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Step 3: Theory

Alternatives

Providing alternative leisure-time activities is an effective means of delivering prevention components and particularly of making contact with vulnerable groups and involving them in preventive or other pro-social activities.

Especially in the field of selective prevention, several good practice examples from EDDRA use alternative leisure-time activities to involve and attract young people into broader interventions that include also social skills training and normative education. See EDDRA:

Mass media

Delivery of drug prevention messages through the mass media is another example of a popular (and very expensive) but controversial strategy.

The usefulness of this method depends to a large extent on the objectives: this method can affect attitudes and knowledge, but rarely behaviour. Thus, its value lies in correcting common misconceptions about and changing attitudes towards legal and illegal drugs. Risk perception, however, is influenced more by own or peer experiences than by information.

A major difficulty remains the differential targeting of very different target audiences with appropriate messages. Isolated studies have found that mass media anti-drug campaigns can be effective if aimed at sensation seekers, and there is some evidence that recall of anti-drug advertising is associated with a reduced probability of marijuana and cocaine/crack use. Overall, however, the evidence for an influence of mass media on consumption behaviour is not strong and the recent re-evaluation of the ONCDP Campaign on Cannabis confirmed the previous evaluation findings that the campaign (despite positive recall rates and differentiation by target groups) had no effect on the attitudes of youth not using marijuana toward its use but that exposure to the campaign was associated with unfavorable effects on youth perceptions of others’ use of marijuana.

In addition, the media can play a role in providing information about and supporting other preventive measures or can increase awareness of them. They can be useful for explaining the reasons behind local structural prevention measures such as controls on the sale and consumption of alcohol, tobacco and cannabis.

Combined with reciprocal and complementary community action, particularly environmental changes, media campaigns have proved more successful in influencing attitudes towards psychoactive substance use than use per se.

Peer-led

The peer approach is a broad definition that includes all interactive education strategies through peer-led groups. It assumes that experiences lived with others or through models of others (see social influence model) can effect changes in behaviour and, like the general health promotion model, it may include elements such as knowledge, resistance skills and social support for non-use.

Peer-led approaches aim to use the interactions between peers, and the associated socialisation and influence, to promote health-related behaviours and reduce drug use. This method makes use of the fact that messages (information, norms, attitudes, behavioural models) are better and more credibly delivered by trusted sources, i.e. peers. The primary method is to use young people (not necessarily the same age as the target audience) who are seen as credible in the eyes of the audience to provide all or some of the teaching component.

Overall, the results indicate that peer-led projects are more effective than other approaches such as parent-led, teacher-led and police-led activities, although research examining the effectiveness of peer-led approaches has produced mixed results. One problem is the diverse nature of peer-led programmes, which makes it more difficult to identify the elements that contribute to their success. One component that is likely to make them more effective is the level of interaction. A peer-led intervention is more likely to be based on active face-to-face communication, in contrast to the typical teacher-led intervention, which is passive and non-interactive.

Over the last decade there has been a major growth in the use of peer education projects in response to a wide range of problems. The proliferation of peer education projects has not been commensurate with the limited evidence available as to the effectiveness of such approaches. This paper provides a short history of peer education techniques and outlines some of the definitional diversity in attempts at characterizing peer education projects. The paper reviews the limited evidence on the effectiveness of peer education projects seen in terms of the impact upon peer educators themselves and the target group of their educational efforts. The paper describes the results of this work and identifies the need to develop a model of peer education evaluation which, whilst being true to the nature of such projects, can also identify effectiveness of peer education in the short, medium and long term.

  • Parkin, S. & McKeganey, N. (2000), 'The Rise and Rise of Peer Education Approaches', Drugs: Education, Prevention & Policy 7(3), 293-310.

Value: the theoretical background to peer education is underdeveloped and the evidence for the effectiveness of this approach is inconclusive. The success of this approach is difficult to ascertain, perhaps due to the wide variation between programmes. Consequently, there is little detailed understanding about the processes involved in such interventions and a lack of clear evidence about their effectiveness. Most positive results of peer led strategy emanate from research in the context of programme (manual)-based prevention programmes, but not from less structured interventions. Peer-led programmes have shown to be most beneficial for the peer leaders themselves.

Police

Contribution of Harry Sumnall, principal researcher at NCCDP.

In some countries, police officers – in uniform – continue to carry out prevention activities in schools. Several evaluations of programmes such as DARE (or similar), which are delivered by uniformed police officers, have shown the ineffectiveness of this approach (Ennett et al., 1994; Lindström et al., 1998), despite all adaptations made to the content of the programmes, probably due to the non-interactive authoritarian aspects of this strategy. This has contributed to a negative view of all drug prevention as being unrealistic, puritan and patronising.

Nevertheless, these programmes remain popular in some Member States because in some countries police officers are the only people who are legally allowed to bring drug samples into school. And there is some recent thinking that DARE may be of benefit in a different way, i.e. in helping to improve relationships between school and police.

Overall, the impact of any of the effective prevention components described in Step 2b is likely to be a somewhat reduced if the components are delivered by police officers.

In the UK, for instance, the police force is one of the most popular external agencies used to support school drug prevention programmes (perhaps because of the illicit nature of many substances), and consequently is one of the most frequently and rigorously evaluated external providers. In Scotland, the majority of secondary (71 %) and primary schools (68 %) receive input from police officers In England and Wales a survey of 41 police forces revealed that most believe themselves to be highly committed to providing drug prevention and education in schools. Despite the popularity of the police as a supporting agency for drug education and the high level of commitment that has been expressed by the forces, there is no convincing evidence that police-led interventions are effective in bringing about long-term behavioural changes.

Added value of the police input

It is argued that, to be more effective, police officers need to modify the nature of their input to drug education in schools. They should restrict their role to a complementary or supportive one based on their specialist knowledge and expertise. The police have a wealth of knowledge in the law relating to drugs, and, through personal and professional experience, the individual, familial and social costs of drug use. Guidelines issued by the UK Association of Chief Police Officers (ACPO) Drug Sub-committee in 1996 state that police input in school-based drug education should be limited to the areas of the police speciality and expertise. However, according to these guidelines, it is not uncommon for police officers to lead drug education sessions, taking the teacher’s role rather than assuming a complementary role. Current guidance recommends that police play a broader role in schools beyond drugs education. This includes reducing the fear of crime amongst teachers and pupils, addressing the problems associated with truancy, influencing the attitude of young people to crime and drugs misuse, helping to reduce levels of disorder within schools and fostering good relations between young people and the community. In effect, the role of a police office in a school should be the same as that of a community beat officer. Where police officers present a drugs education message they must meet relevant occupational standards.

In addition, the police can support and add value to school-based prevention programmes by getting involved in managing drug incidents in schools. The police could help schools with developing and implementing drug policies. If policies are able to balance legal requirements with the needs of young people, then young people can be diverted from the risk of school exclusion or involvement with the criminal justice system.

Case studies involving several police forces have found that prevention of drug use is not the only and most important outcome of police input into drug education in schools. It was found that achieving good relationships with the community (i.e. schools, teachers, children and their parents), building up multiagency working, and raising positive attitudes towards the police among children are all important outcomes for police drug education. Some schools believe that police officers can reinforce existing drug-related messages and welcome opportunities to establish working relationship with the police, so that they can relate to the police when incidents involving drugs occur.

A London-wide multiagency advisory group was set up by the Metropolitan Police Service Drugs Directorate, which aimed to work collaboratively with the Metropolitan Police in devising a revised strategy. The new strategy set out clear aims regarding the police contribution to drug prevention in schools and was considered in the context of ACPO guidance. The police input focused on the law and order aspects of drug use and did not deal with other issues that were not within their expertise (e.g. health and social issues). It also addressed wider role of Police School Involvement Officers, who would be involved with dealing drug-related incidents in schools and providing support for drug policies.

Five sites in the London Metropolitan area piloted this new strategy, and a series of studies examined the feasibility of implementation. Key individuals from the Metropolitan Police Service (managers and practising police officers), schools and multiagency partner organisations were interviewed.

The interviews revealed that the police were highly committed to and had a very high level of understanding of the new strategy. However, some practising police officers expressed concern about one aspect of their new role, namely having to avoid dealing with health aspects of drug use. In addition, some police officers reported that their managers failed to acknowledge their need for preparation, training and resources to fulfil their new drug education role. A further concern that was raised was conflict between the police’s operational and teaching roles, with operational activities sometimes interfering with planned drug education activities. All interviewees felt that the new strategy would create ‘gaps’ in the drug education curriculum. However, police managers believed that police input in drug education involves not only about preventing drug use but also strengthening partnership working with schools. Schools and other agencies also believed that the latter outcome is important. However, there are currently no objective mechanisms to measure this aspect of police input in drug education.

Although the police exhibited a good understanding of the new strategy (and by extrapolation the ACPO guidance), observation of police visits in the pilot schools revealed that police officers were still playing the role of teacher rather than expert contributor and were observed to use some inappropriate teaching methods, perhaps because they were assuming a role, that of a teacher, outside their expertise.

In order to assess the impact of the new strategy among recipients, year 8 pupils from the pilot schools were given pre- and (immediate) post-police intervention surveys that measured changes in drug-related knowledge on the law and procedures, criminal consequences and drug recognition. The results revealed that there was no significant increase in knowledge among the pupils. A focus group conducted with pilot school pupils indicated that police-led interventions needed to be developmentally appropriate. Younger pupils were more positive and enthusiastic about the police input in drug education than older pupils. Also, the younger pupils felt that the police officers were more knowledgeable about illegal drugs than were teachers. Older pupils had more negative attitudes towards the police.

References

Theatre play

Contribution of Harry Sumnall, principal researcher at NCCDP.

A technique that is used to incorporate social and personal skills training in school activities and avoids the need for classroom-based prevention studies is the provision of drama workshops. This tool is especially popular in the UK.

A qualitative assessment of a theatre and drama programme delivered in eight British schools (Fine and Durrant, 1996, in Allott et al., 1999) suggested that the programme was more effective in changing attitudes than was the mere provision of information; however, more research in this area is needed.

Drama or theatre has for some time been used in the UK as a method of providing drug prevention education, and during the 1990s by several government departments recognised this tool as an innovative and popular approach to drug education. Although wide-ranging published evidence of the efficacy of drama methods in changing health-related behavioural intentions is lacking, they appear to be relatively more effective at changing drug-related attitudes than information dissemination approaches, perhaps because they utilise the communication skills of professional actors. Theatre in Education has been introduced into the National Curriculum via Citizenship and Personal Social and Health Education (PHSE), and new companies are being formed to offer education through young persons theatre. This type of approach is considered useful support for existing drug education, rather than a means in its own right.

Two evaluation papers on school-based drug prevention drama programmes were identified in this review (Orme and Starkey, 1998; Needham, 1999). The findings from these studies suggest that the use of drama is associated with a short-term increase in possible mediators of drug use such as drug awareness, drugs knowledge and attitudes towards a broad range of drugs (as opposed to specific types of drugs). This is not markedly inconsistent with the evidence obtained from published literature that Theatre in Education approaches are more effective than information dissemination methods at affecting mediators (i.e. attitudes) of drug use behaviour. Drama seems to cause no marked improvement in skills such as decision-making and problem-solving, and further research is needed to determine its effect on drug use behaviour. However, it must be noted that these interventions are short in duration and it may be inappropriate to expect such brief interventions to have a significant prevention effect.

Interactivity intensity

Interactivity

The social skills, normative beliefs and personal skills components of a prevention strategy need to be implemented with a particularly high degree of interactivity in order to be effective.

Interactive programmes are more effective:

  • Interactive programs – which foster interpersonal skills and active engagement between students and teachers – are more effective than noninteractive programs, which are lecture oriented and stress drug knowledge. Interactive programs are more effective at reducing, preventing or delaying adolescent drug use for all substances combined and for each substance individually – that is, tobacco, alcohol and marijuana).

  • The magnitude of the effectiveness of interactive programs is equivalent across age and ethnic groups and is the same for tobacco, alcohol and marijuana. These programs take universal approaches.’

Interactive educative programmes involving peers are more effective than non-interactive interventions in preventing drug misuse (Black et al., 1998).

Intensity

The most effective delivery methods involve, rather than occasional or one-off sessions, a minimum number of sessions, booster sessions and other means to assure a degree of continuity.

Effective programmes have tended to include booster sessions (White and Pitts, 1998).

Intensive programmes given a large amount of curriculum time (e.g. 10 or more sessions) have been shown to be effective, although intensity alone does not necessarily ensure effectiveness (White and Pitts, 1998).

  • As the number of participants in an interactive program increases, the program's effectiveness decreases, probably due to implementation failures.

  • The success of interactive programs is related to program intensity (intensity is measured by the amount of time devoted to the programme). The more-intensive interactive programs are more effective than those that are less intensive.

  •  Devoting more time to a non-interactive programme did not increase its effectiveness.

References

Motivational interviewing

Motivational interviewing, developed in the USA to fight alcoholism, is a way of talking to people about things they are sensitive about that avoids confrontation. It focuses on hopes and aspirations for career and life, and the potential problems, such as addiction, that could stymie them.

Motivational interviewing is a non-confrontational approach, and involves discussing young people’s hopes and aspirations with them. The students are encouraged to think about how their current substance use, including use of cigarettes and alcohol, may prevent them from achieving what they want to in the future, and whether the consequences of drug use are acceptable to them.

This technique is about encouraging people to explore what they think might be problematic in an atmosphere that makes it more likely that change will take place.

During, for example, 60-minute sessions young people are encouraged to talk about the substances they use. They discuss what they like and dislike about the habit, be it cigarettes, cannabis or alcohol. Dislikes, such as hangovers, and the negative effect these could have on life, are explored.

Youth workers or professional counsellors can carry out the interviews. The technique can be taught in short workshop and with ongoing supervision.

Settings – Where to intervene?

The most typical and most frequent setting for drug prevention is school, in class-room based interventions. The community is often mentioned as an appropriate setting for drug prevention, as it embraces a larger range of our life determinants, but interventions suitable for such a setting are rare in Europe. In practice in Europe, well-designed, intensive and concrete family-based prevention that extends beyond of parents’ evenings or parents’ schools is quite rare.

School

School-based prevention as the first pillar of universal prevention approaches (besides community-based prevention) is de facto carried out in all Member States and is always the first priority in prevention policies.

However, most of the knowledge base in Step 2b for school-based prevention is derived from research on programme-based approaches with defined structural parameters, i.e. manuals, defined sessions with defined contents and materials for each, and defined number, sequence and length of sessions.

All other non-programme-based prevention approaches (also widely used in Europe), such as general teacher training, sporadic or ad hoc sessions, awareness days and the integration of prevention into all education subjects are not evidence-based, and there are as yet no data/evaluations that would support their effectiveness.

‘School based educational programmes have been among the most popular preventive measures much of which occurs, however without any formal assessment of its impact on behaviour. To be effective they need to be provided at a developmentally appropriate time and particularly when interventions are most likely to have an impact on behaviour. Programmes need to be relevant to young people’s life experience by providing material during the period most students are experiencing initial exposure to psychoactive substances, using local prevalence data. Complementary general health/life skills programmes appear to produce greater change than skill-based education programmes alone, suggesting that psychoactive substance use education is best integrated within a well-founded health curriculum. Pre-testing of a programme with students and teachers to ensure its relevance is important in establishing its behavioural effectiveness. While the majority of studies reviewed, deriving mainly from the United States, have abstinence as their goal, there is evidence that programmes having this goal consistently fail to produce behavioural effects suggesting that there is a need to develop programmes with outcomes other than abstinence as their goal.’

Evidence shows that school-based interventions aimed at adolescents can delay for a short time the start of substance misuse by non-users, and temporarily reduce use by some current users, although the effects decrease with time (White and Pitts, 1998).

Community

Community-located prevention EMCDDA

Evidence from the literature: ‘The complexity of evaluating the many initiatives which make up any community based intervention has meant that very few such interventions have been rigorously evaluated. Those that have been tend to focus on a small number of discrete outcome variables such as drink driving convictions and to have employed matched communities or time series analysis. Changes have been more often observed in such areas as acceptance of health orientated policies and increased knowledge. For such changes to be sustained requires that they be institutionalized which itself provides that the initiatives be supported by the relevant community agencies.’

Community initiatives have been more successful in influencing public perceptions of problems and policy responses than in changing individual behaviour, and should be tailored to a population group by using local prevalence data.

Family

The most interesting question in this setting is whether to adopt a selective or universal approach.

Irefrea (www.irefrea.org) has analysed family-based prevention programmes in some EU countries and has found that most interventions are not theory led, only punctual or short term, and are not evaluated. Only a minority of available interventions justify being called a ‘programme’.

Selective family-based prevention is relatively rare in Europe.

British parent-oriented programmes have not been adequately evaluated, although there is an indication that such programmes are poorly attended. Attendance is even lower among parents who drink and smoke more heavily, suggesting that programmes might stigmatise these parents and so discourage high-risk families from attending (Cohen and Linton, 1995, in Allott et al., 1999).

References

 

Theory of reasoned action
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Page last updated: Monday, 23 August 2010