Evaluation of Drug and Alcohol Prevention Strategies: DARE and LST

Addiction can be defined as a behavioural process that provides pleasure and relief from internal discomfort, however, it includes a recurring failure to control the behaviour and a continuation of this behaviour despite its harmful consequences. (Goodman, 1990) Addiction to alcohol is an excessive and harmful consumption of alcohol but with tolerance effects and withdrawal symptoms. It differs from alcohol abuse as alcohol abuse is excessive and harmful consumption without tolerance effects and withdrawal symptoms. However, alcohol abuse can often lead to alcohol addiction in the future.

Addiction to alcohol is one of the leading concerns in the world. Research has shown that alcohol is one of the leading causes of death. A study by Stahre, Roeber, Kanny, Brewer, and Zhang (2014) showed that excessive drinking was responsible for 1 in 10 deaths among working-age adults in the United States. This is because excessive drinking is a massive risk factor for many health-related problems. Alcohol consumption is an underlying cause, either entirely or partly, for over 30 different conditions including cancer, diabetes, liver and pancreas diseases and many more. (Rehm, 2011)

It is also worrying that alcohol related deaths have been rising. A study in the UK by Breakwell, Baker, Griffiths, Jackson, Fegan, and Marshall (2007) found that alcohol-related deaths had increased from 4,144 in 1991 to 8,221 in 2004 and in 2016 this rose to 9,214 according to the Office for National Statistics. Alcohol-related deaths have been rising due to the rise in alcohol consumption. Dawson, Goldstein, Saha, and Grant (2015) looked at changes in alcohol consumption from 2001 to 2013 and found that the prevalence of drinking increased, as did the volume and frequency of drinking. It also found that the prevalence of monthly heavy episodic drinking increased among heavy drinkers. These studies show that alcohol consumption and alcohol-related deaths are rising and suggests that more needs to be done to try and reduce this. Research has shown that people tend to start drinking at a young age. Johnston, and Bachman (1998) found that in the United States 54% of 13-14 year olds, 72% of 15-16 year olds, and 82% of 17-18 year olds had consumed alcohol. Thus showing just how young people start drinking alcohol.

Research has also shown that not only do a large amount of people starting drinking during adolescence but a lot of people have alcohol abuse or alcohol dependence during adolescence. Harford, Grant, Yi, and Chen (2005) found that the prevalence of alcohol abuse and of alcohol dependence with or without alcohol abuse was at its highest for the ages of 18-23 years old, this was followed by adolescents aged 12-27 years old. It was also found that alcohol abuse was lowest for those over 50. These results, therefore, suggest that adolescents do not just start drinking during adolescence but also start drinking excessively at a young age.

Therefore these results suggest that adolescents are most at risk of alcohol abuse, which can lead to alcohol dependence and then to addiction. One of the best ways to try and prevent alcohol addiction is by educating adolescents about alcohol abuse as during adolescence is when most people starting drinking alcohol for the first time. The most effective way to do this is by substance abuse prevention strategies. Substance abuse prevention strategies are strategies that attempt to prevent substance abuse, including alcohol abuse. They are usually conducted in schools and aimed at adolescents. These strategies not only educate about the risks of substance abuse but also work on resisting social pressures and decision making in order to help prevent adolescents from abusing alcohol. This is because research has suggested that adolescents may be most at risk of alcohol abuse because of social factors. A study by Dielman, Campanelli, Shope, and Butchart (1987) found that susceptibility to peer pressure was highly correlated with high levels of adolescent alcohol abuse. Thus suggesting that more than just education about the substances is needed.

Currently used strategies include Project DARE (Drug Abuse Resistance Education) and the Life Skills Training Program by Botvin et al. (1984). They are two most commonly used prevention strategies and there has been much research into their effectiveness. Project DARE (Drug Abuse Resistance Education) is a school-based intervention program taught by police officers that was designed to try and eliminate substance use, including alcohol, in adolescents. It focused on teaching peer resistance skills in the form of lectures, workbook exercises and role-playing sessions. (Rosenbaum, Flewelling, Bailey, Ringwalt, and Wilkinson, 1994).

Clayton, Cattarello, and Johnstone (1996) examined the effectiveness of DARE in a study where over 2,000 11-12 year olds were administered DARE. It was found that DARE produced some initial improvements in the student’s attitudes towards substance use, however, these changes did not continue over time. It was also found that there was no effect on actual substance use. In the 5 year follow up it was also found that there had been no effect on actual substance use. This study has shown that DARE was not effective across 5 years.

However, more research had been conducted on DARE to study its effectiveness over a longer period of time. Lynam et al (1999) conducted a study across 10 years and had a total of 1,002 11-12 year old students receive DARE and then re-evaluated them when they were 20 years old. It was found that the participants’ levels of lifetime alcohol use and their positive and negative expectancies of alcohol before received DARE was significantly related to their levels of lifetime alcohol use and positive and negative expectancies 10 years later. This study suggests that Project DARE is not very effective and had no effect on trying to reduce or eliminate substance abuse. This is, however, an outdated study using an outdated version of DARE. Project DARE has been updated over the years and it is possible that a newer version may have been more effective. However, there has not been much change to DARE. The focus and aim of DARE has stayed the same, as well as the program’s method of delivery according to Lynam et al. From the research on Project DARE it is clear that it is not an effective prevention strategy as the results from the studies on it have shown no effective on the alcohol consumption of the adolescents that received DARE.

The more recent and higher regarded prevention strategy is the Life Skills Training Program (LST) by Botvin et al. (1984). It is a school-based intervention program, taught by teachers, that targets a specific set of risk factors for alcohol and other substance abuse. It is a prevention program that aims to reduce the prevalence of substance abuse in younger populations. (Botvin and Kantor, 2000) It is taught across 3 years and uses cognitive-behavioural skills training techniques, group discussions and classroom demonstrations. It consists of three major components, personal self-management skills, social skills, and drug-related information and skills. (Botvin and Griffin, 2004)

A study by Botvin et al (1984) was conducted using 239 students from two public schools in New York that were randomly assigned to experimental and control conditions. The students in the experimental condition took part in 20-session program (LST) that targeted the major cognitive, attitudinal, social and personality factors that are believed to promote early stages of alcohol misuse. The program contained material on general social skills, decision making, coping with anxiety and resisting peer pressure as well as there being information about the short and long-term consequences of alcohol abuse. In the 6-month follow-up the experimental group were contrasted with the control group, which did not receive LST, and it was found that 54% fewer students reported more frequent drinking, 73% fewer students reported heavier drinking and 79% fewer students reported getting drunk at least once per month.

LST has also been tested on its long-term effectiveness, Botvin et al. (1995) conducted a follow up study 6 years after adolescents received LST. They conducted telephone interviews and email surveys on the adolescents 6 years later and found that LST was effective in the long-term, as 66% fewer adolescents used polydrugs (alcohol, marijuana and tobacco) after having received LST. This suggests that LST is not just a good short-term prevention strategy as it has also been shown to be effective over a long period of time. However, the results may not be reliable as the study was conducted using telephone interviews and email surveys to gather results. The participants could have been dishonest in these surveys as substance abuse can be a taboo subject so some of the participants may have chosen to lie about their substance abuse. Also, only 60.4% of those who participated in the original study participated in this follow up study, if all of the original participants did the follow up study the results may have been different. The results of this study, if reliable, do show that LST is an effective prevention strategy.

However, not all research on LST has shown it to be a completely effective prevention strategy. Botvin et al. (1990) found that the LST program had negative effects on alcohol when it was delivered by teachers and with booster sessions. It was found that many teachers did not implement the program according to the correct protocol. Botvin et al. pointed out that this may be because teachers are not sufficiently trained in teaching cognitive-behavioural life skills. Overall, research would suggest that LST is a fairly effective prevention program but that it can be improved and that alterations of the program could make it a much more effective prevention strategy.

From research, it is clear to see that the current strategies are not currently effective enough in preventing alcohol abuse. Project DARE was shown to be largely ineffective and the LST program although shown to be effective in research could be much improved. That these current strategies are not effective enough is also evident through the fact that since these strategies have been implemented in schools there has still been an increase in adolescent alcohol use as shown by Johnston et al. (2018). Their study found that binge drinking rates had increased slightly since 2016, thus suggesting that the current strategies are not preventing adolescents from excessive drinking.

A proposed strategy for the prevention of alcohol addiction is an adapted version of the Life Skills Training Program, which much research has shown to be effective in both the short-term and the long-term. The adapted version of the Life Skills Training involves a number of changes that research has suggested could improve the effectiveness of it.

This adapted version of LST still has the three major components of LST, personal self-management skills, social skills, and drug-related information and skills. However, it will be a more interactive version of LST. Research by Tobler and Stratton (1997) found that drug prevention programs that were interactive were more effective than those that were not interactive. They also found that smaller interactive groups were more effective than larger interactive groups. In line with these results, it is suggested that an adapted version of LST be interactive rather non-interactive. It is also suggested that it be implemented in smaller groups of 10 students instead of it being implemented in regular classes as the research by Tobler and Stratton showed this to be more effective.

Another change that is proposed would be to try and bring more connectedness and rapport to the program. Having the teachers of the groups build rapport with the students could be highly beneficial to the effectiveness of the program. Rapport is built when the students have the opportunity to voice their perceptions with their teacher and their peers. (Brown, 2001) D’Emidio-Caston and Brown (1998) found that focus groups on drug education allowed students to hear the different sides to substance use. They suggested that hearing only one side of the story about substance use can alienate the students that are in most need of help. Therefore, focus groups will be an important focus of the proposed strategy as it will allow rapport to be built between students and their teacher and will help to involve those that are most in need of drug education. Research has shown that rapport building can be very beneficial for a student’s learning. Buskist and Saville (2004) found that students who experienced rapport with their teacher were more attentive, had increased class enjoyment and a higher attendance level.

It is also proposed that the teachers be fully trained in teaching cognitive-behavioural life skills as research by Botvin et al. (1990) suggested that teachers without this training may have been less effective at teaching LST to students. The research showed that many did not follow the correct protocol of LST and did not teach substantial portions of the program. Having all teachers fully trained in teaching cognitive-behavioural life skills should lead to the strategy being implemented with full fidelity. Therefore, this should make this prevention strategy even more effective as Botvin et al. also found that when LST was taught with full fidelity it was much more effective.

In conclusion, it is clear to see that alcohol addiction is a massive worldwide problem and that current prevention strategies have not been successful enough in preventing alcohol addiction. Although prevention programs such as LST are highly regarded and are used in many states in the United States, it has not been effective enough to decrease the levels of alcohol addiction and alcohol abuse. There are many positive components to such prevention programs, however, there is also a lot of room for improvement and the proposed strategy attempts to improve previous drug prevention strategies by making a more interactive version that will improve the connectedness between student and teacher and thus lead to better learning by the students. It also aims to do this by having the teachers fully trained in teaching cognitive-behavioural life skills as this will increase the effectiveness of the teaching and, therefore, should make the strategy more effective. The proposed strategy has taken into account the negatives of current strategies and has attempted to improve them by adding components that research has shown can be effective in teaching and in teaching drug education.

References

• Botvin, G. J., & Griffin, K. W. (2004). Life skills training: Empirical findings and future directions. Journal of primary prevention, 25(2), 211-232.
• Botvin, G. J., & Kantor, L. W. (2000). Preventing alcohol and tobacco use through life skills training. Alcohol research and health, 24(4), 250-257.
• Botvin, G. J., Baker, E., Botvin, E. M., Filazzola, A. D., & Millman, R. B. (1984). Prevention of alcohol misuse through the development of personal and social competence: A pilot study. Journal of studies on alcohol, 45(6), 550-552.
• Botvin, G. J., Baker, E., Dusenbury, L., Botvin, E. M., & Diaz, T. (1995). Long-term follow-up results of a randomized drug abuse prevention trial in a white middle-class population. Jama, 273(14), 1106-1112.
• Botvin, G. J., Baker, E., Filazzola, A. D., & Botvin, E. M. (1990). A cognitive-behavioral approach to substance abuse prevention: One-year follow-up. Addictive behaviors, 15(1), 47-63.
• Breakwell, C., Baker, A., Griffiths, C., Jackson, G., Fegan, G., & Marshall, D. (2007). Trends and geographical variations in alcohol-related deaths in the United Kingdom, 1991-2004. Health Statistics Quarterly, (33), 6.
• Brown, J. H. (2001). Youth, drugs and resilience education. Journal of Drug Education, 31(1), 83-122.
• Clayton, R. R., Cattarello, A. M., & Johnstone, B. M. (1996). The effectiveness of Drug Abuse Resistance Education (Project DARE): 5-year follow-up results. Preventive medicine, 25(3), 307-318.
• Dawson, D. A., Goldstein, R. B., Saha, T. D., & Grant, B. F. (2015). Changes in alcohol consumption: United States, 2001–2002 to 2012–2013. Drug and alcohol dependence, 148, 56-61.
• D’Emidio-Caston, M., & Brown, J. H. (1998). The other side of the story: Student narratives on the California Drug, Alcohol, and Tobacco Education Programs. Evaluation review, 22(1), 95-117.
• Dielman, T. E., Campanelli, P. C., Shope, J. T., & Butchart, A. T. (1987). Susceptibility to peer pressure, self-esteem, and health locus of control as correlates of adolescent substance abuse. Health education quarterly, 14(2), 207-221.
• Goodman, A. (1990). Addiction: definition and implications. British journal of addiction, 85(11), 1403-1408.
• Harford, T. C., Grant, B. F., Yi, H. Y., & Chen, C. M. (2005). Patterns of DSM‐IV alcohol abuse and dependence criteria among adolescents and adults: results from the 2001 National Household Survey on Drug Abuse. Alcoholism: Clinical and Experimental Research, 29(5), 810-828.
• Johnston, L. D., Miech, R. A., O’Malley, P. M., Bachman, J. G., Schulenberg, J. E., & Patrick, M. E. (2018). Monitoring the Future national survey results on drug use, 1975-2017: Overview, key findings on adolescent drug use.
• Lynam, D. R., Milich, R., Zimmerman, R., Novak, S. P., Logan, T. K., & Martin, C. (1999). Project DARE: No Effects at 10-Year Follow-Up. Journal of Consulting and Clinical Psychology, 67(4), 590-593.
• Office for National Statistics. (2016) Alcohol-specific deaths in the UK: registered in 2016. Retrieved from https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/causesofdeath/bulletins/alcoholrelateddeathsintheunitedkingdom/registeredin2016
• O’Malley, P. M., Johnston, L. D., & Bachman, J. G. (1998). Alcohol use among adolescents. Alcohol Health & Research World, 22(2), 85-94.
• Rehm, J. The risks associated with alcohol use and alcoholism. Alcohol Research & Health 34(2):135–143, 2011.
• Rosenbaum, D. P., Flewelling, R. L., Bailey, S. L., Ringwalt, C. L., & Wilkinson, D. L. (1994). Cops in the classroom: A longitudinal evaluation of Drug Abuse Resistance Education (DARE). Journal of research in Crime and Delinquency, 31(1), 3-31.
• Stahre, M., Roeber, J., Kanny, D., Brewer, R. D., & Zhang, X. (2014). Peer reviewed: contribution of excessive alcohol consumption to deaths and years of potential life lost in the United States. Preventing chronic disease, 11.
• Tobler, N. S., & Stratton, H. H. (1997). Effectiveness of school-based drug prevention programs: A meta-analysis of the research. Journal of primary prevention, 18(1), 71-128.