Expand School-Based Prevention Programs

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Introductory Paragraph

With fatal drug overdoses reaching the highest levels recorded in history, more and more schools are recognizing that students' overall health and wellbeing are of paramount importance as children are often the silent victims of the addiction disease which knows no boundaries. Schools are in a unique position of having the ability to systematically reach a large portion of youth at all stages of development from preschool to late adolescence. Because attending school is a major part of a young person’s life, schools can serve as a leading protective factor from the adverse effects of substance use, misuse, and abuse.

The school campus provides a learning environment and an opportunity to provide education on lifelong healthy skill and behavior development. Choosing curricula which reach all students aligns to a public health approach. School-based prevention programs which focus on broad-based skill building (e.g., psychosocial development, life-skills development, and social-emotional learning, and connectedness) have greater promise than substance-specific programs. [1]

Research shows that school health programs reduce the prevalence of health risk behaviors among youth and have a positive effect on academic performance. [2] Preventing the onset of substance use during the critical years of youth development can have positive lifelong results. Therefore, in addition to providing quality education and social learning environments, schools are taking a proactive health approach with a keen focus on substance prevention. Research has shown that young people who feel connected to their school are less likely to engage in many risk behaviors, including early sexual initiation, alcohol, tobacco, and other drug use, as well as violence and gang involvement. Students who feel connected to their school are also more likely to have better academic achievement, including higher grades and test scores, have better school attendance, and stay in school longer. [3]

There is a vast offering of school-based prevention programs that can enhance and create a whole school approach to youth development which can serve to prevent substance use before it starts. Such a proactive upstream strategy is needed to prevent the devastating consequences of substance use.

Key Information

What Actions Could Improve the Health of Our Nation’s Students?

Behaviors established during adolescence often continue into adulthood, and young people’s experiences during this critical time have long-lasting impacts on their future health and well-being. The Center for Disease Control has established an evidence-based approach to school-based HIV and STD prevention, which also impacts substance use and experiencing violence. These evidence-based strategies benefit all students. Further, activities related to health education and health services can be tailored to address health outcomes other than sexual behaviors, including high-risk substance use, violence, and mental health. Promoting safe and supportive environments, which includes increasing school connectedness and engaging parents, can impact all of these health outcomes. Schools, families, and communities can work together to provide more intentional messages, skills, and mental health support for adolescents so that encouraging trends can continue and troubling trends can be reversed. [4] Most kids believe that a majority of students use substances when, in reality, only a very small percentage does. Changing social norms of a school by educating students on the reality of substance use leads to a changed perspective of drug use as deviant rather than something that "everyone is doing."

What Is a Drug Prevention Program? The most effective prevention programs require a commitment of time, priority standing (curriculum inclusion), and are recurring and consistent. Prevention is NOT as simple as just showing up once and telling individuals to “Just Say No.” As with drug treatment, a “one-size-fits-all” approach to drug prevention is not effective either.

Knowing what works in prevention, and what doesn’t, is vital to keeping young people from developing serious and life-long issues with addiction, as alcohol and other drug abuse remain the problem behaviors contributing to the most serious problems facing our communities today.

Many of the most common strategies being used by well-meaning parents, schools, and communities have been shown by careful research to be ineffective. Some have even caused harm by unintentionally reinforcing pro-use attitudes, behaviors, or norms.

Features of the highest quality and most effective drug prevention programs:

  • Contains evidence-informed and evidence-based strategy.
  • Intentional focus on all substances of use, misuse, abuse (alcohol, nicotine, marijuana, prescription drugs, illicit drugs, over-the-counter drugs/medications).
  • Designed to address data indicative of local problems and their root causes.
  • Reduce risk factors and enhance protective factors.
  • Appropriately timed - students receive accurate information and skill development in advance of age of onset of use.
  • Delivered by teachers/prevention professionals who have achieved a high level of training in the field of substance prevention, intervention, treatment, and recovery.
  • Recurring in nature with follow-up booster lessons at subsequent grade levels.
  • Utilizes multiple teaching techniques including behavior rehearsal, interactivity, open communication which engage all students.
  • Teaches skill development that includes: self-control, emotional awareness, communication, problem-solving, and advanced capacity for learning.
  • Enhances school connectedness with a whole school approach that includes healthy alternative activities.
  • Provides accurate and real-life information that corrects misperceptions versus fabricated scare tactics.
  • Enhances family bonding and communication.
  • Reinforced at the community sector level (policies, laws, media)
  • Inclusive and compassionate taking into account that some youth will have used and/or have close friends and family members who are actively using, living in recovery, or have passed away from a substance use disorder.

The core goal of prevention programs is the development of lifelong attitudes, beliefs, and behaviors that supports healthy choices and open the door for youth to reach their fullest potential. Specifics include: • Delaying the onset of substance use • Decreasing overall substance use • Reduce the loss of life due to overdose

Relevant Research

Although most youth are in good health, some are at an increased risk for behaviors that can lead to poor health outcomes, such as high-risk substance use. According to national datasets, the prevalence of alcohol, tobacco, and other drug use increases rapidly from early to late adolescence, peaks during the transition to young adulthood, and declines through the remainder of adulthood. There is accumulating evidence showing that the initiation of substance use early in life contributes to higher levels of use and abuse later in life. Early-onset is also associated with a host of later negative health, social, and behavioral outcomes including physical and mental health problems, violent and aggressive behavior, and adjustment problems in the workplace and family. [5] The majority of adults who meet the criteria for having a substance use disorder started using substances during their teen and young adult years. [6]

What Actions Could Improve the Health of Our Nation’s Students?

Behaviors established during adolescence often continue into adulthood, and young people’s experiences during this critical time have long-lasting impacts on their future health and well-being. The Center for Disease Control has established an evidence-based approach to school-based HIV and STD prevention, which also impacts substance use and experiencing violence. These evidence-based strategies benefit all students. Further, activities related to health education and health services can be tailored to address health outcomes other than sexual behaviors, including high-risk substance use, violence, and mental health. Promoting safe and supportive environments, which includes increasing school connectedness and engaging parents, can impact all of these health outcomes. Schools, families, and communities can work together to provide more intentional messages, skills, and mental health support for adolescents so that encouraging trends can continue and troubling trends can be reversed. [7] Most kids believe that a majority of students use substances when, in reality, only a very small percentage does. Changing social norms of a school by educating students on the reality of substance use leads to a changed perspective of drug use as deviant rather than something that "everyone is doing."

What Is a Drug Prevention Program? The most effective prevention programs require a commitment of time, priority standing (curriculum inclusion), and are recurring and consistent. Prevention is NOT as simple as just showing up once and telling individuals to “Just Say No.” As with drug treatment, a “one-size-fits-all” approach to drug prevention is not effective either.

Knowing what works in prevention, and what doesn’t, is vital to keeping young people from developing serious and life-long issues with addiction, as alcohol and other drug abuse remain the problem behaviors contributing to the most serious problems facing our communities today.

Many of the most common strategies being used by well-meaning parents, schools, and communities have been shown by careful research to be ineffective. Some have even caused harm by unintentionally reinforcing pro-use attitudes, behaviors, or norms.

Features of the highest quality and most effective drug prevention programs:

  • Contains evidence-informed and evidence-based strategy.
  • Intentional focus on all substances of use, misuse, abuse (alcohol, nicotine, marijuana, prescription drugs, illicit drugs, over-the-counter drugs/medications).
  • Designed to address data indicative of local problems and their root causes.
  • Reduce risk factors and enhance protective factors.
  • Appropriately timed - students receive accurate information and skill development in advance of age of onset of use.
  • Delivered by teachers/prevention professionals who have achieved a high level of training in the field of substance prevention, intervention, treatment, and recovery.
  • Recurring in nature with follow-up booster lessons at subsequent grade levels.
  • Utilizes multiple teaching techniques including behavior rehearsal, interactivity, open communication which engage all students.
  • Teaches skill development that includes: self-control, emotional awareness, communication, problem-solving, and advanced capacity for learning.
  • Enhances school connectedness with a whole school approach that includes healthy alternative activities.
  • Provides accurate and real-life information that corrects misperceptions versus fabricated scare tactics.
  • Enhances family bonding and communication.
  • Reinforced at the community sector level (policies, laws, media)
  • Inclusive and compassionate taking into account that some youth will have used and/or have close friends and family members who are actively using, living in recovery, or have passed away from a substance use disorder.

The core goal of prevention programs is the development of lifelong attitudes, beliefs, and behaviors that supports healthy choices and open the door for youth to reach their fullest potential. Specifics include: • Delaying the onset of substance use • Decreasing overall substance use • Reduce the loss of life due to overdose

Types of Prevention Programming

• Universal - provides all individuals in a population with the information and skills necessary to prevent the problem.

• Selective - targets an entire subgroup that has higher risk, regardless of the degree of risk of any individual within the group.

• Indicated - prevent the onset of substance abuse in individuals who have used a substance but who do not meet the medical criteria for addiction.

Cost-Benefit of Evidence-Based Prevention

Research has shown that preventing drug abuse and other problem behaviors can produce benefits for communities that outweigh the monetary costs. The analysis of the return on investment of evidence-based prevention programs is part of a series of reports prepared by researchers at the Washington State Institute for Public Policy. Together, these reports consistently show that effective prevention programs not only work but can produce dramatic savings [8].

The economic benefit of one evidence-based prevention programs, the Botvin LifeSkills Training (LST) program produced a $50 benefit for every $1 invested in terms of reduced corrections costs, welfare, and social services burden, drug and mental health treatment; and increased employment and tax revenue. LST had the highest return on investment of all substance abuse prevention curricula studied. The cost-effectiveness and benefit-cost of two long-term effective interventions, the Strengthening Families Program: For Parents and Youth 10–14 (SFP 10–14), and Guiding Good Choices (GGC), produced net benefits in preventing adult cases of alcohol abuse. For every dollar spent, a $10 benefit was measured as a result of the SFP 10–14 program, and a $6 benefit was the result of the GGC program. In addition, an analysis of the Skills, Opportunity, And Recognition (SOAR) program had a benefit-to-cost ratio of $4.25 for every dollar spent.

Evidence-Based Drug Prevention Program Registries

There are many strategies that have been confirmed by research to show a positive impact on youth choices and healthy behaviors. Meticulous evaluation have proven evidence-based strategies to be effective over time.

Registries of evidence-based prevention programming are an invaluable resources in the selection of suitable programs that fit with the local landscape. It is very important to note that even the best-designed programs can be ineffective if the fidelity of the implementation process or content is added to or subtracted from the scope and sequence. When researching and making a program selection, careful attention should be given to the fidelity model and the intended design of the program.

When An Evidence-Based Program is Not an Option

Evidence-based programs implemented with fidelity are most likely to help schools improve health outcomes for youth across the life span, there are times when an evidence-based program may not be an option due to readiness, cost, capacity, funding, and/or training barriers. In these cases, innovative, locally developed programs are created and used. When it comes to substance use prevention, extreme levels of caution must be exercised to ensure that the best intentions do not backfire and actually hinder or even cause harm to the local conditions and people the program was intended to help.

Impactful Federal, State, and Local Policies

Dr. Rahul Gupta, Director of the White House Office of National Drug Control Policy has stated that “the Biden-Harris Administration is committed to using data and evidence to guide our prevention efforts so it is important to identify all the factors that may have led to this decrease in substance use to better inform prevention strategies moving forward. The Administration is investing historic levels of funding for evidence-based prevention programs because delaying substance use until after adolescence significantly reduces the likelihood of developing a substance use disorder.”

In general, all prevention policies and selected programs are designed and implemented to reduce risk factors while also harnessing the buffering effects of protective factors. The specific approaches taken to drug prevention are quite varied in states across the county due to the autonomy granted to individual states and schools on the topic. However, all schools in the United States are charged with complying with National Academic Standards, Common Core Standards, and State Standards for Health Education when selecting a drug prevention program/curriculum.


National Programs

SAMHSA maintains information on laws and regulations pertaining to substance abuse and mental health services, programs, and related topics.  A few examples of relevant legislation and funding follow:[9]

  • Safe and Drug-Free Schools and Communities Act (SDFSCA) is Title IV of the "Improving America's Schools Act of 1994” which was a reauthorization of the Elementary and Secondary Education Act of 1965 (ESEA). Programs authorized under this legislation provide financial assistance for state and local drug and violence prevention activities in elementary and secondary schools and institutions of higher education. Activities may be carried out by state and local educational agencies and by other public and private nonprofit organizations. [10]
  • Education Department General Administrative Regulations (EDGAR) Part 86 has particular import for all institutions of higher education (IHEs) that receive federal funding. These regulations were established as part of the 1990 Drug and Alcohol Abuse Prevention Act. [11]
  • Comprehensive Addiction Recovery Act in 2016 and the SUPPORT for Patients and Communities Act in 2018 to address opioid misuse, addiction, and overdose deaths through a variety of initiatives in prevention, treatment, harm reduction, and recovery support.
  • The federal government has also provided billions of dollars directly to states through the SAMHSA’s State Opioid Response grant program in 2017.
  • In 2021, amid considerable increases in substance use during the COVID-19 pandemic, funding to address opioid and other substance use and addiction was included in several COVID-19-relief packages.[12]

Training resources and information regarding best practices is available through the Depart of Education. The Office of Safe and Healthy Students (formerly OSDFS) administers, coordinates, and recommends policy for improving the quality and excellence of programs and activities that are designed to:[13]

  • Provide financial assistance for drug and violence prevention activities and activities that promote the health and wellbeing of students in elementary and secondary schools, and institutions of higher education. Activities may be carried out by State and local educational agencies and by other public and private nonprofit organizations.
  • Participate in the formulation and development of ED program policy and legislative proposals and in overall Administration policies related to violence and drug prevention; drafting program regulations.
  • Participate in interagency committees, groups, and partnerships related to drug and violence prevention, coordinating with other Federal agencies on issues related to comprehensive school health, and advising the Secretary on the formulation of comprehensive school health education policy.
  • Participate with other Federal agencies in the development of a national research agenda for drug and violence prevention.
  • Administer the Department's programs relating to character and civics education.

State Programs

Some states have prevention laws in place that date back to the 1970s. Two current examples of statewide policies include:

  • The Start Talking Maryland Act of 2017. In compliance with the Code of Maryland Regulations (COMAR) 13A.04.18 Programs in Comprehensive Health Education training standard, Using a Skills-Based Approach to Substance Abuse Prevention Education
  • Colorado HB21-1276 - Prevention of Substance Use Disorders was signed into law in June 2021, Section 18 has a focus on the establishment of a Prevention Collaborative.

Available Tools and Resources

Searchable online registries of evidence-based prevention programs

  • Blueprints for Healthy Youth Development at the University of Colorado, Boulder [14]
  • California Evidence-Based Clearinghouse for Child Welfare[15]
  • Coalition for Evidence-Based Policy [16]
  • Collaborative for Academic, Social and Emotional Learning Curricula [17]
  • Office of Juvenile Justice and Delinquency Prevention Model Programs Guide [18]
  • Promising Practice Network [19]
  • PTTC Network Guide to Online Registries for Substance Misuse Prevention Evidence-based Programs and Practices [20]
  • Social Programs That Work [21]
  • Results First Clearinghouse [22]
  • SAMHSA Evidence-Based Resource Center [23]
  • Washington State Health Care Authority, Division of Behavioral Health and Recovery – the Athena Forum [24]
  • What Works Clearinghouse [25]

For more information on prevention programs and frameworks:

  • CDC Framework for Thinking about Evidence [26]
  • NIDA Preventing Drug Use among Children and Adolescents [27]

Helpful resources and guides:

  • The Washington State Institute on public policy (WSIPP) has information on cost-benefit for public health and drug prevention programs. [28]
  • Washington State Health Care Authority, Division of Behavioral Health and Recovery – the Athena Forum [29]
  • SAMHSA Focus on Prevention/Strategies and Programs to Prevent Substance Use[30]
  • The National Institute on Drug Abuse [31]
  • Suicide Prevention Resource Center: Mental Health Promotion and Suicide Prevention for LGBTQIA2S+ Youth a Resource guide for Professionals, Families and Communities [32]

Other Relevant Data Sources:

  • National Center for Drug Abuse Statistics [33]
  • National Survey on Drug Use and Health [34]
  • National Youth Tobacco Survey [35]

Promising Practices

SPORT Prevention Plus Wellness: A single-session screening and brief intervention that integrates substance use prevention with the promotion of physical activity and healthy behaviors for youth.[36]

Positive Prevention Plus: A comprehensive school-based sexual health education and teen pregnancy prevention curriculum.[37]

Olweus Bullying Prevention Program: Includes school-wide, classroom, individual, and community strategies.[38]

Media Detective: Increasing media literacy is a promising approach to school-based substance abuse intervention. Beneficial outcomes include:[39]

  • Increased media skepticism
  • Increased perceived efficiency in resisting pro-drug media messages
  • Greater ability to make counter-arguments to beer advertisements
  • Increased belief that smoking and drinking are "wrong"
  • Reduced middle school boys' intentions to use alcohol or tobacco in the future
  • Reduced opioid misuse

SAFIR -- Substance Abuse Free Indian River[40] This Drug Free Coalition in Vero Beach, Florida, has been implementing several promising programs in schools and working with community partners. “We are very proud of our initiatives: SAFIR Rx, Talk, They Hear You, No One’s House and Friday Night Done Right, but we are particularly excited about Know the Law, which is conducted by law enforcement officers (LEOs) in the classroom,” said Robin Dapp, Executive Director. “It helps bring students and officers together.” At the beginning of each school year, school resource officers provide the Know the Law classes to incoming high school freshmen. The program is designed to make our local youth and young adults aware of the laws and the consequences of breaking the law. The training covers the common offenses committed by youth on a regular basis. Civil Citation is a significant environmental strategy that has been embraced by local law enforcement. SAFIR has supported the delivery of a comprehensive prevention strategy for middle school youth. All middle schools in the community receive Botvin’s LifeSkills Training program, beginning in 6th grade through 8th grade. The curriculum is delivered by the Substance Awareness Center, and consists of a total of 30 lessons.

Boy Scouts & Girl Scouts Each of these groups participates in the DEA Red Ribbon Patch Program[41]. This program empowers young people to create, embrace and strengthen their drug free belief. The Girl Scout Research Institute has aligned its three sets of leadership outcomes (Discover, Connect, and Take Action) to the Developmental Asset framework that is promoted by the Search Institute. [42]

Sources

  1. ↑ Griffin KW, Botvin GJ. Evidence-based interventions for preventing substance use disorders in adolescents. Child Adolesc Psychiatr Clin N Am 2010;19:505–26. CrossRefexternal icon PubMedexternal iconFaggiano F, Minozzi S, Versino E, Buscemi D. Universal school-based prevention for illicit drug use. Cochrane Database Syst Rev 2014;12:CD003020. CrossRefexternal icon PubMedexternal icon
  2. ↑ Murray NG, Low BJ, Hollis C, Cross AW, Davis SM. Coordinated school health programs and academic achievement: A systematic review of the literature. J Sch Health 2007;77:589-600
  3. ↑ https://www.cdc.gov/healthyyouth/protective/school_connectedness.htm
  4. ↑ https://www.cdc.gov/healthyyouth/data/yrbs/pdf/YRBSDataSummaryTrendsReport2019-508.pdf
  5. ↑ Newcomb MD, Locke T. Health, social, and psychological consequences of drug use and abuse. In: Sloboda Z, editor. Epidemiology of drug abuse. Springer; New York: 2005. pp. 45–59.
  6. ↑ U.S. Department of Health and Human Services (HHS), Office of the Surgeon General, Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health. Washington, DC: HHS, November 2016
  7. ↑ https://www.cdc.gov/healthyyouth/data/yrbs/pdf/YRBSDataSummaryTrendsReport2019-508.pdf
  8. ↑ Lee, S., Aos, S., Drake, E., Pennucci, A., Miller, M. & Anderson, L. (2013). Return on investment: Evidence-based options to improve statewide outcomes. October 2013 (Printed on 3-20-14). Olympia: Washington State Institute for Public Policy
  9. ↑ https://www.samhsa.gov/about-us/who-we-are/laws-regulations
  10. ↑ https://ojjdp.ojp.gov/sites/g/files/xyckuh176/files/pubs/gun_violence/sect08-i.html
  11. ↑ https://safesupportivelearning.ed.gov/sites/default/files/hec/product/dfscr.pdf
  12. ↑ https://www.healthaffairs.org/do/10.1377/forefront.20210607.239986/full/
  13. ↑ https://www2.ed.gov/about/offices/list/oese/oshs/aboutus.html
  14. ↑ https://www.blueprintsprograms.org/program-search/
  15. ↑ https://www.cebc4cw.org/search/by-program-name/
  16. ↑ http://coalition4evidence.org
  17. ↑ https://pg.casel.org/
  18. ↑ https://www.ojjdp.gov/mpg/
  19. ↑ https://promisingpractices.net/programs.asp
  20. ↑ https://pttcnetwork.org/centers/pacific-southwest-pttc/product/guide-online-registries-substance-misuse-prevention-evidence
  21. ↑ https://evidencebasedprograms.org/
  22. ↑ https://www.pewtrusts.org/en/research-and-analysis/data-visualizations/2015/results-first-clearinghouse-database
  23. ↑ https://www.samhsa.gov/resource-search/ebp#collapse-samhsa_uswds_base_resourcecenter
  24. ↑ https://theathenaforum.org/best_practices_toolkit
  25. ↑ https://www.ies.ed.gov/ncee/wwc/
  26. ↑ https://www.hidta.org/wp-content/uploads/2021/07/CDC-Understanding-Evidence.pdf
  27. ↑ https://www.hidta.org/wp-content/uploads/2021/07/NIDA-Prevention-Program-Principles.pdf
  28. ↑ https://www.wsipp.wa.gov/BenefitCost?topicId=9
  29. ↑ https://theathenaforum.org/best_practices_toolkit
  30. ↑ https://store.samhsa.gov/sites/default/files/d7/priv/sma10-4120.pdf
  31. ↑ https://www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction/preventing-drug-misuse-addiction-best-strategy
  32. ↑ https://sprc.org/wp-content/uploads/2023/09/LGBTQIA2S-Resource-Guide.pdf
  33. ↑ https://drugabusestatistics.org/teen-drug-use/
  34. ↑ https://nsduhweb.rti.org/respweb/homepage.cfm
  35. ↑ https://www.cdc.gov/tobacco/data_statistics/surveys/nyts/index.htm
  36. ↑ https://www.blueprintsprograms.org/programs/477999999/sport-prevention-plus-wellness/#:~:text=SPORT%20Prevention%20Plus%20Wellness%20is%20a%20health%20promotion,counterproductive%20to%20achieving%20positive%20image%20and%20behavior%20goals.
  37. ↑ https://positivepreventionplus.com/curriculum-downloads/
  38. ↑ https://olweus.sites.clemson.edu/
  39. ↑ http://mediadetectiveprograms.com/media-literacys-role-in-prevention/
  40. ↑ https://safirc.org/
  41. ↑ https://www.getsmartaboutdrugs.gov/get-involved/red-ribbon-week-patch-program
  42. ↑ https://www.girlscouts.org/content/dam/girlscouts-gsusa/forms-and-documents/about-girl-scouts/research/gsle_asset_map_2012.pdf
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