Best school drug prevention programs teach life skills, studies find

Programs that teach middle-school students how to resist peer pressure, to become more assertive and to make better decisions are the most successful kind of drug use prevention programs in schools, according to a new review of recent studies.

Other programs that focus mainly on giving students information about drugs or building self-esteem are less successful, according the review’s lead author, Dr. Fabrizio Faggiano of the University of Piemonte Orientale in Novara, Italy.

“The review produced a consistent pattern of results. Programs based on life skills are the most effective in reducing drug use,” Faggiano says.

Faggiano and colleagues concluded that among potential marijuana users, one of every 33 students would stay away from marijuana after participating in a skills-based antidrug program. The authors looked at 29 randomized controlled studies involving 7287 students and found that five of every 33 students used marijuana.

“Of this, one would be prevented by the intervention, which corresponds to 20 percent of new users,” Faggiano says.

The review appears in the April issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

Most of the studies included students in the sixth and seventh grades, with some studies including older high school students. In most of the studies, the effects of the antidrug programs were evaluated one year after they were introduced to students.

Many of the programs taught life skills like avoiding peer pressure and better decision-making with interactive techniques like role-playing, and the teachers were often educators from outside the school. Few of the programs offered a “booster” or follow-up program after their initial run at a school.

Faggiano and colleagues found that knowledge-based programs that taught children about the physical and psychological effects of drugs improved the children’s knowledge of drugs but did not change their likelihood of trying drugs. Programs that focused on the psychological causes of drug use, such as low self-esteem, also improved drug knowledge and decision-making skills, but did not affect drug use.

DARE, or Drug Abuse Resistance Education, is probably the best-known school-based drug prevention program. In its early years, DARE used a knowledge-based program where police officers and outside educators lectured students about the potential dangers of drugs, according to Michael Roona, a researcher and DARE adviser who has conducted analyses of school-based drug prevention programs for the Robert Wood Johnson Foundation.

Roona says DARE switched to a more interactive, skills-based program after studies in the early 1990s questioned the effectiveness of the original program.

School-based drug prevention programs are popular because they aim to reduce a person’s first use of drugs, and some researchers believe that early experimental use of drugs leads to increased regular drug use and addiction.

This “gateway theory” of drug addiction suggests that drug use “may follow culturally determined steps. Hard liquors and tobacco, for example, are viewed as intermediate between beer and wine and marijuana, while marijuana is a stepping stone to other illicit drugs,” Faggiano explains. Faggiano notes, however, that the gateway theory “is not universally accepted.”

The studies were conducted over the past 20 years, in schools not named by the authors, in these regions: Boston and southern New England, New York City and suburban New York State, the Lexington-Fayette metropolitan region of Kentucky, the Charlotte-Meckelenburg metropolitan region of North Carolina and rural North Carolina, northwestern Arkansas, northern Illinois, Milwaukee, Wisconsin, southwestern Virginia, Los Angeles and Orange County, northern and southern California, Oregon, South Dakota, and Albuquerque, N.M.

Faggiano’s research for the review was supported in part by the Italian National Fund Against Drugs.