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What Hasn't Worked

The new findings on what is effective in reducing rates of substance use and abuse in young people are especially welcome because for years no one really knew what worked when it came to effective prevention strategies, explains Gilbert Botvin, Ph.D., director of Cornell University Medical Center's Institute for Prevention Research. Many of the prevention programs in wide use today, in fact, have had questionable outcomes or have not been evaluated at all, and may well need to be revamped to be more effective.

Ineffective programs hinge on the assumption, Botvin says, "that kids basically use drugs or smoke cigarettes because they don't know any better." Consequently, prevention programs have been designed to bombard adolescents with information about the health dangers of drug use, he says, but that educational strategy didn't necessarily change kids' behavior.

Lack of knowledge about the dangers of alcohol, tobacco, and illicit drugs is only one of many factors that lead to substance abuse problems among adolescents. In general, most teenagers understand the health and social consequences of drugs, and are not easily fooled by exaggerated claims of danger. Prevention programs that attempt to scare adolescents straight with exaggerated warnings "have virtually no impact," says Botvin. A heavy focus on teaching about the dangers of drugs, he maintains, "is doing nothing more than beating a dead horse." In other words, lack of knowledge is not the problem. Most adolescents know smoking cigarettes is bad for their health, Botvin notes, "yet they continue to do so."

Increase in Smoking

In fact, the campaign against teenage smoking illustrates the kind of problems prevention experts have faced in changing young people's behavior by issuing health warnings.

Nationally, about 34 percent of teens use tobacco, with 25 percent having smoked their first cigarette before age 13. About 80 percent of teen smokers take up the habit before age 18. The National Center on Addiction and Substance Abuse at New York's Columbia University found that the ages at which children are beginning to smoke cigarettes daily, drink alcohol, and use marijuana are all decreasing. A 1997 survey of 1,115 teens between the ages of 12 and 17 found that 23.5 percent of 12-year-olds knew a friend or classmate who had used illegal drugs such as LSD, cocaine or heroin -- a jump of 122 percent from 1996. But other researchers have found that there has been an attitude shift among younger teenagers when it comes to using drugs. In December, the Survey Research Center at the University of Michigan in Ann Arbor reported that drug use among eighth graders has stopped climbing for the first time since 1992. Among 18,600 eighth graders surveyed, 29.4 percent said they had tried an illegal drug such as marijuana at least once in 1997, compared with 31.2 percent in 1996.

But while adolescents may be getting clearer messages about illicit drug use, a flurry of anti-tobacco efforts have not turned them off to smoking as much as public health officials had hoped. In fact, surveys show that, in recent years, teens' attitude towards smoking has become more positive, not less. Another University of Michigan study found that the proportion of teenagers who say they disapprove of smoking a pack a day has steadily declined since 1991. Smoking among eighth and 10th graders jumped by nearly half between 1991 and 1996.

Click for Larger Chart

What Young People Think About Substance Abuse

Click on chart to
see full-size version.

"'Just Say No' strategies are not enough" for drug prevention efforts, particularly for high risk youth, says Karol Kumpfer, Ph.D., president of the Society for Prevention Research. "Knowledge alone hasn't been found to change behavior," she adds.

Another problem with current prevention programs, according to Botvin, is that they may actually be starting when students are too young -- but not followed through appropriately. Many schools that employ prevention strategies start when the students are in fifth grade or so, a developmental stage at which many readily adopt the desired anti-drug attitudes. But as these same students get older and leave elementary school for middle school or junior high, they are increasingly exposed to peer substance use; if they see such use without apparent negative consequences, they may dismiss as overblown the scare-tactic lessons they earlier embraced. Adolescent rebellion also becomes a factor. As one teenaged recovering addict says, "They feed you this 'Just say no' stuff when you're really young. . . . You're impressionable because you're a little kid, so you're all for it. . . . You wear the sticker and buy the T-shirt. [But] the thing they don't count on is that right around thirteen or fourteen, you start to learn rebellion." Botvin says prevention educators would do better to wait until sixth grade, when students are about to enter junior high school, and shape their message to take into account the increased skepticism and anti-authoritarianism of their audience.

Botvin says he hopes that spreading the word about what kinds of programs do work will make prevention efforts much more effective. Part of the problem with drug abuse prevention to date is that schools are not using programs that have been tested, according to Botvin. "The best prevention approaches are developed by researchers, generally in universities," he says, but "there is a wide gap between research and practice." In the real world, schools are selecting prevention programs that have been slickly packaged but never tested, he says. "Schools haven't had access to what works." Helping schools learn about and use these proven approaches is one of the biggest challenges for the prevention arena. "When I first got in the field, the challenge was to find something that worked. The challenge now is to use proven programs," Botvin says.

-- Janet Firshein

Chart: Courtesy of the Robert Wood Johnson Foundation
Source for Chart: The University of Michigan News and Information Service, press release, April 9, 1993.

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