Expand School-Based Prevention Programs

Introductory Paragraph

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 are positioned to serve as a leading protective factor from the adverse effects of substance use, misuse and abuse by choosing curriculum inclusion of universal school-based prevention programming, a comprehensive public health approach.

School-based substance use prevention programs that 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 . The school campus provides a learning environment and an opportunity to provide education on lifelong healthy skill and behavior development. 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.

Research shows that school health programs reduce the prevalence of health risk behaviors among youth and have a positive effect on academic performance . 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.

Additionally, 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, and 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 .

There is a vast offering of school-based prevention programs that can enhance and create a whole school approach to youth development that can serve to prevent substance use before it starts; a proactive upstream solution to the devasting consequences that can present with substance use, misuse and abuse.

Key Information

Percentage of adolescents reporting drug use decreased significantly in 2021 as the COVID-19 pandemic endured according to 2021 Monitoring the Future survey .

The Monitoring the Future survey is given annually to students in 8th, 10th, and 12th grades who self-report their substance use behaviors over various time periods, such as past 30 days, past 12 months, and lifetime. The survey also documents students’ perception of harm, disapproval of use, and perceived availability of drugs. The survey results are released the same year the data are collected. From February through June 2021, the Monitoring the Future investigators collected 32,260 surveys from students enrolled across 319 public and private schools in the United States.

“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,” said Dr. Rahul Gupta, Director of the White House Office of National Drug Control Policy. “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.” Reported declines in the use of substances among teens include: • Alcohol: The percentage of students who reported using alcohol within the past year decreased significantly for 10th and 12th grade students and remained stable for eighth-graders. o Eighth graders: 17.2% reported using alcohol in the past year in 2021, remaining steady compared to 20.5% in 2020 (not a statistically significant decrease) o 10th graders: 28.5% reported using alcohol in the past year in 2021, a statistically significant decrease from 40.7% in 2020 o 12th graders: 46.5% reported using alcohol in the past year in 2021, a statistically significant decrease from 55.3% in 2020 • Marijuana: The percentage of students who reported using marijuana (in all forms, including smoking and vaping) within the past year decreased significantly for eighth, 10th, and 12th grade students. o Eighth graders: 7.1% reported using marijuana in the past year in 2021, compared to 11.4% in 2020 o 10th graders: 17.3% reported using marijuana in the past year in 2021, compared to 28.0% in 2020 o 12th graders: 30.5% reported using marijuana in the past year in 2021, compared to 35.2% in 2020 • Vaping nicotine: Vaping continues to be the predominant method of nicotine consumption among young people, though the percentage of students who reported vaping nicotine within the past year decreased significantly for eighth, 10th, and 12th grade students. o Eighth graders: 12.1% reported vaping nicotine in the past year in 2021, compared to 16.6% in 2020 o 10th graders: 19.5% reported vaping nicotine in the past year in 2021, compared to 30.7% in 2020 o 12th graders: 26.6% reported vaping nicotine in the past year in 2021, compared to 34.5% in 2020 • Any illicit drug, other than marijuana: The percentage of students who reported using any illicit drug (other than marijuana) within the past year decreased significantly for eighth, 10th, and 12th grade students. o Eighth graders: 4.6% reported using any illicit drug (other than marijuana) in the past year in 2021, compared to 7.7% in 2020 o 10th graders: 5.1% reported using any illicit drug (other than marijuana) in the past year in 2021, compared to 8.6% in 2020 o 12th graders: 7.2% reported using any illicit drug (other than marijuana) in the past year in 2021, compared to 11.4% in 2020 • Significant declines in use were also reported across a wide range of drugs for many of the age cohorts, including for cocaine, hallucinogens, and nonmedical use of amphetamines, tranquilizers, and prescription opioids.

“In addition to looking at these significant one-year declines in substance use among young people, the real benefit of the Monitoring the Future survey is our unique ability to track changes over time, and over the course of history,” said Richard A. Miech, Ph.D., lead author of the paper and team lead of the Monitoring the Future study at the University of Michigan. “We knew that this year’s data would illuminate how the COVID-19 pandemic may have impacted substance use among young people, and in the coming years, we will find out whether those impacts are long-lasting as we continue tracking the drug use patterns of these unique cohorts of adolescents.”

“We have never seen such dramatic decreases in drug use among teens in just a one-year period. These data are unprecedented and highlight one unexpected potential consequence of the COVID-19 pandemic, which caused seismic shifts in the day-to-day lives of adolescents,” said Nora Volkow, M.D., NIDA director. “Moving forward, it will be crucial to identify the pivotal elements of this past year that contributed to decreased drug use – whether related to drug availability, family involvement, differences in peer pressure, or other factors – and harness them to inform future prevention efforts.”

Youth Risk Behavior Survey (YRBS) The Center for Disease Control’s YRBS monitors priority health risks and experiences among high school students across the country. The YRBS results help in understanding risks that contribute to the leading causes of death and disability among youth and young adults. The 2019 YRBS results will serve as a baseline for years to come as we understand the impact of COVID and help adolescents recover from the effects, both mental and physical, of the COIVD 19 pandemic.

National, state, and local surveys are conducted every 2 years among high school students throughout the United States. More than 13,000 U.S. high school students participated in the 2019 national YRBS. The report includes national YRBS data and data from surveys conducted in 44 states, 28 large urban school districts, 3 territories, and 2 tribal governments.

Encouraging findings from 2009-2012 include decreasing prevalence of current alcohol use and decreases in the prevalence of lifetime use of marijuana, cocaine, methamphetamine, heroin, synthetic marijuana, and injection drug use. However, the findings in the report underscore that substance use among high school students remains common, with approximately one in three students reporting current alcohol use, one in five reporting current marijuana use, and one in seven reporting current binge drinking. Because of the ongoing U.S. opioid crisis, of particular concern are the high rates of lifetime (one in seven students) and current prescription opioid misuse (one in 14 students), and high rates of co-occurring substance use among students currently misusing prescription opioids.

Trend data were available for eight of the 11 substance use measures included in the analyses. Among these measures, current alcohol use, lifetime cocaine, lifetime methamphetamine, lifetime heroin, and lifetime injection drug use decreased during 2009–2019. Lifetime use of synthetic marijuana decreased during 2015–2019. The prevalence of lifetime marijuana use increased during 2009–2013 (36.8%–40.7%) and then decreased during 2013–2019 (40.7%–36.8%). No statistically significant changes from 2017 to 2019 were observed for any of the substance use behaviors.

Other Relevant Data Sources: National Center for Drug Abuse Statistics National Survey on Drug Use and Health National Youth Tobacco Survey State Level Youth Survey’s (ie: Pennsylvania Youth Survey (PAYS), Maryland Youth Risk Behavior Survey (YRBS/YTS), New Jersey, High School Youth Risk Behavior Survey (YRBS), Healthy Kids Colorado Survey (HKCS), Montana, Youth Risk Behavior Survey (YRBS)

The National Survey on Drug Use and Health (NSDUH), conducted in 2015 in the United States on 68,073 people 12 years of age and older, revealed that the prevalence of past-year pain reliever NMU was 3.9% among 12–17-year-olds (Hughes et al., 2016). The 2015 Monitoring The Future (MTF) survey among high school students revealed that older adolescents (12th graders) had the highest annual prevalence of OxyContin® and Vicodin® use (3.7% and 4.4% respectively), with the lowest annual prevalence seen in 8th graders (0.8% and 0.9%, respectively) (Johnston, O'Malley, Miech, Bachman, & Schulenberg, 2016).

 

Opioid Education Programs
Recommendations for selecting a school program

Start by looking at programs that have evidence that they work. The list on Blueprints for Healthy Youth Development is a place to start. Do a keyword search of this registry using the term “opioid prevention” to find programs.

Look for programs that have a good Return on Investment (effective, but not too expensive).

Adopt programs that not only prevent substance use but also promote protective fitness and healthy habits among teens. Programs that integrate substance use prevention with positive behavior promotion are more likely to be accepted and used by youth, families, and funders than those limited to just communicating substance use risks and harm. This was key to the success of the Youth in Iceland program and is backed by many studies.

Promote prevention in multiple settings to reach a broader youth audience and ensure overlapping prevention messages. Critical settings for providing prevention programs include schools and colleges, healthcare, youth and family organizations, juvenile justice, sports and recreation programs, and homes.
Innovate to make evidence-based programs more relevant in these fast-changing times. Research takes time and the opioid crisis is moving fast. You should consider how to innovate and enhance programs that may have targeted other drugs to make them more relevant for today's opioid crisis.

School Prevention Programs have a Positive Impact
In 2012, a special report of the National Survey on Drug Use and Health reported that 75% of youth ages twelve to seventeen reported having seen or heard drug or alcohol prevention messages at school. Of those who received such exposure, 8.9% reported using an illicit drug in the past month, versus 12.3% among students who reported no exposure to such messages.
 

Classroom Resources

            Operation Prevention

• Operation Prevention, a joint partnership between Discovery Education and the DEA, developed free resources that "that are aligned to national health and science standards and integrate seamlessly into classroom instruction." Toolkits and lesson plans have been designed for middle school students and another for high school students. A parent toolkit designed alongside the material to provide further discussion of the topic at home is included as well. See Empower & Strengthen Parents for more strategies to include parents. See Tools & Resources for copies of toolkits.
  
  Not Prescribed
• Not Prescribed is a classroom-based lesson empowering teens with the science and the stories to understand the risks of misusing prescription drugs and the skills to rise above. It is provided at not cost to non-profit organizations and schools.   
  
  Everfi's Prescription Drug Safety Course
• EVERFI provides schools with a free, state-of-the-art on-line learning course on prescription drug safety 
• Due to support from a wide range of public and private supporters in the Presecription Drug Safety Network, EVERFI has the resources and experience to delivier a high-quality E-learning course to schools at no charge.  EVERFI has a long history of provideing training on topics like personal financial management, and they have leveraged that experience to create a 30 to 40-minute course that can be offered in schools or in out-of-school programs.   This report shares some of the impact that this course is having. 
  
  Analysis of Research-Based Programs and Return on Investment
• This report looks at thirteen Youth Marijuana Prevention programs and shares valuable insights on the Return on Investment of these programs. Use of marijuana is a risk factor for starting misuse of opioids, and there are underlying factors where prevention efforts impacts the use of many different types of drugs.
  
  Wsipp_Preventing Youth Substance Use: A Review of Thirteen Programs Benefit-Cost-Results   Preventing Youth Substance Use
  
  Positive Prevention Plus: A comprehensive school-based sexual health education and teen pregnancy prevention curriculum. 

Relevant Research

In this section, please capture any recent findings, reports, or data on the topic. Please also highlight any gaps or existing disparities. Please include references and links to the information so that we may add a footnote for the reader to find further information. Do we have any available research about discriminatory practices? Is there information about the value of access to educational opportunities?

Stigma in School-Based Programs

Researchers in Northern Ireland found that teachers often used scare-based strategies because they believed it would help deter students aged 14 to 16 from using substances. Of the fourteen teachers interviewed, only two had histories of substance use. The twelve other teachers based their perceptions of illicit drug use on the news or the experiences of their friends or students from previous years. The title of the paper is “Junkies, Wasters and Thieves”. These are all words that teachers in the study used to describe individuals who use illicit substances. Numerous teachers told the researchers that they used these words to prevent students from being interested in drug use, even if it meant stigmatizing those affected. The researchers questioned students about how their teachers' language use affected their perceptions of individuals who use drugs. Many students described people who use drugs as criminals, people who “have diseases”, and a disgrace. 

Some students in the school-based program used illicit substances. They reported feeling like an outcast and stated that they could not ask for support or help from their teacher. At many of these schools, using a scare-based approach split the school in half. Half of the students reported believing that individuals who use drugs should be shamed or imprisoned. The other half sympathized with individuals who face difficulties with substance use or had a personal connection with substance use. The drastic difference of opinion led to an us vs. them mindset, creating distinct groups within schools. 

Ultimately, this study displayed the dangers of school-based programs that use a “shock-horror approach” to prevent kids from using substances because they promote stigmatizing individuals and seeing them as unworthy of support.

 

Effectiveness of Different Kinds of School-Based Prevention Programs

Not all school-based programs are created equally. Researchers typically find that more traditional and common approaches, like Drug Abuse Resistance Education (D.A.R.E.), are ineffective. One study found that there should be a greater focus on risk factors specific to the students; and that programs targeting teens need to keep them as an individual in mind, as well as the teen developmental stage and their social context.

Multiple studies have come to the same conclusion that the most effective programs in schools are interactive. As opposed to non-interactive programs, those deemed interactive encourage active participation from every student. Active participation may look like classroom discussions or a lesson plan surrounding skills practice. Importantly, interactions should primarily occur between peers, not between students and the teacher. Non-interactive programs typically involve the teacher leading the class and often using most of the class period to teach via a presentation. When participatory activities are included, they typically involve interactions between the teacher and student, like answering questions, rather than between students.

Along with building self-esteem and improving decision-making skills, school-based programs must also acknowledge the social environment that kids and adolescents live in when surrounded by their peers. Focusing on peer pressure and real-life encounters students may have with friends better prepares them to deal with uncomfortable situations. Studies have found that programs that focus solely on increasing self-esteem and encouraging good decision-making lack a focus on substances, highlighting the importance of encouraging teachers to discuss topics they may view as taboo. Unless teachers discuss realistic scenarios, students will be ill-equipped to use the skills they learned inside the classroom when faced with peer pressure.

 

Effectiveness of School-Based Programs in Rural Communities

A meta-analysis regarding the general effectiveness of school-based programs in rural areas. Researchers concluded that students that benefited from the program the most did not use substances to begin with and were part of an interactive school-based program. It was also discovered that the lessons learned from the program had the greatest impact six months after its completion, and after that, positive effects began to decrease. The results exemplify the importance of starting preventive programs at a young age since those already using substances did not have a reduction in the use of new substances like those who were substance-free.

Impactful Federal, State, and Local Policies

Please list any federal, state, or local laws, policies, or regulations that support this topic or ones that could be a possible barrier. Are there laws or policies other states should know about and replicate for success?

California: Public schools are required to provide drug use education. Specifically, California law requires an anti-drug stance, which has been criticized by many. Due to lack of enforcement, it has not been followed by teachers around the state. So, while schools do ensure that substance use is being discussed in schools, strategies vary from abstinence-based to evidence-based curriculums.

Connecticut: In public schools, students at every grade level must learn about substances and how to avoid their harmful effects (CGS § 10-19(a)). Programs in elementary and secondary schools are required to be looked at by “public health and mental health and addiction services commissioners” to ensure it is a quality curriculum.

Available Tools and Resources

Oftentimes, there are already great resources in the field that have been developed, but they are not housed in a single place. Please use this section to share information about those resources and drive the reader to that resource. It may be a worksheet, toolkit, fact sheet, framework/model, infographic, new technology, etc. I suggest no more than 5 really good links and a corresponding description for the reader. We also can use this section to highlight some of the great resources and programs at SAFE Project.

 

A Toolkit to Start Substance Use Prevention in Elementary Schools 

Provides information and resources for elementary school teachers to begin teaching their students about substance use in an age-appropriate and evidence-based way. Examples of what this toolkit includes are ways to talk about the program with school administrators, parents, and students, as well as grants to apply for and examples of curriculums to teach.

 

Lesson Plan and Activity Finder

The National Institutes of Health created a database that allows teachers to look through lesson plans regarding substance use. The lowest grade level that the resources are aimed at is the fifth grade, and they go up until twelfth grade. There are options to choose either English or Spanish lesson plans.

 

Safety First: Real Drug Education for Teens- Sample Lesson Plan 

The Drug Policy Alliance created the first harm reduction-based substance education program in the United States aimed at high schoolers. It is intended for high school freshman and sophomore students and has fifteen lesson plans lasting around 45 minutes. They offer the entire curriculum after registering at this link:  https://engage.drugpolicy.org/secure/download-safety-first-curriculum?_ga=2.96173340.1473889140.1636474296-215870604.1636330811

Promising Practices

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

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

 Olweus Bullying Prevention Program: Includes schoolwide, classroom, individual, and community strategies.

Media Literacy
Media literacy is a promising approach to school-based substance abuse intervention.

Beneficial outcomes include:

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

Healthy Youth Development Programs in Schools reduce Opioid Misuse
 

Putnam Middle School Social Norms Campaign
In partnership with Putnam Pride, this campaign focused on the common misconceptions that students have about their peers' substance use. 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 would lead to a changed perspective of drug use as deviant rather than something that "everyone is doing."

  Although this program focused on alcohol use, the same idea could be used for prescription opioid drugs as an education tool for students.

 

SAFIR -- Substance Abuse Free Indian River
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.”[9]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.

  SAFIR has supported the delivery of a very comprehensive prevention strategy for our 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.

  A significant environmental strategy that has been embraced by local law enforcement is Civil Citation. See details on
 

Boy Scouts & Girl Scouts
Each of these groups can participate in the DEA Red Ribbon Patch Program. This program empowers young people to create, embrace and strengthen their drug free belief. See Tools & Resources details on participation.