Understanding Prevention and Support in Community Setting: D.A.R.E Program
“Prevention can be defined broadly as policies, programmes and practices designed to reduce the incidence and prevalence of drug use (including alcohol, tobacco, illegal drugs) and associated health, behavioural and social problems.” (Advisory Council on the Misuse of Drugs, UK, 2015)
There is no commonly accepted definition of „drug prevention‟ in Europe. The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) define this as any policy, programme, or activity that is directly or indirectly aimed at preventing, delaying or reducing drug use, and/or its negative consequences such as health and social harm, or the development of problematic drug use (EMCDDA, 2011). This applies to all psychoactive substances, both legal and illegal. Drug prevention activities can target whole populations, subpopulations, or individuals and may address common factors that reduce vulnerability to drug use or which promote healthy development in general. (Warren, 2016)
Prevention of drug use, particularly among young people, is usually a central goal in national policies on illicit drugs, as well as in international declarations and resolutions on drug control. Political leaders and the public usually strongly support drug prevention as a drug policy pillar. Governments and non-governmental organizations in many countries have invested in a wide range of prevention strategies and programs. (Prevention of Drug Use and Problematic Use pg.2)
Reducing harm, supporting recovery (2017) is the first ‘integrated’ drug and alcohol strategy in Ireland. The strategy aims to provide an integrated public health approach to substance misuse. Substance misuse means the harmful or hazardous use of psychoactive substances, including alcohol, illegal drugs and the abuse of prescription medicines. The public consultation, which informed the strategy, highlighted changing attitudes towards people who use drugs, with calls for drug use to be treated first and foremost as a health issue. (pg.7)
The strategy’s vision is for a healthier and safer Ireland, where public health and safety is protected and the harms caused to individual, families and communities by substance misuse are reduced and every person affected by substance use is empowered to improve their health and wellbeing and quality of life.( pg.8)
The EMCDDA classifies prevention types according to a scheme developed by Mrazek and Haggerty (1994). The categories are complementary to one another and replace the previously used categorisation of primary, secondary, and tertiary. This categorisation based on the overall vulnerability of the people addressed – the known level of vulnerability for developing substance use problems distinguishes between the categories, rather than how much or whether people are actually using substances. (Warren, 2016) Universal prevention: Addresses a population at large and targets the development of skills and values, norm perception and interaction with peers and social life. Focus on raising awareness and drug education.
Some of the advantages of the programme:
Some of the disadvantages:
Selective or targeted prevention: Addresses vulnerable groups where substance use is often concentrated and focuses on improving their opportunities in difficult living and social conditions, e.g. Strengthening Families Programme.
Indicated prevention: Addresses vulnerable individuals and helps them in dealing and coping with the individual personality traits, which make them more vulnerable to escalating drug use. There is also interest more recently in environmental prevention, interventions that do not use persuasion to change people’s attitudes and behaviour, but instead use interventions that try to limit the availability of opportunities to use drugs, through national policies, restrictions and actions that affect social and cultural norms, e.g. drug driving policies (EMCDDA, 2011; ACMD, 2015).
Environmental prevention: Addresses societies or social environments and targets social norms including market regulations.
Studies over the past two decades have tried to determine the origins and pathways of drug abuse and addiction – how the problem starts and how it progresses. Many factors have been identified that help differentiates those more likely to abuse drugs from those less vulnerable to drug abuse. Factors associated with greater potential for drug abuse are called “risk” factors, while those associated with reduced potential for abuse are called “protective” factors. However, most individuals at risk for drug abuse do not start using drugs or become addicted. Risk and protective factors can affect children in a developmental risk trajectory, or path. For example, early risks, such as out-of-control aggressive behaviour, may be seen in a very young child. If not addressed through positive parental actions, this behaviour can lead to additional risks when the child enters school. In focusing on the risk path, research-based prevention programs can intervene early in a child’s development to strengthen protective factors and reduce risks long before problem behaviours develop. (NIDA, 2003)
Some important issues concerning the risk factors young people face. (Hawkins et al, 1992)
When risk factors are reduced across family, school, community and for the individual and protective factors enhanced, young people are less likely to develop problems across a range of areas including substance misuse, teenage pregnancy, crime and mental health issues. (Hawkins et al, 1992) Schools are in a strong position to build protective processes.
Life skills are one of the protective factors. Teaching life skills in the classroom has been shown to substantially reduce tobacco, alcohol, and illicit drug use. Life skills work is recommended for all pupils. When aimed at the whole school population, universal programmes will also engage pupils with identified risks.
The Add Health project, a longitudinal study on adolescent health and development found that young people who feel connected to school have better mental health and are less likely to engage in risky behaviours including the use of alcohol and illegal drugs, early sexual activity and violence (Blum et al, 1997). Other researchers have found that pupils respond to efforts to improve academic performance when the feel connected to school.
The risk and resiliency literature emphasise that schools are critical environments for young people to develop strengths and the capacity to adjust to pressure, bounce back from adversity and develop social, academic and vocational competencies necessary to do well in life. Milstein and Henry (2000) specified the protective factors that build resilience and that can be developed within the school setting; positive bonding, clear and consistent boundaries, life skills, caring and support, high expectations and meaningful participation.
A comparative study carried out by the NACD of early school leavers and school-attending students looking at the Risk and Protection Factors for substance use among young people. The study was undertaken in line with Action 98 of the National Drugs Strategy 2001-2008. The study is based on information collected in 2008 during face-to-face interviews with 991 people between 15 and 18 years of age. The target population comprised school-attending students and young people who, having left school, were attending either a Youth reach or
The main findings from the study are hugely important from a policy perspective highlighting as they do the following:
The main goal of any alcohol, tobacco, or drug use prevention program for youth should be to reduce levels of harm, both to the user and to others. The means to this end may be preventing the use of the substance altogether, or limiting or shaping it, or insulating the use from harm. Whatever means the program adopts, the program should be designed based on an assessment of the dimensions of harm related to the substance use in the target population, and measurement of changes in the attributable harm should be included in the evaluation. (Room, 2012)
Several model preventive intervention programs are reviewed, including universal, selected, and indicated programs for schools and families, along with a comprehensive community- based prevention programs (Griffin et al, 2011). Descriptions of the model programs, including information on their primary goals, target audiences, implementation methods, program components, provider training, and evidence of effectiveness, which adapted in part from the SAMHSA Model Program Fact Sheets and the SAMHSA National Registry of Evidence-Based Programs and Policies (NREPP) review of the effectiveness of these model programs are focused on intervention effects on substance use behaviours.
The three programs represent different tiers of prevention: Life Skills Training is a universal program designed for all students in a particular setting; Project Towards No Drug Abuse is a selective program designed for students attending alternative or continuation high schools; and Brief Alcohol Screening and Intervention for College Students is an indicated program designed for college students who are heavy drinkers.
Concerns about the evidence base of programs
The D.A.R.E. (Drug Abuse Resistance Education) program was developed at the initiative of the Los Angeles Police Department for police officers to teach in schools to pre-teen students. (Weiss et al). In its original version, the program was heavily centered on teaching children to “say no” to drugs and had sessions on building self-esteem. The goal was to prevent all use of illicit drugs. The programme was generally very well received by parents, politicians, and the public, and by the late 1990s, about 80 percent of school districts in the http://depts.washington.edu/abrc/basics.htm
United States were using D.A.R.E. They spent hundreds of millions of federal dollars for the program, and it was estimated to be used or closely imitated in over 50 countries. However, numerous evaluations of D.A.R.E. indicated that it had little effect on young people’s drug using behaviour or that the small effect it had dissipated quickly over time.
Remarkably, though the program was widely discredited and criticized in the media, it remained in use in many districts and is still quite widely used in 2015 (Kumar et al, 2013). Many drug prevention experts have criticized the inclusion of poorly evaluated programs among those the United States judges to be “evidence-based.”
The scientific literature on drug prevention programs indicates that there remain many methodological challenges to determining the effectiveness of programs, and there are prominent evaluations in the literature that continue to stir controversy. Nonetheless, there is some consensus with regard to both school-based and mass media programs around a few points:
• To achieve public health goals, drug prevention should focus not only on preventing all use of drugs
• It is not effective simply to scare young people with accounts of the dangers of drugs. Reality-based information that can help them prevents drug-related harms throughout their lives.
• Evaluations of prevention programs suggest strongly that the content of educational programs should be based on formative research that clarifies the particular reality of initiation of drug use and factors influencing continued and problematic use.
• Prevention programs should ideally be thoroughly and independently tested before implementation. (Prevention of Drug Use and Problematic Use pg.16)
Most reviews of prevention programs conclude that combined approaches in a coherent multifactorial strategy improving reality-based knowledge of drug use and drug-related harms, ensuring access to counselling and other services, endeavouring to remove risk factors in schools and other places where young people congregate, improving parents’ capacity to have reality-based conversations with young people, etc. are likely to be more effective than only providing information or building skills of young people.
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