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5. SUBSTANCE ABUSE AND VIOLENCE PREVENTION
5.1 Substance Abuse and Violence Prevention: Literature Reviews
Substance Abuse Prevention
Primary prevention programs and character or social emotional education programs share many of the same goals (Berkowitz & Bier, 2004). Drug and substance abuse prevention and mental health promotion efforts and are most successful when taught as a part of coordinated efforts to teach social emotional learning (Greenberg, et al., 2003; Morgan, 2001). Watkins (1995b) found that in schools where alcohol education is taught as PSE, the drinking rates are lower than when it is taught in science class. A widely used drug abuse prevention programme in Ireland, ‘On My Own Two Feet’, is detailed in Section 5.2.
In a meta-analysis of school-based prevention programmes aimed at reducing problem behaviours, Wilson, Gottfredson and Najaka (2001) found that programmes taught in schools could be effective in reducing alcohol and drug use. In addition, they found that those programmes which focused on social emotional learning positively impacted school behaviours, including dropout and attendance rates. Details of one programme mentioned in this review, Life Skills Training (LST) & another from the review by Catalano, et al. (2004), Project ALERT, can be found in Section 5.2.
The US Department of Health and Human Services (2002) summarized model prevention programmes which aim to improve overall social and behavioural functioning, among other objectives, that also lead to improved academic achievement. Four programmes were relevant to students in KS3 (Across Ages: school & community-based; Leadership & Resiliency Program: school & community-based; PATHS: school-based; Project ACHIEVE: school-based).
Specific positive outcomes included increased school marks, improved attendance (Across Ages; Leadership & Resiliency Program), decreased suspensions, improved attitudes towards school, decreased alcohol and tobacco use (Across Ages), graduation rates, increased sense of school bonding, increased knowledge of and negative attitudes towards substance abuse and violence (Leadership & Resiliency Program), better reading, math and language test scores, significant improvement in students’ abilities to tolerate frustration and willingness to use effective conflict resolution strategies (Project ACHIEVE), improved problem-solving skills, cognitive flexibility, scores on cognitive skills test (PATHS), fewer reported behaviour problems (Leadership & Resiliency Program; Project ACHIEVE). Details of one of the school-based programmes, PATHS, can be found in Section 3.2.
Reviews of cigarette smoking prevention programmes found that smoking was reduced in social-skills development programmes much more than traditional knowledge-only programmes or developmental/social norms orientation programmes (Bruvold, 1993; Lantz, Jacobson, Warner, Wasserman, Pollack, Berson & Ahlstrom, 2000). Other programmes not specifically aimed at reducing smoking, but with more broad social skills development goals also resulted in reduced tobacco use (Botvin, Baker, Dusenbury, Tortu & Botvin, 1990; Moon, et al., 1999)
Universal programmes aimed at violence prevention in schools can be useful in helping prevent situational violence and relationship violence. They particularly can be helpful for violence which can arise out of normal difficult developmental situations, such as school transitions or the onset of adolescence (Farrell, Meyer, Kung & Sullivan, 2001). These programmes are aimed typically at increasing protective factors in students’ lives by teaching helpful skills, such as social skills. However, there are not many well-implemented and thoroughly evaluated programmes in the literature. There is evidence that social and emotional or youth development programmes can help to reduce violent behaviours (e.g., Greenberg, Kusche & Riggs, 2004). A programme specifically aimed at violence prevention, RIPP, can be found in Section 5.2.
A review of school-based problem behaviour prevention programmes showed that programmes can indeed be successful in reducing alcohol and drug use, drop out, non-attendance and other difficult or problem behaviours (Wilson, Gottfredson & Najaka, 2001). The method of delivery was crucial in predicting whether a positive outcome was found. Programmes were more likely to be successful when they were based on solid learning theories and used cognitive behavioural and behavioural modelling methods. Some of the more effective methods were self-control or social competency promotion instruction using cognitive behavioural instructional methods. Neither traditional instructional or individual counselling methods using non-cognitive behavioural methods had any effects on behaviour (Wilson, Gottfredson & Najaka, 2001).
Ingredients for Success
In both substance abuse and violence and other problem behaviour prevention programmes, didactic, knowledge-based programmes appear to have little or no effect on behaviour (Klepp, Oygard, Tell Grethe & Vellar Odd, 1994; Moon, et al., 1999; Tobler, Roona, Ochshorn, Marchall, Streke & Stackpole, 2000; Morgan, 2001; Thomas, et al., 1999; Wilson, Gottfredson & Najaka, 2001). Although Tobler & Stratton, (1997) note that the key facts must also be included. According to a large meta-analysis of drug prevention programmes, those which are interactive are the most likely to cause decrease in drug and substance abuse (Tobler, et al., 2000). Interactive methods of teaching about drugs provide contact and communication opportunities to talk about ideas and to hone drug refusal skills. These methods also involve feedback and an opportunity to practice skills in a safe environment. Three types of interactive drug prevention programmes identified by Tobler, et al. (2000) were social influences, comprehensive life skills and system-wide change.
Research has shown that teaching students the consequences of taking drugs, such as the DARE programme in the United States, is much less effective than teaching students the emotional and social skills to make wise decisions and think for themselves (Morgan, 2001). Students appear to respond negatively or not at all to programmes that threaten dangerous long-term consequences to their lives (Morgan, 2001). Several studies have found that simply expelling students for using drugs in schools does nothing to reduce drug use (Munro & Midford, 2001; Pentz, Dwyer, MacKinnon, Flay, Hansen, Wang, & Johnson, 1989b).
Reppucci, Woolard and Fried (1999) noted that programmes designed to deal with large social problems must address multiple levels, such as the individuals, families, schools and the community. Many studies report that for prevention programmes to maximize effectiveness, they need to involve more than just the classroom (Reppucci, Woolard & Fried, 1999; Moon, et al., 1999). Programmes will be more likely to be successful when they are fully implemented, than those that are partially delivered (Kam, Greenberg & Walls, 2003).
Drug prevention programmes which are successful include teaching elements of personal development, including life skills such as communication, assertiveness, social/relationships, coping and goal-setting. These are central to the self-awareness, personal health and relationships streams of the Personal Development curriculum in Northern Ireland.
5.2 Substance Abuse and Violence Prevention: Selected Specific Programmes
On My Own Two Feet
An Irish social influence-type programme, On My Own Two Feet teaches social skills to resist social pressure in addition to standard drug information. The programme is age-appropriate, implemented nationally and uses various types of interactive methods, including role play.
The programme has received very positive feedback from both teachers and students (Morgan, 2001). It has been found to lead to more negative attitudes and expectations towards drugs than students in control groups (Morgan, Morrow, Sheehan & Lillis, 1996). Although this study did not find a difference in actual substance use compared to the control group, this was a pilot study and further evaluations are expected.
Life Skills Training (LST)
A three-year study by Botvin, et al. (1990) found positive effects of a Life Skills Training (LST) programme aimed at prevention. The programme teaches drug resistance skills to enable students to deal with peers and media pressure to use legal and illegal substances. Also included are personal self-management skills which help students learn how to examine their self-image and its effects on behaviour, set goals and keep track of personal progress, identify everyday decisions and how they may be influenced by others, analyze problem situations and consider the consequences of each alternative solution before making decisions, reduce stress and anxiety and look at personal challenges in a positive light. Finally, the programme teaches general social skills. These teach students the skills to overcome shyness, communicate effectively and avoid misunderstandings, initiate and carry out conversations, handle social requests, utilize both verbal and nonverbal assertiveness skills to make or refuse requests and recognize that they have choices other than aggression or passivity when faced with difficult situations.
For those programs that exhibited a minimum standard of quality of implementation, there was a significant inverse relationship between how well the programmes were implemented and amount of cigarette smoking, drinking frequency, frequency of getting drunk and cannabis use.
A recent evaluation demonstrated multiple positive benefits of participation in Project ALERT with a cohort of middle school (KS3) students (Ellickson, McCaffrey, Ghosh-Dastidar & Longshore, 2003). This positive youth development programme was reviewed in Catalano, et al., (2004), and is based on the combination of 3 concepts: the cognitive factors that influence behaviour, the social norms and the influence of significant others on young people’s behaviours and importance of self-efficacy.
Compared to control students not in the programme, the students in the programme showed curbed cigarette and cannabis smoking behaviours and reductions in alcohol misuse.
RIPP is a universal violence prevention programme for 11-12 year old students. The programme is delivered by a prevention specialist, although it seems likely that aspects of the curriculum could be taught by teachers. Elements include those found in social-emotional programmes, such as knowledge, attitudes and skills that promote non-violence, positive communication and achievement. Students are instructed in the use of a social-cognitive problem-solving model and specific skills for preventing violence (e.g., avoiding potentially violent situations, talking things through; see Meyer & Farrell, 1998; Meyer, Farrell, Northup, Kung & Plybon, 2000). Three basic techniques are used including repetition of behaviours and mental rehearsal of problem-solving methods, experiential learning techniques and traditional instructional methods. Early sessions focus on team building and acquiring knowledge, while later sessions focus on critical thinking and skill building.
Results showed that RIPP participants:
had fewer disciplinary violations for violent offences
fewer in-school suspensions at post-test compared with the control group
also fewer suspensions than the control group at a 12-month follow-up for boys, but not for girls
those who started with higher levels of problem behaviour benefited to a greater degree than those that started with lower levels (Farrell, Meyer & White, 2001)
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