The Terry Project on CiTR #42: Drug Prevention (The Four Pillars Revisited, Part 2 of 5)
Do you remember DARE? It’s a drug education program, but researchers say that it doesn’t work because it exaggerates the harms of drug use. We profile people who say we need to try something new: tell kids the truth. This is part two of the Four Pillars Revisited. Our season-opening series on Vancouver drug policy, produced in partnership with The Tyee, and syndicated at the University of British Columbia, the University of Victoria and Simon Fraser University in Burnaby.
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In 2001, Vancouver’s groundbreaking drug policy, A Framework For Action: A Four-Pillar Approach to Drug Problems in Vancouver, claimed that the city’s drug prevention programs were ineffective and needed to be replaced.
One of the most popular prevention initiatives has been to screen the documentary film Through a Blue Lens. The film, which follows two police officers on their beat in the Downtown East Side, features harrowing scenes of intravenous drug users. Produced in 1999 and seen in 22 countries, the film continues to be screened in some B.C. schools and community centres.
However, a growing academic consensus — in disciplines as diverse as psychology, nursing, social work, and public health — claims that these abstinence-only drug education initiatives, or ‘just say no’ approaches, are ineffective, if not counter-productive.
Meet the researchers who say that traditional drug and alcohol prevention simply doesn’t work:
“The biggest myth is that if a young person is scared of something, they’re not going to do it. We know that’s wrong,” says Michelle Fortin, executive director of WATARI, a drug counseling and support society.
Since The Four Pillars, Vancouver has moved beyond these approaches. DARE, a drug prevention program administered by RCMP officers, is no longer available in Vancouver schools. But what has replaced it?
Should we tell kids that drugs can be fun?
What is the state of drug prevention research?
The Terry Project’s Primer on Prevention:
What does Canada actually spend on prevention?
The provincial government spends about $500,000 on the programs we highlight in this episode. How much does the federal government spend on prevention? According to this study in Drug Policy [PDF – UBC only link] that analyzed the national anti-drug strategy in 2008, not very much. The federal anti-drug strategy is $64 million, but:
“Law enforcement initiatives continue to receive the overwhelming majority of drug strategy funding (70%) while prevention (4%), treatment (17%) and harm reduction (2%) combined continue to receive less than a quarter of the overall funding.”
Why should we invest in prevention?
- According to A Case for Investing in Youth Substance Abuse Prevention [PDF link]
- Drug prevention programs have been shown to save $15-$18 for every dollar spent.
- Youth 15 – 24 are 5x more likely to experience harms from drug use than adults over 25 (Health Canada)
- Substance use costs Canadians an estimated $39.8 billion in a single year (British Columbians account for about $6b of that); 8b of which was direct health care costs, policing costs about $6b, and indirect costs (loss of productivity) somewhere around $24b.
2002 figures (the most recent Canadian figures we could find):
What kind of drug education actually works?
Not PSAs. An article in the Journal of Epidemiology and Community Health [PDF – UBC only link] found very little evidence to support the idea that scary PSAs stop kids from using drugs . In fact, some PSAs were shown to be counter-productive.
For much more detail on prevention research, checkout the Handbook of Drug Abuse Prevention [PDF of book – UBC only link], which includes a chapter on the state of prevention research, the risk and protective factors of adolescent drug use, and the most effective approaches to school-based approaches.
Here’s some things it told us:
When should drug prevention begin?
The literature shows that the earlier the better. Before fourth grade. The programming should not be drug-specific, though. And it should be targeted to the entire population, rather than at specific groups or specific individuals. At later years, it’s good to tailor programming to the specific needs of students who need special support.
How should it be delivered?
Research is unequivocal: it should be interactive, and it should involve peers at high levels.
A note about effectiveness
At best, the effects of a drug prevention program last a couple years. They fade over time, so they have to be followed up. Therefore expectations need to be adjusted.
Risk factors that contribute to adolescent drug use and protective factors that prevent adolescent drug use
- Risk factors are diverse — economic deprivation, neighborhood disorganization, psychological, genetic, family, school-related — and the protective factors are supportive families, inculcation of positive social values, and effective coping mechanisms.
- Internalization of societal values by the parents that lead to warm, conflict-free attachments with parents
- Risk-factors with parents: marital conflict, parental drug use, environmental/neighbourhood issues.
- Personal traits: rebelliousness leads to drug use, as does adolescents who are geared towards “sensation seeking.”
Models for drug prevention that do not work:
- Information dissemination or scare tactics alone do not work. In fact, some studies suggest that they can increase drug use by peaking curiosity.
- Alternatives programming introduces new ideas — e.g. go for a hike instead! — but there is no evidence that this works.
Models for drug prevention that can work:
- Social Influences Model (developed in the 80s by Richard Evans, University of Houston) stresses the influences of peers, media, etc, and uses psychological inoculation to protect kids from those messages and resistance skills training to help them resist them.
- However, a number of studies have shown that resistance skill training does not contribute much to the effectiveness of a program.
- There is better support for normative education which corrects assumptions about how prevalent drugs are. e.g. kids think drugs are everywhere, and resistance training enforces that — but normative education corrects that faulty assumption, showing kids that drugs use amongst their peers isn’t actually that common.
Competence-enhancement approaches can work
- According to this approach, it theorizes that drug abuse is learned through a process of modelling, imitation, and reinforcement, and is influenced by an adolescent’s pro-drug attitudes and beliefs.
- How is the competence-enhancement approach done?
- They give you homework and try to help you form new skills. The best ones form generic coping skills (e.g. dealing with stress and anxiety, social skills, assertiveness, problem-solving) as well as drug-specific resistance skills (how to say no).
In the journal Addiction, there is a literature review [PDF – UBC only link] of school-based drug and alcohol interventions. According to the research, here’s some things to look out for in a good program:
Does the program?
- Have a strong theoretical underpinning that helps people understand why a kid starts to use drugs
- Teach life skills and social learning
- Evaluate its results
- Use a social influence model, that considers parents, community, etc
- Reach children early
- Provide adequate training for the teachers
- Monitoring the staff
- Have buy-in at high levels of the school board
- Integrate into other aspects of students’ lives
If you’d like to learn more about the research that Vancouver Coastal Health uses to inform programs like SACY, read this literature review [PDF download] prepared for them by a consulting firm. It echoes similar research.
“Meta-analytic studies have found that prevention programmes that combine social resistance skills and competence enhancement approaches are among the most effective approaches.’”