Preventing Substance Use Problems Among Young People - A Compendium of Best Practices

Section 4 - Exemplary Programs from the Scientific Literature

This section describes and analyzes 33 programs with a range of aims, target groups and settings that have been shown to be effective through rigorous evaluation. Among the programs presented are eight that focus on the unique needs of injection drug using youth. Programs in this section were identified by:

• defining a minimum standard for inclusion into the candidate pool, which was a quasi-experimental design reporting positive effect on substance use measures in a peer reviewed journal;
• developing a matrix that categorized programs according to target group (universal, selective or indicated) and setting (school, family/parent, community, combined, street);
• reviewing nine credible reviews of effective programs and compiling a list of programs that met inclusion criteria;
• identifying poorly represented areas of the matrix: high risk/street/IDU youth, DWI programs, parent/family programs;
• conductimg a second, targeted search of the literature to fill in gaps and to capture any program evaluations reported in the scientific literature since the most recent reviews, (i.e., 1998 to 2000). Databases searched: CANBASE, CCSADOCS, CEI, ERIC, Medline, ETOH, NCADI and the French-language databases of the Centre québécois de documentation en toxicomanie, and the National Documentation Centre in Lyon, France;
• developing a coding form to rate each study on quality of research design and study outcomes;
• checking the reliability among three raters;
• rating 115 articles and selecting 33 programs that ranked highest in overall quality of research design and outcomes;
• describing the 33 programs based on information contained in research articles;
• sending a description to principal authors of research articles for confirmation of information;
• entering new information from authors and publishers.

Headings have been omitted in cases where no information pertaining to the heading was obtained. Program costs are in the currency of the author's country. In some cases, authors provided additional studies pertaining to the described program. Generally, complete bibliographic information was not received, yet there is sufficient information to obtain the article from the author or publisher.

All Stars

(Based on the strategies of AAPT- the Adolescent Alcohol Prevention Trial)

Target Population:

Universal; 6^th or 7^th Grade students with one-year boosters and a preparatory program for 4^th and 5^th Grades.

Setting:

School-based and community-based versions.

Theoretic Basis:

Cognitive - behavioural.

Program Description:

Focus:

Alcohol, tobacco, and marijuana.

Goals

The program that is commercially available has five goals: 1) establish conventional norms and correct erroneous normative beliefs, 2) build psychological dissonance between substance use and desired lifestyles, 3) establish voluntary commitments to avoid substance use, 4) promote bonding with prosocial institutions, and 5) promote positive parental attentiveness.

Objectives

To test the effectiveness of two methods: normative education versus no normative education and resistance training verses no resistance training on substance abuse use.

Activities

Students learn about true prevalence rates and underlying conventional attitudes through playing games, participating in activities that visually demonstrate students' opinions, participating in structured debates, and by making public commitments about intended future behaviours. There is a combination of interactive and didactic techniques (e.g., films, presentations, homework assignments, surveys, interviews, role-playing, discussions, video tapes, question boxes).

Content

The researched program included 4 - 45 minute "Information" lessons about the social and health consequences of using alcohol and other drugs and 5 lessons of "normative education" that corrected erroneous perceptions of the prevalence and acceptability of alcohol and drug use among peers and established a conservative normative school climate regarding substance use.

Contact Time:

As above plus one-year booster.

Leader Type and Training Provided:

Programs were delivered by program staff; each program specialist received a minimum of 2 weeks of intensive training.

Intended Outcomes:

The goal of the research was to compare the effectiveness of a program that teaches resistance skills and one that reinforces conservative norms; to test the effectiveness of two methods, normative education versus no normative education and resistance training verses no resistance training on substance use. The normative education program designed to correct erroneous perceptions among students about the prevalence and acceptability of these substances significantly deterred the onset of use.

The resistance training program that teaches students ways to resist offers to use substances had no discernable positive impact on use behaviour.

For all three substances, those who received a version of Normative Education as opposed to no normative education, had significantly reduced rates of consumption. For alcohol the strongest effect of normative education was in delaying the onset of ever being drunk.

Adding sex, ethnic and family income as covariates did not change the pattern of results for alcohol and tobacco. However, family income was the only significant covariate for alcohol, tobacco and marijuana. However, including this covariate in analyses actually strengthened the effect of normative education and had no effect on resistance training.

Although the samples were not equivalent across ethnic groups, ethnicity was not a significant covariate nor did it alter the main drug use findings.

The combined program was clearly superior in preventing the prevalence of monthly marijuana use. Resistance training only may have had a slightly harmful effect.

Author's Comments:

• this program was equal to other resistance training programs in content and was well delivered;
• the self-report data reflect reasonably valid responses by subjects;
• speculate that the primary causes of alcohol and drug use have to do with the social availability of and internal expectations about the social acceptability of use of these substances;
• a possible explanation for the failure of the resistance training program in terms of marijuana use is that focusing solely on techniques to resist pressure may actually increase students' perception of prevalence;
• speculate that the success of the resistance training in other trials could be due to norm restructuring even when other mediating processes are thought to operate.

Reviewer's Comments:

Found this study to be a very interesting counterpoint to the studies supporting "resistance skills training". Principles emphasized: there is a focus on covering a number of risk and protective factors; emphasis on the "real" information on prevalence of using various substances; active and creative activities requiring student participation; no booster sessions were incorporated; an intensive 2-week training program for leaders; key programs delivered over a reasonable number of weeks (in comparison to other programs).

Year Program Established:

1987-88 school year.

Associated Studies:

Hansen, Graham, Preventing Alcohol, Marijuana, and Cigarette Use Among Adolescents: Peer Pressure Resistance Training versus Establishing Conservative Norms (1991).

Donaldson SI, Graham JW, Hansen WB. Testing the generalizability of intervening mechanism theories: Understanding the effects of adolescent drug use prevention interventions. Journal of Behavioural Medicine 1994; 17(2): 195-216.

Donaldson SI, Graham JW, Piccinin AM, Hansen WB. Resistance skills training and onset of alcohol use: Evidence for beneficial and potentially harmful effects in public schools and in private Catholic schools. Health Psychology 1995; 14: 291-300.

Hansen WB, Graham JW, Wolkenstein BH, Rohrbach LA. Program integrity as a moderator of prevention program effectiveness: Results for fifth Grade students in the Adolescent Alcohol Prevention Trial. Journal of Studies on Alcohol 1991; 52(6): 568-79.

Hansen WB. Pilot Test Results Comparing the All Stars Program with Seventh Grade D.A.R.E.: Program Integrity and Mediating Variable Analysis. Substance Use & Misuse. 1996; 31(10): 1359-1377.

Harrington NG, Giles SM, Hoyle RH, Feeney GJ, Yungbluth SC. Evaluation of the All Stars Character Education and Problem Behaviour Prevention Program: Pretest-Post-test Effects on Mediator and Outcome Variables for Middle School Students. Health Education Research. In Press.

Program Sponsors:

Staff:

Dept. of Public Health Sciences Bowman Gray School of Medicine Wake Forest University Winston-Salem, North Carolina

Department of Preventive Medicine School of Medicine University of Southern California

Financial:

Supported by a grant from the National Institute on Alcohol Abuse and Alcoholism

Contact:

• William Hansen
  Tanglewood Research, Inc.
  7017 Albert Pick Road,
  Suite D
  Greensboro, NC
  27409
  tel: 336-662-0090