hart13 ppt ch17

© 2011 McGraw-Hill Higher Education. All rights reserved.

Chapter 17Chapter 17

Preventing Substance Abuse


Society’s Attempts to Limit Society’s Attempts to Limit Drug AvailabilityDrug 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?


Defining Goals and Evaluating Defining Goals and Evaluating OutcomesOutcomes

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

Goal of presenting negative information about drugs in schools = prevention of use


Types of PreventionTypes 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



Goals Prevention of use of other, more dangerous

substances Prevention of more dangerous forms of use

Example = college programs encouraging responsible use of alcohol

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



Tertiary prevention Aimed at people have been through

substance abuse treatment or who stopped using a drug on their own

Goal is relapse prevention



Institute of Medicine’s “continuum of care” Prevention Treatment Maintenance

Classification scheme for prevention efforts Universal prevention Selective prevention Indicated prevention



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

Universal prevention = for an entire population Example: community, school

Selective prevention = for high-risk groups within a population


Drugs in the MediaDrugs 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.


Prevention Programs in SchoolsPrevention Programs in Schools

Knowledge-attitudes-behavior model

Affective education Anti-drug norms Social influence model DARE and other programs

in use


Knowledge-Attitudes-Behavior Knowledge-Attitudes-Behavior ModelModel

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



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



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


Affective EducationAffective Education

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

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



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



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


Selected Suggested Alternatives Selected Suggested Alternatives to Drug Useto 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



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


Anti-Drug NormsAnti-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



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



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



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


Social Influence ModelSocial 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



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



Five key elements of the social influence model1. 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

2. Public commitment such as making a public pledge



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



4. Normative education to teach students that they may overestimate the number of their peers who smoke Countering the “everybody is doing it” attitude

5. 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



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


Drug Abuse Resistance Drug Abuse Resistance Education (DARE)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


Drug Abuse Resistance Drug Abuse Resistance Education (DARE)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


Programs That WorkPrograms 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


Peer ProgramsPeer 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


Peer ProgramsPeer 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

Data on effectiveness are not yet available or are inconclusive

Community service (YouthBuild)


Parent and Family ProgramsParent 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



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



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


Community ProgramsCommunity 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


Community ProgramsCommunity 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


Workplace ProgramsWorkplace 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


What Should We Be Doing?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


What Should We Be Doing?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


SAMHSA Center for Substance Abuse SAMHSA Center for Substance Abuse Prevention: Model ProgramsPrevention: Model Programs

Across Ages Athletes Training and Learning

to Avoid Steroids (ATLAS) Child Development Project Communities Mobilizing for

Change on Alcohol Creating Lasting Family

Connections Dare to Be You Families and Schools Together Keep a Clear Mind Life Skills Training

Project ALERT Project Northland Project Towards No Tobacco

Use Reconnecting Youth Residential Student Assistance

Program Safe Dates SMART Team Strengthening Families

Program Too Good for Drugs


Chapter 17Chapter 17

Preventing Substance Abuse

hart13 ppt ch17

Documents

early prevention

mcgrawhill higher education

drug prevention programs

prevention of use programs

dangeroussubstances

drugs students

school selective prevention

drugs ads