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What Works, Best Practices

• By
• Karol L. Kumpfer, Ph.D.
• Director
• Center for Substance Abuse Prevention

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(No Transcript)
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Substance Abuse Prevention What Works!

• Extent of the Drug Problem
• Tobacco, alcohol, and drug abuse is a serious
  
• health and social problem worldwide.
• Drug abuse has been increasing in the USA in
  
• adolescents since 1992. Last year drug abuse
• increased 27 in 12-17 year olds.
• Tobacco, alcohol, and drug abuse significantly
  
• contributes to rising health care costs and
• societal problems.

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• Good News
• We know how to prevent drug abuse by
• strengthening families, schools, and
• communities.
• Bad News
• Prevention of drug abuse is not easy.
• There are no quick fixes. A media campaign
  is
• not enough.

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Public Health Model Triangle
AGENT/DRUG

INDIVIDUAL CHANGE PROGRAMS KNOWLEDGE
ATTITUDE/NORMS SKILLS
SUPPLY REDUCTION INTERDICTION CROP
ERADICATION POLICY AND LAWS REDUCE
ACCESS INCREASE COST
ENVIRONMENT
HOST/PERSON
SYSTEM CHANGE FAMILY SCHOOL
COMMUNITY
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The Intervention Spectrum for Behavioral
Disorders
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Selective Health Risk Groups
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Source Mrazek, P.J. and Haggerty, R.J. (eds.),
Reducing Risks for Mental Disorders, Institute of
Medicine, Washington, DC National Academy
Press, 1994.
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Prevention Three types of prevention
interventions (Mrazek Haggerty, IOM, 1994).
1. Universal (primary prevention with
general population) 2. Selective (secondary
prevention with high-risk groups, such as
children of alcoholics, inner city youth,
pregnant unmarried girls, etc.) 3.
Indicated (secondary prevention with
identified problem youth already manifesting
a risk factor, i.e., school dropouts,
delinquent youth, youth already smoking or
drinking, etc.)
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U.S. Drug Abuse Prevention Workshop Objectives

• Session IIISubstance Abuse Prevention What
  Works!
• Purpose
• To give participants an understanding of
  effective substance abuse prevention strategies

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The Need for Community Coalitions

• Community coalitions have become very popular
  for health promotion and disease prevention.
• The U.S. Center for Substance Abuse Prevention
  has initiated more than 250 community
  partnerships nationwide.
• Additional AOD community coalitions have been
  implemented by
• 1. State and local governments
• 2. The Henry J. Kaiser Family Foundation

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The Need for Community Coalitions (cont.)

• 3. The Robert Wood Johnson Foundations
  Fighting Back coalitions
• 4. The National Cancer Institute's COMMIT and
  ASSIST tobacco and cancer reduction programs
• 5. The U.S. Centers for Disease Control and
  Preventions Planned Approach to Community Health
  (PATCH) health promotion program

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A Rigorous National Evaluation

• Age Groups Surveyed in the 24 Partnerships
• and 24 Comparison Communities

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Adults are Less Likely to Use Illicit Drugs When

• Living in partnership communities,
• Participating in drug prevention activities,
• Living in neighborhoods safe from drugs, and
• Disapproving of drug use.

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Outcome Evaluation ResultsCharacteristics of
Successful Partnerships
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30 Day Illicit Drug UseMALES
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30 Day Alcohol UseMALES
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Four Steps for Choosing a Research-based
Prevention Program
Step 1 Read Reviews of the Research
Literature Psychology Bulletin article
(Hawkins, Catalano, Miller (1992),
Communities That Care (Hawkins, et al.,
1993), The Making of a Drug-Free America
(Falco, 1993). Drug Abuse Prevention
in Multi-ethnic Youth (Botvin, Schinke,
and Orlandi, 1995).
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Four Steps for Choosing a Research-based
Prevention Program (Continued)
Step 2 Gather Local Data Step 3 Determine
Why These High-Risk Individuals Use
Drugs Step 4 Select the Best Prevention
Intervention
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Step 4.1 Where in the Prevention Continuum
to Intervene? First you
should decide where in the Prevention
Possibilities Frontier or risk continuum you want
to intervene 1. Before there
are any risk indicators with general
population using universal approaches, 2.
Using selective approaches for high-risk groups,
or 3. Using indicated approaches for
individuals already using or manifesting
symptoms of use (dropping grades,
isolation, and antisocial behavior).
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Step 4.2 Which Sites to Focus UponSchool,
Family, Community? Step 4.3 Choosing the
Most Effective Approach
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Peer-focused Prevention Approaches
Final pathway to Drug Use Peer Norms and
Pressure Effective Approaches 1. Peer
Resistance Training 2. Normative
Education. Resistance to peer pressure can be
increased through involvement in peer resistance
training programs which have been shown to delay
initiation of drug use (Dielman, Shope, Leech,
Butchart, 1989 Pentz, et al., 1989).
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Prevention Matrix
The following table provides an overview of
Universal, Selective, and Indicated as defined
by school-based approaches, family focused
approaches, and community based approaches.
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Prevention Matrix (Continued)
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Strengthening Schools, Families and Communities
Approaches

• 1.Information Prevention Approaches
• Programs employing this strategy provide
  awareness and knowledge of
• Pharmacological effects of drugs
• Health, psychological and social
• consequences of abuse
• School and community attitudes, norms,
• legal sanctions, and sanctions
• General health education.

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1.Information Prevention Approaches.
(Continued)
Results 1. Increase students' knowledge
about drugs 2. Impact on decreasing or
delaying use is not known because
most information programs do not
measure behavioral objectives
(Moskowitz, 1983)
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• Information-only approaches to prevention have
• been criticized on the following grounds
• 1. Knowledge Alone May Not Change Behavior
• 2. Youth most at-risk for drug use are school
  
• drop-outs
• 3. The information source often not
  considered
• credible by youth
• 4. Most educational programs too short to
  produce
• behavior changes
• 5. Often drug information is not specifically
  
• designed to match the appropriate local
  cultural
• and ethnic traditions

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Information about consequences may deter
low-risk youth from drug initiation, particularly
with highly addictive drugs or drugs with
well accepted negative effects (e.g.,
designer drugs) Information is helpful to
those living with drug users or to
those wanting to know how to identify
symptoms of drug use, intervention methods,
and referral sources
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Strengthening Schools, Families and Communities
Approaches(Continued)

• 2. Prevention Education and Skills Training
• Programs
• More intensive (more hours per person) than
  
• information dissemination programs
• Cost more per participant

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• 2. Prevention Education and Skills Training
• Programs (Continued)
• Examples
• Life skills training
• Peer and media resistance training
• Classroom or small group sessions
• Peer leader/helper programs
• Children of substance abuse groups
• Parenting and family skills training
• classes
• Youth or adult involvement in design
  and
• implementation helps
  (National Assembly,
• 1994)

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The skills training or social competency
approaches behaviorally train students to resist
pressures to use drugs and to learn social
skills through three different strategies 1)
The Social Influences Approach involving
media persuasion resistance training and
peer resistance social skills training, used
in Project STAR, and I-STAR in the
Midwestern Prevention Project (Pentz 1983
Pentz, et al., 1989) and the DARE
program
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• 2. The Normative Education Approach which
• encourages adoption of norms against
  drug use
• and corrects inflated estimates found in
  youth
• about the number of youth who actually
  use
• drugs (Hansen, 1992 Hansen Graham,
  1991)
• 3. The Life Skills or Social Skills Approach
  (Botvin
• and associates., 1990 (a,b,c)) teach
  youth how
• to communicate, control stress and
  feelings of
• anger or anxiety, restore self-concept,
  choose
• prosocial friends, increase social
  status, and
• resist media and peer pressure to use
  drugs

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Intervention methods 1. Demonstrations
of effective and ineffective
behaviors 2. Trainer demonstrations
3. Participant role plays with feedback 4.
Reinforcement for changed behavior
5. Role Modeling 6. Positive peer group norms
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Results Modest reductions in onset and
prevalence of cigarette smoking, alcohol, and
marijuana use if Interactive classes better
than lectures Peer led classes better than
teacher-led classes Some negative effects in
students who were already using
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Strengthening Schools, Families and Communities
Approaches(Continued)
2. Alternative Programs Including
recreational, sports, cultural, and educational
activities Used with high-risk individuals
because of the increased cost
The theoretical justification is that providing
individuals with "alternative
highs incompatible with substance
use will reduce use.
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2. Alternative Programs (Continued)
Also, some research supports a link between
sensation or thrill seeking personality and
drug use Types Experiential Education
Programs involving wilderness experiences,
ropes courses, mountain climbing, rapelling,
and rafting. Community Service Programs
(removing graffiti or developing community
murals), building homes, and volunteering to
help others (Tobler, 1986)
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2. Alternative Programs (Continued) Examples 1.
Amazing Alternatives was developed by
Murray and Perry (1985). 2. CSAP High-risk Youth
Grants with experiential education
programs Results Effectiveness Unclear
(Schaps and associates (1981)
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Results (Continued) Some alternative
activities (academic, religious,
and active hobbies) decrease use and
others (entertainment, sports, social,
extracurricular, and vocational activities)
promote increased use Critical
ingredient is who youth associate with in the
activities
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Strengthening Schools, Families and Communities
Approaches(Continued)
4. Intervention Approaches Indicated
prevention programs for drug users
or individuals showing mental health
symptoms of risk (e.g., delinquency,
aggression, depression, and other anti-social
behavior) Strategies involve
problem identification, screening
and referrals to special therapeutic
programs
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4. Intervention Approaches (Continued) Examples
Student assistance programs (Morehouse,
1979) Peer counseling programs Parent-peer
groups for troubled youth Teen hot lines and
crisis intervention (Tobler, 1986, 1992)
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Community Based Prevention Interventions
1. Public Awareness and Media Campaigns Results
Media campaigns do affect the community's
social norms when combined with other
community prevention strategies
(Wallach, 1985) In addition, the public
demand for credible information about drugs is
increasing and should be satisfied
by accurate and scientifically
credible messages
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1. Public Awareness and Media Campaigns.
(Continued) Examples The Partnership for A
Drug-free America (1994) reports producing
more than 400 anti-drug ads for their
national campaign worth 1.8 billion in
media donations. They were
recently awarded advertising's
most prestigious award for effectiveness the
Grand Effie
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Community Based Prevention Interventions
(Continued)
2. Youth Development Services. Implemented
in community agencies serving high-risk
youth with the purpose of generally
improving youth development and outcomes.
Many of these selective or indicated prevention
programs are funded with CSAP or local county
or state funds from State Block Grant or
state legislative appropriations.
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Community Based Prevention Interventions
(Continued)
3. Social Interaction Skills Training
Approaches The Botvins Life Skills Training
Program a drug prevention
curriculum implemented in
Philadelphia alternative Scholls was found
to increase knowledge about tobacco and
alcohol use, negative attitudes
toward marijuana use, and decrease
school problems, incidents of
drunker aggression, and legal
problems.
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3. Social Interaction Skills Training
Approaches (Continued) The Smart Moves
Program a drug prevention
curriculum based on the original pear
resistance skills training program was
implemented in public housing projects by
Boys and Girls Clubs. Studies
showed that the presence of crack was lower in
developments served by Clubs with
Smart Moves (Schinke, Orlandi, and Cole 1992
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Community Based Prevention Interventions
(Continued)
4. Mentoring Programs Convey positive
values, attitudes and life skills through a
one-to-one relationship with a positive role
model, who may be a culturally matched
community volunteer, college student, parent,
or business professional, or retired person.
Becoming very popular, currently this
approach is not as frequently used (found
in 14 of the first 75 CSAP
high-risk youth grants), except
as part of a more comprehensive program
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Community Based Prevention Interventions
(Continued)
5. Tutoring Programs Tutoring programs
reduce academic problems by improving
academic achievement. Tutors can be
mentors, college students, grandparents,
professionals, or teachers to tutor students in
school or after school.
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Community Based Prevention Interventions
(Continued)
6. Rites of Passage Programs These programs
focus on 1. Responsibility training, skills
training, resiliency, community bonding, and
spiritual values
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6. Rites of Passage Programs (Continued)
Example The Comprehensive Afro-American
Adolescent Services Project operated
by the University of Cincinnati
included twenty 2-hour rites of
passage discussion groups with community
action projects and entrepreneurial training

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Critical Role of Families

• The family is the social unit primarily
  responsible for child rearing functions.
• When families fail to fulfill this
  responsibility, the entire society suffers.
• Families are responsible for providing
• Physical necessities
• Emotional support
• Learning opportunities
• Moral guidance
• Building self-esteem and resilience

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CSAP Family PEPS (1998)

• Effective Family Intervention Strategies
• 1. Parent training
• 2. Family skills training
• 3. Family in-home support
• 4. Family therapy

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Principles of EffectiveFamily-Focused Programs

• 1. There Is No One Best Family-Focused Program.
• Select Programs Based On
• Ages of Children
• Cultural Appropriateness
• General Level of Family Needs (Universal
• Low Risk Families)
• Specific Family Needs. Different Types of
  Family
• Interventions Are Used to Modify Different
  Risk
• and Protective Factors.

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Strengthening Americas Families Program Matrix
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Thirty-four Effective family intervention
programs can be found on web site www-medlib.med
.utah.edu/healthed/ojjdp.htm or call (801)
581-7718 at the University of Utah Health
Education Department