The School as a The School as a Prevention Setting—The Prevention Setting—The

Experience of Drug Abuse Experience of Drug Abuse PreventionPrevention

Zili Sloboda, Sc.D.Zili Sloboda, Sc.D.Senior Research AssociateSenior Research Associate

Institute of Health and Social PolicyInstitute of Health and Social PolicyThe University of AkronThe University of Akron

Tucson, ArizonaTucson, ArizonaOctober 20, 2008October 20, 2008

The source for this presentation comes from The source for this presentation comes from

Sloboda, Z., School Prevention, In: Sloboda, Z., School Prevention, In: Leukefeld, C.G., Gullota, T.P.and Stanton-Leukefeld, C.G., Gullota, T.P.and Stanton-Tindall, M. (Eds.), Tindall, M. (Eds.), Adolescent Substance Adolescent Substance Abuse Evidence-Based Approaches to Abuse Evidence-Based Approaches to Prevention and TreatmentPrevention and Treatment. Springer:New . Springer:New York, December 2008York, December 2008

PresentationPresentation • Demonstrate the availability of effective

drug abuse interventions for schools• Demonstrate how these interventions take

advantage of the protective environment of the school

• Summarize recommendations for school administrators arising from the drug abuse prevention research history to date

The Beginning of a New Era For The Beginning of a New Era For Drug Abuse PreventionDrug Abuse Prevention

• Up through the 1980s—federal moratorium on funding for drug abuse prevention research

• Experience of cardiovascular disease prevention—tobacco and community-based interventions

The New EraThe New Era• The late 1980s till today

– Publication of outcomes of prevention programs with demonstrated effectiveness in key journals

– The First National Institute on Drug Abuse Prevention Conference

• Dialogue between researchers and practitioners• The “Red Book” (Preventing Drug Abuse among

Children and Adolescents)

– The establishment of the Society for Prevention Research and journal, Prevention Science

– Recognition that prevention programming can be effective

The Science Base of The Science Base of PreventionPrevention

• Epidemiology• Child development• Health behaviors—sociology, psychology,

economics• Biology and neuroscience• Intervention development • Evaluation methodologies

Two Types of Epidemiologic Two Types of Epidemiologic Studies Contribute to Studies Contribute to

PreventionPrevention

• Descriptive • Analytic

Descriptive StudiesDescriptive Studies

• Types of drugs used• Relationship of ‘legal’ substances to

‘illegal’ substances• Ages of initiation• Trends in rates of use• Characteristics of drug users

Analytic StudiesAnalytic Studies

• Based on longitudinal studies following children and adolescents over time:– Identify origins and pathways to

initiation of drug use– Factors associated with the continuation

of use to abuse/dependence or non-continuation

– Specify protective factors for vulnerable populations

Stancavage: Theory

Risk Factors: Early ChildhoodRisk Factors: Early Childhood

• Early Childhood Factors have the longest potential impact as they may interfere with normal and successful development– Chaotic home environments– Ineffective parenting– Lack of mutual attachments and

nurturing

Risk Factors Outside the FamilyRisk Factors Outside the Family

Schools, Peers and Community• Inappropriate shy and aggressive behavior

in the classroom• Failure in school performance and school

bonding• Poor social coping skills• Affiliation with deviant peers• Perceptions of approval of drug-using

behaviors

Protective Factors For Protective Factors For Vulnerable PopulationsVulnerable Populations

• Strong family bonds• Parental monitoring—clear rules of

conduct and involvement of parents in lives of children

• Success in school performance• Strong bonds with prosocial

institutions• Adoption of conventional norms

about substance use

Other Factors Influencing Drug Other Factors Influencing Drug UseUse

• Availability of alcohol, tobacco and drugs

• Trafficking patterns• Beliefs that drug use is generally

tolerated

What Have We Learned from What Have We Learned from the Epidemiologic Studies?the Epidemiologic Studies?

• Most children initiate tobacco, alcohol and illicit drug use between the ages of 13 and 16

• There is about a 150% to 200% increase in the use of tobacco, alcohol and other drugs between grades 8 and 10

• Risk to move on to marijuana has been estimated to be at least 3 times greater for persons who smoke or drink

What Have We Learned from What Have We Learned from the Epidemiologic Studies?the Epidemiologic Studies?

• Risk to move on to cocaine is estimated to be at least 75 times greater for persons who used marijuana

• The more risk factors someone has the greater likelihood to use substances.

• The process of becoming a drug user or abuser takes place over time

Applying Epidemiologic Applying Epidemiologic Findings To PreventionFindings To Prevention

• Introduce prevention programming PRIOR to ages of initiation

• Target alcohol, tobacco and marijuana and other substances

• Reinforce prevention messages at the ‘At Risk’ years

• As the process of becoming a drug user takes place over time, prevention interventions must take place across time also!

Applying Knowledge to Applying Knowledge to Prevention Programming Prevention Programming

to to School SettingsSchool Settings

The School As A Prevention The School As A Prevention SettingSetting

• Where children in the United States spend a great proportion of their time.

• The school remains a major socialization institution to reinforce societal values, norms, and acceptable behaviors.

• The school is a protective environment for children where they should feel safe.

The School Environment And The School Environment And Prevention StrategiesPrevention Strategies

• School culture—norms, beliefs and expectancies

• School bonding—classroom behavior and academic performance

• Classroom curriculum• School policy—social control

School CultureSchool Culture

• Common elements or principles:– Creating anti-/non-drug using (tobacco

and alcohol also) normative setting– Dispelling misconceptions regarding

expectancies associated with use of tobacco, alcohol and drugs

– Comprehensive programs involving students, school administration and, when appropriate, parents/caregivers.

School Culture: ExamplesSchool Culture: Examples

• Child Development Project--Schaps• Challenging College Alcohol Abuse--

Johannessen

Findings from the Child Findings from the Child Development ProjectDevelopment Project

• Prevalence of alcohol use declined 11% over 4 years compared to 2% in matched comparison schools

• Prevalence of marijuana use declined by 2% compared to a 2% increase in matched comparison schools

• Prevalence of cigarette use declined by 8% compared with a 3% decline in matched comparison schools

School BondingSchool Bonding

• Common elements or principals:– Focus is on early years, pre-school to

middle school– Enhance competency in reading and

math– Provide interpersonal skills to relate

positively with peers and adults– Involvement of parents in

communication/parenting skills and in school activities

School Bonding: ExamplesSchool Bonding: Examples

• Seattle Social Development Program--Hawkins

• Incredible Years—Webster-Stratton• Early Risers Skills for Success--

August

Seattle Social Development Program: Seattle Social Development Program: Observed Mean Level of School Observed Mean Level of School

Bonding by AgeBonding by Age

Seattle Social Development ProgramSeattle Social Development ProgramHeavy Alcohol Use at Age 18Heavy Alcohol Use at Age 18

Early Risers Skills for SuccessEarly Risers Skills for Success

Classroom Curriculum—Classroom Curriculum—Universal/Selected ProgramsUniversal/Selected Programs

• Common elements:– Dispel misconceptions regarding

normative nature of substance use and expectancies

– Impact perceptions of risks associated with substance use as children and adolescents

– Provide resistance skills to refuse use of tobacco, alcohol and illicit drugs

– Provided over multiple years—middle school and high school

Universal School Curricula: Universal School Curricula: ExamplesExamples

• Life Skills Training--Botvin• Project Alert--Ellickson• Project STAR--Pentz

Findings from 4 Follow-up Findings from 4 Follow-up Studies of Life Skills TrainingStudies of Life Skills Training

Cigarettes Used in Last Month-From Pentz et al. (1989). JAMA, 261(22):3264

0

5

10

15

20

25

30

1984-1985 1985-1986

School Year

Per

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ho

Sm

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d C

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ProgramControl

Alcohol Used in Last Month-From Pentz et al. (1989). JAMA, 261(22):3264

0

2

4

6

8

10

12

14

16

18

1984-1985 1985-1986

School Year

Per

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t W

ho

Use

d A

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ho

l

ProgramControl

Marijuana Used in Last Month-From Pentz et al. (1989). JAMA, 261(22):3265

0

2

4

6

8

10

12

1984-1985 1985-1986

School Year

Per

cent

Who

Use

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ana

Program

Control

Classroom Curriculum—Classroom Curriculum—Indicated ProgramsIndicated Programs

• Common Elements or Principles:– Identify students at high risk for

substance abuse or other associated behavior

– Provide self-control, communications and decision-making skills

– Self-esteem/competency enhancement– Create positive peer support

Indicated School Curricula: Indicated School Curricula: ExamplesExamples

• Reconnecting Youth—Eggert• Project Towards No Drug Abuse—

Sussman• Project SUCCESS--Morehouse

Reconnecting YouthReconnecting Youth

Other Findings (7 months post Other Findings (7 months post intervention)intervention)

• Compared to students not participating in RY:– 18% improvement in grades in all classes– 7.5% increase in credits earned per semester– 54% decrease in “hard” drug use– 48% decrease in anger and aggression

problems– 32% decline in perceived stress– 23% increase in self-efficacy– 33% reported ending alcohol use

Project Toward No Drug UseProject Toward No Drug Use

School PolicySchool Policy

• Common elements or principles, to be effective:– Infractions among students handled

positively with counseling NOT suspension/expulsion

– Should be tied to other prevention activities

School Policies: ExamplesSchool Policies: Examples• No substance use on school properties• Set aside areas for smoking• Drug Free Zones discouraging use and sales• Reducing or eliminating access to and

availability of tobacco, alcohol or other drugs.

• Addressing infractions of policies with positive sanctions by providing counseling or treatment and special services to the students rather than punishing them through suspension or expulsion.

Drug TestingDrug Testing• 1995--the United States Supreme Court

upheld a school’s right to conduct random drug tests of student athletes without any suspicion of use of drugs

• 2002--the Supreme Court carried this decision further by upholding school districts’ rights to extend testing to students participating in other extracurricular activities

Effectiveness of DrugTestingEffectiveness of DrugTesting• Only one randomize, longitudinal study has

been conducted– No differences between control and

experimental students on past month drug use – Authors conclude drug testing is not an effective

deterrent to drug use and actually may increase the risk for future substance use

• Goldberg, L., Elliot, D.L., MacKinnon, D.P., Moe, E.L., Kuehl, K.S., Yoon, M., Taylor, A., & Williams, J. (2007). Outcomes of a prospective trial of student-athlete drug testing: the Student Athlete Testing Using Random Notification (SATURN) study. Journal of Adolescent Health, 41(5): 421-429.

Alternatives to Drug TestingAlternatives to Drug Testing• Screening for at-risk students

– Examples:•Drug Use Screening Inventory•Problem Oriented Screening Inventory

for Teenagers•Personal Experience Screening

Questionnaire

IF YOU SCREEN…IF YOU SCREEN…• WARNING!!!

– Have a plan in place for handling students found positive • That includes the family• That includes counseling• That includes follow-up

Focus on Other Types of Focus on Other Types of Prevention ProgramsPrevention Programs

• Family Relationships: Teach parents skills for better family communications, discipline, firm and consistent rule making, get to know friends, understand problems and concerns

Other Types of Prevention Other Types of Prevention ProgramsPrograms

•Peer Relationships: Develop social competency skills for improved communications, enhancement of positive peer relationships and social behaviors and resistance skills to refuse substances

Other Types of Prevention Other Types of Prevention ProgramsPrograms

• The Community Environment: Enhance anti-substance use norms and prosocial behavior through policy or regulations, mass media efforts, community-wide awareness programs; new laws and enforcement, advertising restrictions; drug free school zones.

RecommendationsRecommendations• Substance use is not the sole problem of

the school • Prevention is a process that takes place

across the lifespan • Interactive programs are more effective for

middle school rather than high school students

• Prevention programs should address multiple substances

• Implementation fidelity is one of the great challenges

• The field of drug abuse prevention is relatively new