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Drug education approaches in secondary schools

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Prevention Research Number 3
Evaluation Report November 2002

Drug education approaches

in secondary schools
by Dr Lena Sanci, Associate Professor John W. Toumbourou, Ms Vanessa San,
Mr Bosco Rowland, Dr Sheryl Hemphill and Mr Geoff Munro
Editorial Assistant: Ms Colleen Farrell

Introduction PART 1
The current literature evaluating drug THE EVALUATION EVIDENCE
education in secondary schools shows
Current evaluation literature on
examples of programs achieving positive
behavioural changes. According to those drug education in schools
working in the field, the resources and There have been two recent and compreh-
strategies for effective drug education appear ensive critical literature reviews on drug
to be emerging gradually in Victoria. Despite education in schools, conducted in Australia
evidence of progress, interviews with for government departments (Midford, Lenton
practitioners in Victoria suggest that many are & Hancock 2000; Midford, Snow & Lenton
pessimistic about whether behavioural 2001). Describing the evolution of approaches
changes can be achieved in the absence of a to drug education in schools since the 1930s to
framework for evaluation. the present, they present the factors that have
This third report in the series of Prevention been shown in experimental trials to maximise
Research Evaluation Reports aims to facilitate the effectiveness of programs in preventing or
access to the growing knowledge of drug delaying the onset of drug use and in reducing
education approaches in secondary schools. drug use.
The first part of this report reviews the Other reviews in recent times present
technical evidence for the effectiveness of drug similar conclusions (White & Pitts 1998; Lloyd
education. The second half reports on a et al. 2000, Botvin et al. 1995, Hansen 1992).
consultation examining practitioner’s views on The more successful approaches to drug
current practice in drug education in Victoria. education have a grounding in the theory of
what is known about the causes of adolescent
What is drug education? drug use, as well as their developmental
pathways in relation to drug abuse and in the
In this report, drug education refers to efforts to psychological theoretical frameworks of social
reduce drug-related harm through the delivery learning and problem behaviour (Dusenbury &
of a structured social-health education curri- Botvin 1990).
culum within the school context, usually by Since this body of evidence has been
classroom teachers, but in some cases by established over several decades of research,
visiting professionals. the authors caution those considering
developing drug education programs to base
them on what is known rather than what
 Prevention Research Evaluation Report
Number 3 November 2002

seems intuitive or ideologically sound. Successful approaches to drug

Historically, poorly conceptualised programs education programs
have been ineffective or, at worst, harmful; for
For the full discussion and references to
example, by increasing drug use (Midford,
successful drug education approaches,
Lenton & Hancock 2000). Factors associated
readers can refer to Midford, Lenton and
with effective drug education programs in
Hancock (2000) or Midford, Snow and Lenton
schools (Ballard, Gillespie & Irwin 1994;
(2001), but the main points are reiterated here.
Coggans & Watson 1995; Dielman 1994;
Successful drug education programs use
Dusenbury and Falco 1995; Kelder et al. 1994)
either the social influence approach or
are that programs should:
programs with multiple components. These
• be research-based/theory-driven
programs place a large emphasis on social
• deliver coherent and consistent messages
influences rather than on information or
• present developmentally appropriate,
approaches that target affective education
balanced information
alone. Affective education approaches in this
• provide resistance-skills training
context refer to programs that address the
• incorporate normative education
feelings or mood of the individual.
• educate before behavioural patterns are
The social influences approach is based
established
upon the belief that young people begin to use
• relate strategies to objectives
drugs because of their self-image and/or social
• address values, attitudes and behaviours
pressures. The social influence approach
of the individual and community
suggests that, in order to resist substances,
• address the inter-relationship between
young people need to be inoculated with
individuals, social context and drug use
counter arguments and to be well practised in
• focus on prevalent and harmful drug use
using them.
• make judicious use of peer leadership
Life Skills Training (LST) is one of the best
• be delivered within an overall framework of
known and successful of the social influences
harm minimisation
approaches (Botvin et al. 1990). The social
• incorporate broader social skills training
influences approach has been shown to have
and be part of a comprehensive health
benefits in reducing other anti-social
education curriculum
behaviours, particularly when it incorporates
• employ interactive teaching approaches
booster sessions at critical points in adolescent
• ensure optimal training and support for
development, reinforcing community
teachers
messages and a parenting component. While
• provide adequate initial coverage and
the original evaluation studies of LST have
continuing follow-up in booster sessions
produced significant education benefits,
• be sensitive to cultural characteristics of
Gorman (1996) has warned that many
the target audience
replication efforts have been less successful.
• incorporate additional family, community,
Affective education assumes that young
media and special population components
people who use drugs have personal
• ensure fidelity of implementation
deficiencies. This approach therefore seeks,
• be evaluated.
among other things, to help clarify the values
Explanation of these factors and the papers and enhance the self-esteem of young people,
from which they derive are presented in the believing that this will delay or curtail the onset
review by Midford, Snow and Lenton (2001). of drug use. But programs based only on

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 Prevention Research Evaluation Report
Number 3 November 2002

affective education have not succeeded in Timing and intensity of

changing behaviour, perhaps because not all education
young people using substances suffer from
personal deficiencies and perhaps because Timing of prevention education is critical.
some might be motivated less by pathology Programs must develop progressively and
and more because they enjoy using drugs. sequentially, and they must be ongoing
throughout secondary education. It is generally
Peer educators and interactive agreed that the best time to begin a program is
in late primary school or in early secondary
strategies
school, when experimentation starts and
Evidence shows that peer educators can be before young people in high-risk groups leave
very effective in prevention education because school early. Program commencement dates,
they operate from a standard of behaviour that however, need to be adjusted, because the
young people consider to be an established onset time of drug experimentation, as well as
norm, but only if selected carefully and if well- the types of drug used, will vary between
supported with management skills from different populations.
professional teachers. Peer educators need to There is evidence that most of the
be credible with high-risk young people, have successful programs are intensive and long-
good communication skills and show term (that is, they include booster sessions).
responsible attitudes, but at the same time be Of the soundly evaluated, effective programs
unconventional (Midford, Lenton & Hancock, reviewed by White and Pitts (1998), most had
2000). In one review, interactive programs ten or more sessions devoted to delivery of the
presented by teachers and other leaders, with program in the first years, and included
role-play, discussion and games, were found booster sessions in later years. A very
to produce similar results to peer education common finding in the evaluation of prevention
(Tobler & Stratton, 1997). It therefore seems programs is that effects tend to be evident
that the interactive component of programs is a immediately following the interventions but
key factor in effective drug education. tend to fall away if further intervention effort is
not made in subsequent years.
Normative information
Students have been found to over-estimate the Fidelity of implementation
extent to which their own age group uses and dissemination
drugs, miscalculating or misjudging what is the
‘normal’ level of experience with drugs. In an As is indicated in this report, there are many
experimental study comparing different forms factors that appear to influence the potential
of drug education, Hansen and Graham (1991) for drug-education programs to change
found that providing normative information on behaviour. How is drug education carried out
drug use that corrected student over- by teachers when no specific management
estimation of peer drug use was an effective programs are in place? In response to 1996
strategy. In their conclusions Hansen & data that teenage drug problems were rising
Graham argued that normative components despite advances in best practice drug
may play a critical role in activating students to education, Hansen and McNeal (1999)
utilise peer resistance strategies. In the observed teachers in twelve middle schools in
absence of a normative component, resistance Forsyth County in the United States. They
training appeared relatively ineffective. found that the teachers observed focused on

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 Prevention Research Evaluation Report
Number 3 November 2002

information, particularly in relation to the health While there are many studies of drug use in
effects of drug use, and paid minimal attention the school aged, there are few studies relating
to resistance skills, clarification of values and to the progression of drug use into young
normative education. The teachers tended to adulthood and the factors associated with
emphasise alcohol and tobacco and, to a vulnerability and resistance during this time
lesser extent, cannabis. Despite having a low (White & Pitts 1998). Such knowledge of the
rate of usage among students, cocaine was ‘where, when and why’ drugs are being used,
discussed 20 per cent of the time and and the meaning drug use has to the user at
amphetamines and inhalants were rarely different stages, will be necessary in the
mentioned. The teachers were found to be design of intervention programs targetted at
very individual in their approaches, in the specific population groups.
drugs they concentrated on and in the life skills Although more research is needed, the
they included. The researchers (Hansen and studies that have examined this question tend
McNeal) concluded that, if their findings were to find that drug education can be effective, not
typical of schools elsewhere, drug education just for the students who are not using drugs at
would fail to make a long-term impact on drug- the start of the program, but also for others
use behaviours. who are. The Alcohol Misuses Prevention
Hansen and McNeal (1999) recommended Study (AMPS, University of Michigan) involved
building programs that give full consideration seven lessons in Grade 7 and 8, using role-
to research-based prevention strategies. They play to teach specific rather than universal
also suggested a focus on increasing teachers’ strategies to resist pressures to use particular
conceptual understandings of drug use and drugs. Maggs and Schulenberg (1998)
prevention and on common patterns in the examined the success of the program in
onset of drug use and experimentation. In altering—from early to middle adolescence—
addition, teachers needed training in the drinking behaviour, including the direction of
components of the program that have been alcohol use and misuse, reasons to drink and
chosen specifically for their effect on mediating reasons not to drink. Results indicated that,
variables associated with drug use, such that while AMPS may alter a young person’s
these components are not omitted. It seems development with regards to drug use, the
that teachers need support and access to good effect was modified if the young person had
materials to work with, and that this support prior experience of unsupervised drinking. For
from a school organisational level would be students who had engaged in unsupervised
important. drinking, AMPS slowed down the growth of
alcohol misuse and reduced the reasons to
Targetted versus universal drink. The implication was that the program
(whole-population) interventions was a positive intervention for students who
were at risk of developing alcohol problems
Most studies evaluating drug education
later on. The program was also effective in
emanate from the United States, where the
discouraging alcohol use among non-users.
focus is on universal strategies to prevent or
The authors suggested that another goal for
delay the onset of drug use. There have been
prevention research might be not to focus on
few intervention programs targetting young
why a particular program worked, but for whom
people from different social and cultural
it worked and why.
backgrounds at different stages of their drug
Project ALERT (Bell, Ellickson & Harrison
use, despite a growing recognition that
1993) was reviewed by White and Pitts (1998)
intervention effectiveness needs to be
because it examined the effectiveness of the
evaluated separately in different populations
program on both young people who were non-
and tailored for different groups (White & Pitts
users and also with young people who had
1998).
already used drugs. Non-users, in the short

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Number 3 November 2002

term, showed more gains than users. In Health education as part of a

another study (Johnson et al. 1990), however, community approach
researchers looked at the effectiveness of the
intervention for young people who had prior In some cases, drug education programs are
use of drugs, and found the program equally conducted as one component in a broader set
effective for both groups. of community activities aimed at reducing
Opening Doors, a program aimed at alcohol and drug use. This type of approach to
preventing or reducing drug use and deviant drug education is appealing, because it links to
behaviour in 167 high-risk young people in evidence that drug use is influenced by the
transition from primary to secondary school, cumulative number of risk factors to which
was assessed by DeWitt et al. (2000). While young people are exposed. By exposing young
the follow-up looked only at the short-term people to a wide-range of prevention activities,
effects, participants reported less frequent intervention planners hope to reduce a greater
drinking, cannabis use, non-prescribed number of risk factors.
tranquilliser use, self-reported theft and Project Northland is a well-known
improved attitudes towards school. In the list of community program that has been
the possible reasons for the program’s implemented in Minnesota in the United States
success, the authors cite high retention rates to reduce youth alcohol use. As one com-
during the 12 months of the program, ponent of this program, a social-influences,
recruitment of community health care health-education curriculum was provided from
professionals to work with teachers, a Grade 6 through to Grade 9 which demon-
promotion of warm parent–child, peer and strated lower rates of alcohol use (Klepp, Perry
teacher relationships, support from the whole & Kelder 1995). These effects tended to
school and an emphasis on building life skills. decline in the years following, so that by Grade
The Opening Doors approach is promising, but 12 there were few significant effects. These
due to several limitations in the study (for findings suggest that the common observation
example, the non-random inclusion of schools) that educational impacts wane over time may
it requires a more rigorous evaluation. also apply to interventions run in the context of
wider community intervention activities.
Harm-minimisation drug
Effectiveness of drug education
education
and the importance of
In contrast to the United States, Australia and
evaluation
Europe have more of a focus on harm-
minimisation strategies for drug education. There is good evidence that school-based
Many of the prevention programs from the education programs, targetting tobacco,
United States aim for total abstinence from alcohol and other drugs and using social-
drug use and therefore evaluate the success of learning principles, can be implemented with
programs in terms of a statistically significant booster sessions in later years. There is also
delay in onset of use. However, recent good evidence that drug education programs
Western Australian research (McBride et al. produce changes, not just in knowledge and
2000) supports the view that school-based attitudes about alcohol and other drug use, but
drug education based on a harm-minimisation also in drug-use behaviours. The challenge is
framework can be effective in reducing alcohol to ensure programs are informed by current
use. Harm-minimisation approaches often scientific knowledge and adequately resourced
introduce students to concepts such as to achieve their potential for behavioural
recommended levels for alcohol use and change. Part 2 explores the extent to which
strategies for avoiding contexts where drug practitioners in Victoria consider that drug-
use may be harmful.

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 Prevention Research Evaluation Report
Number 3 November 2002

education practices are likely to achieve programs by using recognised resources such
behavioural change. as Get Real (DESS 1995), Get Wise (Cahill,
Stafford & Shaw 2000)and Rethinking Drinking
PART 2 (Youth Research Centre 1997).
PRACTITIONER PERSPECTIVES Interview findings suggest that most
secondary school drug education programs
Current practice in secondary are not formally evaluated, nor is there a
school drug education strong understanding of what is meant by
As a complement to the literature review of ‘evaluation’. Teachers indicated that staff
formal, classroom-based drug education, staff meetings and curriculum reviews were the
at the Centre for Youth Drug Studies (CYDS) principle methods used to evaluate their
at the Australian Drug Foundation interviewed programs. Academics and consultants, on the
eleven key informants, namely teachers, other hand, believed schools were only
consultants and policy developers, in order to evaluating programs at a superficial level.
identify differing perspectives on the current Time and money were the most common
state of practice in Victoria. An interview impediments to schools formally evaluating
schedule of eight main questions was drawn their drug education programs. Some
up for each respondent, with each question practitioners suggested that schools did not
having a number of sub-questions that were consider evaluation to be as important, and
modified as appropriate to the type of begrudge putting time and money into it
practitioner being interviewed. because it diverted resources from the
implementation of the program itself.
Effectiveness of drug education On a positive note, schools involved with
the Department of Education & Training’s
and evaluation
current ‘Effective Drug Education’ project were
Findings from our interviews demonstrated a eager to employ the project’s final instruments
number of tensions between the possibilities to evaluate their programs.
for drug education emerging from the research
and the possibilities articulated by Supervised peer leadership
practitioners. Because there is little Most interviewees working in schools reported
behavioural evaluation, practitioners in having implemented some form of supervised
Victorian prevention education remain peer leadership. Some schools reported using
unconvinced about the possibilities of real specific peer-led programs such as ‘Creating
change in the behaviour of young people. Conversations’. The importance of using peer
Interview subjects were varied in their opinion leadership as part of an integrated drug
as to how effective drug education is in education program was emphasised by
secondary schools. Teachers and consultants several interviewees.
tended to argue that the effectiveness of drug Although it was considered an approach
education depended on how ‘effectiveness’ ‘fraught with difficulty’, most respondents
was defined and measured. If it was defined as agreed that supervised peer leadership has a
an increase in knowledge about drug use, a place within secondary schools. However, all
change in attitude or a diminished number of interviewees argued that peer-led programs
drug incidents, teachers and consultants required a high level of organisation to get
judged it to be effective. However, if effec- them ‘off the ground’, and that participating
tiveness means encompassing change in an students needed extensive training before they
individual’s behaviour, they argued that it is could act as peer leaders. Even then, the
almost impossible to make a judgement about students required further guidance and support
whether this has occurred. Schools tended to from teachers and other school staff.
ensure effectiveness of drug education

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 Prevention Research Evaluation Report
Number 3 November 2002

Respondents identified poor programs as Sequential, progressive

those that do not have high quality training, continuing programs in
real clarity in terms of why they exist, high level
Victorian schools
of teacher support, and some resources. As
well as organised peer leadership, some To what extent are drug education programs in
interviewees also mentioned the effectiveness Victorian schools designed to be develop-
of incidental peer leadership mentally appropriate, progressive and
sequential? The teachers interviewed believed
Interactive strategies that the programs in their schools were, in fact,
The majority of respondents agreed with the ‘sequential, progressive and continuing’.
literature that suggests that interactive Consultants were less sure. Put simply, it was
strategies, such as scenarios, role-plays, suggested that some schools provided
group research and classroom discussions, sequential, progressive and continuing drug
were the most effective way to teach drug education programs, while others didn’t. One
education. Teachers and consultants valued consultant said in a sort of nebulous sort of
these strategies because they get students to way, they sort of relate to where the kids are
process information through the lens of their at. Using resources like Get Real or Get Wise
own experience, rather than something they they employ sequential strategies.
have just been told (consultant). Despite Impediments to the implementation of
recognising the value of interactive strategies, ‘sequential, progressive and continuing
respondents also suggested that there were programs’— as recommended by
occasions when a didactic approach worked researchers—were various, but the main
best; for example, in a class in which the difficulty was that health education was not
teacher or students lacked confidence or considered part of the core curriculum.
where there were discipline problems. Consequently, there was no agreed or
specified curriculum. The problem increases in
Normative information senior years, when health education is offered
only as an elective. Other difficulties cited in
The interviewees tended to agree that it is
maintaining these ‘best practice’ programs
useful to incorporate normative information in a
included the high turnover of drug education
drug education program, and many are already
teachers, teachers feeling unqualified to teach
doing this.
drug education and the deficiency in formal
Most respondents indicated that normative
training in the subject. Because of the lack of
information aids kids in giving up the myth that
training, one respondent said teachers felt
everyone is using drugs. Statistics indicating
inadequate, even fearing that the students
drug usage among students of a similar age
would know more than they would.
group or in an Australian setting have more
credibility than statistics about drug use in the Alignment with the individual
United States or Europe.
school drug education strategy
Normative information can be used to
contextualise drug use, but it can also be All respondents were unequivocal in their
counterproductive or of little benefit if it runs emphasis of the positive impact of the
the risk of being interpreted as condoning drug Victorian Individual School Drug Education
use. It has been suggested that normative Strategy (ISDES) process on raising the profile
information should be presented in a balanced of drug education in schools, as well as in the
manner, such as young people’s drug way schools approached drug education.
consumption should be compared with the
alcohol and other drug consumption levels of
adults.

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 Prevention Research Evaluation Report
Number 3 November 2002

Respondents said the ISDES process differences. Other practitioners’ wish lists
emphasised a broader network of support from included consistency in drug educator training
the Department of Education & Training, by and better evaluation of programs, particularly
reinforcing the message that schools and by making the evaluation process an integral
teachers were not alone in delivering drug part of the program.
education.
Informants to the CYDS interviews agreed Conclusion
that within most government and independent A number of research studies have evaluated
schools the drug education curriculum was the effectiveness of drug education. Through
aligned with the classroom component of the these studies, critical program elements are
ISDES. At least 50 per cent of Catholic gradually being identified. The existing
schools, according to a consultant, were evidence suggests that drug education
employing the curriculum strategies outlined in programs have the potential to contribute to
the ISDES document. reductions in harmful youth drug use. In order
to realise their potential, activities need to be
Final comments from Victorian based on appropriate curriculum, be well
practitioners resourced and integrated within a wider set of
One researcher said she would like ongoing intervention activities. Interviews with
acknowledgment, at a political level, that some practitioners suggest that progress is being
students use drugs, and that harm made toward establishing an effective
minimisation was therefore a necessity. Many framework for drug education in Victoria.
expressed a desire for drug education to be Although many of the conditions appear to be
placed in the context of personal development, in place to achieve effective practice, the lack
alongside resilience, connectedness, positive of evaluation is a critical gap that needs to be
self-esteem, families and individual addressed.

This report was prepared for the DrugInfo Clearinghouse by the

Centre for Adolescent Health and the Centre for Youth Drug Studies, Melbourne

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 Prevention Research Evaluation Report
Number 3 November 2002

Hansen WB & McNeal RB Jr 1999 ‘Drug education

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