Grading Drug Prevention Programs, Part 1 & 2

Grading Drug Prevention Programs, Part 1 & 2
Posted by FoM on September 07, 1999 at 11:25:29 PT
Johns Hopkins News
Source: InteliHealth
BALTIMORE  Most schools now offer some type of drug prevention program, whether it's a mention in health class or a formal 14-week program. But do they work? How are they evaluated? 
Research recently released indicated that students who enroll in Drug Awareness Resistance Education (D.A.R.E., the drug prevention program used in more than half the nation's schools, were just as likely to use drugs as those who didn't take the program. What makes a program effective, and what should parents and educators look for? In this two-part InteliHealth interview, Harold E. Shinitzky, Psy.D., an instructor in the Department of Pediatrics at the Johns Hopkins Medical Institutions and an expert on drug prevention programs, explains what qualities are needed to prevent drug abuse. He also reminds parents that they play a tremendous role in preventing drug use.InteliHealth: What messages should a good drug prevention program deliver to students?Dr. Shinitzky: Right now, I'm running a research protocol in the Archdiocese of Baltimore school system. Recently, I listened to a student give a presentation about how he had been a good kid but got involved with some really bad stuff, but now he's straightened out and he's a straight arrow again. That had great impact on other students because it came from a peer. Frequently, we hear adults  particularly athletes  come forward and tell us all about their drug use, and they say, "Now I'm clean and I'm a Super Bowl champion." The message adolescents hear is that "this is how you get there  this is how you get to be a Super Bowl champion." The terrible message is that, "this (drug use) is the path they took," and kids will literally follow it.IH: My child's school has the D.A.R.E. program.Dr. Shinitzky: D.A.R.E. is in over 50 percent of the nation's public and private schools. But the results show that youngsters involved in D.A.R.E., as opposed to those not involved, engage in a similar number of inappropriate behaviors or even more inappropriate behaviors. A group of us met with the nation's drug czar General Barry McCoffery and made that point, and he looked across the table at us and said, "Don't even think of touching D.A.R.E." The problem isn't because of D.A.R.E.; it's bigger than D.A.R.E. He said, "I challenge you  I want you all to come up with different programs. D.A.R.E. is in the schools  let's add to it and make it a better program." And that was a wonderful statement. But that brings up the issue: What can we do?IH: What can we do?Dr. Shinitzky: Part of my role at Hopkins is to go and develop needs-specific prevention programs for schools and community groups. These are based on best-practice programs, programs that have been shown to be effective in decreasing drug use, delaying drug use and increasing bonding with school and family. We take from the best practice models and create these hybrid programs.IH: When should kids have a drug prevention program?Dr. Shinitzky: Ideally, it's before you think they should. The average age of experimentation, of first use, is 12 . Pretty scary, isn't it? We had a 9-year-old brought into the ER. His dad was a heroin addict who injected him with a combination of cocaine and heroin known as a speed ball, for his birthday. A lot of children in the third or fourth grade are exposed to this because their parents or older siblings are using. Statistically, one out of 10 people in this country have a drug or alcohol problem, and one out of four people know someone with a problem. Children who come from families with substance abuse are more likely to develop a problem. We need to address these issues before they become a problem. But there are some other statistics I like to stress. Seventeen percent of eighth-graders used marijuana last year. I'd like to emphasize that means that 83 percent of eighth-graders didn't use marijuana. Twenty-one percent used illicit substances; that means four out of five didn't. Nine percent of 8th graders smoke daily, but that means 9 out of 10 don't smoke daily. Parents say, "I worry about peer pressure." I want to use peer pressure to get to the kids, because the majority of the kids don't use. The prevalence of drug use has dropped since the 1970s, which were kind of the peak years. But the use doubled in the last seven years, since 1991 and 1992. The Office of National Drug Policy allocated about $195 million for drug prevention policy. Since then, we've seen a halt in the increase, and the numbers are stabilizing and, for most of the substances used by eighth- , 10th- and 12th graders, there's been a decrease. That's thanks to successful prevention programs.In part two of this interview, Dr. Shinitzky discusses what is necessary for a successful prevention program and the crucial role parents play.Copyright The Johns Hopkins University, 1999. All rights reserved. This interview is not intended to provide advice on personal medical matters, nor is it intended to be a substitute for consultation.September 6, 1999 Hopkins Q&A: Grading Drug Prevention Programs, Part IIInformed opinion from America's foremost health institutionJohns Hopkins University and Health System BALTIMORE  Recently published research indicates that students who enroll in Drug Awareness Resistance Education (D.A.R.E.), the drug prevention program used in more than half the nation's schools, were just as likely to use drugs as those who didn't take part in the program. What makes a program effective, and what should parents and educators look for? In this second part of an InteliHealth interview, Harold E. Shinitzky, Psy.D., an instructor in the Department of Pediatrics at Johns Hopkins and an expert on drug prevention programs, explains what ingredients are necessary for an effective drug prevention program and the crucial role parents play.InteliHealth: What makes a successful prevention program?Dr. Shinitzky: There's a wonderful article by Linda Dusenberry that summarizes the components of successful prevention programs. She describes several key points. First of all, whatever intervention you're doing, it needs to be research-based. There are a lot of nice programs out there that put together glossy material. They're "feel-good" programs, but there's no evidence that they work. So it needs to be research-based. Second, it needs to be developmentally appropriate. High school programs are more verbal, programs for younger students have more activities. Another area that's very important is social resistance skills training, and that's a variety of peer refusal. Remember back in the 1980s and Nancy Reagan's "Just Say No"? Well, that didn't work as a stand-alone intervention. If someone is in the position of having to say no, it's already too late.IH: What else makes a successful program?Dr. Shinitzky: Normative education. The majority of youth do not use. When you hear someone say, "Well, everyone's doing it, everyone's using," that's because birds of feather flock together; so maybe in their small social circle everyone is. But everyone else isn't. Also, the program needs to stress broad-based skills, which are certain theoretical constructs such as assertiveness, decision-making, goal-setting, conflict resolution and communication skills. Those are all broad-based interventions. In whatever program is out there, they need to work on those concepts. They need to make good decisions based on good decision-making skills, and they need to be able to set long-term goals. The next point is interactive techniques. We use role-playing, role-reversal, multimedia stimulations and peer discussions. The program should be very interactive. People refer to these as "theory-based, activity-driven." For example, we know youngsters with better self-esteem do less drugs; so let's do an activity that promotes self-esteem. Teacher training and support are necessary. Let's have teachers facilitate, but give them training and support. Finally, the program needs adequate coverage and support. It's not just one afternoon when you say, "Here's McGruff the Crime Dog  don't do that." You also need follow-up; a lot of these programs only evaluate at the end of the program. They might, say, ask kids to name four characteristics that will keep them from using drugs. Say before the intervention, the kids name two, and then after 12 or 14 weeks, they can write down five characteristics, and we say, "Yeah, it worked." But six months or a year or five years after the program there's no follow-up, and the kids forget everything they learned.IH: Anything else?Dr. Shinitzky: The programs need to be culturally sensitive. Here at Hopkins we've created a program that includes the seven principles of Kwanzaa: unity, cooperative economics, self-determination, collective work and responsibility, purpose, creativity and faith.IH: So what program do you recommend?Dr. Shinitzky: The most elegant program is Project STAR, which stands for Student Taught Awareness and Resistance. It was developed by Mary Ann Pentz at the University of Southern California.IH: What makes it so good?Dr. Shinitzky: The programs should try to address as many different domains as possible in a youngster's life. There are five domains: What are the issues for the individual? What's going on with the peer group? What's going on in the family? What's going on in the school? What's going on in the community? Those are the five areas. When I do an intervention, I address those areas. STAR hits all of them. It's impressive.IH: Any other programs?Dr. Shinitzky: Probably the best known, and one that has more than five years of research outcomes, is Life Skills Training, created by Gil Botvin at Columbia University. It's a universal intervention. Many school districts throughout the country are implementing this program.IH: You mentioned that D.A.R.E. doesn't produce the desired results. Could a poorly done drug program cause damage?Dr. Shinitzky: Yes. Some programs bring in ex-users to speak to students, and it seems to glorify it. I mentioned the "feel-good" programs that look nice and make the schools feel good because they can say they've done something. It gives a false sense of security. We need to be really vigilant.IH: Where can educators find more information on these programs?Dr. Shinitzky: The National Institute on Drug Abuse developed a packet of material called NIDA Goes To School. That was supposed to be sent to every school, and you could request it. Also, I wrote an article, "Substance Abuse in Children: Prediction, Prevention and Protection," that was published in the October 1998 issue of the Archives of Pediatric and Adolescent Medicine.IH: What did your research protocol show?Dr. Shinitzky: The two schools were comparable prior to the intervention. At the completion of Project Champions, the intervention school did not achieve any differences. "Bummer." But when we compared the intervention school to the control school, there were statistically significant differences. But when we looked at the control school, we noticed that when it came to family relationships, kids really slipped off the edge, especially in freshman year. In the Project Champions school, we found that the value kids placed on family relationships and on moral values stayed the same before and after the intervention. They valued their parents opinions, and the parents knew where their kids were. In comparison, at the control school, the message from the kids came across as "My folks don't know where I am, and they don't care." Project Champions forestalled the natural decrement that we see in adolescents. We're continuing to research this project.IH: How can parents be involved?Dr. Shinitzky: Students report the place of least use, the place where drug use happens least, is in the school. The second least is at home. Where it happens most is at a friend's house. When students who have substance abuse problems were asked about how their parents monitored them, ranging from high to low, 68 percent of kids who binge drink reported that their parents are low monitors. Parents play a tremendous role, a huge role, in what's going on in their children's lives.IH: One question that parents  particularly those of a certain age  wrestle with is: Should I tell them about my own drug use?Dr. Shinitzky: That's a real easy question, and it's such a misleading, red herring issue. When we say, "I did, but now I want you not to," what kind of a double standard is that? These parents bring this up, but they don't bring up all the other stuff they did back then. Kids need to hear a consistent message. There were times in our country and culture when things were different than they are now. The substances now are more potent and they are more addictive. We didn't have crack cocaine back then, or crystal methamphetamine. Kids now are sucking on the whipped cream can, and using substances such as Wite Out or Liquid Paper or any of the things you have under your sink. One of the most abused is whipping cream cans, where kids press the nozzle enough so that the cream doesn't come out but the propellant does. Go into any 7-Eleven on the weekend, and you'll notice they're sold out of whipped cream. Then there's the date-rape drug, Rohypnol, known as "roofies," which is odorless and colorless and can be put in any drink. It's more sedating than Valium, and causes short-term memory loss for a half an hour before it was given, and you're in a fog for about eight hours.IH: What should parents do when small kids ask if they can taste the wine or a beer?Dr. Shinitzky: From the writings of the Bible to the next presidential election, someone will hoist the fruit of the vine. And it's OK if it's understood that this is for a special occasion. But there are a lot of adults, like the CEO who closes deals with a brandy and drinks at lunch and has a cocktail when they come home, who self-medicate all day. And there are a lot of adults who watch sporting events and slap 'em back down. If you condone that, you're setting an example for your children. But there are more people in society who use than who abuse.IH: Are prevention dollars well spent?Dr. Shinitzky: For every dollar you spend on treatment, you save $7 to $12 on incarceration and lost productivity. For every dollar you spend on prevention, you save $4 to $5 on treatment. The Office of National Drug Control Policy last year allocated $195 million to prevention efforts. The comprehensive long-term prevention programs are beginning to show promising results. We need to continue our efforts. It is vital to be aware that through the implementation of prevention programs with children, we have the opportunity to touch the future.Copyright The Johns Hopkins University, 1999. All rights reserved. This interview is not intended to provide advice on personal medical matters, nor is it intended to be a substitute for consultation.September 7, 1999 InteliHealth
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