SUBSTANCE ABUSE PREVENTION PROGRAMS - SCHOOL BASED

INTRODUCTION

There has been a recent increase in substance abuse - alcohol, nicotine, marijuana, & other drugs in 8th through 12th graders in the USA.

* Prevention is important because it offers a logical alternative to treatment.

* Schools offer the most efficient access to large numbers of adolescents.

* Evidence exists that substance abuse results from a number of different factors - including cognitive, attitudinal, social, pharmacological,personality, &developmental factors. Social factors are the most powerful influences promoting the initiation of tobacco, alcohol, & drug abuse. Generally one drug is a "gateway" to other drugs.

* During adolescence, the influence of parents is typically supplanted by that of the peer group. Here they shift from a "concrete operational" mode of thinking to a more "formal operational" mode which is more relative, abstract, & hypothetical. This thinking helps them to formulate more counter arguments to antidrug messages. Since adolescents have a sense of immortality & invulnerability they tend to minimize risks related to drugs.

PREVENTION STRATEGIES:

* Supply Reduction by legal means have generally not been very effective.

* Demand Reduction includes education, prevention & treatment programs * Primary Prevention intervention targets kids before they start using.

* Secondary Prevention involves screening and early intervention.

* Tertiary Prevention involves preventing progression & disability.(Rehab)

MAJOR PREVENTIVE APPROACHES:

INFORMATION DISSEMINATION

Increase knowledge of drugs & their effects & damage by instruction, literature, AV or assembly programs. Research has shown no prevention results in drug use & abuse.

AFFECTIVE EDUCATION

Increasing self-esteem & responsible decision making with instruction & experiencial activities - Not Effective

ALTERNATIVE APPROACHES

Youth centers and recreational activities like sports or vocational training- Not effective

SOCIAL RESISTANCE SKILLS

Teaching students specific skills for effectively resisting both peer & media pressures to smoke, drink, or use drugs has been effective. Ex. rate of smoking reduced by ~40%. These programs may use peers & videos to develop resistance skills.

PERSONAL AND SOCIAL SKILLS TRAINING

These approaches use proven cognitive- behavioral skills training methods based on social learning theory & problem behavior theory. They teach generic skills for coping with life & the application of general skills to situations directly related to substance abuse. This training has proven to be very effective.

LIFE SKILLS TRAINING APPROACH

The only prevention approaches that have been demonstrated to have an effective impact on substance use behavior are those that teach junior high school students social resistance skills either alone or in combination with approaches designed to enhance general personal competence by teaching an array of personal and social life skills. These preventive interventions have generally been implemented with middle & junior high school students. There is a need for booster sessions to provide ongoing prevention throughout adolescence.

Personal & Social Skills Training prevention approaches typically teach 2 or more of the following:

* General problem- solving & decision-making skills

* General cognitive skills for resisting interpersonal or media influences

* Skills for increasing self-control and self-esteem

* Adaptive coping strategies for relieving stress and anxiety

* General social skills* General assertive skills.

These skills are taught using a combination of instruction, demonstration, feedback, reinforcement, behavioral rehearsal (practice during class) & extended practice through behavioral homework assignments. The intent of these programs is to teach the kind of generic skills for coping with life that will have a relatively broad application beyond reducing drug abuse.

Most programs have focused on 7th graders but some have started with 6th graders. Program length have been between 7 & 20 sessions with 1 or 2 sessions per week. Most have used adults as primary program providers like teachers, social workers, or program providers. The most studied program was the Life Skills Training (LST) which demonstrated a reduction in new smokers by 42 - 75%. Other studies have shown effectiveness in decrease in alcohol & marijuana use. These studies have been effective for different cultural groups like the Hispanics & Afro-American youth.

Long term followup data from one of the largest school-based substance abuse prevention studies ever conducted found reductions in smoking, alcohol, & marihuana use 6 years after the initial baseline assessment. (Done with nearly 6,000 7th graders from 56 public schools in New York state.) The students were randomly assigned to control or prevention groups. They had 15 sessions of LST in the 7th grade, 10 sessions in the 8th grade and 5 sessions in the 9th grade. The prevalence of cigarette smoking, alcohol use, and marihuana use for the prevention students was up to 44% lower than the controls. (Ref: Botvin GL, et al Long- term followup results... JAMA 1995;273:1106-1112.)