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Ff3cctivc lhvg Abusc Yrcvcntion 1'rograms
Statement Prepared by
William 13 . Hansen, Ph .D .
President
'1'anglcwood 12cscarch . Inc .
Cletmnona, NC
Lpldcnuology
T)uring ihe past twenty yeare . signiPr :nv prngre.ee ha q haen tnniie anutnw ¢cienlietc ard
pr,lotiuonen ; in understanding the eau :;e : ; and :ullutionx of drus u :;e problems . The primary fact
thilt lta8 DCCtt ICatlleQ f1V111 thls Cx!)CtICItI :C is thal tlie CltallCli$C WC fHGC MhCil a11t1/e5 .1'nl 2 tl/n g
issues is daunting . Those who wish ta become enguRed in prevention and inten•ention must
realir.e that . as current epidemiologic studies attest (Johnston . O'Mallev & Rachman, 1996) .
attempts to change the patterns of drug use result in faiiure at least as often as it results in
sucuess . Afler a decade of funding dedicated to winning the war on druy ;;, the country is
currently experiencing an increaxe in illicit drug use among school age youths . Such a situntion
suggestz that, at a minimum, the solutiuns of the past need to he seriously reconsidered .
Fortunately, additional hope from scientific research, including examples of programs that have
documented sut:eess, is available .
An cpidcntic of illicit drug uvic emcrYcd unlcm- American young pcuplc in thc 19Ci(ln and
continued to expand through the 1970s . Marijuana vras the most popular illegal drug, with use
among high school seniors gaining majority status: in the high school class of 1979, 6(1 .4%
reported having used marijuana (Johnston et al ., 1994) . Use of marijuana peaked around 1979
or 19R(1, and thre dexalde nf Ihe. 19ROc aaw :t nnntiietnnt dr.r.linn tn n point whe;rn nnnmll
prevalence was cut in half, pcing fiom one in two seniors in the class of 1979 to one in four
scttiurs in lltc class uf 1991 . Mvrc rcccntly, thcre ltas bccn a substautial tuntarc+und . llaily usc
ratcs wcttr 3 .6 k, ut 1994 and revcal a trend ot increase that does not appear to tac icvclutg ott .
Onc cvh .ctAncc that. gcncraily increased throughout the 199Oa ic inhalants . Amonv high school
somor„ the annual use rate oUsolvod iIl 1993 was 7 .0%, the higluft eince observations began in
1975 . Utllikc many drugs of abuse, inhalants can hc found in ncarly cvcry homc . garagc, r,nd
otYlcc in America . They can be purchased in f i'ocCry stores, dtug stores . hardware stores and
gas stati[lnS . Inhalant use has seen its greatest incrCaSC atrionG young adolescents .
'1'ho decline in illicit drug use between 1980 and 1990 has been largely attributed to the
VmniUus Anti-Drug Act which pumped hundreds of nlillions of dollars into schools and
communities to ConlbaI iilicit dfll g use . However, two Tacts shotlld bC noted . liirst, the Sian of
the decline in IIlal7luana, alilphCtattllnCs, sedative and tobacco 0.sC predated the expenditure Ot
fcde ral fllllds and continued at about the san1C 1Tttc despite the Infnslon Ot tedCral dollats .
Secund, thr, recent h1151 about in somc fianns of dlvg use corresponded to a period of relatively
high levels of funditlg whcrn programs and training wcro in placc . '1'his is particularly important
givcu uur uudcrstaudittr, aClhc (imc coursc o! drul ; usc Jcvclvputcu/ ; atnvtu; youttts, tltc
I
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proportion of studcnts who use drugs incrcascs gradually bcginning in nriddlc or junior high
schoal, not abruptly at grade twelve or CICCCn . 'lhis SUQgCSTS T118t t11C tUlll about which was
foanally observed in high school seniors in 1991 had its bcgintlings several years earlier .
Prevention
Kcducirtz thc tlczrtatnl Lin' drugs tuust be pait uf a cuttiprchcnsivc natiuual sLnUCLy fur
addressing the nation's drug problems . '!hc goal ot prevention is to delay, deter, or eliminate
the onset of suhslanae use within populations . At the core nl-Prevention programs are,weveral
aeenmplinnc Lh ;u decerve. txmeidersuinn . il iq now widely rer.ngniie.tl thnt prevenlinn prngram .
that are effective have several eunmtnn t'eaturen (Dusenburv and Falcu . 1943) . Primary among
theui is ptugiam liwua . Ptngtmu luwti - the utc .mxa uf tlte piugiaut and whut the lnugaut
attempts Lu chang e - is the most important element of preventive intervention .
The history of prevention suggests that there have been three eras of program develnpment .
The first era can he characterir .ed as being intuiLin-drivien . Intuitive programs predominate in
our schools and communities today . These programs rcl7ect common sense ideas . ideology .
and doing what appears tu he popular or exciting .
The seumd era ctf prosram developement is characlerii .ed by theory-driven pro; rams . These
programz . primarily funded thrnugh research prcijectx sponsored by the National Inxtitute tin
Drug Abuso (NiDA) and the Nationul Institute on Alcohol Abusus and Alcoholivm (NiAAA)
have relied on a comhinatiun of host-discipline theory (i .e . theories in which the program
developer was trained as a student) and intuition (nllen not admitted) to guide program
development . Thus, social psychologists liicused un strategies that reflected the theories of
Ihr.ir di .ciplinn cuch ae Cnr .i :d Ir.nrning Theory (R:mdnra . 14474) nntl Ihe Thenry nfRe;iume,d
Action (Ajzon & 1'ighlicin, 1J78) . Sociologists tbcuscd on Social Control'1'hcory (Hirachi,
19b8), itcscanlrcrs gruuudcd in public lualtlr uscd tlrc Hcalth 13clicf Mutlcl (Rust .7lstuck, ct al,
1S'/ :1) . Prevention pro ;rauuncrs have used assumpttons about cause and clTCct that are uilurctlt
in each of these theoretical perspectives to develop preventive interventions . 'fhc dccadc of the
19RU's witncsscd nutncrnua field trials in which varitius comhinatinna of clcmcntc were
delivered and tong-tcrm follow-up traclanC behavioral cftocts coaiplctcd .
Much ot' what is known about cffcctivc school-bascd cun9cular approaches has been learned
from rescarchcr-nzitiatcd intervention trials .
ltl a recent review, Toblcr and Stratton (in press) have examined four groups of programs :
(a) information programs . (b) affcctivc programs which also included intoiillation cotnponcins,
(c) social influence progratns which also tCndcd to include infortnation, and (d) multiplc
component programs, usually including sontc clcmcnt of all three ofthc previous groups but
Clllphasizitld social influence in coti,jutlct(on with additional effective strategies . '1'obicr and
Stratton (lil press) used means and standard devlatlollS to calculate erfCCt size 4taflshcS for each
of the studica reviewed above . 'lbblcr'a rovicw incrcnscd the number of studics in thc annlysis
arttl cuutluctcd attalyscs on Lwu data scts . '11u: first iucludCd all rcput'tcd studics lur wlnch cLlccl
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sizes could bc determined . '1'hc second included only those studies fmm the larger group that
met methodological standards tor inclusion (adequate follow-up, control groups, ctc .) .
1'ro>:rutns that wcrc primarily informational or affcctivc in nature had relatively small cttcct
sizes . Yrogralns that featured social influences approaclres or included life s~lls approaches in
addition to social nlflucnccs approaches were, in comparison, relatively of'toctivo . Such
prug ralns include PrUject SMALtT' and Pru,Jv

To YatkBranner
Ianptwcoa86tarcA,nc .In.tplLi,h61yU1 raptoo :aw[Ones®j.ae7Lmonea, noa .iix+rm
shown to havc nuniunal potcntialto changc bchavior .
Table I
Correlations lictwccn Modifiable Mediators and 1'hu il
Mediating Variable Alcohol . Tobacco Inhalants Tlllcit
l?sc
I)Ng5
Normative Reliel's -0 .63 -0 .52 -0,38 •U .42
Life Style Compatibility -U .C 1 -0 .56 -0 .38 -0 .37
Comnutmcnt -0 .59 -0 .59 -0 .33 -0 .30
Bclicfs about Conecyucnccs -0 . 55 -U .45 -0 .39 -0 .13
12,csistancc Skills -U 4U -0 .33 -0 .31 -U .25
Goal-setting -0 .?,5 -0 .25 -0 .20 -U .19
iecisinn Skills -0 .24 -0 .24 -U .18 -0 .19
Activities/Alternatives -0 .23 -0 .25 -U .t7 -0 .16
Sclf listcctn -U .19 -0.21 -0 .20 -0 .17
Stress Mana,cntcnt Skills -0 .12 -U .13 -U,13 -U,U7
Sucial!Lilk Skills U .US -0 .02 0 .04 0 .05
Assiatanc,c Skilis 0 .05 U .05 0 .03 0-01
tn the end, success in school-based prevention requires the development of a significant
knowledge base . The importance of this technical capability cannot he trver-emphtu ;ired .
Without it, preventive approaches will fail more often than they succeed . The lact that failure
charactcrizc :r ncariy all nan-resoarch-hascd curriculur approachcv undurycuresthiv point .
Currently, the school-based prevention field is characterized and dominated by individuals and
groups who believe strongly in the value ul'preventitm . More often than not, intuitive
approaches that Lend to he adopted seldom . if ever, achieve prevention goals . No matter how
wide¢pread or pnpidar a prnKram may hr., ellet•tivenev,; in prevenling the inaet uf enh%snre nsrt
and abuse murLL remain the primary and sole criterion by which programs are judged .
The state-of-the-art in prevention programming now clearly favors programs that are datadriven
; programs must tar,;et and change mediating variables that are strongly predictive of
substance use development . Many of the approaches that have been popular in the past .
including huilding self esteem, teachin g g eneric naciai skillti, an d teaching s:pecilic skills such as
stress managcmcnt arc nct likciy to bc cffcctivc in school-bascd prcvcntiou . Yrogrants thar
target thcsc characteristics may fultill othCr IICCdS . but arC not likely Io 17C effective aS
preventive tools .
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