Kids, Drugs, and Drug Education,
A Harm Reduction Approach
by Marsha Rosenbaum, Ph.D.
The Lindesmith Center, San Fransisco, California
TABLE OF CONTENTS
Foreword
Introduction
Drug Education in the U.S
What’s Wrong with Drug
Education?
A Harm
Reduction Approach to Drug Education
Model Programs
Conclusions
Endnotes
LIST OF FIGURES
Figure 1:
Estimated Numbers of Lifetime Users of Illicit Drugs, Alcohol, and Tobacco in
U.S. Population – Aged 12 and Older – 1979-1994
Figure 2: Estimated Numbers of Lifetime Users
of Illicit Drugs, Alcohol, and Tobacco in U.S. Population in the Past 30 Days –
Aged 12 and Older- 1979-1994
Figure 3: Percentages Reporting Past Month Use
of any Illicit Drug – Aged 12 to 17 – 1979-1994
At the time of this publication, the
federal government announced that drug use among teenagers has doubled since
1992. Not unexpectedly, both political parties seized upon the news to bolster
their political ambitions and to declare once again a „new war on drugs.“ Lost
in the debate were the facts that since the survey began, drug use has declined
substantially among all youth, that illicit drug use among our youth for harder
drugs (cocaine, heroin, and amphetamines) is extremely rare, and that the major
drugs being used by our youth are tobacco and alcohol. Regardless of these data,
one must always be concerned with all forms of drug abuse among our children and
how best to prevent it. This monograph by Dr. Marsha Rosenbaum re-examines some
of our assumptions regarding the best way to educate our youth on the dangers of
drugs. Her article argues for a more factual approach for educating our youth
rather than scare tactics that seem to be ineffective. A number of promising
prevention models are presented that may well serve to help reduce the level of
harm caused by all forms of drugs.
We welcome any thoughts you have on this
important issue.
James Austin, Ph.D.
Executive Vice President
On April 29, 1996, Bill Clinton did what
all presidents must do in the approach of an election year. He announced a „new“
war on drugs, designed to encourage abstinence. Among Clinton’s weapons in his
arsenal is education as the means to eradicate drug use among teenagers. The
hope is that if initial involvement with drugs can be prevented, a drug-free
America may someday be a reality.‘
Given the widespread use of drugs in the
U.S., the goal of complete abstinence may be unrealistic. According to the most
current household survey by the National Institute on Drug Abuse (NIDA),
approximately 79 million Americans have used illegal drugs, primarily marijuana,
at least once in their lifetime (Figure 1). This number has increased steadily
since the survey began in 1979 when the estimated number was 59.6 million. Less
than 20 percent of these experimenters (approximately 12.5 million Americans)
used illegal drugs regularly, or each month (Figure 2). The number of regular
users has declined sharply since 1979 with the largest reductions occurring for
the category of marijuana and hashish. In other words, whereas nearly one-third
of Americans have tried illegal drugs, less than 5 percent of the population
uses them regularly. And, alcohol and cigarettes remain the most dominant form
of legal drug use.
Teenage drug use is of particular concern
to all Americans. As shown in Figure 3, in 1994 9 percent of adolescents (age
12-17) had experimented with drugs on a regular (at least once monthly) basis.
The 1994 numbers are slightly higher than those reported in 1993 (7 percent) but
they are much lower than the 1979 figure of 19 percent.
Although the Clinton administration
champions it as a new form of drug war weaponry, drug education in the U.S. is
not new. It was first conceived as part of a health education program by the
Women’s Christian Temperance Union in the late 1800 S.2 In the 1960s, drug
education programs were designed to frighten kids out of using heroin,
marijuana, LSD, and methamphetamines. The programs of the early 1970s carried a
more ambivalent message, that „the mere use of addictive drugs was not
necessarily bad, that children had to be encouraged to learn all they could
about the favorable and unfavorable effects of drugs in order to be able to make
their own decisions about drug use.“‚ This „soft“ approach, promoted by the Drug
Abuse Council, the Do It Now Foundation, and even the federal government, did
not endure. By 1973 the White House Special Action Office for Drug Abuse
Prevention (SAODAP) stopped producing materials endorsing such strategies. „SAODAP
issued a set of guidelines regulating the content of all subsequent
materials-including an end to all scare tactics, stereotyping of drug users,
exaggerated, dogmatic statements, and demonstrations of the proper use of
drugs.“‚
During the late 1970s and early 1980s, drug
education programs proliferated with the explicit goal of „primary prevention.“
By 1983 any materials that did not endorse abstinence were censored from the
drug education curriculum. For example, perhaps the most thorough and
informative book for teenagers, Chocolate to Morphine: Understanding Mind-Active
Drugs, by Dr. Andrew Weil and Winifred Rosen, was hastily removed from drug
education curricula shortly after its 1983 publication because it stressed the
importance of nonabusive relationships with drugs rather than total abstinence!
Nonetheless, drug education programs were defined as more sophisticated than the
old scare tactics, giving children information about the dangers of drugs as
well as concrete psycho-social techniques for countering „peer pressure.“ Former
First Lady Nancy Reagan instructed inner city children on how to „just say no.“
Drug education programs were also designed to instill self-esteem and
self-control in school-children so they could fight the lure of drugs.
Unfortunately, drug education does not seem to have successfully achieved its
goal of abstinence among teenagers. In the years directly following the scare
tactics and resistance campaigns, studies indicated an increase in drug-use
among the targeted population.6 By the 1990s, following the „just say no“
campaign of the 1980s, the use of marijuana and psychedelic drugs has increased
among teens.7
Although approximately 8 percent of 12 to
17-year-olds used illicit drugs on a monthly basis in 1994, this percentage has
increased from 6.6 percent in 1993. Marijuana use among this age group has risen
from 4 percent in 1992 to 7.3 percent in 1994.9
As a sociologist and the mother of two
teenagers, I am concerned about drug use as well as drug education. Based on the
experience of my own children, 1 have begun to question the methods by which
children are taught about drugs. T want to know why drug education has not
achieved its goals, despite an outpouring of millions of dollars into this
effort. My children have been given the standard „dose“ of drug education
through school and the media, but seem as ill-informed as I was at their age.
Like most parents, I wish „the drug thing“ would magically disappear and my
children would simply abstain from using all intoxicating substances. I know
this wish to be a fantasy. I can hope, however, that my children will not fall
into the trap of a heroin addict I interviewed nearly twenty years ago. She,
like myself at the time, was a „nice Jewish girl“ who came from a middle class
suburb in a large metropolitan area. Genuinely intrigued by her situation, I
asked how she had ended up in jail and addicted to heroin. I will never forget
what she told me, „When I was in high school they had these so-called drug
education classes. They told us if we used heroin we would become addicted. They
told us if we used marijuana we would become addicted. Well, we all tried
marijuana and found we did not become addicted, so we figured the entire message
was b.s. I then tried heroin, got strung out, and here I am.“
We must begin to think critically about
drug education in the U.S. This pamphlet begins by investigating the weaknesses
of our most recent drug education programs. We then turn to an alternative
approach to drug education: harm reduction. Finally, the most promising actual
programs, both in the U.S. and abroad, are presented as models.
Drug education in the U.S. begins with
young children, often starting as early as the third grade or approximately age
eight. First, a particular program is usu ally adopted by a school and then the
school’s own teachers or outside „experts“ teach the program’s curriculum. No
set content exists for such pro grams and these classes are sometimes couched in
courses such as „family life,“ or „health education.“ In order to insure
continued funding, drug education programs must produce „effective results.“ An
objective review of the research findings to date, however, clearly demonstrates
that most prevention programs have never been evaluated or have been evaluated
using flawed research methods. In short, we do not know what works. As Mathea
Falco reports, „Many schools rely on programs which have not been evaluated or,
worse yet, have been found to have no impact. In 1988, a review of 350 differ
ent school programs found that only 33 had any valid evaluation data, while just
three programs reported reductions in tobacco, alcohol, or drug use. „°
Proponents and opponents agree, however, that drug education programs are
difficult to evaluate because test results are not always a valid indicator of
fail ure or success.“ For instance, older children often do not take the
programs seriously and may sabotage the testing process.“ Others simply
regurgitate course content without sincere attitude or behavioral commitment. ‚3
Further, many programs claiming effectiveness use weak pre-test and post-test
evaluation designs. These evaluations consist of administering a questionnaire
to students to assess their attitudes and behaviors relative to whatever drug(s)
are the focus of the particular program. The students‘ responses represent their
attitudes toward drug use and actual drug use in the 6-12 months prior to the
program. After the youth have completed the program, they receive a post-test
questionnaire containing the same items as the pre-test questionnaire. If there
are any differences between the pre-test and post-test results, program staff
will interpret this as evidence that the program has had a positive effect.
The problem with such an evaluation is that
there is no control or comparison group in the drug prevention program.
Consequently, differences between the pre-test and post-test scores may be the
result of a number of factors that are unrelated to program participation.
Researchers refer to these as „confounding“ factors. For example, improvements
in the scores may be the result of the Hawthorne effect, or knowing that one
„should“ do better after completing the program. The student may alternately be
exposed to factors completely unrelated to the drug education course, causing a
change in attitudes and behavior. Studies show that while drug education
programs may influence attitudes toward drugs, these programs produce little
behavioral change. High school children, in particular, may state reasons for
avoiding drugs, yet use them anyway.“ Some argue that although there are
sometimes post-program increases in drug use as children age, onset is later and
the numbers of users is fewer.“ Other researchers insist that the programs are
too short, and once the lessons stop, their effects cease.“ They also maintain
that any program without „environmental consistency“ will fail:
It cannot be assumed that increased levels
of perceived risks or personal susceptibility concerning specific drug-related
behavior will automatically translate into behavioral changes. The experiences
students have as they interact with their environment will potentially either
positively or negatively reinforce their attempts to deal with the environmental
pressures related to drug use. Attempts are likely to be supported if they are
reinforced by peer reactions, social approval, availability of satisfactory
alternative activities or other environmental reinforcers. Attempts to change
behavior that are met with peer rejection, lack of participation in enjoyable
activities, or other negative environmental reinforcers are not likely to be
sustained over time.17
One of the most popular and prevalent
school-based drug education programs is DARE (Drug Abuse Resistance Education).
Since 1990, DARE has received over $8 million in direct federal funding plus
millions more in state and local funds. Approximately 20,000 police officers
have delivered drug education to an estimated 25 million youth as part of the
DARE program. Evaluation after evaluation has shown „no long term effects
resulting from DARE exposure.““ A five-year study tracking DARE students and
published in 1994 has shown that „quantitative and qualitative data both point
in the direction of no longterm effects for the program in preventing or
reducing adolescent drug use.““ A study funded by the National Institute of
Justice (which the agency later attempted to suppress), found the following:
DARE’S limited influence on adolescent drug
use behavior contrasts with the program’s popularity and prevalence. An
important implication is that DARE could be taking the place of other, more
beneficial drug use curricula that adolescents could be receiving. At the same
time, expectations concerning the effectiveness of any school-based curriculum,
including DARE, in changing adolescent drug use behavior should not be
overstated. 20
Finally, targeting „at risk“ populations
for drug education may be ineffective at best. Anti-drug programs do not address
deeper sociological risk factors of poverty, joblessness, lack of adequate
housing and education.21 In addition, the definition of some children as „at
risk“ may ultimately be harmful by resulting in labeling and exclusionary
policies.22
What’s Wrong with Drug Education?
Drug education in the U.S. is based on
several questionable assumptions about adolescence and drug use: 1) total
abstinence is a realistic goal; 2) the use of illegal substances necessarily
means abuse; 3) one form of drug use inevitably leads to other, more harmful
forms; 4) understanding the risks inherent in drug use will deter children from
experimentation; and 5) children are incapable of making responsible decisions
about an issue as serious as drug use. Contemporary drug education programs have
as their underlying premise the futile goal of abstinence from all illegal
drugs. The expectation that adolescents will not experiment with altered states
of consciousness is unreal at best.23, 24 Championing abstinence has thus lead
to the inevitable failure of programs that have made this their primary goal
because some form of drug use is nearly universal, and certainly integral to
American culture .25 Thus, drug education programs, by virtue of their most
basic assumption, are doomed to fail. As Erich Goode says:
Almost all drug education programs strive
for prevention as their ultimate goal. It is possible that this goal is
unrealistic with current experimenters and users. Perhaps moderate or wise use
is a more realistic goal.“
Another assumption pervading drug education
is that use is equal to abuse. Some programs use the terms interchangeably while
others utilize an exaggerated definition of use that results in defining
anything other than one-time experimentation as abuse. A problem with the
blurring of distinctions between use and abuse is the inconsistency with
students‘ observations or experiences. When young people are told that
once-a-month use of a substance is abuse, they often snicker. They see others,
and often themselves, as people who have used an illegal substance without any
of the addictive or deleterious effects that would constitute „abuse.“ No
consensus exist as to which behaviors constitute drug use or drug abuse.
Programs that do not differentiate between these two are therefore ineffective.“
,“
A theory inherent in drug education is the
„gateway“ or „stepping stone“ hypothesis. This theory argues that alcohol and
cigarettes are „stepping stones“ to illegal drugs, and the „softer“ illegal
drugs such as marijuana are the gateway to „harder“ drugs such as cocaine and
heroin.29 There is no evidence, however, that the use of one drug leads to
another, and several studies have found that the vast majority of students who
try drugs do not become abusers.30 Another premise of drug education is that if
children simply understood the dangers of drug experimentation they would
abstain.“ In the effort to encourage abstinence, „risk“ and „danger“ messages
are often exaggerated. Aside from glaring falsehoods and ridiculous analogies
(e.g., the fried egg commercial) these messages are often inconsistent with
children’s actual observations and experiences. In spite of what they may have
heard, marijuana use did not make them seek out cocaine or heroin, Ecstasy did
not melt their spine. According to Moore and Saunders:
Young people dutifully attend these classes
and are then re-subjected to a world where drug taking is the norm rather than
the exception. They see and experience the costs and benefits of drug use.
Stories of the terrible side effects of drugs ring hollow alongside their own
and others‘ experience of drugs.“
The typical response of children to such
contradictory information is to simply discredit the message as in the case of
the heroin addict I interviewed in the 1970s.
Finally, most programs are predicated on
the notion that teenagers are incapable of making decisions about drug use.
Students are given the inconsistent message that although they must resist peer
pressure and make their own decisions about drug use, they must always say „no.“
A common complaint about the DARE program, according to Wysong, Aniskiewicz and
Wright, was from students who did not believe their opinions were taken into
account:
It’s like nobody cares what we think …
The DARE cops just wanted us to do what they told us and our teachers never
talked about DARE … It seems like a lot of adults and teachers can’t bring
themselves down to talk to students … so you don’t care what they think
either.33
Aside from being intelligent, critical
thinkers, teenagers sometimes have experienced drug use, before, during and
after having received drug education. They often use their own experience and
intelligence to decide whether or not to use drugs. In fact, most decide on
their own to refrain. Studies conducted to discover the reasons why teenagers
quit using marijuana found that health reasons, short term problems and negative
drug effects, based on students own experience, motivated them. Thus, any form
of drug education should interact with and respect both their ability to reason
and their own experiences.34
A Harm Reduction Approach
to Drug Education
Despite billions of dollars in drug
prevention efforts, a sizable number of Americans continue to use drugs.
Adolescent experimentation with drugs con tinues as well. Though we cannot
eliminate drug use altogether, we can at least try to minimize its dangers. The
best we can hope for, in lieu of total absti nence, is responsible use based on
informed decisions. We must approach drugs in the same way we approach other
potentially dangerous substances and activi ties. For instance, instead of
banning the automobile, which kills far more teenagers than do drugs, we enforce
traffic laws, prohibit driving while intoxi cated, and insist that drivers wear
seat belts. We then likewise teach young adults how to use alcohol responsibly
with messages like „know when to say when.“ We put warning labels on
pharmaceutical drugs.
The basic assumptions and goals underlying
this type of drug education program are designed to result in harm reduction.
Watson defines this new approach as:
the philosophical and practical development
of strategies so that the outcomes of drug use are as safe as is situationally
possible. It involves the provision of factual information, resources,
education, skills and the development of attitude change, in order that the
consequences of drug use for the users, the community and the culture have
minimal negative impact (p.14).3 5
Basic Assumptions
A harm reduction drug education program has
four basic assumptions. First, „drugs“ must be categorized broadly to include
all intoxicating substances, including those which are legal. The fact that one
drug or another is legal or illegal has very little to do with its inherent
dangers, and a cursory look at the history of drug policy in the United States
reveals that the placement of a substance in either a legal or illegal category
is political rather than purely pharmacological. For example, marijuana smoking
has not been proven to cause a single death, while tobacco smoking has been the
cause of millions of deaths. The fact that marijuana is illegal and tobacco is
not is obviously political. The National Organization for the Reform of
Marijuana Laws, however, is nowhere as powerful as the tobacco industry, and
therefore cannabis remains illegal while cigarettes are widely available.
Another example is the drug MDMA, which
lowers users‘ defenses without loss of control, enabling them to communicate
more effectively in both therapeutic and non-therapeutic settings. MDMA or
„Ecstasy,“ currently cannot be used for any purpose in this country even though
before it became illegal in 1985 many licensed therapists reported remarkable
psychotherapeutic results.“ Another drug used by psychotherapists, Prozac is an
anti-depressant that enables chronically depressed individuals to function at
normal levels. Therapists report initial positive results but diminishing
returns and side effects with long term use. Nonetheless, Prozac, because it is
manufactured by a large and powerful pharmaceutical house is fully legal, and
prescribed to hundreds of thousands of users.
Children have a knack for seeing through
inconsistencies and unfair practices, and are far less concerned with the
legality of activities than are adults, who understand the implications of
breaking the law. It is not enough to tell students they must refrain from
certain drugs because they are illicit. Children often do not care and are
sometimes attracted to drugs because they are illegal. Children will, however,
use or reject a given substance for reasons having to do with its effects,
availability, reputation, etc.
An effective drug education program must
acknowledge legal status as a risk factor in itself because becoming involved
with the criminal justice system has devastating implications beyond the
physical effects of drug use. Teachers must then go on to discuss drugs as
substances that affect the mind and body, without using legality as a way to
distinguish between acceptable and unacceptable drugs. In a drug education
curriculum it is imperative to categorize drugs in the broadest way possible,
casting off distinctions between legal and illegal drugs in order to educate
children about the nature of all psychoactive substances, including alcohol,
caffeine, over-the-counter substances, and prescription drugs. A second basic
assumption of a harm reduction drug education program is that total abstinence
is not realistic. Drugs have always been and are likely to remain a part of
American culture. We routinely alter our states of consciousness through
accepted means such as alcohol, tobacco, caffeine, and prescription medications.
Americans are perpetually bombarded with messages that encourage them to
medicate with a variety of substances. In this context, and often acknowledging
that legal-illegal distinctions are irrelevant to many adolescents,
experimentation with mind-altering substances is „normal.“37 Since total
abstinence is not a realistic goal, we must take a pragmatic rather than
moralistic view toward drug use. Like sexual activity, drug use will happen, so
instead of becoming morally indignant and punitive, we should assume the
existence of drug use and seek to minimize its negative effects.
A third assumption is that it is possible
to use drugs in a controlled responsible way, and the use of mind-altering
substances does not necessarily constitute abuse. The majority of drug use (with
the exception of nicotine, which is the most addictive of all substances) does
not lead to addiction or abuse. Instead, 80-90 percent of users control their
use of psychoactive substances.38 We quote from Goode:
The truth is, as measured by harm to the
user, most illicit drug users, like most drinkers of alcohol, use their drug or
drug of choice wisely, nonabusively, in moderation; with most, use does not
escalate to abuse or compulsive use.3 9
As a consequence of its illegal status,
responsible drug use is often hidden. Those with a „stake in conventional life“
have the most to lose from exposure.“ They control their use of substances,
legal and illegal, to insure their status as conventional people. It is a
mistake to assume that because responsible users of illegal drugs are not
visible that they do not exist. Children could benefit from understanding how
others achieve a moderate, responsible lifestyle in which drug use is present
but made safe through a variety of conscious mechanisms. If, in the context of
drug education, adolescents see and hear exclusively from abstainers or
ex-addicts, how will they know how to function in the middle?
A fourth assumption of a harm reduction
drug education program in that perhaps nothing is more crucial regarding safe
drug use than context. In his seminal work, Drug, Set and Setting, Norman
Zinberg imparts the notion of three essential elements which lay the groundwork
for an understanding of drug use.“ First, the pharmacology of the drug itself is
important, as well as the dosage level. Second, the „set,“ or psychological
state, of the user at the time of use must be understood. Finally, the setting,
including geography, social group and even weather affects one’s experience of a
particular drug. These three elements form the context of use, and make the
differences between drug use and abuse, and it is within this context that
educational efforts must be placed.42
Goals of Drug Education
Although harm reduction approaches to drug
use have not yet become institutionalized, they are not new. Mothers Against
Drunk Driving (MADD) and Students Against Drunk Driving (S’ADD), as well as many
„designated driver“ programs, have taken such an approach to alcohol use.
Instead of attempting to prohibit alcohol use completely, these approaches have
sought to minimize the dangers of driving while intoxicated. David Duncan used a
similar approach to glue sniffing in the early 1970s, which resulted in an end
to a series of deaths related to unsafe „huffing.“43
In order to reduce drug-related harms,
goals of drug education should first include facts about the physiological
effects of drugs, as well as their risks and benefits. Drug education courses
allow us the opportunity to teach children physiology. Programs should begin
with an extensive look at how drugs affect the body.
There are many concrete risks and dangers
in the use of psychoactive substances. We must, however, separate the real from
the imagined dangers of drugs and impart this information within the appropriate
context. Drugs can provide users with a number of benefits, and this simple but
contradictory fact explains why drug use persists. The trick is to find a
balance between cost and benefit. A useful drug education program will help
students to strike a balance between real information and propaganda designed
only to deter use. An explanation for the continued increase of marijuana use
among teenagers, is their refusal to believe the exaggerated negative
information that has been disseminated over the past decade.
We must incorporate children’s experience,
expertise and intelligence in a drug education curriculum. Children often know
more than we credit them with about drugs through experience, family, and the
media. They are also much more thoughtful, intelligent and concerned about their
own well-being than adults may acknowledge. An effective drug education program
will incorporate these observations.44 Both „peer education,“ where the students
themselves direct the program, and „confluent education,“ where information is
coupled with experience, are two such vehicles.45 In order to achieve the goal
of incorporating children’s experience and expertise, there must be no
repercussions for their input and honesty.
Finally, positive role models must be
incorporated into drug education. It has become common practice for individuals
„in recovery,“ who have had prior abusive relationships with drugs, to teach
children about the pitfalls of using drugs. These individuals, who have
obviously failed to control their use seem unlikely models, and are comparable
to obese people teaching classes on weight control. Yet, individuals who have no
experience with such substances are equally as unlikely to capture the attention
of students. Employees of drug treatment facilities as teachers have a conflict
of interest, since their employers profit from a definition of drug abuse that
is broad and requiring treatment.
Individuals with non-problematic
experiences with drugs, who can act as positive role models, should educate
children about drug use.“ These individuals should not endorse use but convey
the methods they themselves use for avoiding abuse or accidents, e.g., keeping
dosages at moderate levels, pacing, not driving while intoxicated, and never
using drugs at work or school.
Parents who have experimented with drugs
should talk to their children. However, in the past fifteen years, with DARE
police suggesting criminal justice sanctions, even parents who used drugs
moderately have become secretive. Instead of providing examples of responsible
use, most hide and deny their use, withholding important practical information
from their children and deceiving them. In addition, open and honest
communication between parent and child has been curtailed.
I recently attended a series of „drug
awareness“ evenings at my 12-year-old’s middle school. The course, taught by two
employees of a local drug treatment program, utilized a number of factually
erroneous scare tactics to dissuade children from experimentation. The program
disappointed but did not surprise me. It did nothing to educate my child about
the actual risks and how to minimize the effects of drug use. I would have
preferred no drug education to the rhetoric that passes for information today.
There are a small number of programs in the
United States and abroad that disseminate useful information about drugs to
young people. These programs contain written as well as audio-visual materials
and are taught in a classroomlike setting. Since these programs are viewed as
unconventional due to their assumptions and goals about drug use and education,
they have not been incorporated into school curricula. Some have continued to
operate, nonetheless, and serve as examples in the structuring of new,
innovative programs. Harm-Reduction Drug Education (HRDE)
Conceived by Julian Cohen, Ian Clements,
and James Kay, Harm-Reduction Drug Education is a drug education approach used
in the United Kingdom. Cohen says,
HRDE is secondary rather than primary
prevention on the understanding that we cannot prevent drug use per se and that
attempts to do so may be counterproductive. It is education about rather than
against drugs … It is non-judgmental and neither condones or condemns drug use
but accepts that it does, and will continue to, occur. As such it is consumer
education. A key aim is to develop an open and honest dialogue with young
people. A key principle is that the right of young people to make their own
decisions regarding drug use is respected.“
The program’s form varies according to
group needs and local situation. Rather than „resisting peer pressure,“ HRDE’s
goal is to foster what it calls „positive peer support.“ For example, students
learn techniques for performing lifesaving techniques in the event of an
overdose or accident. With an emphasis on peer involvement in education,
teachers take on the role of facilitator. Materials for the program consist of
Taking Drugs Seriously, for ages 12 and older, and Don’t Panic for
professionals.48 There are eight main sections:
1. Facts about drugs-which gives accurate
information and focuses on benefits as well as risks.
2. Personal drug use-in which risk-taking
is examined in a non judgmental manner.
3. Attitudes-in which stereotypes are
challenged.
4. Harm reduction-in which drug, set, and
setting factors are highlighted.
5. The law and drugs-which looks at laws
and rules, legal rights, and handling conflict.
6. Giving and receiving help-which focuses
on the skills needed to help oneself and to help others.
7. Community action-which looks at
responses to drug use both locally and nationally.
8. Parents and Community Workshop-to help
educate parents and other adults.49
HRDE has had limited exposure in the United
Kingdom. Advocates of traditional primary prevention, and who control funding,
are reticent to use the program without preliminary results. Without exposure,
however, it is impossible to gather information on the program. Still, HRDE has
structured a practical program that incorporates the assumptions and goals
underlying effective drug education.
Mothers Against Misuse and Abuse
Mothers Against Misuse and Abuse (MAMA) was
founded in Oregon in 1982 by Sandee Burbank. According to longtime drug educator
Mark Miller, its purpose is „to provide education and information on legal and
illegal drugs.“ MAMA uses a „rational“ approach by „providing current and
scientific drug education and information to all ages of society; offering
individual and familyoriented alternatives to drug use; creating critical lines
of communication between law enforcement, educators, service providers, parents
and youth; questioning the Madison Avenue techniques of advertising
over-the-counter drugs, alcohol, nicotine and caffeine.“50
MAMA currently utilizes pamphlets as
written foundations for their programs. In the foreword to „How to Teach Your
Children About Drugs,“ Mark Miller reveals his perspective:
I’ve often been asked if I could provide
parents with a realistic, health-oriented means of teaching their children about
drugs. These parents wanted an approach that accurately portrayed the world of
drugs, with techniques that promoted responsible decision-making skills lacking
in much of today’s drug education. …Many felt approaches such as „Just Say No“
are simplistic, ineffective and confusing. Drugs are extensively advertised,
openly consumed by adults and easily obtained in grocery stores … This
pamphlet provides information and guidelines to help parents and children make
responsible decisions in a drug-filled worlds‘
Other pamphlets include „Drugs and Seniors“
and „Using Alcohol Responsibly.“ The program is based on a generic set of „Drug
Consumer Safety Rules“ that apply to prescription drugs, over-the-counter
substances, tobacco, caffeine, alcohol, and illegal drugs. For each of these
substances or class of substances the reader is encouraged to ask: 1) What is
the name of the chemical?; 2) What part of may body does it effect?; 3) What is
the correct dosage?; 4) What drug interactions will occur?; 5) What allergic
reactions can occur?; 6) Will it produce tolerance?; 7) Will it produce
dependence?
MAMAS program is not radical. It includes
real information about both legal and illegal drugs. MAMA’S value lies in its
comprehensive, non judgmental, yet cautionary perspective on drug education.
Drug education is vital to the prevention
of drug abuse. Traditional approaches, however, because they are based on
questionable assumptions about drug use in general and adolescent behavior, in
particular, have not succeeded in achieving this goal.
A useful approach to drug education
incorporates the tenets of a „harm reduction“ perspective. For a variety of
social, cultural and personal reasons, drug use (illegal or legal) will never be
eliminated. Thus, we must assume the existence and use of psychoactive
substances and focus our energies on reducing their harmful effects. As Duncan
states, this approach may run contrary to that of traditional drug educators:
Many health educators will be uncomfortable
with this direction. They may see it as a surrender in the war on drugs. Others
will see it as a refocusing of our efforts on what really matters for health
education-the prevention of health problems. It is the proper role of health
educators to help people live healthier lives, not to act as moral police.52
Drug education should be based on realistic
assumptions about drug use. Specific goals and programs should be tailored
around these assumptions. We should not lose sight of the fact that human beings
are complex, human behavior is always changing and teenagers are bright and
critical. Programs must address the needs of individuals within their social
context and be as flexible, open, and creative as the young people they must
educate.
l . Mathea Falco, The Making of a Drug-Free
America. New York: Times Books, 1992.
2. Patricia A. Winters, „Getting High:
Components of Successful Drug Education Programs,“ Journal ofAlcohol and Drug
Education, v. 35, n. 2, Winter, 1990.
3. Avram Goldstein, Addiction: From Biology
to Drug Policy. New York: W .H. Freeman and Company, 1994, p. 207.
4. Erich Goode, Drugs in American Society.
New York: McGraw-Hill, Inc., 1993, p. 334. Goode also cites H.S. Resnick, It
Starts With People: Experiences in DrugAbuse Prevention. Washington, D.C.: U.S.
Department of Health, Education and Welfare, 1978.
5. Andrew Weil, M.D. and Winifred Rosen,
Chocolate to Morphine: Understanding Mind-Active Drugs, Boston: Houghton Mifflin
Co., 1983.
6. Lloyd D. Johnston, Patricia M.
O’Malley and Jerald G. Bachman, „National Survey Results on Drug Use from
Monitoring the Future Study, 1975-1992,“ U.S. Department of Health & Human
Services, PHS, 1993.
7. In a report prepared for the White House
Office of National Drug Control Policy by ABT Associates in Cambridge,
researchers found marijuana use up in most areas of the country, and
„Hallucinogens such as LSD, mescaline and PCP are re-emerging…“ The San
Francisco Chronicle, May 12, 1994, p. A12.
8. Preliminary Estimates from the 1994
National Household Survey on Drug Abuse. U.S. Department of Health and Human
Services: Advance Report Number 10, September 1995.
9. Ibid
10. Mathea Falco, The Making of a Drug-Free
America. New York: Times Books, 1992.
11. William H. Bruvold, „A Meta-Analysis of
the California School-Based Risk Reduction Program,“ Journal of Drug Education,
v. 20, n. 2, 1990; Chwee Lye Ching, „The Goal of Abstinence: Implications for
Drug Education,“ Journal o fDrug Education, v. 11, n. l, 1981.
12. Constance Lignell and Rugh Davidhizar,
„Effect of Drug and Alcohol Education on Attitudes of High School Students,“
Journal ofAlcohol and Drug Education, v. 37, n. 1, Fall, 1991.
13. Chwee Lye Ching, „The Goal of
Abstinence: Implications for Drug Education,“ Journal of Drug Education, v. 11,
n. 1, 1981.
14. Sehwan Kim, Jonnie McLeod and Charles
L. Palmgren, „The Impact of the `I’m Special‘ Program on Student Substance Abuse
and Other Related Student Problem Behavior,“ Journal of Drug Education, v. 19,
n. 1, 1989; William H. Bruvold, „A Meta-Analysis of the California School-Based
Risk Reduction Program,“ Journal of Drug Education, v. 20, n. 2, 1990; Susan G.
Forman, Jean Ann Linney and Michael J. Brondino, „Effects of Coping Skills
Training on Adolescents at Risk for Substance Abuse,“ Psychology of Addictive
Behavior, v. 4, n. 2, 1990; Michael D. Newcomb, Bridget Fahy and Rodney Skager,
„Reasons to Avoid Drug Use Among Teenagers: Associations with Actual Drug Use
and Implications for Prevention Among Different Demographic Groups,“ Journal of
Alcohol and Drug Education, v. 36, n. 1, Fall, 19’90.
15. Mary Ann Pentz, James H. Dwyer, David E
MacKinnon, et al,
„A Multicommunity Trial for Primary
Prevention of Adolescent Drug Abuse: Effects on Drug Use Prevalence,“ JAMA, v.
261, n. 22. June 9, 1989. 16. Raymond Tricker and Lorraine G. Davis,
„Implementing Drug Education in Schools: An Analysis of the Costs and Teacher
Perceptions,“ Journal of School Health, v. 58, n. 5, May, 1988; Phyllis
Ellickson, Robert M. Bell and Kimberly McGuigan, „Preventing Adolescent Drug
Use: Long-Term Results of a Junior High Program,“ American Journal of Public
Health,
v. 83, n. 6, June, 1993.
17. Brian R. Flay, Stacey Daniels and
Calvin Cormack, „Effects of Program Implementation on Adolescent Drug Use
Behavior,“ Evaluation Review, v. 14, n. 3, June, 1990, p. 448.
18. Earl Wysong, Richard Aniskiewicz and
David Wright, „Truth and DARE: Tracking Drug Education to Graduation and as
Symbolic Politics,“ Social Problems, v. 41, n. 3, August, 1994; Dennis
Rosenbaum, Robert L. Flewelling, Susan L. Bailey, Chris L. Ringwalt, Deanna L.
Wilkinson, „Cops in the Classroom: A Longitudinal Evaluation of Drug Abuse
Resistance Education (DARE),“ Journal of Research in Crime and Delinquency, Vol.
31, No. 1, February 1994, 3-34.
19. Earl Wysong, Richard Aniskiewicz and
David Wright, „Truth and DARE: Tracking Drug Education to Graduation and as
Symbolic Politics,“ Social Problems 41 (3), August 1994.
20. Susan T. Ennett, Nancy S. Tobler,
Christopher L. Ringwalt, Robert Flewell ing, „How Effective is Drug Abuse
Resistance Education? A MetaAnalysis of Project DARE Outcome Evaluations,“
American Journal of Public Health, Vol. 84, No. 9, September 1994, p. 1394-1401.
21. Peter Greenwood, „Substance Abuse
Problems Among High-Risk Youth and Potential Interventions,“ Crime and
Delinquency, Vol. 38, No. 4, October, 1992, pp. 444-458.
22. Joel Brown and Marian DAMMED Caston,
„On Becoming `At Risk‘ Through Drug Education,“ Evaluation Review Vol 19, No. 4,
August 1995, p. 451-492.
23. Andrew Weil, The Natural Mind, Boston,
MA: Houghton-Mifflin Company, 1972; Joel Fort, The Addicted Society, New York:
Grove Press, 1981.
24. „Drug Use Among Youth: No Simple
Answers to Guide Prevention,“ GAO Report, December, 1993.
25. Chwee Lye Ching, „The Goal of
Abstinence: Implications for Drug Education,“ Journal of Drug Education, v. 11,
n. 1, 1981.
26. Erich Goode, Drugs in American Society.
New York: McGraw-Hill, Inc., 1993, p. 335.
27. David F. Duncan, „Problems Associated
with Three Commonly Used Drugs: A Survey of Rural Secondary School Students,“
Psychology of Addictive Behavior, v. 5, n. 2, 1991, p. 93-96.
28. „Drug Use Among Youth: No Simple
Answers to Guide Prevention,“ GAO Report, December, 1993.
29. Denise Kandel, „Stages in Adolescent
Involvement in Drug Use,“ Science, v. 190, 1975, p. 912-914; Steve. G. Gabany,
Portia Plummer, „The Marijuana Perception Inventory: The Effects of Substance
Abuse Instruction,“ Journal of Drug Education v 20, n. 3, 1990, p. 235-245.
30. Brown, J.H. and Horowitz, J. E.,
„Deviance and deviants: Why adolescent substance use prevention programs do not
work“ Evaluation Review 17, 5, 1993, pp. 529-555; Lynn Zimmer and John Morgan,
Exposing Marijuana Myths: A Review of the Scientific Evidence. New York: Open
Society Institute, October ,1995, p.14.
31. Jerald G. Bachman, Lloyd D. Johnston,
Patrick M. O’Malley, „Explaining the Recent Decline in Cocaine Use Among Young
Adults: Further Evidence That Perceived Risks and Disapproval Lead to Reduced
Drug Use,“ Journal of Health and Human Social Behavior, v. 31, n. 2, June, 1990,
p. 173-184.
32. David Moore and Bill Saunders, „Youth
Drug Use and the Prevention of Problems,“ International Journal on Drug Policy,
vol. 2, n. 5, March-April, 1991, p. 3.
33. Earl Wysong, Richard Aniskiewicz and
David Wright, „Truth and DARE: Tracking Drug Education to Graduation and as
Symbolic Politics,“ Social Problems 41 (3), August 1994.
34. Chorsie E. Martin, David F. Duncan and
Eileen M. Zunich, „Students Motives for Discontinuing Illicit Drug Taking,“
Health Values: Achieving High Level Wellness, v. 7, n. 5, September-October,
1983, p. 8-11.
35. Watson, M., „Harm Reduction: Why do
It?“ International Journal of Drug Policy 5, 13-15, 1991.
36. Beck, J. And Rosenbaum, M., Pursuit of
Ecstasy: The MDMA Experience. New York: SUNY Press, 1994.
37. M. Newcomb and P Bentler, „Consequences
of Adolescent Drug Use: Impact on the Lives of Young Adults,“ Newbury Park, CA:
Sage, 1988; J. Shedler and J. Block, Adolescent Drug Use and Psychological
Health: A Longitudinal Inquiry, American Psychologist, v. 45, 1990, p. 612-630.
38. Thomas Nicholson, „The Primary
Prevention of Illicit Drug Problems: An Argument for Decriminalization and
Legalization,“ The Journal of Primary Prevention, v 12, n. 4, 1992; Charles
Winick, „Social Behavior, Public Policy, and Nonharmful Drug Use,“ The Milbank
Quarterly, v. 69, n. 3, 1991.
39. Erich Goode, Drugs in American Society.
New York: McGraw-Hill, Inc., 1993, p. 335.
40. Dan Waldorf, Craig Reinarman and
Sheigla Murphy, Cocaine Changes. Philadelphia: Temple University Press, 1991;
Jerome Beck and Marsha Rosenbaum, Pursuit of Ecstasy: The MDMA Experience. New
York: SUNY Press, 1994.
41. Norman Zinberg, Drug, Set, and Setting.
New Haven: Yale University Press, 1984.
42. For an interesting discussion of the
role of context in cross cultural settings, see Charles Grob and Marlene Dobkin
de Rios, „Adolescent Drug Use in Cross-Cultural Perspective,“ The Journal of
Drug Issues, v. 22, n. 1, 1992.
43. David Duncan, Thomas Nicholson, Patrick
Clifford, Wesley Hawkins, and Rick Petosa, „Harm Reduction: An Emerging New
Paradogm for Drug Education,“ Journal of Drug Education Vol. 24, No. 4, 1994,
p.281-290.
44. Chorsie E. Martin, David E Duncan and
Eileen M. Zunich, „Students Motives for Discontinuing Illicit Drug Taking,“
Health Values: Achieving High Level Wellness, v. 7, n. 5, September-October,
1983, p. 8-11.
45. For an excellent discussion of peer
education see Julian Cohen, „Achieving a Reduction in Drug-related Harm through
Education,“ in Nick Heather, Alex Wodak, Ethan A. Nadelmann and Pat O’Hare,
eds., Psychoactive Drugs and Harm Reduction: From Faith to Science. London:
Whurr, 1993; and for confluent education see Joel H. Brown and Jordan E.
Horowitz, „Deviance and Deviants: Why Adolescent Substance Use Prevention
Programs Do Not Work,“ Evaluation Review, v. 17, n. 5, October, 1993,
p. 529-555.
46. Zigmund A. Kozicki, „Why Do Adolescents
Use Substances (Drugs/Alcohol)?“ Journal of Alcohol and Drug Education, v. 32,
n. l, Fall, 1986.
47. Julian Cohen, „Achieving a Reduction in
Drug-Related Harm through Education,“ in Nick Heather, Alex Wodak, Ethan A.
Nadelmann and Pat O’Hare, eds., Psychoactive Drugs and Harm Reduction: From
Faith to Science, 1993, p. 69.
48. I. Clements, J. Cohen and J. Kay,
Taking Drugs Seriously: A Manual of Harm Reduction Education on Drugs.
Liverpool: Healthwise, 1991; Cohen, J. and Kay, J., Don’t Panic: Responding to
Incidents of Young People’s Drug Use. Liverpool: Healthwise.
49. Julian Cohen, „Achieving a Reduction in
Drug-Related Harm through Education,“ in Nick Heather, Alex Wodak, Ethan A.
Nadelmann and Pat O’Hare, eds., Psychoactive Drugs and Harm Reduction: From
Faith to Science, 1993, p. 71.
50. Mothers Against Misuse and Abuse,
„Using Alcohol Responsibly,“ Mosier, Oregon: MAMA.
51. Sandee Burbank and Mark Miller, „How to
Teach Your Children About Drugs,“ Hosier, Oregon: MAMA, p. 1.
52. David E Duncan, „A New Direction for
Drug EducationHarm Reduction,“ The Catalyst Vol. 22, No. 2, Fall 1995, p. 8-9.