The School as a Prevention SettingThe Experience of Drug Abuse Prevention

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The School as a Prevention SettingThe Experience
of Drug Abuse Prevention

• Zili Sloboda, Sc.D.
• Senior Research Associate
• Institute of Health and Social Policy
• The University of Akron

Tucson, Arizona October 20, 2008
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The source for this presentation comes from
Sloboda, Z., School Prevention, In Leukefeld,
C.G., Gullota, T.P.and Stanton-Tindall, M.
(Eds.), Adolescent Substance Abuse Evidence-Based
Approaches to Prevention and Treatment.
SpringerNew York, December 2008
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Presentation

• 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

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The Beginning of a New Era For Drug Abuse
Prevention

• Up through the 1980sfederal moratorium on
  funding for drug abuse prevention research
• Experience of cardiovascular disease
  preventiontobacco and community-based
  interventions

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The 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

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The Science Base of Prevention

• Epidemiology
• Child development
• Health behaviorssociology, psychology, economics
• Biology and neuroscience
• Intervention development
• Evaluation methodologies

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Two Types of Epidemiologic Studies Contribute to
Prevention

• Descriptive
• Analytic

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Descriptive Studies

• Types of drugs used
• Relationship of legal substances to illegal
  substances
• Ages of initiation
• Trends in rates of use
• Characteristics of drug users

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Analytic 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

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Stancavage Theory
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Risk 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

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Risk 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

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Protective Factors For Vulnerable Populations

• Strong family bonds
• Parental monitoringclear 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

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Other Factors Influencing Drug Use

• Availability of alcohol, tobacco and drugs
• Trafficking patterns
• Beliefs that drug use is generally tolerated

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What Have We Learned from 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

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What Have We Learned from 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

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Applying Epidemiologic Findings 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!

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Applying Knowledge to Prevention Programming to
School Settings
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The School As A Prevention Setting

• 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.

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The School Environment And Prevention Strategies

• School culturenorms, beliefs and expectancies
• School bondingclassroom behavior and academic
  performance
• Classroom curriculum
• School policysocial control

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School 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.

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School Culture Examples

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

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Findings from the Child Development 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

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School 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

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School Bonding Examples

• Seattle Social Development Program--Hawkins
• Incredible YearsWebster-Stratton
• Early Risers Skills for Success--August

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Seattle Social Development Program Observed Mean
Level of School Bonding by Age
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Seattle Social Development ProgramHeavy Alcohol
Use at Age 18
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Early Risers Skills for Success
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Classroom CurriculumUniversal/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 yearsmiddle school and
  high school

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Universal School Curricula Examples

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

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Findings from 4 Follow-up Studies of Life Skills
Training
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Classroom CurriculumIndicated 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

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Indicated School Curricula Examples

• Reconnecting YouthEggert
• Project Towards No Drug AbuseSussman
• Project SUCCESS--Morehouse

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Reconnecting Youth
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Other Findings (7 months post 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

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Project Toward No Drug Use
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School 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

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School 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.

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Drug Testing

• 1995--the United States Supreme Court upheld a
  schools 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

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Effectiveness 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.

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Alternatives to Drug Testing

• Screening for at-risk students
• Examples
• Drug Use Screening Inventory
• Problem Oriented Screening Inventory for
  Teenagers
• Personal Experience Screening Questionnaire

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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

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Focus on Other Types of Prevention Programs

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

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Other Types of Prevention Programs

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

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Other Types of Prevention Programs

• 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.

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Recommendations

• 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