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March 1, 2000
Vol. 57
No. 6

Tackling Teens' No. 1 Problem

Sometimes the phrase “just say no” just doesn't work. What are the key elements of a successful substance-prevention program?

Substance abuse plays a significant role in teen health. In the past four annual Back to School national surveys (1995–98), both middle and high school students reported that drugs are their biggest concern. Indeed, the number of high school teens who report that drugs are used, sold, or kept at their schools rose from 72 percent in 1996 to 78 percent in 1998.
Tobacco use among teenagers jumped by nearly one-third in the last six years, with an alarming increase among African American youths. The Centers for Disease Control and Prevention found that rates of tobacco use—including cigarettes, cigars, and smokeless tobacco—rose among high school students from 27.5 percent in 1991 to 36.4 percent in 1997. This is particularly disturbing in light of a 1998 Morbidity and Mortality Weekly Report (Centers for Disease Control and Prevention) that predicted that one-third of teens who become regular smokers will eventually die of a tobacco-related disease.
In response to the 1985 Drug-Free Schools Act, more than 2,000 substance-prevention curriculums flooded the market. By 1991, schools were spending an estimated $125 million on drug-education curriculums, according to a federal report (U.S. Department of Education, 1999). But most of those programs had not been properly evaluated. A five-year study, commissioned by the Department of Education, found that the majority of those 2,000 curriculums didn't do much good (Silvia, Thorne, & Tashjian, 1997).
As a result, a federal mandate issued in May 1998 requires that school districts receiving federal antidrug money use programs that demonstrate effective prevention of or reduction in drug use. In addition, districts must periodically evaluate the results.
"We need to use more programs that are based on sound research and evaluations," says William Modzeleski, the director of the Safe and Drug-Free Schools and Communities Program, the department's $568 million antidrug effort.

The Best Programs

So what does work? Making the Grade: A Guide to School Drug Prevention Programs (Drug Strategies, 1999) provides the most comprehensive answer to date. The updated and expanded report, first published in 1996, evaluates the 50 most popular prevention programs in the United States. A panel of six experts from the fields of prevention, public health, and education reviewed the programs for Drug Strategies, a Washington, D.C., nonprofit organization that promotes effectiveness in prevention-oriented education.
Only 16 percent of the reviewed curriculums scored As in overall quality. One top scorer was Project ALERT, which earned straight As in the three main review categories: overall quality, ease of administration, and rehearsal and role plays. To date, 18,000 teachers nationwide have been trained to administer the program, with 4,500 more expected to be trained by year's end.
Middle and High School Drug-Prevention Curriculums

Middle and High School Drug-Prevention Curriculums

The following programs received an A in overall quality in Making the Grade: A Guide to School Drug Prevention Programs (Drug Strategies, 1999).

  • Alcohol Misuse Prevention Program (Series), University of Michigan, Institute for Social Research, P.O. Box 1248, Ann Arbor, MI 48106, (734) 647-0587

  • Life Skills Training, Princeton Health Press, 115 Wall St., Princeton, NJ 08540, (800) 636-3415

  • Michigan Model for Comprehensive School Health, Michigan Department of Community Health, 3423 N. Martin Luther King Blvd., Lansing, MI 48909, (517) 335-8390

  • Project ALERT, Best Foundation, 725 S. Figueroa St., Ste. 1615, Los Angeles, CA 90017, (800) ALERT-10

  • Project Northland, Hazeldon Publishing and Education, P.O. Box 176, Center City, MN 55012-0176, (800) 328-9000

  • Project TNT, ETR Associates, P.O. Box 1830, Santa Cruz, CA 95061-1830, (800) 321-4407

  • Reconnecting Youth, National Education Service, 1252 Loesch Rd., Bloomington, IN 47404

  • STAR, Department of Preventive Medicine, University of Southern California, 1441 Eastlake Ave., MS-44, Los Angeles, CA 90033-0800, (213) 865-0325


Key Elements

Project ALERT illustrates the key elements of an effective program.

Age Appropriate

Research reveals that 6th, 7th, and 8th graders are at a crucial age for either adopting or rejecting the use of substances. A 1994 report of the Surgeon General found that almost 90 percent of adult smokers begin smoking at or before age 18. The transition from ages 12 to 13 signals the biggest increase in teen use of tobacco, alcohol, and drugs (National Center on Addiction and Substance Abuse, 1998). Over the three-year period from ages 12 to 15, the proportion of teens who have smoked cigarettes in the previous month soared from 2 to 21 percent, and the number of teens who say that they smoked marijuana jumped from 1 to 34 percent. Project ALERT is designed to reach these middle-level students.

Social Influences

A Department of Education report (Silvia, Thorne, & Tashjian, 1997) revealed that the social-influence model was the most effective type of program in preventing drug abuse. This model, which focuses primarily on identifying and dealing with social pressures related to drug use (from peers, parents, or the media, for example), was more effective than the knowledge-based model, which presents factual information about the legal, biological, and psychological effects of drugs. Through small-group activity, role playing, and discussion, Project ALERT students learn to recognize both internal and external pressures. To understand the power of advertising, for instance, students analyze what a tobacco or liquor ad is suggesting and then rewrite the ad to reflect what they know to be true about smoking or drinking. Student examples include "Once you start, you KENT stop smoking" and "Absolut Stupidity."

Refusal Skills

Although many students learn about the dangers of drugs, many lack the skills to resist drugs. Through role playing, Project ALERT teaches kids not just to say no, but also how to say no. For example, when a boy offers Lindsey a cigarette in the video Lindsey's Choice, the teacher stops the tape and asks students to role-play different ways to say no. Then she turns the video back on to illustrate three ways that Lindsey declined his offer.


Interactive techniques, such as Socratic questioning, role playing, brainstorming, and small-group activities, are far more effective than lectures and other one-way forms of communication. "There's a lot of active participation," notes Linda Schwenn, a teacher at Gauer Elementary School in Anaheim, California. "They're not just sitting and listening to a lecture."
To study the impact of internal pressures, teachers present students with a scenario, such as the following: A guest brings beer to a party. No one pressures you to drink, but you still feel as if maybe you should. In an impromptu skit, students act out their conflicting inner voices. One voice says, "Well, maybe I should. It looks like everyone is having fun." Another voice says, "Yeah, but I might blow my track meet tomorrow."

Normative Education

One Project ALERT exercise asks, "How many kids your age used alcohol in the last month?" Most middle-grade students guess 80 to 90 percent. In fact, the correct answer is 24 percent, according to the Monitoring the Future study, which reviews 8th grade usage patterns (National Institute on Drug Abuse, 1998).
"Peer pressure is very exaggerated in kids' minds," notes Monique Guidry, a 7th grade teacher at Burbank Middle School in Boulder, Colorado. "They need to be reassured that not everyone is doing it." Comparing students' perceptions of cigarette, alcohol, and marijuana use with actual statistics from survey research drives home this message.

Family Involvement

Involving the family increases the likelihood of effectiveness and promotes longer-lasting results. Marsha Prine, a junior high science teacher at Parklane Academy in McComb, Mississippi, cites the Project ALERT exercise that calls for students to ask their parents questions: When you were a teenager, was there peer pressure? How did you resist it? What was your most embarrassing moment as a teenager? Prine explains, This allows parents to remember back to when they faced the same pressures and needed to belong. As a result, if the child does have a problem with drugs or alcohol, the parent will be less likely to just blame or punish. The child will see not just the action, but also the "why" of the action.

Cultural Sensitivity

"So many programs advocate 'Just say no,'" notes Yanita Anaya, the school-based coordinator for Proyecto Community Health Awareness Council in Mountain View, California, a federally funded program designed for Latino students. She continues, But that approach can create animosity—"You're smoking and drinking. I'm not." The Latino family is so interconnected and close-knit that that approach can create conflict. It can stress out a family that's already feeling stressed. Project ALERT advocates a different tactic: "I'm making my own decision. You can make your own decision. And I have the skills to say no if I want to." It brings out the child's individuality.

A Field-Tested Program

  • One-third of a reduction in the initiation of marijuana and tobacco use;
  • A 50 to 60 percent reduction in heavy smoking among experimenters; and
  • An equally effective reduction in use for high- and low-risk students and minorities.
A follow-up program for high school students, called ALERT Plus, is under development, with South Dakota schools participating as research sites.

Low Cost

Considering the scarcity of antidrug funds, Project ALERT's low cost is noteworthy. Thanks to the grant from the Conrad N. Hilton Foundation, a Project ALERT teacher can be trained for $125. This cost covers a required one-day training workshop and the complete two-year curriculum, including 14 detailed lesson plans, eight classroom videos, an overview video for colleagues and the community, and 12 posters. Teachers also receive free print and video updates. Once a teacher is trained, there are no ongoing per-pupil costs, and new students can be reached year after year.

Research-Based Drug Programs

"At a time when drug use among young people is unacceptably high, we need to evaluate rigorously how our schools are dealing with the problem," says Malthea Falco, president of Drug Strategies. He summarizes:
Researched-based programs, which develop such key elements as family involvement, cultural sensitivity, and refusal skills, help schools encourage students to stay substance-free.

Centers for Disease Control and Prevention. (1998). The incidence of initiation of cigarette smoking—United States, 1965–1996. In Morbidity and Mortality Weekly Report, 47(39), 837–840. Also available: www2.cdc.gov/mmwr/

Drug Strategies. (1999). Making the grade: A guide to school drug prevention programs. Washington, DC: Author.

National Center on Addiction and Substance Abuse. (1998). Back to school 1998: The CASA national survey of American attitudes on substance abuse IV: Teens, teachers, and principals. Washington, DC: Author.

National Institute on Drug Abuse. (1998). Monitoring the future [On-line]. Available: www.nida.nih.gov/NIDAHome1.html

Silvia, E. S., Thorne, J., & Tashjian, C. (1997). School-based drug prevention programs: A longitudinal study in selected school districts. Final report. Washington, DC: U.S. Department of Education.

U.S. Department of Education. (1999). Federal education legislation enacted in 1994: An evaluation of implementation and impact. Washington, DC: Author.

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