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“ W hat W orks, B est P ractices”

“ W hat W orks, B est P ractices”. By Karol L. Kumpfer, Ph.D. Director Center for Substance Abuse Prevention. Substance Abuse Prevention: What Works!. Extent of the Drug Problem: • Tobacco, alcohol, and drug abuse is a serious

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“ W hat W orks, B est P ractices”

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  1. “What Works, Best Practices” By Karol L. Kumpfer, Ph.D. Director Center for Substance Abuse Prevention

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  3. Substance Abuse Prevention: What Works! Extent of the Drug Problem: • Tobacco, alcohol, and drug abuse is a serious health and social problem worldwide. • Drug abuse has been increasing in the USA in adolescents since 1992. Last year drug abuse increased 27% in 12-17 year olds. • Tobacco, alcohol, and drug abuse significantly contributes to rising health care costs and societal problems. 3

  4. Good News: • We know how to prevent drug abuse by strengthening families, schools, and communities. Bad News: • Prevention of drug abuse is not easy. There are no quick fixes. A media campaign is not enough. 4

  5. Public Health Model Triangle AGENT/DRUG INDIVIDUAL CHANGE PROGRAMS • KNOWLEDGE • ATTITUDE/NORMS • SKILLS SUPPLY REDUCTION • INTERDICTION • CROP ERADICATION • POLICY AND LAWS • REDUCE ACCESS • INCREASE COST ENVIRONMENT HOST/PERSON • SYSTEM CHANGE • FAMILY • SCHOOL • COMMUNITY 5

  6. The Intervention Spectrum for Behavioral Disorders T r e a t m e n t C a s e I d e n t i f i c a t i o n S t a n d a r d T r e a t m e n t n o f o r K n o w n i Indicated— Diagnosed Youth M t D i s o r d e r s n a e i n v t e r e P n C o m p l i a n c e a Selective— Health Risk Groups n w i t h L o n g - T e r m c e T r e a t m e n t ( G o a l : R e d u c t i o n i n R e l a p s e a n d R e c u r r e n c e ) A f t e r c a r e Universal— General Population ( I n c l u d i n g R e h a b i l i t a t i o n ) Source: Mrazek, P.J. and Haggerty, R.J. (eds.),Reducing Risks for Mental Disorders, Institute of Medicine, Washington, DC: National Academy Press, 1994. 6

  7. Prevention: Three types of prevention • interventions (Mrazek & Haggerty, IOM, 1994). • 1. Universal (primary prevention with • general population) • 2. Selective (secondary prevention • with high-risk groups, such as children • of alcoholics, inner city youth, pregnant • unmarried girls, etc.) • 3. Indicated (secondary prevention with • identified problem youth already • manifesting a risk factor, i.e., school • dropouts, delinquent youth, youth • already smoking or drinking, etc.) 7

  8. U.S. Drug Abuse Prevention Workshop Objectives Session III:Substance Abuse Prevention: What Works! Purpose: • To give participants an understanding of effective substance abuse prevention strategies 8

  9. The Need for Community Coalitions • Community coalitions have become very popular for health promotion and disease prevention. • The U.S. Center for Substance Abuse Prevention has initiated more than 250 community partnerships nationwide. • Additional AOD community coalitions have been implemented by: 1. State and local governments 2. The Henry J. Kaiser Family Foundation 9

  10. The Need for Community Coalitions (cont.) 3. The Robert Wood Johnson Foundation’s “Fighting Back” coalitions 4. The National Cancer Institute's COMMIT and ASSIST tobacco and cancer reduction programs 5. The U.S. Centers for Disease Control and Prevention’s Planned Approach to Community Health (PATCH) health promotion program 10

  11. 1994-95 1996 Total Adults Tenth graders Eighth graders Total: 14,807 12,092 26,899 12,842 13,042 25,884 14,151 16,539 30,690 41,800 41,673 83,473 Annual Site Visits to 24 Partnerships • Annual Site Visit Reports (N=24) • Composite Reports (N=24) A Rigorous National Evaluation Age Groups Surveyed in the 24 Partnerships and 24 Comparison Communities 11

  12. Living in partnership communities, Participating in drug prevention activities, Living in neighborhoods safe from drugs, and Disapproving of drug use. Involvementin Drug Prevention Activities 12 12 3 9 6 Vote for Issue B Red Ribbon Days • • SAMHSA-CSAP Less Likelihood of Illicit Drug Use DISAPPROVAL OF DRUGS In the Past Month Community Partnership Neighborhood Perceived Safe From Drugs Adults are Less Likely to Use Illicit Drugs When: 12

  13. Inclusive and Broad-based Membership Strong Core of Partners Comprehensive Vision Shared Vision Decentralized Units High Number of Prevention Contact Hours Avoidance or Resolution of Severe Conflict Reasonable Staff Turnover Outcome Evaluation Results:Characteristics of Successful Partnerships 13

  14. Adults 10th Graders 8th Graders 32 28 12 11 30 26 28 10 26 24 9 Adjusted Prevalence Rates (%) 24 8 22 22 7 20 20 6 p036* p005* p025* 0 0 0 t1 t2 t1 t2 t1 t2 Partnership Communities Comparison Communities *one-tailed 30 Day Illicit Drug UseMALES 14

  15. Adults 10th Graders 8th Graders 48 34 66 32 64 30 46 Adjusted Prevalence Rates (%) 62 28 26 60 p030* 0 44 p005* Partnership Communities 0 0 t1 t2 t1 t2 t1 t2 Comparison Communities *one-tailed 30 Day Alcohol UseMALES 15

  16. Four Steps for Choosing a Research-based Prevention Program • Step 1: Read Reviews of the Research Literature • • Psychology Bulletin article (Hawkins, Catalano, • & Miller (1992), • • Communities That Care (Hawkins, et al., 1993), • • The Making of a Drug-Free America • (Falco, 1993). • • Drug Abuse Prevention in Multi-ethnic Youth • (Botvin, Schinke, and Orlandi, 1995). 16

  17. Four Steps for Choosing a Research-based Prevention Program (Continued) • Step 2: Gather Local Data • Step 3: Determine Why These High-Risk • Individuals Use Drugs • Step 4: Select the Best Prevention Intervention 17

  18. Step 4.1: Where in the Prevention Continuum • to Intervene? • First you should decide where in the Prevention • Possibilities Frontier or risk continuum you want • to intervene: • 1. Before there are any risk indicators with • general population using universal approaches, • 2. Using selective approaches for high-risk groups, or • 3. Using indicated approaches for individuals already • using or manifesting symptoms of use (dropping • grades, isolation, and antisocial behavior). 18

  19. Step 4.2: Which Sites to Focus Upon—School, • Family, Community? • Step 4.3: Choosing the Most Effective Approach 19

  20. Peer-focused Prevention Approaches • Final pathway to Drug Use= Peer Norms and Pressure • Effective Approaches • 1. Peer Resistance Training • 2. Normative Education. • Resistance to peer pressure can be increased • through involvement in peer resistance training • programs which have been shown to delay initiation • of drug use (Dielman, Shope, Leech, & Butchart, • 1989; Pentz, et al., 1989). 20

  21. Universal Selective Indicated General population (mixed low, high risk) Targeted Population at High risks Targeted Individuals at High Risk School-based approaches I. Information II. Education curriculums • social inoculation • peer resistance • normative education • life skill training III. School climate change programs • school policies • instructional changes IV. School coalitions • multiple approaches I. Alternative Programs • youth skills training • after school or special class/club • sports or recreation II. Cultural pride & competency III. Peer leadership IV. Tutoring V. Mentoring VI. Children of Alcoholics Groups VII. Trauma & Violence Prevention VIII. Parent-peer groups • alternatives programs • peer leadership • peer counseling • tutoring • mentoring • cultural pride • in-school suspension • student assistance • student crisis line & warm lines • school support group • aftercare group • alternative schools/classes Prevention Matrix The following table provides an overview of Universal, Selective, and Indicated as defined by school-based approaches, family focused approaches, and community based approaches. 21

  22. Universal Selective Indicated • parent education - groups - lectures -curriculums • parent support • parent skills training (1-7 sessions) • family skills training (1-7 sessions) Family-focused approaches • home visits • parent skills training (10+ sessions) • family skills training (7+ sessions) • family case/ manager • parent support groups • family skills training • parent-peer group for troubled youth • parent self-help support group • tough love • family treatment - structural - strategic - functional • family services Community-based approaches • youth clubs • recreation • outdoor challenges • mentoring • tutoring • school homework support • community partners (inner city, housing projects) • public awareness • community mobilization • community coalitions/task forces • school/community partnerships • church sponsored youth groups • rites of passage programs • gang & delinquency prevention • alternative programs • job skill training • job apprentice programs Prevention Matrix (Continued) 22

  23. Strengthening Schools, Families and Communities Approaches 1.Information Prevention Approaches Programs employing this strategy provide awareness and knowledge of: • Pharmacological effects of drugs • Health, psychological and social consequences of abuse • School and community attitudes, norms, legal sanctions, and sanctions • General health education. 23

  24. 1.Information Prevention Approaches. (Continued) • Results • 1. Increase students' knowledge about drugs • 2. Impact on decreasing or delaying use is • not known because most information • programs do not measure behavioral • objectives (Moskowitz, 1983) 24

  25. • Information-only approaches to prevention have been criticized on the following grounds: 1. Knowledge Alone May Not Change Behavior 2. Youth most at-risk for drug use are school drop-outs 3. The information source often not considered credible by youth 4. Most educational programs too short to produce behavior changes 5. Often drug information is not specifically designed to match the appropriate local cultural and ethnic traditions 25

  26. • Information about consequences may deter • low-risk youth from drug initiation, particularly • with highly addictive drugs or drugs with well • accepted negative effects (e.g., designer drugs) • • Information is helpful to those living with drug • users or to those wanting to know how to identify • symptoms of drug use, intervention methods, • and referral sources 26

  27. Strengthening Schools, Families and Communities Approaches(Continued) 2. Prevention Education and Skills Training Programs • More intensive (more hours per person) than information dissemination programs • Cost more per participant 27

  28. 2. Prevention Education and Skills Training Programs (Continued) Examples • Life skills training • Peer and media resistance training • Classroom or small group sessions • Peer leader/helper programs • Children of substance abuse groups • Parenting and family skills training classes • Youth or adult involvement in design and implementation helps (National Assembly, 1994) 28

  29. The skills training or social competency approaches • behaviorally train students to resist pressures to use • drugs and to learn social skills through three • different strategies: • 1) The Social Influences Approach involving • media persuasion resistance training and • peer resistance social skills training, used • in Project STAR, and I-STAR in the • Midwestern Prevention Project (Pentz • 1983; Pentz, et al., 1989) and the • DARE program 29

  30. 2. The Normative Education Approach which encourages adoption of norms against drug use and corrects inflated estimates found in youth about the number of youth who actually use drugs (Hansen, 1992; Hansen & Graham, 1991) 3. The Life Skills or Social Skills Approach (Botvin and associates., 1990 (a,b,c)) teach youth how to communicate, control stress and feelings of anger or anxiety, restore self-concept, choose prosocial friends, increase social status, and resist media and peer pressure to use drugs 30

  31. Intervention methods • 1. Demonstrations of effective and ineffective • behaviors • 2. Trainer demonstrations • 3. Participant role plays with feedback • 4. Reinforcement for changed behavior • 5. Role Modeling • 6. Positive peer group norms 31

  32. Results • Modest reductions in onset and prevalence of • cigarette smoking, alcohol, and marijuana use if: • • Interactive classes better than lectures • • Peer led classes better than teacher-led • classes • • Some negative effects in students who • were already using 32

  33. Strengthening Schools, Families and Communities Approaches(Continued) • 2. Alternative Programs • Including recreational, sports, cultural, and • educational activities • • Used with high-risk individuals because • of the increased cost • • The theoretical justification is that providing • individuals with "alternative highs” • incompatible with substance use will • reduce use. 33

  34. 2. Alternative Programs (Continued) • • Also, some research supports a link between • sensation or thrill seeking personality and • drug use • Types • • Experiential Education Programs involving • wilderness experiences, ropes courses, • mountain climbing, rapelling, and rafting. • • Community Service Programs (removing • graffiti or developing community murals), • building homes, and volunteering to help • others (Tobler, 1986) 34

  35. 2. Alternative Programs (Continued) • Examples • 1. Amazing Alternatives was developed by • Murray and Perry (1985). • 2. CSAP High-risk Youth Grants with • experiential education programs • Results • • Effectiveness Unclear (Schaps and • associates (1981) 35

  36. Results (Continued) • • Some alternative activities (academic, • religious, and active hobbies) decrease use • and others (entertainment, sports, social, • extracurricular, and vocational activities) • promote increased use • • Critical ingredient is who youth associate • with in the activities 36

  37. Strengthening Schools, Families and Communities Approaches(Continued) 4. Intervention Approaches • Indicated prevention programs for drug users or individuals showing mental health symptoms of risk (e.g., delinquency, aggression, depression, and other anti-social behavior) • Strategies involve problem identification, screening and referrals to special therapeutic programs 37

  38. 4. Intervention Approaches (Continued) • Examples: • • Student assistance programs • (Morehouse, 1979) • • Peer counseling programs • • Parent-peer groups for troubled youth • • Teen hot lines and crisis intervention • (Tobler, 1986, 1992) 38

  39. Community Based Prevention Interventions 1. Public Awareness and Media Campaigns Results • Media campaigns do affect the community's social norms when combined with other community prevention strategies (Wallach, 1985) • In addition, the public demand for credible information about drugs is increasing and should be satisfied by accurate and scientifically credible messages 39

  40. 1. Public Awareness and Media Campaigns. (Continued) Examples • The Partnership for A Drug-free America (1994) reports producing more than 400 anti-drug ads for their national campaign worth $1.8 billion in media donations. They were recently awarded advertising's most prestigious award for effectiveness— the Grand Effie 40

  41. Community Based Prevention Interventions (Continued) • 2. Youth Development Services. • Implemented in community agencies serving • high-risk youth with the purpose of generally • improving youth development and outcomes. • Many of these selective or indicated prevention • programs are funded with CSAP or local county or • state funds from State Block Grant or state • legislative appropriations. 41

  42. Community Based Prevention Interventions (Continued) • 3. Social Interaction Skills Training Approaches: • • The Botvin’s Life Skills Training Program: • a drug prevention curriculum implemented • in Philadelphia alternative Scholls was found • to increase knowledge about tobacco and • alcohol use, negative attitudes toward • marijuana use, and decrease school • problems, incidents of drunker aggression, • and legal problems. 42

  43. 3. Social Interaction Skills Training Approaches: • (Continued) • • The Smart Moves Program: a drug prevention • curriculum based on the original pear • resistance skills training program was • implemented in public housing projects by • Boys and Girls Clubs. Studies showed • that the presence of crack was lower in • developments served by Clubs with Smart • Moves (Schinke, Orlandi, and Cole 1992 43

  44. Community Based Prevention Interventions (Continued) • 4. Mentoring Programs: • Convey positive values, attitudes and life skills • through a one-to-one relationship with a positive • role model, who may be a culturally matched • community volunteer, college student, parent, • or business professional, or retired person. • Becoming very popular, currently this • approach is not as frequently used (found in • 14% of the first 75 CSAP high-risk youth grants), • except as part of a more comprehensive program 44

  45. Community Based Prevention Interventions (Continued) • 5. Tutoring Programs: • Tutoring programs reduce academic problems by • improving academic achievement. Tutors can be • mentors, college students, grandparents, • professionals, or teachers to tutor students in • school or after school. 45

  46. Community Based Prevention Interventions (Continued) • 6. Rites of Passage Programs: • These programs focus on: • 1. Responsibility training, skills training, • resiliency, community bonding, and spiritual • values 46

  47. 6. Rites of Passage Programs (Continued) Example: The Comprehensive Afro-American Adolescent Services Project operated by the University of Cincinnati included twenty 2-hour rites of passage discussion groups with community action projects and entrepreneurial training 47

  48. Critical Role of Families • The family is the social unit primarily responsible for child rearing functions. • When families fail to fulfill this responsibility, the entire society suffers. • Families are responsible for providing: • Physical necessities • Emotional support • Learning opportunities • Moral guidance • Building self-esteem and resilience 48

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  50. CSAP Family PEPS (1998) Effective Family Intervention Strategies 1. Parent training 2. Family skills training 3. Family in-home support 4. Family therapy 50

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