Fear and Loathing in Drug Abuse Prevention (DARE)

from a Course on Drugs & Human Behavior by UMM by Dr. Jeff Ratliff-Crain of UMM

Drug use prevention & education

When talking about drug-use prevention, we need to keep in mind one of the observations that was made earlier-- an absolute drug-free society is not a realistic goal. Far from a cop-out, that observation can lead to more realistic prevention efforts that will do more good than the tactics that would need to be taken to obtain that dubious goal.
GOALS of primary prevention (referring to activities undertaken prior to an individual using):
Reduce use
Delay use in those that will
-- create an environment that will encourage drug-free living
-- sensitize people to the signs/signals/dangers of drug abuse so that treatment intervention occurs as early as possible
-- Most educational programs, programs designed to reduce availability (e.g., law), etc., reflect this type of goal.
In class I asked what your experiences were with drug education. There were many reports of the most typical first response: scare tactics. Tell them all of the physical, social, personal losses that will occur if drugs are used. This is linked to the idea that drug-use is, defacto, wrong; bad; to be punished; unwelcomed. You and society may well see that as true. However, keep the goals of prevention in mind. You're trying to target the highest-risk kids, not the lowest risk. NEED TO THINK ABOUT WHAT THE ANTECEDENTS TO DRUG USE ARE!
So, what are the dangers associated with fear tactics?--
1) inconsistent with what they may see around them.
2) potentially will push higher-risk students away because
a) they, or friends, are already using-- have labeled them as "bad"
b) of who the message is coming from. If feeling outcast already, the message will have little effect.
c) distrust message; lose effectiveness if extreme message can be found false-- lose credibility on all levels. The more gruesome or extreme the message, the more likely this outcome is.
Fear has limited effect-- need to give alternatives and can backfire (if afraid, tend to avoid. If can't avoid supposed source (drugs), discount source of info.
Rogers (1983) Protection motivation theory:
Fear can facilitate change because it induces a motivation to protect the self. To motivate that change in the way desired, the following must be met:
1.The target of the threat must be convinced that the dangers are serious;
2.The target is convinced that the dangers are probable;
3.The recommended actions for avoiding the threat will be effective;
4.The target believes that he/she can actually carry them out.
More recent prevention programs have also been focusing on the other common antecedents to drug-use-- self-esteem, social support, confidence and assertiveness being big aspects. Also, involvement of the community has increased (although involvement of FAMILY is probably the toughest, yet most necessary aspect.)
In class, we focused a bit on DARE (Drug Abuse Resistance Education). Why? Because it is so popularly used in this state and elsewhere. The short summary in the text (Chapt. 17) of the issues surrounding DARE's effectiveness reflects the conclusion stated in class. The worth of this program is of continued controversy. Certainly, it's popular. However, that popularity seems separate from DARE's effects on drug use. I raise it as an issue in class because there are other programs, and the singular emphasis on DARE diverts limited prevention funds and efforts from those alternatives. Don't take my word for it. Here's some links that discuss DARE, drug use prevention, and the alternatives:
A NIDA-sponsored 1996 conference on Drug Abuse Prevention, includes evaluation of programs (such as DARE) and research on components of programs that work: National Conference on Drug Abuse Prevention Research: Presentations, Papers, and Recommendations
(Summary of research that specifically refers to DARE is included can be found in: Prevention Programs: What Are the Critical Factors That Spell Success?)
A summary of a recent longitudinal study (by Donald R. Lynam, and colleagues, at the University of Kentucky):
PROJECT D.A.R.E.: No Effects at 10-Year Follow-up
In contrast to the research reported on above, the DARE web site provides a slightly different view of the program. Although last year they tempered expectations about the program (rightfully stating that no one education program can be expected to, by itself, solve the drug problem), they still provided a very positive and selective assessment of themselves. DARE is in the process of testing a revised program that is designed to deal with many of the criticisms leveled against it. It is of some concern that the existing form of DARE continues to be promoted and used when other programs with better research support exist. Overwhelmingly, people feel good about DARE and wish to keep it. Is that enough to have it be the cornerstone of our drug education programs?
The DARE home page: http://www.dare-america.com/index2.htm contains updates regarding the program, testimonials, merchandise, etc. They do discuss the ongoing research for the new program. However, they also still promote 'DARE classic' and fail to acknowledge the program's effectiveness regarding youth drug use. A telling example is this item included on their "research and evaluations" page http://www.dare-america.com/home/Resources/Story1eb3.asp?N=Resources&M=16&S=43
D.A.R.E. works…and we can prove it!
Illinois D.A.R.E. Assessment2001
Author: Dr. Joseph Donnermeyer, Ohio State UniversityMethodology: A comprehensive assessment of D.A.R.E. in Illinois, which included D.A.R.E. students and various "stakeholder" groups including: Parents, Teachers, Principals, Officers and C.E.O.'s of law enforcement agencies. 1,500 D.A.R.E. students were given both pre and post tests as part of this study.Findings: Teachers surveyed gave an over-all rating of the D.A.R.E. program in the good to excellent range of 97%. D.A.R.E. effectively teaches children to say no to drugs and violence according to 92.8% of parents surveyed. 94.5% of parents recommend the D.A.R.E. program be continued based on their child's experience. 86% of principals surveyed believe students will be less likely to use substances after the D.A.R.E. program.
This research only notes DARE's popularity and public perceptions. Although potentially useful tools for a prevention program to capitalize on, there is nothing about the program's effects on actual drug use.
They do also note a published study showing that knowledge about smoking's dangers was positively correlated with not smoking among youth, and that DARE students were among the more knowledgeable. However, their selection of articles is selective. For example, a recent meta-analysis of DARE's effectiveness (combining results from various studies on DARE and student drug use) concluded the following:
West, S. L., & O'Neal, K. K. (2004). Project D.A.R.E. outcome effectiveness revisited. American Journal of Public Health, 94(6), 1027-1029.
From the abstract:
Objectives: We provide an updated meta-analysis on the effectiveness of Project D.A.R.E. in preventing alcohol, tobacco, and illicit drug use among school-aged youths. Methods: We used meta-analytic techniques to create an overall effect size for D.A.R.E. outcome evaluations reported in scientific journals. Results: The overall weighted effect size for the included D.A.R.E. studies was extremely small (correlation coefficient=0.011; Cohen d=0.023; 95% confidence interval = -0.04, 0.08) and nonsignificant (z=0.73, NS). Conclusions: Our study supports previous findings indicating that D.A.R.E. is ineffective.
The revised DARE holds some promise. However, until that promise has been proven, it's important for communities and individuals to be aware of the limitations of DARE or any one, single approach to drug education and prevention. Popularity should not be a major criteria for a program's selection and we should be open to exploring other or additional prevention programs rather than relying so heavily on single feel-good measures.
So, what makes an effective program? Several qualities were noted in class. Two overriding principles were noted:
Be research-based and theory-driven.
Integrate multiple areas of person's life (broad-based and integrative). Doomed for failure if restricted to classroom.
In dealing with the information provided, the following were noted:
Give developmentally appropriate information.
Include normative information.
Include adequate and sufficient follow-up.
Make non-use and non-users seen as attractive role-models (and that means attractive to the target audience, not some grown-up 'ideal').
Techniques for providing the information included:
Use interactive techniques.
Be aware of social and cultural factors in the issues raised and techniques used.
Appeal to both genders.
Focus attention on the participants, to make it personally relevant.
Actively involve parents and families.
Interact with community.
There are many others-- these are the biggies, however.
Reference back to the Psychological portion of this course reminded you that consequences that are proximal and certain will have greater impact on motivations. A drug prevention strategy that focuses on diseases that might occur 30-40 years from now won't affect motivation for what will happen after school today.
Further, the attitudes and beliefs that drug education are designed to affect only address a part of the decision-making process. Remember the role of norms and perceptions of control or self-efficacy. Also, while it might appear that one can easily control whether to begin use of a drug or not, part of perceived control over that behavior involves the extent that the person sees appropriate and attractive alternatives for use. Refer back to the Psychological Factors notes for a refresher on theories about use.