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The most consistent feature of workplace drug prevention programs has been

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Chapter 17


Preventing Substance Abuse


Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction


or distribution without the prior written consent of McGraw-Hill Education.


17-*


Possible aims:


Prevent all drug use including alcohol use?


Prevent drug abuse and its associated harms?


Drugs have always been a part of our society


The relative number of people who have problems with legal drugs is small


Because prevention efforts are focused on teaching people how to coexist with these drugs


Can we do the same with illegal drugs?


What are We Trying to Prevent?


Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction


or distribution without the prior written consent of McGraw-Hill Education.


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Traditional approach


Presentation of negative information about drugs in schools


Goal of approach


Prevention of drug use


Evaluation of effectiveness


How many students used drugs in the future?


Until the early 1970s, most drug prevention programs were not evaluated


Defining Goals and Evaluating Outcomes


Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction


or distribution without the prior written consent of McGraw-Hill Education.


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Primary prevention


Aimed at young people who have not yet tried drugs


May encourage abstinence but may arouse curiosity


Secondary prevention


Aimed at people who have experimented with drugs


Goal: prevention of use of more dangerous drugs


Example: colleges encouraging responsible use of alcohol


Tertiary prevention


Aimed at people have been through drug treatment


Goal: relapse prevention


Prevention: Public Health Model


Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction


or distribution without the prior written consent of McGraw-Hill Education.


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Efforts are categorized based on target population:


Universal prevention


The entire population


Example: community, school


Selective prevention


High-risk groups within a population


Example: students doing poorly in school


Indicated prevention


Individuals who show signs of developing problems


Example: adult arrested for a first DUI offense


Prevention: Continuum of Care


Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction


or distribution without the prior written consent of McGraw-Hill Education.


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Knowledge-attitudes-behavior model


Affective education


Anti-drug norms


Social influence model


DARE


Prevention Programs in Schools


Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction


or distribution without the prior written consent of McGraw-Hill Education.


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Programs typically involved presentations by police, former drug users, or pharmacologists


Often included traditional scare tactics and/or pharmacological information


Assumptions of the approach


Increasing student knowledge about drugs will…


Change their attitudes and these changed attitudes will…


ecrease drug-using behavior


Knowledge-Attitudes-Behavior Model


Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction


or distribution without the prior written consent of McGraw-Hill Education.


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1970s: model began to be questioned


Research findings


Students with more knowledge about drugs tend to have more positive attitudes about drug use


Early prevention efforts were:


Effective in increasing knowledge about drugs


Ineffective in altering attitudes or behavior


Concerns raised that drug education programs were increasing drug use


By teaching students about drugs that they otherwise wouldn’t have been exposed to


Knowledge-Attitudes-Behavior Model


Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction


or distribution without the prior written consent of McGraw-Hill Education.


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Affective domain focuses on emotions and attitudes, which may underlie some drug use


Examples:


Students may use drugs for excitement or relaxation


For feelings of power or control


In response to peer pressure


Drug use may be reduced by helping children


To know and express their feelings


To achieve altered emotional states without drugs


To feel valued and accepted


Affective Education


Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction


or distribution without the prior written consent of McGraw-Hill Education.


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Values clarification


Teaching students to recognize and express feelings and beliefs


Assumes students have factual information about drugs


Emphasis placed on generic decision-making skills


Alternatives to drugs


Assumes students might take drugs for the experience


Emphasis on alternative nondrug activities that give “natural highs”


Personal and social skills


Assumes drug use is in response to personal or social failure


Emphasis on communicating with others and providing success experiences


Affective Education: Concepts


Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction


or distribution without the prior written consent of McGraw-Hill Education.


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In the 1980s, there were growing concerns about affective education approaches


Not enough emphasis on acquisition of skills needed to resist interpersonal pressures to start using drugs


Two new approaches were developed in response to these criticisms


Refusal skills


Drug-free schools


AntiDrug Norms


Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction


or distribution without the prior written consent of McGraw-Hill Education.


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Refusal skills


Focus on teaching students to respond to peer pressure to use drugs


“Just say no”


Drug-free schools


1986: Federal government began providing direct aid for drug-prevention


Anti-Drug Norms


School policies were designed to demonstrate that the school did not condone drug use


Examples: locker searches, no tobacco use on school grounds


Many of these policies remain in place even though a “drug-free” society is probably unrealistic


Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction


or distribution without the prior written consent of McGraw-Hill Education.


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Image source: © Corbis Images (Image Ch17_12SmokingRefusal)


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Social Influence Model


A prevention model adopted from successful smoking programs


Advantages of education research on smoking prevention programs directed at adolescents


Large enough proportion of adolescents smoke so that measurable behavior change is possible


Health consequences of smoking are so clear that there is consensus that preventing smoking is an appropriate goal


Social Influence Model


Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction


or distribution without the prior written consent of McGraw-Hill Education.


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Training in refusal skills


Demonstrating the kinds of social pressures that peers might use to encourage smoking


Modeling a variety of appropriate responses


Normative education


Students tend to overestimate peer smoking


Presenting factual information about smoking trends


Reducing “everybody is doing it” attitude


Social Influence Model: Key Elements


Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction


or distribution without the prior written consent of McGraw-Hill Education.


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Use of teen leaders


Using older students as role models


Public commitment


Standing before peers and promising not to smoke


Countering advertising


Teaching students to analyze and discover the hidden messages in ads


Teaching how these messages differ from the actual effects of smoking


Social Influence Model: Key Elements


Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction


or distribution without the prior written consent of McGraw-Hill Education.


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DARE = Drug Abuse Resistance Education


Developed in 1983 in Los Angeles


Spread to all states by the early 1990s


Widely accepted initially despite lack of studies supporting its effectiveness


Contains many components of earlier prevention models


Delivered by trained, uniformed police officers


Includes elements of social influence model


Refusal skills, teen leaders, and public commitment


Includes elements of affective education


Self-esteem building, alternatives to drug use, decision making


DARE


Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction


or distribution without the prior written consent of McGraw-Hill Education.


*


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Studies on effectiveness:


1994:


Increased self-esteem


No evidence for long-term reduction in drug use


1994:


Increased knowledge about drugs and social skills


Effects on drug use were marginal


2004:


Review of earlier studies showed program effect is small and not statistically significant


Despite failure to demonstrate a significant impact of the DARE program on drug use…


It continues to be widely used


DARE


Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction


or distribution without the prior written consent of McGraw-Hill Education.


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Some programs based on the social influence model


Demonstrated to have beneficial effects on actual drug use


ALERT


Cigarette experimenters were more likely to quit or to maintain low rates of smoking


Initiation of marijuana smoking among nonusers reduced


Level of marijuana smoking among users reduced


Life Skills Training


Teaches resistance skills, normative education, media influences, and general self-management and social skills


Programs That Work


Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction


or distribution without the prior written consent of McGraw-Hill Education.


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Peer influence approaches


Based on open discussion among a group of children or adolescents


Underlying assumption is that the opinions of an adolescent’s peers are significant influences on behavior


Peer participation programs


Emphasize becoming participating members of society


Often focuses on youth in high-risk areas


May involve activities such as paid community service


Data on effectiveness are not yet available or are inconclusive


Peer Programs


Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction


or distribution without the prior written consent of McGraw-Hill Education.


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Informational programs


Provide basic information about alcohol and drugs and their use and effects


Rationale for these programs is that well-informed parents


Can teach appropriate attitudes


Can recognize potential problems


Family interaction approaches


Families work as a unit to examine, discuss, and confront issues relating to drug use


Programs can improve family communication and strengthen knowledge and skills


Parent and Family Programs


Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction


or distribution without the prior written consent of McGraw-Hill Education.


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Parenting skills programs


Focuses on communication, decision-making, setting goals and limits, and when and how to say no to a child


Parent support groups


Key adjuncts to skills training or in planning community efforts


Parent and Family Program


Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction


or distribution without the prior written consent of McGraw-Hill Education.


*


Image Source: © Simon Marcus/Corbis (Image Ch17_01MotherDaughter)


17-*


Several reasons for organizing prevention programs on the community level


Coordinated approach at different levels can have a greater impact


Drug education and prevention can be controversial


Programs that involve many groups can receive more widespread community support


Community Programs


Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction


or distribution without the prior written consent of McGraw-Hill Education.


*


17-*


Community-based programs can involve many resources, including local businesses and the public media


Communities Mobilizing for Change on Alcohol


One of SAMHSA’s model prevention programs


Community Programs


Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction


or distribution without the prior written consent of McGraw-Hill Education.


*


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All companies and organizations that obtain federal funding have to adopt a “drug-free workplace” plan


Most consistent feature of workplace programs


Random urine screening


Ultimate goal:


Prevent drug use by making it clear through policies and actions that it is not condoned


Workplace Programs


Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction


or distribution without the prior written consent of McGraw-Hill Education.


*


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What needs to be done in a situation depends on the motivations for doing it


Example 1: State requirement for drug education


Most appropriate approach might be a balanced combination of factual information and social skills training


Important to avoid inadvertent demonstration of things you don’t want students to do


Example 2: Widespread concern about a local “epidemic” of drug and alcohol use


Goal would be to organize a community planning effort


Important to avoid negative approaches shown to be ineffective


What Should We Be Doing?


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