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Step 2b: Theory

Social skills

Social skills are probably the most important component of social influence programmes. Social skills can lead young people to become involved in rewarding but non drug-using activities and they may become involved in new types of social networks containing low-risk rather than high-risk peers.

Assertiveness

Ability or set of abilities necessary to express our feelings, thoughts and opinions, at the right moment and in a suitable way, without denying the rights of the others. To behave assertively requires the development of some abilities: to distinguish between assertion, aggression and passivity, to express in a sincere way a positive affection and feelings towards other people (positive assertiveness), to show negative reactions, feelings or discord with other people (negative assertiveness), or to express desires and feelings, all this while having analysed the situation and the feelings of the others. As assertive abilities can be increased with a suitable training, many drug prevention programmes include assertiveness training in their components with the objective to help adolescents to maintain their decision of not consuming drugs, even in front of peer pressure.

Instruments: EIB Assertiveness

Communication skills

Examples for communication skills would be for instance ‘cool refusals’ (against cigarette, alcohol, cannabis offers), making compliments, showing empathy, listing capacities, flirting, making contacts, behaving in an unknown social environment (alone at a party, in a new class etc.). There is, for instance, a typical male lack of flirting capacities that explains part of intensive consumption patterns (alcohol/cannabis in order to be able to approach girls). Training in flirting skills is also in Europe now considered a relevant ingredient, while previously this standard content of social skills programmes had always been seen as ‘ridiculously American’ and not much used in Europe.

EU-DAP questionnaire

Peer pressure resistance/refusal skills

Resistance skills training is one of the classical components of life-skills programmes. When applied to drug abuse by adolescents or young adults, it is the notion that peers put pressure on individuals to conform to group norms which may include the illegal taking of drugs. The individual who is the focus of the presumed pressure is seen to be easily influenced and passive in the face of the active pressure. The concept has contributed to the development of primary prevention strategies which have emphasised skills training in refusing offers of drugs (ODCPP, 2000). Recently, there have been doubts and criticism whether this element is really an effective component (Ashton, 2003, Canning, 2004). Another point of criticism is that too strong a focus on ‘peer pressure’ gives the notion that drug use of young people is entirely or to a large extent a matter of the influence of ‘dangerous’ peers, omitting that the selection of (maybe deviant) peer groups, and the feeling of belonging to a certain circle of friends is a more complex and interactive process than just succumbing to the pressure of bad others due to a personal deficit.

On assertiveness

Personal skills

Coping skills

The concept of coping was developed in the 1940–1950s. It refers to a set of cognitive and behavioural efforts that permanently change in order to face specific external or internal demands perceived as overwhelming or overflowing one’s own resources. If these efforts are effective in problem solving, they provide relief, reward, calmness and balance, therefore definitively diminishing stress. An individual must evaluate a situation while confronting pain or even disability, redefining him/herself and modifying her/his short or long term goals (García Rodríguez, Martínez Luna FR).

In order to use this component as an evaluation indicator, see the respective instruments in the Evaluation Instruments Bank:

Tools

Decision making skills

Decision-making programmes teach a process for asking rational decisions about substance use. They typically teach young people a strategy for identifying problems, creating solutions and making choices among alternatives. Making decisions about more general life issues may also be addressed. Decision-making frameworks may or may not be directly applied to an individual’s drug use. Mediating processes that are expected to change as a result of decision making programmes are skills for making rational decisions and the application of rational procedures for dealing with problem situations. Instructional formats may include lectures about decision-making processes, discussions about options, the completion of worksheets or even role playing about decisions and their consequences (Hansen 1992).

Tool: EIB decision making skills

Goal setting

Goal setting programmes teach skills for setting and attaining goals and encourage the adoption of an achievement orientation. There is an emphasis on identifying drug and alcohol use as incongruent with these goals. Goal setting may be placed within a realistic framework of resources, skills, time and rewards. Goal setting programmes use a variety of instructional techniques, including didactic instruction and workbook exercises. Students may complete projects outside of class or may monitor their performance on a variety of goals. There may be rewards for achievement. Students may also be taught to reward themselves for achievement. Goal setting programmes are postulated to effect changes in drug and alcohol use through the development of an achievement orientation and a motivation to strive for achievement. Also mediating the prevention effects are the application of skills for setting and achieving positive life goals. Values clarification approaches may appear similar to, but differ from, goal setting approaches in that goal setting is oriented toward building a specific set of skills whereas values clarification programmes are oriented to setting priorities and ordering life choices accordingly (Hansen, 1992).

Self-efficacy

Self-efficacy is the perception of control over the successful completion of a particular behaviour. It plays a crucial and independent role in shaping behavioural intentions. Use self-efficacy represents the ability to obtain drugs: some adolescents will use drugs simply because they can get them. Refusal self-efficacy represents the ability to resist social pressure to use drugs.

Components addressing self-efficacy have been recommended for use in programmes for older students aiming to increase academic and social competence. For example, a feature of prevention efforts targeted at native American youth is that skills training is often coupled with ‘bicultural competence’ interventions. These teach adolescents coping skills for negotiating between mainstream and native cultures to increase a sense of self-efficacy in both cultures. Research has provided evidence to support bicultural approaches, as young people who received culturally sensitive skills training showed positive changes in drug using behaviour, drug-related knowledge and attitudes, decision-making skills and interactive abilities compared to controls. There is also some evidence for a long-term impact on drug use behaviour.

Self-control

Neurobehavioural disinhibition comprises a cluster of emotional tendencies, behavioural symptoms, and problems in cognitive function that indicate that a child has not adequately developed psychological self-control, a capacity that depends on normal neurological development. The disinhibited child's behaviour is chronically out of touch with the demands of the situation. He or she has a hard time meeting a school's learning requirements and does not relate easily to either adults or peers. He may engage in 'externalising behaviour' or 'acting out', typically through disruptiveness, unprovoked aggression, defiance of authority, or delinquency. His behaviour is also marked by impulsivity and an inability to persist in pursuing his goals.

Components addressing self-control have been recommended for use in programmes for primary school students aiming to improve academic and social-emotional learning to address risk factors for drug abuse, such as early aggression, academic failure, and school dropout.

Tool: EIB Motivation and School Attendance

Knowledge (about drugs and consequences)

Knowledge provision is the most popular content of prevention interventions. The underlying assumption is that people would change their behaviour when they are informed about the extent and nature of harm associated with a given behaviour. Knowledge provision components are mostly based on the health belief model.

On the basis that 'knowledge is power', it is assumed that a lack of knowledge leaves people exposed to substance use, while an awareness of the relevant facts allows them to choose healthy lifestyle patterns. Knowledge about substance use is a mediating variable and is often used as an indicator in outcome evaluation.

Knowledge provision is nevertheless always a necessary (but not the most important) part of effective drug prevention programmes, but the information about substances must be balanced and relevant to young people’s social reality For instance, information on short term and social (including cosmetic) effects — like effects on skin, smell, breath, teeth for tobacco; ridiculous behaviour for alcohol; logorrhoea and lack of aggression control for cocaine — should be more enhanced than long-term health effects.

Value: For universal prevention, information provision alone was not found to be an effective component throughout all studies (Hansen, 1992; Dusenbury and Falco, 1995; Paglia and Room, 1999; Tobler et al., 2000; Tobler, 1992) and can even be counterproductive in the sense that it raises curiosity and therefore initiation into drug use. There are, however differences in the ways of information provision: for example, fear arousal models used within the knowledge-based approaches have been seen as generally ineffective because the message has moral overtones and is not congruent with young people’s subjective experiences — drug use does not always lead to immediate and severe health problems. On the other hand, realistic and factual information provision on dug effects (including legal consequences) appeared sometimes to be effective for consuming or vulnerable youth in selective prevention (in the sense of a harm reduction like approach). However, a recent meta-analysis of prevention programmes for vulnerable young people (Roe and Becker, 2005) found that — as for universal prevention — information-based approaches have also in selective prevention no or low impact on consumption behaviours or attitudes.

Notes: Do not confound information provision on drugs with:

  • information provision and discussion on the real extent of drug use in the population and among peers: normative education
  • information and discussion on the role of industry and publicity messages: normative education

Normative education

Attitudes, normative education and value clarification

Especially for young people, their perceptions of societal normality, for example the prevalence of experimental cannabis use (lifetime prevalence) and of social acceptance (for example risk perception, perceived availability of drugs) play a major role in determining an individual’s values and behaviours

Normative beliefs correcting overestimations of peer use

Addressing normative beliefs means to correct the very widespread belief of young people that drug consumption among their peers is normal and frequent, by providing feedback of survey data showing actual prevalence rates and through guided class discussions on opinions toward substances. Normative education seeks to undermine popular beliefs that drug use is prevalent and acceptable. Highlighting anti-drug social norms and attempting to form non-use norms by discussing alternative ways to achieve the perceived benefits of substance use are further components. Also exposed are the tactics of the alcohol and tobacco advertisements and counter-arguments to those messages are taught (Paglia & Room, 1999). Correcting such misperceptions is potentially a powerful strategy for changing alcohol and drug use among young people. Hansen & Graham (1991), for example, developed a program to manipulate individual normative beliefs about substance use among young adolescents. This program has reduced overall alcohol and marijuana consumption of eighth graders who participated in the program during the seventh grades. In addition to changing individuals' normative beliefs, it may also be possible to do likewise within groups. Norm-referent groups and peer opinion leaders may be appropriately targeted to establish a conservative use norm as part of the group identity.

Normative beliefs are especially important among Cannabis using youth, as they tend to extrapolate the level of use of their immediate peers towards ‘normality’ and therefore to overestimate the prevalence of drug use (Page & Roland, 2004). This might especially happen through processes of (drug-using) peer selection.

Value clarification and cognitive discrepancy

For instance amongst Cannabis users, the symbolic value of Cannabis is connected to positive values as ‘ecological’, ‘pacifist’, ‘natural’, ‘protest against the high-performance, keep-order norms of globalised societies’. Only a few projects, however, contain elements to question and demystify these values and little research literature is available on this issue. See below about demystification. For tobacco prevention, for instance, value clarification is more frequently used by highlighting and discussing the strong cognitive discrepancy of young people … who have on one side strong political and moral opinions and values, e.g. against globalisation, US-imperialism, and for sustainable lifestyles and economies … and support on the other side — while smoking tobacco — exactly one of the most globalised and omnipotent industries in the world.

Myth correction

Some common myths about drug use can lead to misleading beliefs. For example, young people may believe that drug use will create peer group acceptance or help them cope with problems when in reality, drug use can actually prevent them from actively managing these issues. In fact, recent research has shown that these misleading beliefs are a comparatively strong psychosocial predictor of drug use. Listing the logical steps involved in the construction of a drug use myth may help to destroy its impact on behaviour, by uncovering the false parts of the myth.

Stereotyping

A stereotype-oriented lesson may also accomplish a second goal. If high risk youth do not view themselves as being deviant as they assumed others had judged them, possibly, reactions against this stereotype may energize an effort to avoid drug use, as well as portray oneself more favourably. Valuing Life and Health Goals Enhancing the value of life goals can increase motivation for learning adaptive coping.

Tools

Attitudinal perspectives and argumentative reinforcement

An attitude can be defined as a general predisposition that is acquired over time which is used to judge a person, event or situation, and to act accordingly. For example, a young person’s general view towards drug use develops over time but is likely to be as a result of the attitude held by the family or peer group, therefore if the family or peer group have a positive attitude towards drug use it is likely to mean that the young person will hold a positive attitude about drug use, which therefore, can be considered as a risk factor for drug use. To this effect, many prevention programmes have included components that aim to change the attitude towards drug use, while acknowledging that an attitude is an established bias/predisposition that can be difficult to change.

On the contrary, many young people start with negative attitudes to alcohol and drug use, but rarely have to give explanation for their attitudes toward these behaviours and so when challenged, their attitude is easily undermined.

Tool: EIB Attitudes to drug use

Value: There are several indications that normative education and value clarification are very potent components (Sussman et al., 2004, Roe and Becker, 2005, Roland and Page, 2004, Cunningham, 2001, Reis et al., 2000) both for universal and selective prevention. They are, however, not very much used in Europe until now.

Notes: Not to be confounded with peer resistance training or refusal skills, despite being somehow connected. The departure point of normative education and value clarification is not to presume that young people using drugs do this because of being weak and seducible by the peer pressure of dangerous friends. Obviously, there are interactions of peer selection and peer norms. These implicit norms and values are to be questioned and contested in a critical way through normative approaches.

Alternatives to drug use

Alternative-based programmes offer activities that are considered incompatible with substance use. These programmes provide structured activities as well as information about drugs and incentives to participate in alternative activities. Alternative-based programmes may prevent the development of drug use by reducing time of exposure to at-risk situations and by providing the skills needed to pursue healthy activities that are incompatible with drug use. In theory, young people will gain pleasure and personal satisfaction from undertaking healthy and socially acceptable activities, and therefore will not need to resort to drug use. (See ‘Alternatives as delivery method’). However, offering alternative leisure-time occupations by itself has no proven preventive effects.

Value for prevention: the success of alternative-based programmes appears to depend on the type and level of activities involved. For example, it is unlikely that participation in a single leisure activity will affect drug use; however, if leisure activities are integrated into a broader community-based approach, this may have an effect on reducing drug use. The younger people are when they become involved in alternative-based approaches, the more likely they will be to incorporate alternative activities in their adolescent and adult lifestyle. However, alternative-based programmes are typically complex, making it difficult to identify and evaluate the key components of such a programme.

Affective education

Self-esteem components focus on developing individual feelings of self-worth and value. Students are taught to accept and play down failings and difficulties. Self-labelling of failure is discouraged. An appreciation of one’s natural or developed strengths and uniqueness is encouraged. Self-awareness and self-image program topics, while not strictly directed at improving self-esteem, are included under this category. Self-esteem programmes frequently rely on discussion and workbook activities. Group reinforcement of personal qualities is sometimes included (Hansen, 1992).

The concept of self-esteem is further specified into emotional, family-related and academic self-esteem (Martinez et al., 2003).

Value: low for universal prevention, despite its popularity. Meta-analyses of prevention programmes found no influence of self-esteem components in the effectiveness of prevention interventions (see Tobler below, HDA, WHO). Self-esteem itself is not a protective factor against drug use (experimenting with drugs). On the contrary, there is often a positive relationship between self-esteem and initiation into drug use; see Martinez (2003).

Notes:

  • not to be confounded with self-efficacy, which is rather linked to personal skills and social skills
  • the value of self-esteem for selective prevention is not yet clearly established, neither as a component, nor as an outcome variable. There are doubts, however, whether self-esteem programmes can actually raise self-esteem.

In order to use this component as an evaluation indicator, see the respective instrument in the Evaluation Instruments Bank

Regulatory measures — environmental prevention strategies

See a more exhaustive definition of environmental strategies on the prevention section of the EMCDDA website.

Educational prevention measures must be preceded and framed by regulatory policies on legal drugs, as these have an even greater impact on delaying the initiation into use of legal and illegal drugs (Hawks, 2002; Cannings, 2004). Examples are national laws on smoking in public places or workplaces, restrictions on the sale of legal drugs and national norms on alcohol sale as well as local norms on alcohol consumption (depending on time and location).

In most Member States, it is a feasible prevention measure to influence local norms, rules or legal regulations on legal drugs, even if these are different from national laws. In addition, in some countries the local authorities are allowed (within explicit limits) to formulate their own legal arrangements on illegal drugs: examples are coffee shops (NL) and big dance parties (several countries).

Furthermore, the concrete normative setting in schools has an important role. According to Butters (2005) , ‘the likelihood of adopting a certain behaviour may depend on the extent to which that behaviour already exists in a particular environment. Therefore, attending a school with a pervasive subculture and user networks may create an environment in which the temptation or pressure to use becomes overwhelming.’ This illustrates why some Member States insist that all schools have in place drug policies that define procedures and rules about consumption, availability and trafficking of legal and illegal substances in and around school premises.

It is popular to call structural prevention interventions ‘control measures’ or decry them as limitations of civil liberties, but this is distorting reality. The immense economic and political power of the tobacco and alcohol industries means that these measures are necessary to protect young people from mass media and advertising pressure to consume these legal drugs. These industries predominantly and specifically target young people and victimise the most vulnerable of them.

Physical and economic availability of tobacco

The level of enforcement of anti-smoking policies in Member States is highly correlated with the level of adolescent smoking. As tobacco smoking is a good predictor for cannabis use and escalation of its use, this shows the importance of environmental prevention strategies.

Physical and economic availability of alcohol

The regulated availability of alcohol in most countries has meant that it has been the most intensely studied of the psychoactive substances. Changes in its availability, whether effected by lowering the age of its legal availability, decreasing its cost in real terms or increasing the number of outlets from which it can be legally sold, have all been found to increase its consumption.

A variety of measures, including the introduction of random breath testing, the strict enforcement of liquor licensing laws and the adoption of responsible serving practices, have been found to reduce alcohol-related problems in countries with the means to impose such sanctions. Increasing the real cost of alcohol, or at least not allowing its erosion by means of taxation, has been found to be one of the most effective though least popular means of reducing problems associated with alcohol.


 

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The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) is the reference point on drugs and drug addiction information in Europe. Inaugurated in Lisbon in 1995, it is one of the EU's decentralised agencies. Read more >>

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Page last updated: Thursday, 19 August 2010