Loosening the Grip: a handbook of Alcohol Information 9th



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Billions of dollars are spent annually on school-based drug education programs, with youthful drug use remaining near peak levels since the 1980s. Institutional, policy, and program evidence presented here suggests that although primarily delivered in schools, the educational community rarely participates in the development of drug education; and despite the finding that "no-use" programs such as Drug Abuse Resistance Education (D.A.R.E.) or Life-Skills Training (LST) are likely ineffective, they continue to thrive in schools. This may be explained by insufficient educational participation and scientific discourse considering these issues; and the role of interest group politics, such as the symbiotic relationship between government, researchers, and the tobacco industry, in drug education. In addition to this evidence, resilience based program alternatives, evaluation, and implications are discussed. Copyright 2001, Baywood Publishing

Fell JC, Voas RB. The effectiveness of reducing illegal limits for driving: Evidence for blood alcohol concentration (BAC) lowering the limit to .05 BAC. Journal of Safety Research 37(3): 233–243, 2006. (52 refs.)


Purpose: This scientific review provides a summary of the evidence regarding the benefits of reducing the illegal blood alcohol concentration (BAC) limit for driving and providing a case for enacting a .05 BAC limit. Results: Fourteen independent studies in the United States indicate that lowering the illegal BAC limit from .10 to .08 has resulted in 5-16% reductions in alcohol-related crashes, fatalities, or injuries. However, the illegal limit is .05 BAC in numerous countries around the world. Several studies indicate that lowering the illegal per se limit from .08 to .05 BAC also reduces alcohol-related fatalities. Laboratory studies indicate that impairment in critical driving functions begins at low BACs and that most subjects are significantly impaired at .05 BAC. The relative risk of being involved in a fatal crash as a driver is 4 to 10 times greater for drivers with BACs between .05 and .07 compared to drivers with .00 BACs. Summary: There is strong evidence in the literature that lowering the BAC limit from .10 to .08 is effective, that lowering the BAC limit from .08 to .05 is effective, and that lowering the BAC limit for youth to .02 or lower is effective. These law changes serve as a general deterrent to drinking and driving and ultimately save lives. Impact on Industry: This critical review supports the adoption of lower illegal BAC limits for driving. Copyright 2006, National Safety Council

Galea S,Worthington N, Piper TM, Nandi VV, Curtis M, Rosenthal DM. Provision of naloxone to injection drug users as an overdose prevention strategy: Early evidence from a pilot study in New York City. Addictive Behaviors 31(5): 907–912, 2006. (16 refs.)


Introduction: Naloxone, an opiate antagonist that can avert opiate overdose morality, has long been prescribed to drug users in Europe and in a few US cities. However, there has been little documented evidence of naloxone distribution programs and their feasibility in the peer reviewed literature in the US. Methods: A pilot overdose prevention and reversal program was implemented in a New York City syringe exchange program. We assessed demographics, drug use, and overdose history, experience, and behavior at baseline, when participants returned for prescription refills, and 3 months after baseline assessment. Results: 25 participants were recruited. 22 (88%) participants were successfully followed-up in the first 3 months; of these, 11 (50%) participants reported witnessing a total of 26 overdoses during the follow-up period. Among 17 most-recent overdoses witnessed, naloxone was administered 10 times; all persons who had naloxone administered lived. Discussion: Naloxone administration by injection drug users is feasible as part of a comprehensive overdose prevention strategy and may be a practicable way to reduce overdose deaths on a larger scale. Copyright 2006, Elsevier Science

Hallfors D, Cho H, Sanchez V, Khatapoush S, Kim HM, Bauer D. Efficacy vs effectiveness trial results of an indicated “model” substance abuse program: Implications for public health. American Journal of Public Health 96(12): 2254–2259, 2006. (22 refs.)


Objectives. The US Department of Education requires schools to choose substance abuse and violence prevention programs that meet standards of effectiveness. The Substance Abuse and Mental Health Services Agency certifies "model" programs that meet this standard. We compared findings from a large, multisite effectiveness trial of I model program to its efficacy trial findings, upon which the certification was based. Methods. 1370 high-risk youths were randomized to experimental or control groups across 9 high schools in 2 large urban school districts. We used intent-to-treat and on-treatment approaches to examine baseline equivalence, attrition, and group differences in outcomes at the end of the program and at a 6-month follow-up. Results. Positive efficacy trial findings were not replicated in the effectiveness trial. All main effects were either null or worse for the experimental than for the control group. Conclusions. These findings suggest that small efficacy trials conducted by developers provide insufficient evidence of effectiveness. Federal agencies and public health scientists must work together to raise the standards of evidence and ensure that data from new trials are incorporated into ongoing assessments of program effects. Copyright 2006, American Public Health Association

Lynam DR, Milich R, Zimmerman R, Novak SP, Logan TK, Martin C, et al. Project DARE: No effects at 10-year follow-up. Journal of Consulting and Clinical Psychology 67(4): 590–593, 1999. (16 refs.)


The present study examined the impact of Project DARE (Drug Abuse Resistance Education), a widespread drug-prevention program, 10 years after administration. A total of 1,002 individuals who in 6th grade had either received DARE or a standard drug-education curriculum, were reevaluated at age 20. Few differences were found between the 2 groups in terms of actual drug use, drug attitudes, or self-esteem, and in no case did the DARE group have a more successful outcome than the comparison group. Possible reasons why DARE remains so popular, despite the lack of documented efficacy, are offered. Copyright 1999, American Psychological Association, Inc.

Midford R. Does drug education work? (review). Drug and Alcohol Review 19(4): 441–446, 2000. (29 refs.)


Recent research indicates that certain drug education programmes do stop or delay the onset of drug use under optimum conditions. Social inoculation programmes have generally enjoyed the greatest degree of success, but the behaviour changes have been confined to a small number of students; have not been uniform across all drugs and have diminished over time. Research on the cost effectiveness of drug education programmes indicates that they compare favourably with the cost effectiveness of most law enforcement approaches, but are not as cost effective as treatment. While there are some methodological qualifications, the drug education literature does indicate that soundly conceptualized and rigorously implemented programmes can influence drug using behaviour and that comprehensive provision of such programmes is likely to produce a net social cost saving to society. This does not mean that proven drug education programs will necessarily be implemented. The most powerful factor in the implementation process is selection of programmes on the basis of ideal outcomes, rather than on the evidence of what can realistically be achieved. Ultimately, this is self-defeating, because programme failures will again discredit the whole drug education approach. Drug education programmes must be selected because they have demonstrated the ability to have a beneficial impact on youth drug use and youth drug problems. Copyright 2000, Australian Medical and Professional Society on Alcohol and Other Drugs

Peterson AV Jr., Kealey KA, Mann SL, Marek PM, Sarason IG. Hutchinson Smoking Prevention Project: Long-term randomized trial in school-based tobacco use prevention. Results on smoking. Journal of the National Cancer Institute 92(24): 1979–1991, 2000. (87 refs.)


Background: No long-term impact has yet been observed with the use of the social-influences approach to school-based smoking prevention for youth. However, whether this lack of impact is due to methodologic problems with the studies or to the failure of the interventions is unclear. The Hutchinson Smoking Prevention Project (HSPP), conducted from September 1984 through August 1999, aimed to attain the most rigorous randomized trial possible to determine the long-term impact of a theory-based, social-influences, grade 3-12 intervention on smoking prevalence among youth. Methods: Forty Washington school districts were randomly assigned to the intervention or to the control condition. Study participants were children enrolled in two consecutive 3(rd) grades in the 40 districts (n = 8388); they were followed to 2 years after high school. The trial achieved high implementation fidelity and 94% follow-up. Data were analyzed with the use of group-permutation methods, and all statistical tests were two-sided. Results: No significant difference in prevalence of daily smoking was found between students in the control and experimental districts, either at grade 12 (difference [Delta] = 0.2%, 95% confidence interval [CI] = -4.6% to 4.4%, and P = .91 for girls; Delta = 0.3%, 95% CI = -5.0% to 5.5%, and P = .89 for boys) or at 2 years after high school (Delta = -1.4%, 95% CI = -5.0% to 1.6%, and P = .38 for girls; Delta = 2.6%, 95% CI = -2.5% to 7.7%, and P = .30 for boys). Moreover, no intervention impact was observed for other smoking outcomes, such as extent of current smoking or cumulative amount smoked, or in subgroups that differ in n priori specified variables, such as family risk for smoking. Conclusion: The rigor of the HSPP trial suggests high credence for the intervention impact results. Consistent with previous trials, there is no evidence from this trial that a school-based social-influences approach is effective in the long-term deterrence of smoking among youth. Public Domain

Rosenbaum DP, Hanson GS. Assessing the effects of school-based drug education: A six-year multilevel analysis of project DARE. Journal of Research in Crime and Delinquency 35(4): 381–412, 1998. (60 refs.)


A randomized longitudinal field experiment was conducted to estimate the short- and long-term effects of the Drug Abuse Resistance Education program (D.A.R.E.) on students' attitudes, beliefs, social skills, and drug use behaviors. Students from urban, suburban, and rural schools (N = 1,798) were followed for more than six years, with surveys administered each year from 6th through 12th grades. Teachers were also surveyed annually to measure students' cumulative exposure to supplemental (post-D.A.R.E) drug education. Multilevel analyses (random-effects ordinal regression) were conducted on seven waves of posttreatment data. The results indicate that D.A.R.E. had no long-term effects on a wide range of drug use measures, nor did it show a lasting impact on hypothesized mediating variables, with one exception. Previously documented short-term effects had dissipated by the conclusion of the study. Some D.A.R.E.-by-community interactions were observed: Urban and rural students showed some benefits, whereas suburban students experienced small but significant increases in drug use after participation in D.A.R.E. Copyright 1998, Sage Publications, Inc.

Swisher JD. Sustainability of prevention. Addictive Behaviors 25(6): 965–973, 2000. (23 refs.)


This paper outlines the guidelines for sustaining prevention and makes suggestions for getting from the field's current status to greater levels of permanence for prevention. The paper begins by reviewing the status of prevention, then focuses on major considerations for achieving sustainability, including two processes of institutionalization, comprehensive programming and professionalism. Copyright 2000, Pergamon Press

Tighe T, Sac L, eds. Journal of Drug Issues 36(2): entire issue, 2006.


Note: Devoted to the evaluation of Fighting Back Program.

Wallace SK, Staiger PK. Informing consent: Should “providers” inform “purchasers” about the risks of drug education? Health Promotion International 13(2): 167–171, 1998. (47 refs.)


This paper argues that most drug education is problematic as an 'evidence-based' intervention, as it either lacks sufficient empirical support for its implementation, or it continues in the face of negative results. It is argued that drug education is a good example of an entrenched but risky public health intervention which is unimpeded by any burden of evidence, but this fact is not well known in the purchasing communities, which often mandate such preventive programs universally. A morally informed public health policy would suggest that such quality assurance data is mandatory for the continuation or maintenance of any preventative drug education. Copyright 1998, Oxford University Press
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