Life Skills Training (LST) - a classroom-based universal prevention programme to reduce the long-term risk of alcohol, tobacco and drugs in middle-school

At a glance

Country of origin
Last reviewed 
Age group
11-14 years
Target group 
Pre-adolescents (11 – 14 years) students of the secondary school
Programme setting(s)

The Life Skills Training programme (LST) is a three-year classroom-based universal middle-school prevention programme. It aims to reduce the long-term risk of the use/abuse of alcohol, tobacco and drugs. The life skills curriculum targets social and intrapersonal factors by providing the knowledge, attitudes, and self-management skills necessary to (i) actively resist social influence to engage in substance use, (ii) reduce susceptibility to negative influence, (iii) increase resilience and drug awareness, and (iv) decrease motivation to engage in substance use.

LST was developed in the United States by Gilbert J. Botvin, and adapted to Italy in 2008. It has been scientifically validated in multiple sites.

Contact details 

Veronica Velasco, PhD
ATS Milano Città Metropolitana, Health Promotion Division, Specific Prevention Unit, Milan
Email: vvelasco[a]

Programme developer/owner
Gilbert J. Botvin, Ph.D.
Weill Cornell Medical College, New York

Program information contact
National Health Promotion Associates, Inc.

Overview of results from the European studies

Last reviewed 
Evidence rating  
Additional studies recommended

Studies overview

The programme has been evaluated in one quasi-experimental study and one four-year follow-up study in Spain, and one quasi-experimental design in Italy.

The Spanish quasi experimental study was conducted with an intervention group (n=2,567) and a control group (n=2328) enrolled in the last year of Primary Education in Spain (1999) at two time points. Intervention effects were measured by means of chi square, t-tests and tests of covariance. Last month and weekly tobacco use were not significantly affected by the intervention. Initiation of tobacco use among those that had initiated first use was significantly lower in the intervention group. Among those that had already tried alcohol the increase of use was significantly lower in the intervention group. A higher increase of alcohol use in the control group was established. A significantly higher number of participants reduced monthly wine use in the intervention group. There was a significant difference between first time alcohol use between IG and CG. These results should be interpreted cautiously considering that they were studied in a time-frame of only 6 months (November 1997 - January 1998). Effects on 'anti-social behaviour' were analysed but not analysed in relation to the substance use outcomes. 

The Spanish four-year (1995-1999) follow-up study (Gomez Frágüela 2003) involved one control group (n=485) and two intervention groups. The first intervention group (n=235) got the intervention from teachers, the other from professional prevention workers (n=309). A validated questionnaire was administered at four time points and analysed by means of ANOVA and pairwise multiple comparisons. The 15 and 27 months follow-up demonstrated some intervention effects. The 39 month follow up demonstrated similar monthly consumption frequency of tobacco, beer and spirits for all three groups but significantly lower general consumption of cannabis, tranquillizers and amphetamines in the intervention group. Consumption in the two intervention groups was significantly lower compared to the control group.

The Italian quasi-experimental design was conducted among 31 intervention group schools and 24 comparison group schools. The pre-test measurement was conducted prior to the start of the programme, and the post-test eight months after the first year, follow-up after the booster sessions in two subsequent years. The study showed significant effects at post-test in smoking initiation during the first year, weekly drunkenness initiation, and smoking initiation during third years. With regards to alcohol use, there was a lower normative expectation about adults’ drinking and fewer students reported weekly drunkenness. It appears that substance use related differences are less significant at two-year follow-up.

The programme has been rated as Model Plus by Blueprints for Healthy Youth Development based on a review of studies conducted world-wide

References of studies

Countries where evaluated



Protective factor(s) addressed
Individual and peers: clear morals and standards of behaviour
Individual and peers: individual/peers other
Individual and peers: Problem solving skills
Individual and peers: refusal skills and decision making
Individual and peers: skills for social interaction
Risk factor(s) addressed
Community: laws and norms favourable to substance use and antisocial behaviour
Outcomes targeted
Other educational outcomes
Emotional well-being
Depression or anxiety
Emotion regulation, coping, resilience
Positive relationships
Substance use
Alcohol use
Use of illicit drugs
Smoking (tobacco)

Description of programme

The original version of the Life Skills Training programme (LST) is a 3-year universal prevention programme for secondary school students targeting the use of gateway substances (tobacco, alcohol, and marijuana) and violence. It consist of 30 sessions over three years: 15 core sessions in first year, 10 booster sessions in the second year, and 5 booster sessions in the third year (9 in the Italian adaptation). Additionally, there are violence prevention lessons each year (3 in the first and 2 in the second and third years).

LST has three major components: (i) personal self-management skills, which enable students to examine their self-image, set goals, identify everyday decisions, analyse problems and consequences, and reduce stress and anxiety; (ii) social skills, that enable students to overcome shyness, communicate effectively, carry out conversations, handle social requests, and be assertive; and (iii) information and resistance skills specifically related to drug use, that teach students how to recognize and challenge common misconceptions, resistance skills for peer pressure, and decrease normative expectations.

The sessions are delivered by classroom teachers and LST instructions. The skills are taught using interactive teaching techniques, such as instruction, demonstration, feedback, reinforcement, and practice. Teachers guide students in practicing the skills outside the classroom setting. The booster sessions in the following years are designed to reinforce the material, and focus on the continued development of skills and knowledge to enable students to cope more effectively with the challenges they face.

Italian adaptation:

LST was chosen by the Lombardian Government because of its strong evidence-base of effectiveness, theoretical foundation and fit with local needs and Italian professional values. The stakeholders identified an educational approach to prevention that focused on enhancing students’ social and personal skills, consistent with the broader life skills education strategy popular in Italy; the programme was then modified to meet the local needs, traditions, and guidelines with regards to prevention in Lombardy.

All materials used were translated into Italian, adapted to the Italian culture, and integrated with existing complementary instructional materials. For instance, adaptations were made to the content of the program in order to address cultural differences regarding alcohol, drugs, and violent behaviours, and to ensure that behavioural rehearsal and other activities were culturally appropriate to Italian students. Additional adaptations concerned the training and technical support services for health professionals and teachers within the regional infrastructure that disseminates the program. Teachers’ training, technical assistance and on-going support were adapted to address local needs, promote high-quality implementation, integrate the program within local organizational contexts, and strengthen the infrastructure that uses and disseminates the program in order to promote sustainability (Velasco et al. 2015).

LST in Lombardy focuses on specific objectives to each group of recipients:
1. Increase the baggage of personal resources (life skills) in secondary school students;
2. Reinforce teachers' educational functions, modify their representations on health promotion issues, and develop a realistic approach to the current characteristics of substance use;
3. Support, within the school context, a perspective aimed at promoting health and preventing the use of substances, which involves the whole school, encourages mutual support, and integrates the project with the school activities.

Implementation Experiences