Drug education approaches in secondary schools

Prevention Research Evaluation Report Number 3 November 2002 Drug education approaches in secondary schools by Dr Lena Sanci, Associate Professor John W. Toumbourou, Ms Vanessa San, Mr Bosco Rowland, Dr Sheryl Hemphill and Mr Geoff Munro Editorial Assistant: Ms Colleen Farrell Introduction The current literature evaluating drug education in secondary schools shows examples of programs achieving positive behavioural changes. According to those working in the field, the resources and strategies for effective drug education appear to be emerging gradually in Victoria. Despite evidence of progress, interviews with practitioners in Victoria suggest that many are pessimistic about whether behavioural changes can be achieved in the absence of a framework for evaluation. This third report in the series of Prevention Research Evaluation Reports aims to facilitate access to the growing knowledge of drug education approaches in secondary schools. The first part of this report reviews the technical evidence for the effectiveness of drug education. The second half reports on a consultation examining practitioner s views on current practice in drug education in Victoria. What is drug education? In this report, drug education refers to efforts to reduce drug-related harm through the delivery of a structured social-health education curriculum within the school context, usually by classroom teachers, but in some cases by visiting professionals. PART 1 THE EVALUATION EVIDENCE Current evaluation literature on drug education in schools There have been two recent and comprehensive critical literature reviews on drug education in schools, conducted in Australia for government departments (Midford, Lenton & Hancock 2000; Midford, Snow & Lenton 2001). Describing the evolution of approaches to drug education in schools since the 1930s to the present, they present the factors that have been shown in experimental trials to maximise the effectiveness of programs in preventing or delaying the onset of drug use and in reducing drug use. Other reviews in recent times present similar conclusions (White & Pitts 1998; Lloyd et al. 2000, Botvin et al. 1995, Hansen 1992). The more successful approaches to drug education have a grounding in the theory of what is known about the causes of adolescent drug use, as well as their developmental pathways in relation to drug abuse and in the psychological theoretical frameworks of social learning and problem behaviour (Dusenbury & Botvin 1990). Since this body of evidence has been established over several decades of research, the authors caution those considering developing drug education programs to base them on what is known rather than what

seems intuitive or ideologically sound. Historically, poorly conceptualised programs have been ineffective or, at worst, harmful; for example, by increasing drug use (Midford, Lenton & Hancock 2000). Factors associated with effective drug education programs in schools (Ballard, Gillespie & Irwin 1994; Coggans & Watson 1995; Dielman 1994; Dusenbury and Falco 1995; Kelder et al. 1994) are that programs should: be research-based/theory-driven deliver coherent and consistent messages present developmentally appropriate, balanced information provide resistance-skills training incorporate normative education educate before behavioural patterns are established relate strategies to objectives address values, attitudes and behaviours of the individual and community address the inter-relationship between individuals, social context and drug use focus on prevalent and harmful drug use make judicious use of peer leadership be delivered within an overall framework of harm minimisation incorporate broader social skills training and be part of a comprehensive health education curriculum employ interactive teaching approaches ensure optimal training and support for teachers provide adequate initial coverage and continuing follow-up in booster sessions be sensitive to cultural characteristics of the target audience incorporate additional family, community, media and special population components ensure fidelity of implementation be evaluated. Explanation of these factors and the papers from which they derive are presented in the review by Midford, Snow and Lenton (2001). Successful approaches to drug education programs For the full discussion and references to successful drug education approaches, readers can refer to Midford, Lenton and Hancock (2000) or Midford, Snow and Lenton (2001), but the main points are reiterated here. Successful drug education programs use either the social influence approach or programs with multiple components. These programs place a large emphasis on social influences rather than on information or approaches that target affective education alone. Affective education approaches in this context refer to programs that address the feelings or mood of the individual. The social influences approach is based upon the belief that young people begin to use drugs because of their self-image and/or social pressures. The social influence approach suggests that, in order to resist substances, young people need to be inoculated with counter arguments and to be well practised in using them. Life Skills Training (LST) is one of the best known and successful of the social influences approaches (Botvin et al. 1990). The social influences approach has been shown to have benefits in reducing other anti-social behaviours, particularly when it incorporates booster sessions at critical points in adolescent development, reinforcing community messages and a parenting component. While the original evaluation studies of LST have produced significant education benefits, Gorman (1996) has warned that many replication efforts have been less successful. Affective education assumes that young people who use drugs have personal deficiencies. This approach therefore seeks, among other things, to help clarify the values and enhance the self-esteem of young people, believing that this will delay or curtail the onset of drug use. But programs based only on Page 2 of 9

affective education have not succeeded in changing behaviour, perhaps because not all young people using substances suffer from personal deficiencies and perhaps because some might be motivated less by pathology and more because they enjoy using drugs. Peer educators and interactive strategies Evidence shows that peer educators can be very effective in prevention education because they operate from a standard of behaviour that young people consider to be an established norm, but only if selected carefully and if wellsupported with management skills from professional teachers. Peer educators need to be credible with high-risk young people, have good communication skills and show responsible attitudes, but at the same time be unconventional (Midford, Lenton & Hancock, 2000). In one review, interactive programs presented by teachers and other leaders, with role-play, discussion and games, were found to produce similar results to peer education (Tobler & Stratton, 1997). It therefore seems that the interactive component of programs is a key factor in effective drug education. Normative information Students have been found to over-estimate the extent to which their own age group uses drugs, miscalculating or misjudging what is the normal level of experience with drugs. In an experimental study comparing different forms of drug education, Hansen and Graham (1991) found that providing normative information on drug use that corrected student overestimation of peer drug use was an effective strategy. In their conclusions Hansen & Graham argued that normative components may play a critical role in activating students to utilise peer resistance strategies. In the absence of a normative component, resistance training appeared relatively ineffective. Timing and intensity of education Timing of prevention education is critical. Programs must develop progressively and sequentially, and they must be ongoing throughout secondary education. It is generally agreed that the best time to begin a program is in late primary school or in early secondary school, when experimentation starts and before young people in high-risk groups leave school early. Program commencement dates, however, need to be adjusted, because the onset time of drug experimentation, as well as the types of drug used, will vary between different populations. There is evidence that most of the successful programs are intensive and longterm (that is, they include booster sessions). Of the soundly evaluated, effective programs reviewed by White and Pitts (1998), most had ten or more sessions devoted to delivery of the program in the first years, and included booster sessions in later years. A very common finding in the evaluation of prevention programs is that effects tend to be evident immediately following the interventions but tend to fall away if further intervention effort is not made in subsequent years. Fidelity of implementation and dissemination As is indicated in this report, there are many factors that appear to influence the potential for drug-education programs to change behaviour. How is drug education carried out by teachers when no specific management programs are in place? In response to 1996 data that teenage drug problems were rising despite advances in best practice drug education, Hansen and McNeal (1999) observed teachers in twelve middle schools in Forsyth County in the United States. They found that the teachers observed focused on Page 3 of 9

information, particularly in relation to the health effects of drug use, and paid minimal attention to resistance skills, clarification of values and normative education. The teachers tended to emphasise alcohol and tobacco and, to a lesser extent, cannabis. Despite having a low rate of usage among students, cocaine was discussed 20 per cent of the time and amphetamines and inhalants were rarely mentioned. The teachers were found to be very individual in their approaches, in the drugs they concentrated on and in the life skills they included. The researchers (Hansen and McNeal) concluded that, if their findings were typical of schools elsewhere, drug education would fail to make a long-term impact on druguse behaviours. Hansen and McNeal (1999) recommended building programs that give full consideration to research-based prevention strategies. They also suggested a focus on increasing teachers conceptual understandings of drug use and prevention and on common patterns in the onset of drug use and experimentation. In addition, teachers needed training in the components of the program that have been chosen specifically for their effect on mediating variables associated with drug use, such that these components are not omitted. It seems that teachers need support and access to good materials to work with, and that this support from a school organisational level would be important. Targetted versus universal (whole-population) interventions Most studies evaluating drug education emanate from the United States, where the focus is on universal strategies to prevent or delay the onset of drug use. There have been few intervention programs targetting young people from different social and cultural backgrounds at different stages of their drug use, despite a growing recognition that intervention effectiveness needs to be evaluated separately in different populations and tailored for different groups (White & Pitts 1998). While there are many studies of drug use in the school aged, there are few studies relating to the progression of drug use into young adulthood and the factors associated with vulnerability and resistance during this time (White & Pitts 1998). Such knowledge of the where, when and why drugs are being used, and the meaning drug use has to the user at different stages, will be necessary in the design of intervention programs targetted at specific population groups. Although more research is needed, the studies that have examined this question tend to find that drug education can be effective, not just for the students who are not using drugs at the start of the program, but also for others who are. The Alcohol Misuses Prevention Study (AMPS, University of Michigan) involved seven lessons in Grade 7 and 8, using roleplay to teach specific rather than universal strategies to resist pressures to use particular drugs. Maggs and Schulenberg (1998) examined the success of the program in altering from early to middle adolescence drinking behaviour, including the direction of alcohol use and misuse, reasons to drink and reasons not to drink. Results indicated that, while AMPS may alter a young person s development with regards to drug use, the effect was modified if the young person had prior experience of unsupervised drinking. For students who had engaged in unsupervised drinking, AMPS slowed down the growth of alcohol misuse and reduced the reasons to drink. The implication was that the program was a positive intervention for students who were at risk of developing alcohol problems later on. The program was also effective in discouraging alcohol use among non-users. The authors suggested that another goal for prevention research might be not to focus on why a particular program worked, but for whom it worked and why. Project ALERT (Bell, Ellickson & Harrison 1993) was reviewed by White and Pitts (1998) because it examined the effectiveness of the program on both young people who were nonusers and also with young people who had already used drugs. Non-users, in the short Page 4 of 9

term, showed more gains than users. In another study (Johnson et al. 1990), however, researchers looked at the effectiveness of the intervention for young people who had prior use of drugs, and found the program equally effective for both groups. Opening Doors, a program aimed at preventing or reducing drug use and deviant behaviour in 167 high-risk young people in transition from primary to secondary school, was assessed by DeWitt et al. (2000). While the follow-up looked only at the short-term effects, participants reported less frequent drinking, cannabis use, non-prescribed tranquilliser use, self-reported theft and improved attitudes towards school. In the list of the possible reasons for the program s success, the authors cite high retention rates during the 12 months of the program, recruitment of community health care professionals to work with teachers, a promotion of warm parent child, peer and teacher relationships, support from the whole school and an emphasis on building life skills. The Opening Doors approach is promising, but due to several limitations in the study (for example, the non-random inclusion of schools) it requires a more rigorous evaluation. Harm-minimisation drug education In contrast to the United States, Australia and Europe have more of a focus on harmminimisation strategies for drug education. Many of the prevention programs from the United States aim for total abstinence from drug use and therefore evaluate the success of programs in terms of a statistically significant delay in onset of use. However, recent Western Australian research (McBride et al. 2000) supports the view that school-based drug education based on a harm-minimisation framework can be effective in reducing alcohol use. Harm-minimisation approaches often introduce students to concepts such as recommended levels for alcohol use and strategies for avoiding contexts where drug use may be harmful. Health education as part of a community approach In some cases, drug education programs are conducted as one component in a broader set of community activities aimed at reducing alcohol and drug use. This type of approach to drug education is appealing, because it links to evidence that drug use is influenced by the cumulative number of risk factors to which young people are exposed. By exposing young people to a wide-range of prevention activities, intervention planners hope to reduce a greater number of risk factors. Project Northland is a well-known community program that has been implemented in Minnesota in the United States to reduce youth alcohol use. As one component of this program, a social-influences, health-education curriculum was provided from Grade 6 through to Grade 9 which demonstrated lower rates of alcohol use (Klepp, Perry & Kelder 1995). These effects tended to decline in the years following, so that by Grade 12 there were few significant effects. These findings suggest that the common observation that educational impacts wane over time may also apply to interventions run in the context of wider community intervention activities. Effectiveness of drug education and the importance of evaluation There is good evidence that school-based education programs, targetting tobacco, alcohol and other drugs and using sociallearning principles, can be implemented with booster sessions in later years. There is also good evidence that drug education programs produce changes, not just in knowledge and attitudes about alcohol and other drug use, but also in drug-use behaviours. The challenge is to ensure programs are informed by current scientific knowledge and adequately resourced to achieve their potential for behavioural change. Part 2 explores the extent to which practitioners in Victoria consider that drug- Page 5 of 9

education practices are likely to achieve behavioural change. PART 2 PRACTITIONER PERSPECTIVES Current practice in secondary school drug education As a complement to the literature review of formal, classroom-based drug education, staff at the Centre for Youth Drug Studies (CYDS) at the Australian Drug Foundation interviewed eleven key informants, namely teachers, consultants and policy developers, in order to identify differing perspectives on the current state of practice in Victoria. An interview schedule of eight main questions was drawn up for each respondent, with each question having a number of sub-questions that were modified as appropriate to the type of practitioner being interviewed. Effectiveness of drug education and evaluation Findings from our interviews demonstrated a number of tensions between the possibilities for drug education emerging from the research and the possibilities articulated by practitioners. Because there is little behavioural evaluation, practitioners in Victorian prevention education remain unconvinced about the possibilities of real change in the behaviour of young people. Interview subjects were varied in their opinion as to how effective drug education is in secondary schools. Teachers and consultants tended to argue that the effectiveness of drug education depended on how effectiveness was defined and measured. If it was defined as an increase in knowledge about drug use, a change in attitude or a diminished number of drug incidents, teachers and consultants judged it to be effective. However, if effectiveness means encompassing change in an individual s behaviour, they argued that it is almost impossible to make a judgement about whether this has occurred. Schools tended to ensure effectiveness of drug education programs by using recognised resources such as Get Real (DESS 1995), Get Wise (Cahill, Stafford & Shaw 2000)and Rethinking Drinking (Youth Research Centre 1997). Interview findings suggest that most secondary school drug education programs are not formally evaluated, nor is there a strong understanding of what is meant by evaluation. Teachers indicated that staff meetings and curriculum reviews were the principle methods used to evaluate their programs. Academics and consultants, on the other hand, believed schools were only evaluating programs at a superficial level. Time and money were the most common impediments to schools formally evaluating their drug education programs. Some practitioners suggested that schools did not consider evaluation to be as important, and begrudge putting time and money into it because it diverted resources from the implementation of the program itself. On a positive note, schools involved with the Department of Education & Training s current Effective Drug Education project were eager to employ the project s final instruments to evaluate their programs. Supervised peer leadership Most interviewees working in schools reported having implemented some form of supervised peer leadership. Some schools reported using specific peer-led programs such as Creating Conversations. The importance of using peer leadership as part of an integrated drug education program was emphasised by several interviewees. Although it was considered an approach fraught with difficulty, most respondents agreed that supervised peer leadership has a place within secondary schools. However, all interviewees argued that peer-led programs required a high level of organisation to get them off the ground, and that participating students needed extensive training before they could act as peer leaders. Even then, the students required further guidance and support from teachers and other school staff. Page 6 of 9

Respondents identified poor programs as those that do not have high quality training, real clarity in terms of why they exist, high level of teacher support, and some resources. As well as organised peer leadership, some interviewees also mentioned the effectiveness of incidental peer leadership Interactive strategies The majority of respondents agreed with the literature that suggests that interactive strategies, such as scenarios, role-plays, group research and classroom discussions, were the most effective way to teach drug education. Teachers and consultants valued these strategies because they get students to process information through the lens of their own experience, rather than something they have just been told (consultant). Despite recognising the value of interactive strategies, respondents also suggested that there were occasions when a didactic approach worked best; for example, in a class in which the teacher or students lacked confidence or where there were discipline problems. Normative information The interviewees tended to agree that it is useful to incorporate normative information in a drug education program, and many are already doing this. Most respondents indicated that normative information aids kids in giving up the myth that everyone is using drugs. Statistics indicating drug usage among students of a similar age group or in an Australian setting have more credibility than statistics about drug use in the United States or Europe. Normative information can be used to contextualise drug use, but it can also be counterproductive or of little benefit if it runs the risk of being interpreted as condoning drug use. It has been suggested that normative information should be presented in a balanced manner, such as young people s drug consumption should be compared with the alcohol and other drug consumption levels of adults. Sequential, progressive continuing programs in Victorian schools To what extent are drug education programs in Victorian schools designed to be developmentally appropriate, progressive and sequential? The teachers interviewed believed that the programs in their schools were, in fact, sequential, progressive and continuing. Consultants were less sure. Put simply, it was suggested that some schools provided sequential, progressive and continuing drug education programs, while others didn t. One consultant said in a sort of nebulous sort of way, they sort of relate to where the kids are at. Using resources like Get Real or Get Wise they employ sequential strategies. Impediments to the implementation of sequential, progressive and continuing programs as recommended by researchers were various, but the main difficulty was that health education was not considered part of the core curriculum. Consequently, there was no agreed or specified curriculum. The problem increases in senior years, when health education is offered only as an elective. Other difficulties cited in maintaining these best practice programs included the high turnover of drug education teachers, teachers feeling unqualified to teach drug education and the deficiency in formal training in the subject. Because of the lack of training, one respondent said teachers felt inadequate, even fearing that the students would know more than they would. Alignment with the individual school drug education strategy All respondents were unequivocal in their emphasis of the positive impact of the Victorian Individual School Drug Education Strategy (ISDES) process on raising the profile of drug education in schools, as well as in the way schools approached drug education. Page 7 of 9

Respondents said the ISDES process emphasised a broader network of support from the Department of Education & Training, by reinforcing the message that schools and teachers were not alone in delivering drug education. Informants to the CYDS interviews agreed that within most government and independent schools the drug education curriculum was aligned with the classroom component of the ISDES. At least 50 per cent of Catholic schools, according to a consultant, were employing the curriculum strategies outlined in the ISDES document. Final comments from Victorian practitioners One researcher said she would like acknowledgment, at a political level, that some students use drugs, and that harm minimisation was therefore a necessity. Many expressed a desire for drug education to be placed in the context of personal development, alongside resilience, connectedness, positive self-esteem, families and individual differences. Other practitioners wish lists included consistency in drug educator training and better evaluation of programs, particularly by making the evaluation process an integral part of the program. Conclusion A number of research studies have evaluated the effectiveness of drug education. Through these studies, critical program elements are gradually being identified. The existing evidence suggests that drug education programs have the potential to contribute to reductions in harmful youth drug use. In order to realise their potential, activities need to be based on appropriate curriculum, be well resourced and integrated within a wider set of ongoing intervention activities. Interviews with practitioners suggest that progress is being made toward establishing an effective framework for drug education in Victoria. Although many of the conditions appear to be in place to achieve effective practice, the lack of evaluation is a critical gap that needs to be addressed. This report was prepared for the DrugInfo Clearinghouse by the Centre for Adolescent Health and the Centre for Youth Drug Studies, Melbourne Page 8 of 9

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