Are all drug-prevention programs effective?; Family: A Johns Hopkins psychologist says not all programs work, and some might even do some harm.

THE BALTIMORE SUN

In America in the '90s it's practically a given: In addition to reading, writing and arithmetic, schools are expected to teach children about drugs.

But how effective are school-based drug education and prevention programs? Should you enroll your child in one?

According to Harold E. Shinitzky, a psychologist with the Johns Hopkins Hospital, school-based programs are definitely worthwhile -- but only if parents and school administrators have made the right choices.

"You've probably heard this before: For every dollar spent on drug treatment you save $12 of cost to society," says Shinitzky. "Well, for every dollar spent on prevention, you save $4 in treatment. You don't have to be a math major to see the advantages of that."

Along with Dr. Harolyn Belcher of the Kennedy Krieger Institute, Shinitzky has reviewed the past decade of substance abuse prevention programs to uncover traits common to the most successful efforts.

His interest was not just academic. He has created his own substance abuse education program, called Project Champions, that the Baltimore Archdiocese uses. In a recent interview, Shinitzky discussed his views on what parents should look for in drug prevention programs.

Q: Since you are critical of the feel-good, "Just say no" programs of the past, what gives you hope that school-based drug education works?

A: The mentality in the past was that we had to do something. It could be school-based initiatives. It could be community-based or on TV. But there was no assessment of what worked and what didn't work.

The nice thing about the latest [Clinton administration] initiative is that they are actually studying the impact -- on knowledge, attitude and behavior. They're following a group of people and monitoring them.

Q. What have we seen so far?

A. The initial results are pretty powerful in terms of changing knowledge and attitude, and that's just for the government initiative. There have been a number of programs in the past that have now been studied over five years. They've turned out to be wonderful programs. Gilbert Botvin at Cornell University has a program called Life Skills Training. It's probably the most well-known prevention initiative. It's across the country. It's a very comprehensive, universal intervention, meaning you give it to all the kids at a school.

The feel-good programs didn't really monitor the outcomes. They'd have a pre-test, give the intervention and then a post-test, and say, "Oh, look, there's been a change." The impressive thing is when there's been a change the next year, and the next year, and the next year.

Q. Is there an ideal age to reach children?

A. The sooner, the better. Whenever you think you want to start an intervention, you should do it at a younger age. As adults, we're usually more reactive than proactive. The best age to start is before a child is in school, and work with the family.

Q. That's very early.

A. You could almost say you should start before a child is born. Parents have to be role models. Parents can't abdicate their role and say the school is responsible for raising my child and giving them their morals and values.

Q. What factors are common to successful programs?

A. They need to be research-based. You have to be able to know what's going into it and coming out of it. They need to be culturally sensitive. It has to fit the population. You can't just pull it off the shelf and apply it to anyone. It needs to be age-appropriate. There needs to be a peer refusal component.

They need to take advantage of peer pressure. In the last national study, approximately 20 percent of eighth-graders studied said they used an illicit substance in the past year. You and I would agree that's atrocious. Well, it also means that four out of five eighth-graders didn't. A lot of people tend to miss that fact. About 11 percent of eighth-graders used inhalants. That's terrible. But it also means 9 out of 10 kids aren't, and I want to emphasize that. Somehow, it doesn't get publicity. The good child is the norm.

These broad-based interventions mean don't wait until they face this problem and teach peer refusal skills. Way before that, it's about decision-making, goal-setting, assertiveness, self-esteem, character development, these are all part of raising a resilient child.

Q. Sometimes, it seems these drug education programs are filled with hyperbole, exaggerating risks. Doesn't that harm their credibility with kids?

A. That's the shock value approach. It's like driver's education and the "hamburger" films that showed terrible crashes. But then you drove and you didn't die. You promote these shock values and they prove false, you get a boomerang effect. Kids think, "It's not happening to me so it doesn't apply to me." When you push a horrific ending that happens infrequently, you negate and discredit your message. Kids need and want factual information and that's what these programs provide.

Q. Most parents don't get to pick the drug education program their school adopts. How should I judge what my child's school is doing?

A. The first thing to do is to advocate for these effective programs, maybe contacting a local agency that might have one in place. Most programs right now are just feel-good. A lot of parents may not know what makes up the best practices. You need to contact agencies involved in this issue.

Q. Could a drug education program harm my child?

A. Yes, absolutely. A lot of programs only use the shock value. Whenever I've talked to adolescents after an intervention, their perception can be very different from what we anticipate. Here's an example. We used to use athletes talking about their own long-term drug or alcohol use and their struggle toward recovery. Well, that sounded like a nice message to be sending. You talk to a lot of adolescents -- especially the males who look up to these athletes -- and what they heard is that part of the process of becoming a phenomenal athlete and getting all this wealth and fame was engaging in these illicit activities. That was the wrong message to be sending.

Q. Across the country, DARE remains popular. Does it work?

A. It's an interesting program, but the results are less than anticipated. When the youngsters who take DARE are compared to a control group that doesn't, the DARE kids score about the same as the control group. In some areas, worse.

DARE didn't cause kids to engage in high-risk behaviors. It's just that the problem is bigger than DARE.

Q. Is it OK for my child to sign up for DARE?

A. Yes. Some discussion is better than none at all. You need to be proactive. The time to do the intervention is before you think you need to.

Sources

For more information on drug education and school-based programs, contact:

* Join Together, a national nonprofit alcohol, drug, tobacco and gun violence prevention agency www.jointogether.org 617-437-1500

* National Institute on Drug Abuse, an agency within the U.S. Department of Health and Human Services www.nida.nih.gov

* National Clearinghouse for Alcohol and Drug Information that provides free publications on alcohol and drug abuse 800-729-6686

* National Health Information Center, the HHS agency that answers consumer health questions 800-336-4797

* The Office of National Drug Control Policy www.whitehousedrugpolicy.gov

* The Kaiser Family Foundation, which provides a free booklet on how parents can talk to their children about drugs and other issues www.talkingwithkids.org 800-CHILD44

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