Evaluation of Drug and Alcohol Prevention Strategies: DARE and LST

Addiction can be defined as a behavioural process that provides pleasure and relief from internal discomfort, however, it includes a recurring failure to control the behaviour and a continuation of this behaviour despite its harmful consequences. (Goodman, 1990) Addiction to alcohol is an excessive and harmful consumption of alcohol but with tolerance effects and withdrawal symptoms. It differs from alcohol abuse as alcohol abuse is excessive and harmful consumption without tolerance effects and withdrawal symptoms. However, alcohol abuse can often lead to alcohol addiction in the future.

Addiction to alcohol is one of the
leading concerns in the world. Research has shown that alcohol is one of the
leading causes of death. A study by Stahre, Roeber, Kanny, Brewer, and Zhang
(2014) showed that excessive drinking was responsible for 1 in 10 deaths among
working-age adults in the United States. This is because excessive drinking is
a massive risk factor for many health-related problems. Alcohol consumption is
an underlying cause, either entirely or partly, for over 30 different
conditions including cancer, diabetes, liver and pancreas diseases and many
more. (Rehm, 2011)

It is also worrying that alcohol
related deaths have been rising. A study in the UK by Breakwell, Baker,
Griffiths, Jackson, Fegan, and Marshall (2007) found that alcohol-related
deaths had increased from 4,144 in 1991 to 8,221 in 2004 and in 2016 this rose
to 9,214 according to the Office for National Statistics. Alcohol-related
deaths have been rising due to the rise in alcohol consumption. Dawson,
Goldstein, Saha, and Grant (2015) looked at changes in alcohol consumption from
2001 to 2013 and found that the prevalence of drinking increased, as did the
volume and frequency of drinking. It also found that the prevalence of monthly
heavy episodic drinking increased among heavy drinkers. These studies show that
alcohol consumption and alcohol-related deaths are rising and suggests that
more needs to be done to try and reduce this. Research has shown that people
tend to start drinking at a young age. Johnston, and Bachman (1998) found that
in the United States 54% of 13-14 year olds, 72% of 15-16 year olds, and 82% of
17-18 year olds had consumed alcohol. Thus showing just how young people start
drinking alcohol.

Research has also shown that not only
do a large amount of people starting drinking during adolescence but a lot of
people have alcohol abuse or alcohol dependence during adolescence. Harford,
Grant, Yi, and Chen (2005) found that the prevalence of alcohol abuse and of
alcohol dependence with or without alcohol abuse was at its highest for the
ages of 18-23 years old, this was followed by adolescents aged 12-27 years old.
It was also found that alcohol abuse was lowest for those over 50. These
results, therefore, suggest that adolescents do not just start drinking during
adolescence but also start drinking excessively at a young age.

Therefore these results suggest that adolescents are most at risk of alcohol abuse, which can lead to alcohol dependence and then to addiction. One of the best ways to try and

prevent alcohol addiction

is by educating adolescents about alcohol abuse as during adolescence is when most people starting drinking alcohol for the first time. The most effective way to do this is by substance abuse prevention strategies. Substance abuse prevention strategies are strategies that attempt to prevent substance abuse, including alcohol abuse. They are usually conducted in schools and aimed at adolescents. These strategies not only educate about the risks of substance abuse but also work on resisting social pressures and decision making in order to help prevent adolescents from abusing alcohol. This is because research has suggested that adolescents may be most at risk of alcohol abuse because of social factors. A study by Dielman, Campanelli, Shope, and Butchart (1987) found that susceptibility to peer pressure was highly correlated with high levels of adolescent alcohol abuse. Thus suggesting that more than just education about the substances is needed.

Currently used strategies include

Project DARE (Drug Abuse Resistance Education)

and the Life Skills Training Program by Botvin et al. (1984). They are two most commonly used prevention strategies and there has been much research into their effectiveness. Project DARE (Drug Abuse Resistance Education) is a school-based intervention program taught by police officers that was designed to try and eliminate substance use, including alcohol, in adolescents. It focused on teaching peer resistance skills in the form of lectures, workbook exercises and role-playing sessions. (Rosenbaum, Flewelling, Bailey, Ringwalt, and Wilkinson, 1994).

Clayton, Cattarello, and Johnstone
(1996) examined the effectiveness of DARE in a study where over 2,000 11-12
year olds were administered DARE. It was found that DARE produced some initial
improvements in the student’s attitudes towards substance use, however, these
changes did not continue over time. It was also found that there was no effect
on actual substance use. In the 5 year follow up it was also found that there
had been no effect on actual substance use. This study has shown that DARE was
not effective across 5 years.

However, more research had been
conducted on DARE to study its effectiveness over a longer period of time.
Lynam et al (1999) conducted a study across 10 years and had a total of 1,002
11-12 year old students receive DARE and then re-evaluated them when they were
20 years old. It was found that the participants’ levels of lifetime alcohol
use and their positive and negative expectancies of alcohol before received
DARE was significantly related to their levels of lifetime alcohol use and
positive and negative expectancies 10 years later. This study suggests that
Project DARE is not very effective and had no effect on trying to reduce or
eliminate substance abuse. This is, however, an outdated study using an
outdated version of DARE. Project DARE has been updated over the years and it
is possible that a newer version may have been more effective. However, there
has not been much change to DARE. The focus and aim of DARE has stayed the
same, as well as the program’s method of delivery according to Lynam et al.
From the research on Project DARE it is clear that it is not an effective
prevention strategy as the results from the studies on it have shown no
effective on the alcohol consumption of the adolescents that received DARE.

The more recent and higher regarded
prevention strategy is the Life Skills Training Program (LST) by Botvin et al.
(1984). It is a school-based intervention program, taught by teachers, that
targets a specific set of risk factors for alcohol and other substance abuse.
It is a prevention program that aims to reduce the prevalence of substance
abuse in younger populations. (Botvin and Kantor, 2000) It is taught across 3
years and uses cognitive-behavioural skills training techniques, group
discussions and classroom demonstrations. It consists of three major
components, personal self-management skills, social skills, and drug-related
information and skills. (Botvin and Griffin, 2004)

A study by Botvin et al (1984) was
conducted using 239 students from two public schools in New York that were
randomly assigned to experimental and control conditions. The students in the
experimental condition took part in 20-session program (LST) that targeted the
major cognitive, attitudinal, social and personality factors that are believed
to promote early stages of alcohol misuse. The program contained material on
general social skills, decision making, coping with anxiety and resisting peer
pressure as well as there being information about the short and long-term
consequences of alcohol abuse. In the 6-month follow-up the experimental group
were contrasted with the control group, which did not receive LST, and it was
found that 54% fewer students reported more frequent drinking, 73% fewer
students reported heavier drinking and 79% fewer students reported getting
drunk at least once per month.

LST has also been tested on its
long-term effectiveness, Botvin et al. (1995) conducted a follow up study 6
years after adolescents received LST. They conducted telephone interviews and
email surveys on the adolescents 6 years later and found that LST was effective
in the long-term, as 66% fewer adolescents used polydrugs (alcohol, marijuana
and tobacco) after having received LST. This suggests that LST is not just a
good short-term prevention strategy as it has also been shown to be effective
over a long period of time. However, the results may not be reliable as the
study was conducted using telephone interviews and email surveys to gather
results. The participants could have been dishonest in these surveys as substance
abuse can be a taboo subject so some of the participants may have chosen to lie
about their substance abuse. Also, only 60.4% of those who participated in the
original study participated in this follow up study, if all of the original
participants did the follow up study the results may have been different. The
results of this study, if reliable, do show that LST is an effective prevention
strategy.

However, not all research on LST has
shown it to be a completely effective prevention strategy. Botvin et al. (1990)
found that the LST program had negative effects on alcohol when it was
delivered by teachers and with booster sessions. It was found that many
teachers did not implement the program according to the correct protocol.
Botvin et al. pointed out that this may be because teachers are not
sufficiently trained in teaching cognitive-behavioural life skills. Overall,
research would suggest that LST is a fairly effective prevention program but
that it can be improved and that alterations of the program could make it a
much more effective prevention strategy.

From research, it is clear to see
that the current strategies are not currently effective enough in preventing
alcohol abuse. Project DARE was shown to be largely ineffective and the LST
program although shown to be effective in research could be much improved. That
these current strategies are not effective enough is also evident through the
fact that since these strategies have been implemented in schools there has
still been an increase in adolescent alcohol use as shown by Johnston et al.
(2018). Their study found that binge drinking rates had increased slightly
since 2016, thus suggesting that the current strategies are not preventing
adolescents from excessive drinking.

A proposed strategy for the
prevention of alcohol addiction is an adapted version of the Life Skills
Training Program, which much research has shown to be effective in both the
short-term and the long-term. The adapted version of the Life Skills Training
involves a number of changes that research has suggested could improve the
effectiveness of it.

This adapted version of LST still has
the three major components of LST, personal self-management skills, social
skills, and drug-related information and skills. However, it will be a more
interactive version of LST. Research by Tobler and Stratton (1997) found that
drug prevention programs that were interactive were more effective than those
that were not interactive. They also found that smaller interactive groups were
more effective than larger interactive groups. In line with these results, it
is suggested that an adapted version of LST be interactive rather
non-interactive. It is also suggested that it be implemented in smaller groups
of 10 students instead of it being implemented in regular classes as the
research by Tobler and Stratton showed this to be more effective.

Another change that is proposed would
be to try and bring more connectedness and rapport to the program. Having the
teachers of the groups build rapport with the students could be highly
beneficial to the effectiveness of the program. Rapport is built when the
students have the opportunity to voice their perceptions with their teacher and
their peers. (Brown, 2001) D’Emidio-Caston and Brown (1998) found that focus
groups on drug education allowed students to hear the different sides to
substance use. They suggested that hearing only one side of the story about
substance use can alienate the students that are in most need of help.
Therefore, focus groups will be an important focus of the proposed strategy as
it will allow rapport to be built between students and their teacher and will
help to involve those that are most in need of drug education. Research has
shown that rapport building can be very beneficial for a student’s learning. Buskist and Saville (2004) found that students who
experienced rapport with their teacher were more attentive, had increased class
enjoyment and a higher attendance level.

It is also proposed that the teachers
be fully trained in teaching cognitive-behavioural life skills as research by
Botvin et al. (1990) suggested that teachers without this training may have
been less effective at teaching LST to students. The research showed that many
did not follow the correct protocol of LST and did not teach substantial
portions of the program. Having all teachers fully trained in teaching
cognitive-behavioural life skills should lead to the strategy being implemented
with full fidelity. Therefore, this should make this prevention strategy even more
effective as Botvin et al. also found that when LST was taught with full
fidelity it was much more effective.

In conclusion, it is clear to see
that alcohol addiction is a massive worldwide problem and that current
prevention strategies have not been successful enough in preventing alcohol
addiction. Although prevention programs such as LST are highly regarded and are
used in many states in the United States, it has not been effective enough to
decrease the levels of alcohol addiction and alcohol abuse. There are many
positive components to such prevention programs, however, there is also a lot
of room for improvement and the proposed strategy attempts to improve previous
drug prevention strategies by making a more interactive version that will
improve the connectedness between student and teacher and thus lead to better
learning by the students. It also aims to do this by having the teachers fully
trained in teaching cognitive-behavioural life skills as this will increase the
effectiveness of the teaching and, therefore, should make the strategy more
effective. The proposed strategy has taken into account the negatives of
current strategies and has attempted to improve them by adding components that
research has shown can be effective in teaching and in teaching drug education.

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