Drug Prevention Programs Research Articles

A synthesis review of exemplary drug abuse prevention programs in the United States

In the United States, there has been a concerted emphasis during the past 30 years toward identifying and implementing evidence-based drug prevention programs. The wealth of prevention efficacy research has contributed to the publication of several recent reports on promising, model, and effective programs. We identified five such recent reports, four from the federal government and one from a private foundation, that had nominated and described 100 exemplary prevention programs. Of these 100 programs, 70 reported on evidence of effectiveness. We conducted a qualitative analysis on these 70 exemplary programs. Based on a systematic review process, we identified 10 elements that were characteristic of most (at least 75%) of the programs. These 10 elements are described and discussed in light of public policy issues.

Evidence‐Based Drug Policies

This paper addresses three types of drug policies: drug laws, drug prevention strategies, and drug treatment strategies that might be used to improve drug policies. For each of these three categories, the paper discusses what criminological research tells us about the best practices. Research suggests that drug abuse prevention and treatment have statistically and clinically significant effects. The terms ‘prevention’ and ‘treatment’ are, however, often used indiscriminately and with reference to many different concepts. To assume that everything that is called prevention or treatment is effective would be foolish: not every drug prevention program is effective; not every treatment program has an effect in terms of reducing recidivism. Research has made it possible to identify successful prevention and treatment programs for drug abusers. However, the programs that research would suggest are not always those chosen by practitioners or widely funded by policymakers.

Project ALERT with Outside Leaders: What Leader Characteristics are Important for Success?

A previously published effectiveness study of Project ALERT delivered in schools by outside providers from Cooperative Extension found no positive effects for the adult or teen-assisted delivery of the curriculum despite high-quality implementation. Those findings and the likelihood that more outside providers will deliver evidence-based drug prevention programs in the future, led to this investigation of possible influences of leaders' personal characteristics on ALERT's program effects. Influence of leader characteristics on students' drug use and mediating variables for use were assessed by modeling program effects on within-student change as a function of leader characteristics. Students in classrooms with adult leaders who were more conscientious, sociable, or individuated were more likely to experience beneficial program effects. Students in teen-assisted classrooms with teen leaders who were more sociable or, to a lesser extent, highly individuated, showed more positive effects. Implications for research and practice are discussed.

Science, Social Work, Prevention: Finding the Intersections

Over the past 25 years the science of prevention of adolescent health and behavior problems has matured as a result of longitudinal studies of predictors of these problems and controlled studies of preventive interventions focused on those predictors that have revealed efficacious prevention strategies. This article builds on three Aaron Rosen lectures: Aaron Rosen's call for the use of evidence-based practice in the first lecture in this series, Mark Fraser's call for more intervention research in social work, and Claudia Coulton's explorations of Place of Community in SocialWork Practice Research. It documents key developments in prevention science over the past 25 years and explores what these developments could mean for social work education and research over the next few years. KEY WORDS: evidence-based practice; prevention science; research; social work ********** In my early working days, I lived in a rural fishing community off the coast of Washington. I , was the county's juvenile probation officer. I had a position subsidized by the state through the intensive probation subsidy program. That program provided money for probation officers in Washington counties to do intensive counseling with reduced caseloads in hopes of sending fewer young people to state institutions. I mention this here because it was as a probation officer that I first became convinced of the importance of preventing adolescent behavior problems before young people encounter the juvenile justice system. I worked with young people ages 12 to 17 referred for delinquent behavior and drug possession. Over time, I came to see my job as akin to operating an ambulance service at the bottom of a cliff. We were the emergency workers patching up those who fell over the edge. That experience convinced me that we must broaden crime reduction efforts beyond the justice system to include prevention. I will return to the intensive probation program later in this article. Before 1980 there was little evidence that delinquency or adolescent drug abuse could be prevented. School-based drug prevention programs that were evaluated were found to be largely ineffective (Elmquist, 1995; Hansen, 1992; Moskowitz, 1989). Some studies found that school-based drug information programs were associated with increased drug use among teenagers (Tobler, 1986). In 1980 a review of the delinquency experiments conducted in the United States to that year identified nine well-controlled trials (Berleman, 1980). None of them was effective in preventing delinquency. Perhaps the most notable was the Cambridge Somerville Study, a program of wrap-around services for high-risk boys. Dr. Richard Cabot of Harvard believed that the intervention of a friendly, socialized adult with a vulnerable when the child was still young might lead the child to a normal nondelinquent life. In 1935 he funded a nonprofit foundation that sustained the delinquency prevention study for 10 years. Cabot employed community-based counselors who worked predominantly in the field in this economically disadvantaged community. Services were individualized for each and his parents. The model was casework with the individual boy (Berleman, p. 130). Counselors used their practice wisdom to address needs they encountered. The randomized controlled trial of this intervention showed that the program had no effects on police contacts for delinquency or commitments to state institutions. A long-term follow-up of the program conducted by McCord (1992) found that youths exposed to the program were more likely than the control group to develop serious behavior problems, alcoholism, and mental health problems over their lives. The Hippocratic oath requires that physicians never do harm to anyone. This is our responsibility as social workers as well. Our best conceived interventions could do harm. We must evaluate our ideas to know what outcomes they produce. …

Avoiding “Truth”: Tobacco Industry Promotion of Life Skills Training

Purpose To understand why and how two tobacco companies have been promoting the Life Skills Training program (LST), a school-based drug prevention program recommended by the Centers for Disease Control and Prevention to reduce youth smoking. Methods We analyzed internal tobacco industry documents available online as of October 2005. Initial searches were conducted using the keywords “life skills training,” “LST,” and “positive youth development.” Results Tobacco industry documents reveal that since 1999, Philip Morris (PM) and Brown and Williamson (B&W) have worked to promote LST and to disseminate the LST program into schools across the country. As part of their effort, the companies hired a public relations firm to promote LST and a separate firm to evaluate the program. The evaluation conducted for the two companies did not show that LST was effective at reducing smoking after the first or second year of implementing the program. Even so, the tobacco companies continued to award grants to schools for the program. PM and B&W’s role in promoting LST is part of a public relations strategy to shift the “youth smoking paradigm” away from programs that highlight the tobacco industry’s behavior and toward programs in which the industry can be a partner. Conclusions Individuals and organizations responsible for developing and implementing tobacco control and youth smoking prevention programs should be aware of PM and B&W’s role and motivations to encourage the wide-spread adoption of LST in schools.

Conversation with Cees Goos

Conversation with Cees Goos

An Interdisciplinary Approach for the Integration and Diffusion of Substance Abuse Prevention Programs

Effective substance abuse prevention programs help students develop knowledge as well as psychosocial competencies that can help them resist or delay the initiation of alcohol, tobacco and other drug (ATOD) use. This paper describes the integration process used in a five-year project, Adoption of Drug Abuse Prevention Training (ADAPT), to study the effectiveness of two methods of drug prevention programming, based on Botvin's Life Skills Training (LST) program.1 Botvin's standard LST program1 was implemented in three middle/junior high schools, the integrated or infused delivery of LST (I-LST) was implemented in three similar middle/junior high schools, and both methods of delivery were compared with three matched schools that received no treatment. Rather than implementing the traditional LST program, teachers in the infused condition developed a set of prevention lessons each year from the standard LST curriculum constructs and delivered them within their standard subject areas. This infused or integrated approach provided increased dosages of consistent prevention messages from multiple sources within the school in conjunction with their regular subject matter. Strategies for diffusion and adoption of the infused LST model are discussed as well as the teacher training process, lesson implementation, and evaluation procedures. The participating teachers' experiences, recommendations and difficulties are presented, and a sample program infusion matrix is included. Outcome results indicate that neither standard LST nor an infused LST delivery method was found effective for the entire sample, although some encouraging results were found for the females in the study.

L’abus de drogue chez les jeunes

In an on-going review of the literature dealing with the assessment of drug abuse treatment and prevention programs, the authors indicate that changes are occurring in basic concepts : the concept of addiction has been expanded and a more systemic approach to drug use and abuse is more prevalent. An examination of the relationship between adolescent drug use and the related psychosocial images leads to an outline of two main evaluative approaches : the moralistic a priori approach and the empirical social approach. To efficiently prevent youthful drug abuse, they propose that primary preventive actions should focus on demand factors and be complemented with secondary preventive actions focused on supply factors.

Socio‐environmental influences on adolescents’ alcohol outcome expectancies: a prospective analysis

To investigate the prospective influence of social influence and social bonding variables on the development of alcohol outcome expectancies among adolescents with and without drinking experience. Longitudinal data from students in the control schools of a field trial designed to evaluate a school-based drug prevention program. A total of 19 middle schools in South Dakota, USA. An alcohol outcome expectancy scale administered to 1410 students in grades 8 and 9. After using confirmatory factor analysis (CFA) to develop an expectancies measure, multiple-group (grade 8 drinkers versus grade 8 non-drinkers) path analysis was used to model 9th grade alcohol expectancies. Grade 8 social influence and bonding variables were used as predictors, controlling for grade 8 expectancies. At the bivariate level, peer and adult influences and social bonding variables were related consistently to alcohol outcome expectancies among drinkers and non-drinkers. A bivariate relationship between alcohol advertising and alcohol expectancies was found among drinkers only. In the multivariate model, greater alcohol use by important adults predicted independently increased alcohol positivity among drinkers; greater perceived approval of alcohol use by parents and peers predicted diminished perceived potency of alcohol among non-drinkers. Advertisement exposure and social bonding variables were not independent predictors of alcohol expectancies in the multivariate model. These findings suggest that attempts to alter adolescents' alcohol expectancies are likely to fail unless they address the influence of immediate social models on these beliefs.

Changes in the Number of Methadone Maintenance Slots as Measures of “Fighting Back” Program Effectiveness

This study examined trends in the number of available methadone maintenance treatment (MMT) slots to evaluate a community-based drug prevention program. In the 1990s, the “Fighting Back” (FB) initiative sought to reduce substance use and harm through community-based coalitions in 14 sites across the U.S. Nine state agencies provided MMT data for 28 FB and control communities for a 10-year period prior to and during the program. Opioid use data from a general population survey conducted in the same communities by the national evaluation team were also examined. Counter to expectation, implementation of the FB program was associated with significantly less expansion of MMT slots when compared to control communities. This trend was not attributable to opioid use in those communities, which did not change during the same period. The implication of the findings as well as the historical context of methadone maintenance treatment since the 1990s is also discussed.

Long-term effects of a single adult methamphetamine challenge: minor impact on dopamine fibre density in limbic brain areas of gerbils.

BackgroundThe aim of the study was to test long-term effects of (+)-methamphetamine (MA) on the dopamine (DA) innervation in limbo-cortical regions of adult gerbils, in order to understand better the repair and neuroplasticity in disturbed limbic networks.MethodsMale gerbils received a single high dose of either MA (25 mg/kg i.p.) or saline on postnatal day 180. On postnatal day 340 the density of immunoreactive DA fibres and calbindin and parvalbumin cells was quantified in the right hemisphere.ResultsNo effects were found in the prefrontal cortex, olfactory tubercle and amygdala, whereas the pharmacological impact induced a slight but significant DA hyperinnervation in the nucleus accumbens. The cell densities of calbindin (CB) and parvalbumin (PV) positive neurons were additionally tested in the nucleus accumbens, but no significant effects were found. The present results contrast with the previously published long-term effects of early postnatal MA treatment that lead to a restraint of the maturation of DA fibres in the nucleus accumbens and prefrontal cortex and a concomitant overshoot innervation in the amygdala.ConclusionWe conclude that the morphogenetic properties of MA change during maturation and aging of gerbils, which may be due to physiological alterations of maturing vs. mature DA neurons innervating subcortical and cortical limbic areas. Our findings, together with results from other long-term studies, suggest that immature limbic structures are more vulnerable to persistent effects of a single MA intoxication; this might be relevant for the assessment of drug experience in adults vs. adolescents, and drug prevention programs.

Effects of a School-Based Drug Abuse Prevention Program for Adolescents on HIV Risk Behavior in Young Adulthood

Early onset of substance use among adolescents has been found to be associated with later risky sexual behaviors. This study examined long-term follow-up data from a large randomized school-based drug prevention trial to (1) investigate the long-term impact of the prevention program on drug use and sexual behaviors that put one at elevated risk for HIV infection; and (2) use growth modeling procedures to examine potential mechanisms of intervention effects. Self-report survey data were collected from students in the 7th grade, prior to the intervention in 1985, and in grades 8, 9, 10, and 12. Participants in the intervention condition received a 30-session drug prevention program in 7th through 9th grades. Follow-up surveys were completed by 2042 young adults (mean age = 24) in 1998. As young adults, participants were considered to be engaging in high-risk behavior for HIV infection if they reported having multiple sex partners, having intercourse when drunk or very high, and recent high-risk substance use. The intervention had a direct protective effect on HIV risk behavior in the overall sample in young adulthood. Furthermore, among participants receiving 60% or more of the prevention program, analyses showed that the intervention significantly reduced growth in alcohol and marijuana intoxication over the course of adolescence, which in turn was associated with a reduction in later HIV risk behavior. The behavioral effects of competence-enhancement drug prevention programs can extend to risk behaviors including those that put one at risk for HIV infection.

Adolescent Drug & Alcohol Use in the 21st Century

Screening for drug abuse should be a part of adolescent health maintenance visits. Good interviewing skills using open-ended, nonjudgmental questions in a private setting may elicit a history of drug abuse. A detailed and comprehensive history is important to recognize family dynamics, early behavioral changes (Table 5, see page 198), comorbid psychiatric conditions, and the adolescent's attitude toward substances of abuse. A good physical exam may reveal clinical sequelae of drug abuse. Testing for drug abuse should be done with the patient's consent except in cases where judgment is impaired. Periodic screening for drugs is a part of drug treatment and rehabilitation. The typical pediatrician is not equipped to provide drug counseling and treatment to the abusing adolescent. Specialized referral centers would be ideal, and clinicians need to be aware of local resources in their communities. Anticipatory guidance explaining the ill effects of drugs is mandatory. Prevention should be aimed at increasing public awareness of the consequences of drug abuse, improving parenting techniques, and introducing school-based drug prevention programs. The fight against substance abuse needs to be a community effort in which the individual, the family and the primary care physician play important roles.

Drug education and prevention: Has progress been made?

Ten years after publication of the UK Government's strategy for drug misuse in 1995, Tackling Drugs Together, the impact of drug education and prevention programmes remains less than desired. The 1995 strategy envisaged a new emphasis on education and prevention and there have been developments since then in drug education, especially with universal programmes delivered in schools. This paper considers the extent to which progress has been made in drug education and prevention since the 1995 strategic focus on young people and prevention of drug misuse was set out by government.

Blueprint: A positive step toward strong evidence

One of the challenges facing public policy makers is to decide which drug and alcohol prevention programmes should be introduced into schools or, for that matter, other child and youth settings. In...

The Impact of Schools Self-Administering Substance Abuse Surveys: An Evaluation

The literature suggests that administering drug surveys to public school students is best done by persons outside of the school system (or at least unfamiliar to the students). This is the approach used by the long-time Monitoring the Future project. Because of the increased costs that administration by outside research associates requires (both time and transportation), we decided to design an experiment that would compare it to administration by school personnel. Six school systems were split, and 3756 surveys were administered, about half by outside research associates and half by school personnel. The results indicate that there were minimal and non-significant differences between the two groups. On the basis of these results, we draw the conclusion that school personnel are able to administer survey instruments without affecting the quality of the results and, thus, that school districts may safely use such data in the evaluation of their drug education and drug prevention programs.

An innovation in drug prevention programs for adolescents: The Hong Kong Astro Project

Recent approaches to drug prevention have turned to focus on comprehensive strategies that target early risk factors and that strengthen protective factors in adolescence. To develop a drug prevention program that is evidence-based and conceptually sound for the Chinese community. The "Astro" project was designed for high-risk youths in Hong Kong and consisted of three psychosocial primary prevention programs conducted in structured group sessions. A three-year longitudinal study and control group comparisons are integrated in this project for the program evaluation. The findings showed that the experimental group, after participating in the programs, was generally better than the control group in terms of social skills, knowledge of drugs, refusal skills, attitudes towards drugs, and the behavioral intention to avoid drug abuse. It suggests that this program could function well as a drug prevention program.

Results of an Independent Evaluation of Project ALERT Delivered in Schools by Cooperative Extension

Reported are results of an independent effectiveness study of the Project ALERT drug prevention program implemented in eight Pennsylvania middle schools by outside program leaders employed by Cooperative Extension. In this randomized, 2-cohort longitudinal evaluation, 1,649 seventh-grade students completed a pretest and four waves of posttests over the 2-year program and 1-year follow-up. Project ALERT's effectiveness was tested through a 3-level hierarchical linear model. Analyses failed to yield any positive effects for substance use or mediators for use in the adult or teen-assisted delivery of the curriculum. An extensive set of additional analyses detected no differential program effects by student risk level, gender, school, or level of implementation quality. Potential explanations for outcomes relative to Project ALERT's original effectiveness trial are discussed, as well as implications for future research, including the need to conduct independent effectiveness studies of previously validated programs in a variety of contexts.

Why It Is So Difficult to Form Effective Community Coalitions

Reviews of large‐scale community coalition evaluations suggest that most have not been successful either in involving a broad array of institutions or in meeting their outcome goals. Informed by the literature and by insights from fieldwork, a social‐structural theoretical explanation is offered for this lack of success. To summarize: coalition structures and the concept of community are loosely defined; local structures attempt to cope with problems that have regional, state, national, and international roots; ethnic, class, and racial divisions lead to cooptation; the narrative of past failed interventions creates current problems; organizations with different sizes and institutional affiliations have problems in working together; and the presence of many organizations leads to confused decision‐making processes. In addition, drug and alcohol prevention program funding is dwarfed by the funds of the alcohol and illegal drug industries. Recognizing these issues in advance and focusing interventions can help to alleviate the effects of these structural problems.

Razões para o não-uso de drogas ilícitas entre jovens em situação de risco

Although there are many studies on risk factors for drug use, little has been known about the reasons that prevent people away from drug use. The aim of this study was to identify the reasons that would prevent low-income youngsters against psychotropic drug experimentation and use, even when living in a drug dealing environment. A qualitative study was carried out in an intentional sample selected according to a set of criteria. Sixty-two youngsters, aged between 16 and 24 years, from low-income families who have never used psychotropic drugs (32 subjects) or who were heavy drug users (30 subjects) were interviewed. Each interview lasted on average 110 minutes. Among non-users, access to information and a protective family structure were identified as major reasons from preventing youngster from drug use. Comprehensive information on the outcomes of drug use and affective bonds between parents and their children, assured by feelings of support and respect, seems to be important in helping them avoid drug use. The importance of these two factors as reasons to keep youngsters away from drugs is emphasized when their lack is mentioned and censured by drug users. The outlook of those who have never used drugs in their lifetime and their reasons should be considered in the development of drug prevention programs targeting low-income youngsters.