Are all drug-prevention programs effective?

Family: A Johns Hopkins psychologist says not all programs work, and some might even do some harm.

October 24, 1999|By Peter Jensen | Peter Jensen,SUN STAFF

In America in the '90s it's practically a given: In addition to reading, writing and arithmetic, schools are expected to teach children about drugs.

But how effective are school-based drug education and prevention programs? Should you enroll your child in one?

According to Harold E. Shinitzky, a psychologist with the Johns Hopkins Hospital, school-based programs are definitely worthwhile -- but only if parents and school administrators have made the right choices.

"You've probably heard this before: For every dollar spent on drug treatment you save $12 of cost to society," says Shinitzky. "Well, for every dollar spent on prevention, you save $4 in treatment. You don't have to be a math major to see the advantages of that."

Along with Dr. Harolyn Belcher of the Kennedy Krieger Institute, Shinitzky has reviewed the past decade of substance abuse prevention programs to uncover traits common to the most successful efforts.

His interest was not just academic. He has created his own substance abuse education program, called Project Champions, that the Baltimore Archdiocese uses. In a recent interview, Shinitzky discussed his views on what parents should look for in drug prevention programs.

Q: Since you are critical of the feel-good, "Just say no" programs of the past, what gives you hope that school-based drug education works?

A: The mentality in the past was that we had to do something. It could be school-based initiatives. It could be community-based or on TV. But there was no assessment of what worked and what didn't work.

The nice thing about the latest [Clinton administration] initiative is that they are actually studying the impact -- on knowledge, attitude and behavior. They're following a group of people and monitoring them.

Q. What have we seen so far?

A. The initial results are pretty powerful in terms of changing knowledge and attitude, and that's just for the government initiative. There have been a number of programs in the past that have now been studied over five years. They've turned out to be wonderful programs. Gilbert Botvin at Cornell University has a program called Life Skills Training. It's probably the most well-known prevention initiative. It's across the country. It's a very comprehensive, universal intervention, meaning you give it to all the kids at a school.

The feel-good programs didn't really monitor the outcomes. They'd have a pre-test, give the intervention and then a post-test, and say, "Oh, look, there's been a change." The impressive thing is when there's been a change the next year, and the next year, and the next year.

Q. Is there an ideal age to reach children?

A. The sooner, the better. Whenever you think you want to start an intervention, you should do it at a younger age. As adults, we're usually more reactive than proactive. The best age to start is before a child is in school, and work with the family.

Q. That's very early.

A. You could almost say you should start before a child is born. Parents have to be role models. Parents can't abdicate their role and say the school is responsible for raising my child and giving them their morals and values.

Q. What factors are common to successful programs?

A. They need to be research-based. You have to be able to know what's going into it and coming out of it. They need to be culturally sensitive. It has to fit the population. You can't just pull it off the shelf and apply it to anyone. It needs to be age-appropriate. There needs to be a peer refusal component.

They need to take advantage of peer pressure. In the last national study, approximately 20 percent of eighth-graders studied said they used an illicit substance in the past year. You and I would agree that's atrocious. Well, it also means that four out of five eighth-graders didn't. A lot of people tend to miss that fact. About 11 percent of eighth-graders used inhalants. That's terrible. But it also means 9 out of 10 kids aren't, and I want to emphasize that. Somehow, it doesn't get publicity. The good child is the norm.

These broad-based interventions mean don't wait until they face this problem and teach peer refusal skills. Way before that, it's about decision-making, goal-setting, assertiveness, self-esteem, character development, these are all part of raising a resilient child.

Q. Sometimes, it seems these drug education programs are filled with hyperbole, exaggerating risks. Doesn't that harm their credibility with kids?

A. That's the shock value approach. It's like driver's education and the "hamburger" films that showed terrible crashes. But then you drove and you didn't die. You promote these shock values and they prove false, you get a boomerang effect. Kids think, "It's not happening to me so it doesn't apply to me." When you push a horrific ending that happens infrequently, you negate and discredit your message. Kids need and want factual information and that's what these programs provide.

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