Example: community, school
 Selective prevention = for high-risk groups within a
population
 Example: students doing poorly
in school
 Indicated prevention = for
individuals who show signs of
developing problems
 Example: adult arrested for a
first offense of driving under the
influence of alcohol
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9. Drugs in the Media
 Don’t be a Patsy Advertisement Campaign
 The ads showed an over-protective mother “patting down” her
daughter before she left the house.
 The ad ended with “Don’t be a Patsy. Learn a better way at
drugfree.org.”
 The advertisements are a shift from the 1980s “This is
your brain on drugs ads, which overstated the harmful
effects of drugs on young people.
 These types of embellishments decrease the credibility of drug
educators and lead young people to reject all drug-related
information from so-call informed sources.
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10. Prevention Programs in Schools
 Knowledge-attitudes-
behavior model
 Affective education
 Anti-drug norms
 Social influence model
 DARE and other programs
in use
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11. 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
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12. Knowledge-Attitudes-Behavior
Model
 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
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13. Knowledge-Attitudes-Behavior
Model
 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
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14. Affective Education
 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
 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
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15. Affective Education
 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
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16. Affective Education
 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
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17. Selected Suggested Alternatives
to Drug Use
Level of experience Motives Possible Alternatives
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
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18. Affective Education
 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
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19. Anti-Drug Norms
 1984 review of drug prevention programs
 Most programs don’t contain an appropriate
evaluation component
 Few studies have demonstrated any success in terms
of actual substance abuse prevention
 Increased knowledge about drugs has virtually no
impact on substance abuse
 Affective education approaches appear too
experiential and place too little emphasis on skills
necessary to resist pressure to use drugs
 Anti-drug norms programs were developed in part in
response to these findings
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20. Anti-Drug Norms
 Refusal skills and pressure
resistance strategies
 Focus on teaching students to
recognize and respond to peer
pressure to use drugs
 Presented within the broader
context of self-assertion and
social skills training
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21. Anti-Drug Norms
 Typical program
 Film that demonstrates effective
ways of responding
 Follow-up student discussion
 Practice with techniques presented in
the film
 Approach shown to be effective in
reducing cigarette smoking
among adolescents
 Adapted for other drugs and
behaviors
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22. Anti-Drug Norms
 Drug-free schools
 1986: Government began providing direct aid to local
school districts for drug-prevention activities
 DOE recommended school policies designed to
demonstrate that the school and community do not
condone drug use or underage alcohol use
 Examples of school policies
 Locker searches
 Ban on tobacco use on school grounds
 Part of trend of teaching generally accepted values
rather than the more “value-free” approach taken in
the 1970s
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23. Social Influence Model
 Advantages of education research on smoking
prevention programs directed at adolescents
 Large enough proportion of adolescents smoke so
that measurable behavior change is more easily
detectable
 Health consequences of smoking are so clear that
there is a good community consensus that preventing
smoking is an appropriate goal
 Easy to verify self-reported use of tobacco through
saliva tests
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24. Social Influence Model
 Many approaches to drug-abuse prevention have been
tried with smoking behavior
 Key lessons can be learned from research findings
about these approaches
 It is possible to design effective smoking
prevention programs
 Presenting information about the delayed
consequences of smoking (e.g., lung
cancer) is relatively ineffective
 Presenting information on immediate
effects (e.g., shortness of breath) is more
effective
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25. Social Influence Model
 Five key elements of the social influence
model
1. Training in refusal skills through films, discussion,
and practice
 Students taught ways to refuse without being negative as
well as ways to be assertive and insist on the right to
refuse
1. Public commitment such as making a public
pledge
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26. Social Influence Model
3. Countering advertising
by inoculating children
against it
 Students taught to analyze
and discover the hidden
messages in ads and how
these messages differ
from the actual effects of
smoking
 Example: advertisements
associating cigarette use with
healthy young athletes
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27. Social Influence Model
4. Normative education to teach students that
they may overestimate the number of their
peers who smoke
 Countering the “everybody is doing it” attitude
4. Use of teen leaders to talk to younger
students about cigarettes
 Older students can explain that neither they nor
their friends smoke and how they have dealt with
others’ attempts to get them to smoke
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28. Social Influence Model
 Possible improvements by applying the cognitive
development approach to smoking behavior
 Don’t automatically assume that all students need
training in social skills or refusal skills
 Students make active, conscious decisions in
preparation for trying smoking and becoming an
occasional or regular user
 Prevention programs might be different at each stage of
cognitive development
 Risk and protective factors reviewed in Chapter 1
have more influence on drug behavior than any
information or education program devised
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29. 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
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30. Drug Abuse Resistance
Education (DARE)
 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
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31. 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
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32. 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
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33. Peer Programs
 Peer participation
programs
 Emphasize becoming
participating members of
society
 Often focus on youth in
high-risk areas
 May involve activities such
as paid community service
Community service (YouthBuild)
 Data on effectiveness are
not yet available or are
inconclusive
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34. 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
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35. Parent and Family Programs
 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
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36. Parent and Family Programs
 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
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37. 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
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38. Community Programs
 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
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39. 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
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40. What Should We Be Doing?
 What needs to be done in a particular situation
depends on the motivations for doing it
 Example 1: State requirement for drug education as
part of health curriculum, in the absence of a
particular drug problem
 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
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41. What Should We Be Doing?
 Example 2: Widespread concern and fervor about a
local “epidemic” of drug and alcohol use
 Goal would be to use energy to organize a community
planning effort
 Best approach would combine efforts on many levels
 Need to avoid scary, preachy, negative approaches than
have been shown to be ineffective
 Information and training available from the SAMHSA
Center for Substance Abuse Prevention
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42. SAMHSA Center for Substance Abuse
Prevention: Model Programs
 Across Ages  Project ALERT
 Athletes Training and Learning  Project Northland
to Avoid Steroids (ATLAS)  Project Towards No Tobacco
 Child Development Project Use
 Communities Mobilizing for  Reconnecting Youth
Change on Alcohol
 Residential Student Assistance
 Creating Lasting Family
Program
Connections
 Dare to Be You  Safe Dates
 Families and Schools Together  SMART Team
 Keep a Clear Mind  Strengthening Families
 Life Skills Training Program
 Too Good for Drugs
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43. Chapter 17
Preventing
Substance Abuse
© 2011 McGraw-Hill Higher Education. All rights reserved.