The Best Prevention Research Tells Us Harm Reduction Is the Best We Can Hope For

Following are five key points about addiction prevention programs and the current research, the best ever conducted on the question, and the three key results of the research and three conclusions from this (see Effectiveness Bank Bulletin , February 25, 2011):

Prevention and Research

1. American substance abuse prevention programs center around DARE (created by Los Angeles police chief Daryl Gates) and similar informational, scare, and guest monkey lectures from recovering addicts and alcoholics.

2. Wikipedia – correctly – states: “DARE is currently used in schools worldwide, although scientific research has found it to be ineffective in reducing alcohol or drug use and there is evidence that it may increase drug use among some groups.” DARE is administered by police departments and is sacrosanct in America. (InAddiction-Proof Your Child I describe being kicked out of the high school nearest to me’s “drug awareness night” by the police chief.) The national program constantly plays catch-up by trying to introduce evidence-based techniques through the persons of police officers not trained nor particularly adept at participatory learning.

3. The current research was conducted cross-nationally in Europe as the European Drug Addiction Prevention trial (EU-Dap) – labeled in English “Unplugged” – based on the best-tested (through American research) prevention techniques. Seven countries (Belgium, Germany, Spain, Greece, Italy, Austria and Sweden) and 170 schools were recruited, including 7000+ 12-14-year-old students, the largest sample ever in a European drug education trial. This youthful age group was targeted (a) in order to reach the high-risk children already embarked on such behavior, (b) to anticipate the more widespread substance use that occurs through the teen years. The research compared schools in which the program was implemented versus comparable sites where it was not – a field experiment – the most powerful possible design in such circumstances.

4. The program comprised 12 lessons taught by the schools’ own teachers with two-and-a-half days’ training, using interactive methods and giving and receiving feedback in small groups. The curriculum was supplemented by peer-led meetings and workshops for parents. Only about half the schools taught all of the curriculum units, peer-led activities were rarely conducted due to peer leaders withdrawing and lack of interest among their classmates. Finally, few parents attended workshops (about a quarter) and a critical element of the workshops – role-playing – was generally omitted.

5. The content of the programs informed students about substances, trained students about how to resist pressure to use, enhanced decision-making and social and life skills, reinforced attitudes that sustain continued abstinence, and emphasized the “normative beliefs” model – showing students that they overestimated use by peers.

Results

1. Overall: The bottom line is that the great efforts required – and which schools only partially met – did not produce great benefits: “the findings are not strong enough to alter the view that drug education in secondary schools makes a minor contribution to the prevention of problems related to drinking and illegal drug use.”

2. Drugs: There were fairly consistent trends in reductions in the drug use measures – but not one achieved statistical significance. Since there tends to be a drop-off of any gains measured in such research over time, this finding is quite discouraging.

3. Alcohol: The program did not have a significant impact on drinking rates or even on frequent drinking – but did curtail problem drinking: At the 18-month follow-up, compared with controls, significantly more Unplugged pupils (87% v. 85%) continued to say they had not been drunk in past month, fewer who had gotten drunk once or twice in the past month at baseline got drunk more frequently (16% v. 33%), and more ceased getting drunk at all (59% v. 39% of those who got drunk).

Conclusions

1. Systematic research has given us no strong cause for hope that school-based programs – even when they are well-designed – can reduce drug and alcohol use.

2. The best that can be shown to be accomplished by effective programs is inpreventing drunkenness among young people (remember – these were, at the outset of the study, 12-14 year-old Europeans) when they do drink, although drinking rates per se are undiminished.

3. We are awaiting a global breakthrough in Western societies in conceptualizing and approaching substance use, starting with young people: the goal of zero tolerance appears to be a constantly eroding, never fulfillable aspiration that serves more as a lodestar than as something we are likely to attain.

The Drug and Alcohol Alert Effectiveness Bank Bulletin ends with an extremely worthwhile statement, if a modest one, about education, young people, and life:

Mixed and generally inconclusive findings of a prevention impact from school programs targeting substance use do not negate the possibility that general attempts to create schools conducive to healthy development will affect substance use along with other behaviors.

Reference:

Caria M.P., Faggiano F., Bellocco R. et al.  Effects of a school-based prevention program on European adolescents’ patterns of alcohol use,Journal of Adolescent Health 48:182-188 (2011).