Can Science-Based Prevention Deliver the Goods in the Real World

This has been a banner year for prevention education. "Science-based prevention" has become the buzzphrase in Washington. Only programs validated by research shall receive Federal endorsement. Even the sacrosanct Drug Abuse Resistance Education program, whose sponsors long ago learned to make cosmetic changes in response to criticism, has been encouraged to incorporate scientifically validated prevention strategies.

The alternative receiving most of the attention in Washington is known as Life Skills Education (LSE). (1) Positive outcomes reported for LSE include delaying initiation of substance use and moderate reductions in overall use for both predominantly white and minority groups. However, none of the findings suggests that this approach is even remotely likely to eliminate alcohol and other drug use among youth. Rather, some statistically significant reductions have been reported, which admittedly cannot be said for strategies based mainly on information about the dangers of substance use. But statistical significance in controlled research situations is not necessarily equivalent to practical significance.

With large numbers of subjects and multiple criteria of success, mere statistical significance may be trivial in real-world terms. In short, the bang may not be worth the buck, and life skills education requires I lot of the latter. Classroom instruction time amounts to fifteen hours in grade 7, ten in grade 8, and five in grade 9. Adequate inservice training and tight administrative monitoring are also essential.

There also are serious grounds for questioning whether LSE can achieve even moderate gains when it is no longer embedded in a formal research study. The special condi-tions associated with funded research include motivational incentives for administrators
and teachers, full training for teachers, greater control over implementation, and research staff observing classroom delivery. These conditions promote greater compliance among district and local school staff.

But implementation difficulties are evident, even in controlled research studies. A recent study by Gilbert Botvin, PhD, and his colleagues reported statistically significant results for LSE schools versus control schools on only two of twelve measure of alcohol and drug use. (2) In an effort to improve on these meager results, classrooms that covered less than 60 percent of the curriculum were eliminated from the experimental group data set, resulting in loss of about 25 percent of the experimental subjects.

Even with outside observers regularly visiting classrooms and openly recording teacher behavior, the cutoff had to be set at a little over half of the LSE curriculum delivered! There is every reason to doubt that even this level would be achieved for schools not participating in a controlled research study.

Experience tells us that prevention education enjoys a very low priority among most educators. Their feet are held to the fire over academic learning, which is, after all, the function for which society supports schooling. There is another problem - the theory on which LSE is grounded. Does it really address why the great majority of older teenagers have had experience with alcohol and about half marijuana?

Life Skills Education addresses many desirable aspects of personal development. These include skills for building self-esteem, resisting advertising pressure, managing anxiety, and developing effective communication. There is also training on resisting social influences that promote substance use.

Still, it seems unlikely that deficits in these important areas of human development have much to do with substance use by the majority of youth. Why are we so quick to accept the idea that all kids try alcohol and illicit drugs because they suffer from deficits, or worse, are social deviants, the cover word for criminal? If that were true, then youth itself is a pathological condition.

Ready acceptance of the deficit/deviance hypothesis may be another instance of the assault on youth in our society, documented in Mike Males's Scapegoat Generation. (3) Perhaps those who are so ready to accept deficit and deviance notions as applied to virtually all youth might explain how it is that so many socially and academically successful young people do use alcohol and experiment with drugs, whether we like to admit it or not.

Youth themselves take a different view. They consistently maintain that most kids use alcohol and drugs to have fun and because they want to know what it is like. Perhaps these kids are too unsophisticated to come up with the elaborate explanations favored by adults who have studied psychology and sociology. But what if they are substantially correct, at least for most of their peers who do not go beyond experimentation? Having fun and exercising curiosity are hallmarks of healthy adolescence.

We bombard children and youth with messages about alcohol and drugs. Red Ribbon Weeks, assemblies, and classroom instruction combine with posters and banners exhorting abstinence from booze and dope. Kids would have to be brain dead not to be curious about the object of all the fuss.

Recently the respected Research Triangle Institute released the results of a national study of school-based prevention. (4) The original plan had been to identify from a national data base a set of districts that met the criteria for comprehensive prevention programming, including K-12 prevention instruction coordinated across grade levels, at least three prevention components in addition to classroom instruction, community involvement, and special training for prevention staff.

Each of nine districts meeting these criteria on paper was then matched on demographic and other characteristics against a comparison district with minimal prevention programming. The idea was to find out whether there would be more substance use and higher incidence of risk factors in minimal districts as contrasted with comprehensive districts. The findings about actual delivery of prevention programs were so significant that they overshadowed the findings on student outcomes.

• The original classification of the school districts as comprehensive vs. minimal on prevention programming could not be maintained. Even within ostensibly comprehensive districts, delivery at the school level varied enormously.
• None of the local efforts approached the level of program comprehensiveness or consistency that has been achieved in controlled research studies.

The last point is the most disturbing. It verifies what has already been suggested in relation to Life Skills Education. Programs that have been developed and studied in research situations are not adequately implemented in most real-world situations.

Whether the new science-based approaches will live up to the promises made on their behalf remains to be seen. A few years ago at a conference in Washington, DC, I heard a distinguished researcher suggest that the principle of engagement in prevention was Ready, fire, aim! Do the political rules of engagement under which prevention operates mean that once again we will be aiming at the wrong target?

Recently I participated in a working session on a proposal to evaluate a new prevention curriculum based on a different view of the problem of youth substance use. I suggested alcohol and drugs will go on being easy to obtain for the indefinite future and, consequently, that the choice between using versus not using will continue to confront young people. The Washington consultant connected by conference call immediately interjected that any implication that choice was necessarily involved in youth substance use was anathema in her town. If this sounds crazy, one just needs to spend time in Washington, where political postures define truth.

Apparently we are supposed to invent approaches to alcohol and drug prevention that will eliminate choice, replacing that dangerous human function with knee-jerk avoidance. This is quite an order, though not one with much chance of success in a free society. Perhaps that is the real reason why we flounder about believing that peer pressure or low self-esteem are the primary reasons most kids try alcohol and drugs. It is easier to blame the kids than to have the courage to rethink the nature of the problem and how we must deal with it.

1. Life Skills Education is a prevention program developed at Cornell Medical School under the direction of Gilbert Botvin, Ph.D. Its major components include resistance skills training designed to promote resistance to peer pressure and advertising messages; normative education which corrects misperceptions about how many peers are actually using substances, and training in social and life skills to improve self-esteem and self-efficacy, deficits which are assumes to underlie drug experimentation and use by children and adolescents.

2. Botvin, G.J., Baker, E., Dusenbury, L., & Botvin, M. (1996). "Long-term follow-up results of a randomized drug abuse prevention trial in a white, middle-class population." Journal of the American Medical Association, 273(14):1106-1112.

3. Males, Mike A. (1996) The scapegoat generation: America's war on adolescents. Monroe, Main: Common Courage Press.

4. Sylvia, E. & Thorne, Judy. (1997). "School-based drug prevention programs: A longitudinal study in selected school districts." Research Triangle Institute, P.O. Box 21294, Research Triangle Park, NC 27709.

Rodney Skager, PhD, is with the University of California, Los Angeles, and it a contributing editor of Prevention File.