Substance Abuse Prevention Takes to the Classroom.
By the time children reach eighth grade, nearly one in four has tried marijuana, a quarter have been drunk and one in five has sniffed inhalants. More than half have tried beer, wine or the like. The number of teens receiving substance abuse treatment on any given day between 1991 and 1996 - when illicit drug use soared among adolescents in this country - almost doubled from 44,000 to 77,000.
But children start experimenting way before that.
Two percent of fourth graders (9- and 10-year-olds) huff inhalants on a monthly basis, and nearly 8 percent have tried beer, according to a recent nationwide survey by the National Parents' Resource Institute for Drug Education. Kids also say such substances are "easy to get."
How do we get them to stop before they even start? Researchers agree the best defense is comprehensive prevention involving the community, parents, the media and schools. For years, the bulk of the effort has been waged where kids are most accessible - school. But schools might not be doing all they can. Some experts say state leaders need to take a look at more successful and sophisticated programs that are working in a handful of places.
FOCUSING ON WHAT WORKS
School prevention programs today are far more sophisticated than those of 30 years ago when they made their debut. As the body of research on what works has grown, programs have changed.
Initially, if substance abuse prevention was introduced at all, it was maybe a onetime discussion in health class or during a special assembly preaching what alcohol and drugs were and about their dangers. These attempts gave way to emotional and moralistic appeals that often bordered on, if not crossed into, scare tactics. Sometimes, prevention addressed the self-esteem and emotional well-being of students.
About 15 years ago or so something called the "social influences" strategy was developed, and it appears to be working, says Doug Longshore of the Drug Policy Research Center of RAND, a nonprofit research and analysis group. Successful programs include two major components, "normative education" (in other words letting kids know that not everybody is doing it) and resistance skills.
"Kids typically overestimate how widespread drug use really is," says Longshore. Actual statistics, he adds, "come as a real eye-opener and take a lot of the peer pressure off."
Teaching resistance skills gives kids effective ways of saying no. Kids role-play or act out situations like being offered a cigarette. Videos and workbooks give examples. Rather than a simple no thank you, Longshore explains, kids are taught to say things like, "No thanks, I'm running track." Or "No, I don't smoke. Let's get a soda instead."
The results from such programs - Project ALERT, developed by RAND, and the Life Skills Training program from Cornell University Medical College to name a couple - have been impressive.
More than a dozen studies show Life Skills Training can reduce tobacco, alcohol and illicit drug use by an average of 50 percent when schools using the prevention program are compared with control groups. Even more impressive are studies that have shown that six years after participating in the program, kids are still saying no to alcohol and other drugs.
"We now have solid scientific evidence that prevention can work - with the right kind of prevention program and when properly implemented," says Gilbert Botvin, professor and director of the Institute for Prevention Research at Cornell University Medical College and developer of the proven program called Life Skills Training.
Botvin's program has won the approval of the Centers for Disease Control and Prevention, the American Medical Association and the American Psychological Association, who all call it a program that works. The U.S. Office of Juvenile Justice and Delinquency Prevention gives funding to middle schools and junior high schools who want to implement the Life Skills Training Drug Prevention Program.
The program usually starts in sixth grade with 15 sessions lasting about 45 minutes each. Seventh graders get 10 sessions and eighth graders five lessons. By reinforcing social and psychological factors that discourage substance use and abuse, the training provides students with refusal skills so they can chose not to use tobacco, alcohol and drugs. It also builds students' sense of self-worth and confidence and gives them tools needed to cope with social anxiety. They also learn the consequences of substance use.
This summer, West Virginia trained 87 percent of its sixth grade teachers in the Life Skills program and intends to train the rest of them this fall.
SPENDING FEDERAL MONEY
Experts at the U.S. Department of Education's Drug-Free Schools and Communities program, the No. 1 source for prevention funding for schools, want to change the way federal funds are being used.
Last year, the federal program, which gives some $500 million annually to states, school districts and schools, issued its principles of effectiveness. The four-part rule requires schools and districts that receive such money to:
* Use objective data to identify their needs.
* Establish measurable goals and objectives for their programs.
* Implement programs of demonstrated effectiveness.
* Assess progress toward achieving state goals.
The rule change came on the heels of a Department of Education-sponsored study of school-based drug prevention programs that discovered districts "rarely implemented" programs that have been shown to work. The study, which involved 19 school districts, found that the most common program components were student instruction, student support such as counseling or peer mediation and special events. The study suggested that the best programs were those with a full-time prevention coordinator. Not surprisingly, the survey also showed that the amount and content of prevention programming varied from classroom to classroom and school to school. It found that teachers and counselors did not have enough "time, support, training or motivation" to provide all the instruction that they had planned to provide.
"The evidence was clear we were not being successful with Safe and Drug-Free Schools money in developing comprehensive drug and violence prevention programs," says Bill Modzeleski, director of the program.
Part of the problem, Modzeleski says, is that there isn't enough money. Fifty-nine percent of all school districts receiving the federal money get less than $10,000.
"This amount is inadequate to develop what's needed to prevent youth drug use and violence. As a result, school districts are likely to sponsor the kinds of prevention programs they can afford, not the ones that their students deserve."
He added that districts aren't always aware of what curricula are effective, plus some states don't have sufficient staffing to administer the program.
Besides proposing that the Principles of Effectiveness rule become law, the Safe and Drug-Free Schools and Communities program is asking that funds be directed to school districts that demonstrate the most need. The proposal calls for states to fund no more than half their schools and distribute money based upon need and quality of application. Although the proposal is controversial, since some districts that are now receiving funding will not qualify under the proposed guidelines, Modzeleski said the change is necessary.
"Continuing the current practice of spreading funding so broadly is unlikely to result in the kinds of program improvements that need to be made," he said.
The overall challenge, Modzeleski and other researchers agree, is encouraging districts to spend their money on programs that work.
STATES TAKE ACTION, TOO
States, too, have taken up the push to ensure that the investment they make in prevention is money well spent.
This past session, both Texas and Florida passed bills aimed at encouraging effective prevention.
Under Florida's new $9 million grant program, applicants must measure improvements in student attitudes or behaviors and set goals and objectives based on a needs assessment. At least 50 percent of the grant funds must go to replicate prevention programs that have been evaluated and proved effective.
"We haven't really been able to get the measurable outcomes we've wanted. I think we've gotten frustrated over the years with programs that haven't been able to do things," says Florida Representative Sandra Murman, who sponsored the bill.
Murman said the goal is to find effective prevention. The bill also calls for Florida's Department of Children & Family Services to create a substance abuse prevention Internet Website.
Iowa and Oregon are not only aiming at effective programs, but targeting a specific drug problem - methamphetamine in Iowa and inhalant abuse in Oregon.
Iowa residents entering treatment programs for methamphetamine use skyrocketed in the '90s. In 1992, 1 percent of those in treatment programs said their drug of choice was methamphetamine; in 1998 that proportion had jumped to 12 percent - a 1,100 percent increase. That prompted the Iowa Legislature to appropriate $83,000 in 1998 to develop an anti-methamphetamine message directed at teenagers through the school system and public service advertisements. This year, the lawmakers approved an additional $30,000 to develop a model substance abuse prevention program based on a program at North High School in Des Moines.
"It's important we visit programs, be aware of what's successful and try and give some direction to the funding," says bill sponsor Iowa Senator Elaine Szymoniak.
Other states are finding more money for school-based prevention. Ohio for the first time approved state general revenue money in addition to federal funds for prevention measures. Under an initiative by Governor Bob Taft, the Ohio Legislature included $2 million in the state's biennium budget for FY 2000 and $2.12 million for FY 2001 to hire full-time "Safe and Drug-Free Schools" coordinators.
"It's a step - a step in a good direction," said Judy Airhart, state coordinator for the program.
Senator Robert Gardner, chairman of the Education Committee, says investing in effective prevention makes good sense.
"Anything we can do to combat the drug problem with prevention is beneficial," says Gardner. "However, we have to make sure we are getting a return on our investment."
Assessment is essential he says.
ADDRESSING A SERIOUS PROBLEM
Funding school-based prevention programs at the state level is nothing new for Washington. Ten years ago, the state passed an Omnibus Alcohol and Controlled Substances Act funded by a tax on alcohol, cigarettes and carbonated beverages.
The act places intervention specialists in local schools to work with students who have been referred for substance use or who may be at risk. The specialists assist in referrals to treatment providers, help students come back to school after being treated for alcohol or substance abuse, and provide prevention and intervention services to students and families. There are student assistance programs in 28 percent of the state's schools, and last year the program received $4.8 million in state funding.
"Indirectly, there was recognition that there weren't enough federal or local funds to address the prevention issue," said Martin Mueller, program supervisor for Safe and Drug-Free Schools in Washington.
"The program has proved to be very effective for the kids who are served."
THERE'S GOOD NEWS
The good news is that the tide of rising substance abuse among teens appears to be turning.
The most recent Monitoring the Future study, an annual nationwide survey of eighth, 10th and 12th graders begun in 1975 at the University of Michigan's Survey Research Center, showed a "modest" downturn after six years of steady increases. A decrease in marijuana use accounted for most of the observed decrease.
Nonetheless, the latest survey, which was released last December, found 22 percent of all eighth graders said they had tried marijuana. And 49 percent of 12th graders said they had done so. Meanwhile, a third of all high school seniors reported being drunk at least once in the 30 days preceding the survey.
But researchers and others appear cautiously optimistic.
"We think we have turned the ship around," says Department of Education program director Modzeleski.
The director is also encouraged by recent state involvement.
"I see a greater acceptance on the part of legislatures to get involved," Modzeleski says.
That's also good news, says Cornell's Botvin.
"State legislators can play a pivotal role by disseminating information in their own states about what works," he said. "Even more important, where possible, is to pass legislation limiting the use of federal or state funding to programs for which there is clear evidence that they can actually decrease tobacco, alcohol and illicit drug use."
Florida Representative Murman agrees that states should become more involved. "I think that states have to get hold of the problem of drug abuse among children.
"We can't wait for the federal government to give us all the answers."
RELATED ARTICLE: PREVENTION AT ITS BEST
Forget red ribbons, refrigerator magnets, bumper stickers, pledges of swearing off drugs and alcohol, and threats about killing brain cells. In the Child Development Project, one of seven model prevention programs selected by the federal Substance Abuse and Mental Health Services Administration, marijuana, alcohol and other substances are never even mentioned.
"Not in any way, shape or form," says its developer Eric Schaps. Instead, the highly acclaimed program to prevent substance abuse in high-risk children focuses on transforming elementary schools into "caring communities of learners."
Younger students are paired with older kids in weekly classroom activities. Parent involvement is encouraged through once or twice monthly homework projects. The connections between the school and the families it serves are fostered with special events like a Family Read-Aloud and a Family Heritage Museum.
The classroom climate itself is changed with an emphasis on cooperative learning and a teaching approach that helps students take responsibility for establishing classroom norms and managing their own behavior.
The idea, says Schaps, is to "make schools a place of connection and value. Once you get kids bonded to schools, they continue to do better."
And not just academically or socially.
Students from schools in Jefferson County, Ky., Dade County, Fla., and White Plains, N.Y., who participated in a demonstration project for Schaps's program, reduced their substance use significantly: Alcohol use fell 11 percent; marijuana, 2 percent; and tobacco use, 8 percent.
According to a 1997 report of the National Longitudinal Study on Adolescent Health, the closer teens are to their parents and the more connected they feel to school, the less likely they are to smoke, drink or use other drugs.
This feeling of connection, Schaps says, is one of the essential factors in protecting kids from substance abuse. Given that, Schaps believes prevention programs that focus on school bonding could be the "wave of the future."
Another award winning program, Across Ages, was developed in Philadelphia. It pairs middle school students with elders in the community and includes community service activities along with a curriculum of problem solving and resistance skills and parental involvement.
Other school-based prevention programs worth looking at are:
* The Michigan Model for Comprehensive School Health, grades K-12. Available through the Michigan Department of Community Health, (517) 335-8390, www.emc.cmich.edu.
* Life Skills Training, grades 6-8 or 7-9. Available from Princeton Health Press, (800) 636-3415, www.lifeskillstraining.com.
* Project ALERT, grades 6, 7 or 7, 8. Available through the BEST Foundation, (800) ALERT-10, www.projectalert.best.org.
* Reconnecting Youth, grades 9-12. Available through the National Educational Service, (800) 733-6786, www.nesoline.com.
* STAR (Students Taught Awareness and Resistance), grades 5-8. Available through the Department of Preventive Medicine, University of Southern California, (213) 865-0325.
More information about each of these programs is in Making the Grade from Drug Strategies at 1575 Eye Street, NW, Suite 210, Washington, D.C. 20005. Or call (202) 289-9070 or visit their Website at www.drugstrategies.org.
RELATED ARTICLE: MIDDLE SCHOOL: A CRITICAL PERIOD
Making the shift from elementary school to middle school can be tough on youngsters. A recent survey by the National Parents' Resource Institute for Drug Education dramatically illustrates that the transition from fifth to sixth grade is a truly vulnerable time when it comes to drug and alcohol use.
The national survey, which represented responses of 26,086 students in 22 states, found that kids' use of alcohol, tobacco and other drugs quadruples from fourth to sixth grade. The study also found that students in all three grades greatly overestimated how many of their friends use drugs when compared with actual personal reported use. This finding is significant because research by the National Institute on Drug Abuse placed drug use by peers as one of the strongest correlations in predicting adolescent drug use.
Additional PRIDE survey results:
* 4.1 percent of fourth graders have used cigarettes, 7.7 percent, beer, and 6.3 percent, inhalants.
* Students who reported using marijuana at least once during the past year escalated from 0.8 percent among fourth graders to 3.7 percent among sixth graders.
* Cigarette smoking and beer drinking roughly doubled between the fifth and sixth grades.
* 27 percent of fifth graders said "a few" or "a lot" of their friends smoke cigarettes when only 7 percent actually reported they did.
* Sixth graders believe 14 percent of their friends smoke marijuana while only 4 percent of students said they did.
* 2.4 percent of students in fourth through sixth grade use inhalants monthly
Olivia Mayer is a free-lance writer from Denver, Colo. For information on substance abuse treatment programs for youth, call NCSL's Louise Bauer at (303) 830-2200.