|The Center for Educational Research and Development|
analysis of American school-based drug education, this review critically
examines past perspectives and practices and how they shaped current programs.
Among the key findings emerging from this analysis: Contrary to the popular
belief that drug education began in the 1960s, its roots actually go back
at least 115 years to the advent of compulsory temperance instruction.
Although the particular substances targeted by such approaches have changed,
the underlying approaches and dominant "no-substance-use" injunction has
not. Despite the existence of "informed choice" approaches, throughout
much of this period, evaluation efforts continue to be constrained by the
limited dictates of "no--use" perspectives. A pragmatic alternative to
contemporary "Just Say No" education is offered that strives to minimize
potential harm resulting from the uninformed misuse of licit and illicit
substances. A unique evaluative strategy designed to assess the effectiveness
of this form of "informed choice" or "‘harm reduction" drug education is
Typically, the advent of school-based drug education has been situated amid the 1960s drug crisis. Although formal evaluation of such efforts did commence at this time, drug education itself actua!ly dates much further back to the late 19th century. Even within the substance abuse prevention field, there is little awareness that by 1901, every state and territory had passed legislation mandating some form of "temperance instruction" to be taught in the public schools. Up until now, the profoundly ahistorical nature of the contemporary anti-drug campaign has inspired little effort to consult the collective wisdom garnered from past experience. This article attempts a partial redress of shortsightedness by carefully reviewing our long tradition of school-based drug education. In particular, what instructive lessons can be gleaned from our experience? How have various perspectives and approaches evolved over time? In what ways do they continue to shape our understanding and assessment of prevention efforts today?
From the socio-historical overview provided in this article, several findings are noted:
Presented findings were deemed historically relevant and meaningful only after several comparative steps were undertaken. In particular, contradictory evidence, spurious relations, and rival explanations were all taken into account throughout the analytical process (Kirk and Miller 1986; Miles and Huberman 1994). For illustrative purposes, a number of quotations from historical documents are provided that serve as exemplars for many of the principal themes of this article. Each exemplar meets the criterion of being historically representative of a particular point of view or construct through comparative analysis.
This article begins with a close look at the pivotal early years of the American drug education experience. Particular attention is devoted to the enormously influential, but largely forgotten, "scientific temperance instruction" developed and proselytized by Mary H. Hunt and the Woman’s Christian Temperance Union (WCTU) in the late 1800s. For half a century, this school-based approach effectively dominated the picture and established the precedents for much of what we associate with the field of drug education today.
Of central importance to
this article is the respective role and importance of information provision
among the various educational perspectives that have been influential at
different points along the historical timeline. In light of the growing
rejection of scare tactics efforts, a more realistic informed choice educational
approach is described. In marked contrast to Just Say No directives that
currently dominate drug prevention strategies in the United States, this
Just Say Know approach strives to minimize the potential harm resulting
from the misuse of any drug, regardless of its legal status. The article
concludes with an in-depth look at what an appropriate and defensible evaluative
strategy might look like, one that assesses the effectiveness of such a
harm-reduction approach in achieving its desired objectives. As a result
of largely unquestioned no-use objectives within the field, traditional
evaluations have left unexamined certain critical educational effectiveness
indexes. In general, evaluations of drug education programs provide little
insight as to the quality of information conveyed by such efforts or their
ability to reduce potential misuse of various substances.
The advent of formal school-based drug education dates back to the early 1880s. It was at this time that members of the recently formed WCTU sought to take preventive action against alcohol, tobacco, and other intoxicating "narcotics" by reaching youth before they had begun to use them. The WCTU perceived alcohol and, to a lesser extent, tobacco, opium, and other narcotics to be the primary cause for most of the social ills besetting a rapidly growing and changing America (Austin 1895; Cook 1895).
In 1880, the WCTU established a Department of Scientific Instruction to oversee their temperance education efforts, with Mary H. Hunt at the helm (Hunt 1891; Leiter 1890). Francis Willard, the charismatic leader of’ WCTU during this time, described the passion that drove her fellow crusader, citing Mrs. Hunt’s fervent belief that the success of the temperance reform depends on the universal education of the successive generations of the people as to the real nature and physiological effects of alcoholic beverages. To accomplish this in the United States, she now devoted her life (Willard 1886, 252-53).
For the next quarter of a century up until her death in 1906, Mrs. Hunt would devote extensive time and energy to ensuring the implementation of carefully planned "Scientific Temperance Instruction" in schools across the nation. Properly taught, she believed that students not only would be abstainers for life but also would bring a school-bred bias in favor of prohibition to the ballot box when they were old enough to vote (Erickson 1988; Lender and Martin 1987; McCarthy 1964).
Mrs. Hunt and her colleagues were enormously successful in promoting their agenda on a number of legislative fronts. Bolstered by continuous support from the National Education Association among other groups, the WCTU’s campaign to enact scientific temperance education laws met with rapid acceptance (Mezvinsky 1961). Beginning with Vermont in 1882, within a decade, all but 10 states had compulsory temperance instruction laws. In 1886, the federal government mandated such education in all nationally owned schools, including the military academies (Hunt 1897).
Reflective of similar statutes enacted elsewhere, the California Education Code of 1887 provided the following directions in regard to curriculum:
Instruction must be given in all grades of school and in all classes during the entire school course, in manners and morals, and upon the nature of alcohol and narcotics and their effects upon the human system. (Hunt 1891, 72)
By 1901, every state and territory had passed temperance education laws, resulting in more than 22 million students receiving compulsory instruction on the evils of alcohol, tobacco, and other narcotics during the following school year (Mezvinsky 1961).
Mrs. Hunt and her colleagues also devoted considerable time and effort to conducting teacher training as well as assisting authors of popular school physiology and hygiene texts in making the necessary revisions required to earn coveted WCTU approval (cf. prefaces to Blaisdell 1893; Brown 1887). To be deemed "acceptable," textbooks were required, among other things, to teach that "alcohol was a dangerous and seductive poison," advocate total abstinence, and avoid all references regarding alcohol as a medicine (Leiter 1890; Hunt 1897). If the texts did not receive the approval, certain states and schools were reluctant or even forbidden from using them (Hunt 1891).
Within four years after the textbook revision program had begun in 1888, the number of endorsed textbooks had risen from 0 to 23. Still more were to follow in subsequent years as authors and publishers sought to get approval to join in the lucrative market created by the rapid spread of mandatory temperance instruction laws across the nation (Mezvinsky 1961).
Driven by their fervent commitment to stamping out "Demon Alcohol," tobacco, and other narcotics, the WCTU resorted to what is often derisively referred to as scare tactics drug education. These tactics took various forms: graphic portrayals of the physical harms and moral degradation associated with substance use, the message that all use—no matter the amount or form— was abuse, and the now familiar refrain that the latest scientific findings backed their claims.
The bulk of narcotics education was devoted to graphic depictions of their inherent dangers (Blaisdell 1893; Brown 1887; Nattress 1893; Overton 1897). Even a cursory review of such popular school texts as Dr Blaisdell’s Our Bodies and How We Live (1893), Dr. Brown’s The House I Live In (1887) or Dr. Overton ‘s Applied Physiology (1897) reveals the remarkable attention devoted to depicting the dreadful consequences awaiting youthful experimentation. Reflective of the comprehensive approach in which most of these temperance texts discussed intoxicant dangers, Public School Physiology and Temperance (authorized by the Education Department of Ontario, Canada in 1893) portrays the dangers posed by "alcoholic stimulants and narcotics" toward every bodily organ or function explored in the manual. As the physician/author explains in his preface:
The pupil is, in this way, at every turn confronted with the evil effects of alcohol and tobacco, the dangers accompanying their use, and the tremendous risk of tampering with such powerful agents of destruction. (Nattress 1893. iii)
The WCTU emphasized that students must be informed of the "appalling effects of drinking habits upon the citizenship of the nation, the degradation and crime resulting" (Hunt 1897, 47). Not surprisingly, each of the approved temperance texts devotes considerable detail to describing the alarming effects of alcohol and other intoxicants on the moral centers of the brain. In the B!aisdel! text, it is stated that "Beer is responsible for many crimes. It seems to have a benumbing effect upon the moral nature that prepares the drinker for wicked and cruel deeds and for deliberate crime" (Blaisdell 1893, 89 ).
The WCTU-approved hygience texts took great pains in pointing out inherent risk accompanying the use of alcohol in any form. As one of the "fundamental facts" underlying the "Science of Total Abstinence," Mary Hunt (1902) maintained that "Alcohol, like all other narcotics, has the power when taken frequently, even in small quantities, to create an abnormal desire for more, which may become uncontroIIable and destructive. (P. 2)
Because as this group believed,
"alcohol, like all other narcotics has power... to create an abnormal
desire for more," each of the WCTU approved texts took great pains
in repeatedly pointing out the inherent accompanying the use of alcohol
in any form. Exemplifying this absolute no-use injunction, Blaisdell
(1893) rejected the popular notion that consumption of low alcohol products
such as hard cider, beer, and light wine is somehow safer than that of
hard liquor, for the simple reason that,
"No one is safe who begins to take any liquor containing alcohol. Entire abstinence is the only safeguard against forming the alcoholic appetite...no liquor containing alcohol should ever be used as a flavoring for pies, puddings-sauces, jellies, or any other article of food." (P. 87)
From this standpoint, it is easy to understand the WCTU’s position that "The children of this country must not be sacrificed to false teachings in favor of moderate drinking" (Hunt 1904, 17). In a related fashion, the approved textbooks describe how the use of any narcotic fosters not only an"uncontrollable appetite" for more of the same substance, but often induces one to experiment with other intoxicants as well. These approaches linking any substance use with abuse provided one of the earliest definitions of a "no-substance-use" message.
In this early version of the "stepping stone" theory, cigarettes were often accorded a prominent role (Sullum 1996). After alcohol, which commanded the lion’s share of concern in the various texts, tobacco, particularly in the form of cigarettes, typically occupied second place in terms of the amount of space devoted to its discussion. Cigarettes were also popular subjects in the plethora of songs and poems written for children of all ages to sing or recite. A particularly intriguing verse appearing in a turn of the century manual called Temperance Helps for Primary Teachers, anticipated a phrase that would become popular eight decades into the future:
Say No! to tobacco, that
Say No! to all evils, they only can lead
To shame and to sorrow; Oh, shun them, my boy,
For wisdom’s fair pathway of peace and of joy
(Preese 1901, 55)
Underscoring his assertion that "the use of cigarettes by young people cannot be too severely condemned," Blaisdell quotes an editorial that appeared in the New York Medical Record:
The evils of tobacco are intensified a hundred fold upon the young. Here it is unqualifiably and uniformly injurious. It stunts the growth, poisons the heart, impairs the mental powers, and cripples the individual in every way... Sewer gas is bad enough, but a boy had better learn his Latin over a man-trap than get the habit of smoking cigarettes. (In Blaisdell 1893, 203)
In reading Mrs. Hunt’s monthly School Physiology Journal as well as temperance texts targeted for the advanced grades, one finds copious quotations from prominent sources such as the above to provided credence and authority to sundry claims. Countering the popular public sentiment of the time that beer was considerably less dangerous than the hard liquors as a result of its much lower alcohol content, Blaisdell (1893) provides a detailed refutation for why this simply was not the case. Relying on the best of authorities for support, he explains how "A copious beer-drinker often looks the very picture of health, and boasts of the healthfulness of his favorite beverage; but the testimony of physicians, surgeons, and life-insurance companies is that the beer-drinker, of all others, is most liable to swift and sudden death from some slight causes. The surgeon dreads him for a subject, for his blood is often in such a state that a slight cut may develop into a gangrenous wound that ends quickly in death. A slight cold brings on a fatal pneumonia in spite of the best physician's efforts." (Pp. 89-90)
From early on, scientific temperance instruction and the information conveyed in the WCTU-approved textbooks were the subject of severe criticism. In fact, opposition came from many fronts, ranging from presidents of several prominent universities to the well-respected "Committee of Fifty to Investigate the Liquor Problem," a group of scholars organized to study the alcohol issue in the 1890s (Bowditch and Hodge 1903). Articles and editorials also appeared in the popular press, taking both the instruction and the endorsed textbooks repeatedly to task for exaggeration and attempting to bring about moral reform under the guise of science (Mezvinsky 1961; "Editorial" 1887). Although most of these critics acknowledged the considerable costs caused by drunkenness and alcoholism to both individuals and society, they generally pointed to the responsible moderation practiced by the majority of American drinkers as posing little or no harm.
It was the Physiological Sub-Committee of the Committee of Fifty that waged the most concerted attack on the activities of Mary Hunt and her associates at the WCTU. Based on their extensive review of "scientific temperance instruction" as it existed at the turn of the century, the subcommittee concluded that it was "neither scientific, nor temperate, nor instructive" (Bowditch and Hodge 1903, 44).
In particular, the subcommittee argued that the absolutist nature of instruction had failed "to observe the distinction between the diametrically opposite conceptions of use and abuse.... It should not be taught that the drinking of one or two glass of beer or wine by a grown-up person is very dangerous, for it is not true. (Bowditch and Hodge 1903, 44, xxii)
Outraged by these allegations, Mary Hunt organized a full-scale counterattack, even going so far as obtaining a resolution passed by the U.S. Senate in support of her approach. More than 100,000 copies of her Reply to the Physiological Sub-Committee of the Committee of Fifty were published, accusing them of bias and misrepresentation of facts (Hunt 1904).
Both sides repeatedly invoked the latest findings of "science" to their respective positions on school-based drug education. This never-ending battle for ownership of the "truth" is equally commonplace in contemporary debates between roughly similar oppositional camps today. In regard to information provision about illicit drugs, one finds accusations of scare tactics coming from one direction and "advocating use" issuing from the other.
After excoriating scientific temperance instruction on many levels, the Physiological Sub-Committee lamented how entrenched in the educational system and the minds of legislators this total abstinence approach had become. As a consequence, they conceded that "the removal of this educational excrescence will be no easy task... a prolonged struggle will be necessary to free our public school system from the incubus which rests upon it. (Bowditch and Hodge 1903, 45)
History indeed proved their assessment to be correct, as scientific temperance instruction would continue to thrive for another three decades. Always alert to signs of its diffusion overseas, Mary Hunt enthusiastically noted the recent enactment of laws in France that mandated anti-alcohol instruction for students at all grade levels (Hunt 1905).
In actuality, compulsory education on alcohol in France, which had begun in 1895 in response to the rapid rise in distilled spirits consumption, corresponded much more with the sentiments of the Committee of Fifty and other groups opposed to the WCTU’s scientific temperance instruction. Despite similarities in the methods used to convey their intended messages, French students were being provided with a very different injunction than their American counterparts. They were only encouraged to abstain from the use of distilled liquors. When it came to fermented beverages such as wine, cider, and beer, students were instructed to "use but don’t abuse" and strive to drink in moderation (Gershman 1987). As such, the French system of temperance instruction appears to represent the first attempt by a government to enact compulsory "responsible use" or harm-reduction drug education.
Interestingly enough, the American temperance movement had originally organized around a similar injunction against distilled spirits rather than all alcoholic beverages in its formative years earlier in the 19th Century. However, sentiment had overwhelmingly moved against the use of all alcoholic beverages by the time the WCTU and scientific temperance instruction came on the scene. (Lender and Martin 1987; Levine 1978; Rorabaugh 1979)
In the eyes of many, the enactment of national Prohibition signaled that the WCTU’s efforts had passed the ultimate evaluative test it had set for itself. As Mary Hunt had confidently predicted back in 1906, "The child is born who will see the last legalized saloon, brewery and distillery of alcoholic drinks go from the United States, if the people now enforce the temperance education laws they have enacted." (Hunt 1906, 67)
In the WCTU’s eyes, more
than 35 years of educating the "abstainers of tomorrow" had led to this
reward. When national Prdhibition went into effect in the 1920s,
however, the WC’TU responded by pursuing their temperence education
efforts with even greater fervor. Aided by the National Education
Association, they sought to guard against any complacency that threatened
their hard-fought success (McCarthy 1964; Milgram 1976;"Teaching Topics"
1931; Ormond 1929).
The repeal of the "Noble Experiment" in the early 1930s signaled the beginning of the end for scientific temperance instruction. Despite the efforts of its advocates, it soon began to recede from the public consciousness and school curriculum. States and local school districts where "dry" remained strong continued to instruct students about the evils of alcohol and the benefits of abstinence. The WCTU, NEA, American Medical Association, and other groups helped to ensure that acceptable textbooks were readily available to assist them (cf. Palmer 1931).
Amid the societal ambivalence toward alcohol and tobacco observed during the middle years of this century, it was not unusual to find many scbools providing little or no instruction at all about these substances (Lender and Martin 1987; Milgram 1976).
Across the nation, however, the growing acceptance of the WCTU's public enernies #l and #2 among the adult population led to the increasing abandonment of total abstinence instruction regarding alcohol and tobacco in schools. Increasingly, some schools began providing a form of "responsible decision-making" education about alcohol, described by not solely focusing on no-use and scare-tactic oriented programs, while at the same time providing more objective information than in the past. This was typically coupled with an injunction for students to await legal drinking age before putting their newly gained wisdom to the test (Milgram 1976). As the opening paragraphs of a popular 1952 pamphlet admonishes the young reader, "Wait until you are grown up!" is the emphatic advice that science and society offer to all young people when they consider beginning to smoke or to drink (Rathbone 1952, 1).
Interestingly enough, the same author, a professor of health and physical education at Columbia University, concludes her remarkably tempered discussion of both the pros and cons of alcohol use by asking " If you are a boy or girl of school age, should you begin drinking? If you have already begun, should you continue? This is a choice you must make for yourself. It is hoped that the information and ideas presented above have helped you to arrive at an intelligent decision." (Rathbone 1952, 39)
During the next several decades up through the present day, school-based alcohol education has undergone a number of shifts in dominance between these three competing perspectives of Just Say No, Just Say Know or Just Say Nothing (Langton 1991; Milgram 1976).
In regard to the WCTU’s other targeted "narcotics" (i.e., opiates and cocaine), a Just Say Nothing perspective eventually supplanted Just Say No efforts for a time in the decades following their prohibition. Unlike alcohol, an informed choice approach was rarely, if ever, broached for these substances until the 1970s. This divergence in accepted approaches for different intoxicants is explained by Rathbone, who observes that "with tobacco, the main problem is not to go beyond moderation...With regard to alcohol, a person may also indulge moderately with no very serious effect... With narcotics, the situation is different. The cumulative effects are extremely rapid, and, within a matter of days after taking the first marihuana smoke or "shot" of pain-killing drug, one may be an addict. (Rathbone 1952, 3-4)
At least initially, the increasing demonization of heroin and cocaine in the 1920s and marijuana in the 1930s was accompanied by efforts to alert the populace to these menaces threatening the nation. Particularly prominent among these were the founding of the International Narcotic Education Association by war hero, former Alabama congressman, and ardent prohibitionist, Richard P Hobson. Among its other activities, Hobson’s organization staged a number of international Narcotic Education Weeks for both school children and the general public from the mid-1920s through the early 1930s (Morgan 1981).
Although initially popular, enthusiasm and monetary support for such efforts rapidly declined, largely as a consequence of active opposition of prominent government offlcials and other influential parties. In general, these individuals viewed control of the "narcotics problem" as best left up to the legal profession, who appeared to have the problem well in hand. Many critics of Hobson and others who sought to alert children to the dangers posed by narcotics viewed such efforts as merely advertising the hitherto attractions of these "forbidden fruits" to impressionable young minds (Anslinger and Tompkins 1953; Morgan 1981; National Commission on Marihuana and Drug Abuse 1973). In one prominent book written just before the repeal of Prohibition, the author summed up the dilemma facing those would wish to provide school-based "narcotic education": The proposed introduction of narcotic education into the public schools, like sex education, raises some questions which it is not easy to answer. One of the most serious of these is the reputed danger of stimulating the curiousity and adventure interest of the child through emphasizing either negatively or positively the unusual effects of drugs upon both mind and body...Whether or not such instruction would actually have these effects has never been ascertained by truly scientific investigations. Theoretically, however, the danger deserves serious consideration. It leads us to suggest that the more indirect methods of education may serve the purposes intended. (Payne 193, 2l9-20)
As evidenced in the above quotation, the 50-year legacy of compulsory school-based scientific temperance instruction was already becoming forgoten history among the new drug warriors emerging in the post-prohibition era. Despite the WCTU’s best efforts, alcohol and tobacco were not considered part of the "narcotic problem," let alone the primary representatives of it.
Foremost among those arguing against school-based drug education was Harry Anslinger, who was to play a dominant role in all matters of drug policy and control during his long-standing reign as commissioner of the Federal Bureau of Narcotics (now Drug Enforcement Administration) from 1930 through 1962. Through his efforts, education of the populace remained largely confined to well-orchestrated media blitzes for a number of decades (Beck 1988; Zinberg and Robertson 1972).
A particularly notorious example of this was the time Anslinger began to issue frequent press releases in 1935 that documented the horrible crimes committed by marijuana-intoxicated youth and/or addicts. With headlines announcing "The New Narcotic Menace" and the "Crusade Against Marijuana," articles that contained remarkably similar accounts appeared in major newspapers and national magazines. This was hardly surprising, in that mainstream media relied almost solely on the Federal Bureau of Narcotics (FBN) for their facts, figures, and requisite horror stories (Becker 1963). The success of Anslinger’s efforts in this particular instance was found in the smooth passage of the Marijuana Tax Act of 1937 by Congress (Dickson 1968; Morgan 1981).
Anslinger’s media campaigns
were primarily focused on influencing public opinion to garner necessary
support for his own personal bureaucratic objectives. Throughout his lengthy
tenure, he actively discouraged most efforts at educating youth about illicit
drugs. Regardless of the "fear quotient" conveyed by any particular approach,
Anslinger contended that intensive or informational forms of school-based
drug education merely served to arouse unnecessary curiosity among impressionable
youth (Anslinger and Tompkins 1953; Finlator 1973). Nevertheless,
as Wallack (1980) observes: The efforts of the FBN in the 1930’s, in what
could probably roughly be characterized as the first federally sponsored
drug education campaign, established a trend that was to be followed through
the 1960’s—the use of sensationalism and scare tactics and the avoidance,
repression, or minimization of scientific information. (P 57)
In 1963, an "Advisory Commission on Narcotic and Drug Abuse" appointed by President Kennedy recommended a fundamental shift in direction regarding drug abuse prevention. In advocating much more intensive school-based drug education, they challenged the long-dominant view held by many, including Anslinger, who had only recently stepped down and passed away the previous year from his position as head of the Federal Bureau of Narcotics: "There is a vigorous school of thought which opposes educating teenagers on the dangers of drug abuse. The argument runs that education on the dangers of drug abuse will only lead teenagers to experimentation and ultimately to addiction. The Commission rejects this view...The Commission feels that the real question is not whether the teenager should be educated, but who should educate him? Should it be the street corner addict, or should it be the schools, churches, and the community organizations?" (The President’s Advisory Commission on Narcotic and Drug Abuse 1963, 18)
Perhaps somehow anticipating the unprecedented explosion in youthful drug use that would soon sweep the nation, the committee recommended more diligent provision of information-based "fear-arousal" drug education programs for student populations: "The teenager should be made conscious of the full range of harmful effects, physical and psychological, that narcotics and dangerous drugs can produce. He should be made aware that, although the use of a drug may be a temporary means of escape from the world about him, in the long run these drugs will destroy him and all he aspires to. (The President’s Advisory Commission on Narcotic and Drug Abuse 1963, 17-l8)
In response to the mounting youthful drug crisis confronting the country, President Nixon followed up his declaration of a "War on Drugs" with a mandate to help ensure that all students from kindergarten through high school would receive the education considered vital to stemming the threatening epidemic.
Combined with already existing state and local funding, this masive influx of federal support only added to the confusing array of haphazardly conceived prevention efforts seeking to convince youths to stay away drugs such as LSD and marijuana embraced by the counterculture. The vast majority of drug education programs were not well coordinated or conceived (National Commission on Marihuana and Drug Abuse 1973).
Added to this muddle was the excessive reliance on fear arousal or scare tactics approaches characteristic of the majority of school-based prevention efforts. In one of the first comprehensive explorations of student drug use, Blum and Associates (1969) lamented the "increasing polarity" and distrust experienced by students in response to the punitive and moralistic paternalism shown them. As a consequence, "Dishonesty in this area weakens credibility in all areas; hypocrisy generates wide distrust; reliance on external control and authoritative pronouncement weakens the development of internal controls and learning to make informed decisions...Educators are in the uncomfortable position of knowing that most prevalent methods of drug education are ineffective and in many cases contribute to the very problem they seek to control." (Blum et al. 1969, 356-57)
Surveying the chaotic prevention field in existence at the time of their review in the early 1970s, the congressionally appointed National Commission on Marihuana and Drug Abuse arrived at essentially similar conclusions, observing that "no drug education programs in this country, or elsewhere, has proven sufficiently successful to warrant our recommending it." (National Commission on Marihuana and Drug Abuse 1973, 357)
Concerned about the profound
disorganization of the field and the troubling implications accompanying
overreliance on scare tactics approaches, the commission further concluded
that "the avalanche of drug education in recent years has been counterproductive"
and called for a national moratorium on drug education until better strategies
for implementation and evaluation could take place (National Commission
on Marihuana and Drug Abuse 1973).
Buoyed by mounting frustration with traditional drug education efforts, a number of promising developments began to emerge in the 1970s. A number of these were noted in a series of progress reviews in the prevention field put out by the federal government (Boldt, Reilly, and Haberman 1973; DuPont, Goldstein, and O’Donnell 1979; National Institute on Drug Abuse 1975; Nellis 1972). These reviews, written and published by the federal government’s National Institute on Drug Abuse (NIDA) and its predecessor the National Institute of Mental Health (NIMH) indicate a shift toward a pragmatic stance befitting the realities of the burgeoning drug scene. The goal of this new stance—misuse or abuse prevention—was fundamentally different from the goal of the past stance—total abstinence (Edwards 1973; Feinglass 1972; McCune 1973; Richards 1972; Swisher 1979). This goal of minimizing or preventing problematic consequences associated with substance use assumes a harm-reduction perspective rather than an abstinence-based perspective. At the time, these programs were not labeled harm-reduction programs; that term was almost unknown in the drug abuse field until the advent of the AIDS epidemic in the 1980s.
In rejecting abstinence-only approaches, Australian researcher Marion Watson describes the pragmatism underlying such efforts: "Harm reduction in relation to drug use is the philosophical and practical development of strategies so that the outcomes of drug use are as safe as is situationally possible. It involves the provision of actual information, resources, education, skills and the development of attitude change, in order that the consequences of drug use for the users, the community and the culture have minimal negative impact." (Watson 1991, 14)
Exemplifying the profound differences in program philosophy and objectives between past and emerging models, Swisher (1979) listed some key assumptions that were increasingly guiding drug education during the latter half of the 1970s. Among these guiding principles, two of particular significance were the following:
The closing chapter
of the Handbook on Drug Abuse reflects a significant shift in governmental
policy that was taking place toward the end of the 1970s. It is here
that lead editor and former NIDA director, Robert Dupont (1979),
provides his vision of a more tolerant, humane "Future of Drug Prevention."
In this essay, he declares:" We as a Nation have come out of a period which
extended from the 1920s into the mid-1960s...We have gone through a decade
of profound reaction to this ill-informed early period. Many
Americans, especially the most sophisticated, have concluded that
we must turn drug abuse policy issues over to the scientist to avoid ever
again repeating the errors of earlier decades." (P. 451)
After making the bold pronouncement quoted above, DuPont enthusiastically hopped on board the "Parent Power" bandwagon the following year. The parent power movement, which rapidly gained strength and influenced government policy during the Reagan/Bush era, was a group of activist parents who began organizing in Georgia in the late 1970s over concern about their children’s use of drugs. Writing in early 1980, DuPont explained the unexpectedly rapid reascendance of a form of drug education that he had previously dismissed as the "errors of earlier decades": A few years ago parent power’s simple message—"no"—on drug use by youths contrasted with the prevailing message of the experts—"Your body is your own; it is your decision to use or not to use any drug." However, the experts have seemed relieved to have parents tell them the bottom line on drug abuse prevention and have generally set about finding, within their own areas of expertise, constructive ways to join the parent power movement. (P. 2)
The parents’ power movement rapidly transformed prevention policy and practice across the country; they effectively collaborated with government and professionals in the substance abuse field in carrying out the necessary revisions of curriculums and materials to reflect the strict adherence to no-use messages and "zero tolerance" in our latest ‘War on Drugs" (Baum 1996; Manatt 1979; U.S. Department of Education 1988; White House Conference for a Drug Free America 1988).
Since the beginning of the parent power movement, the steady growth of prevention funding have helped to ensure increasing sophistication and wider implementation of prevention efforts. In popular school-based drug education programs, students are often given information by police officers and former drug addicts, told of the dangers of using drugs through techniques often intended to arouse their fears, given rewards such as T-shirts and bumper stickers for complying with the no-use message, and taught how to refuse the use of substances through decision-making programs (Brown, D'Emidio-Caston, and Pollard 1997).
However, the rigidity of no-use dictates of programs in the 1980s and 1990s practically ensures an incomplete and biased presentation of the current knowledge regarding both legal and illegal drugs. In the process, the "decision making skills" approach that came into fruition back in the 1970s has been essentially co-opted by contemporary efforts that no longer permit students to make responsible, informed choices regarding their drug use. Instead, the modern version consists of refusal skills training in which any "decisions" to be made have been firmly predetermined in advance for the target population (Baum 1996; Brown, D’Emidio-Caston, and Pollard 1997; Duncan 1992; Rosenbaum 1996).
In addition to the school-based programs, a massive media campaign led by the Partnership for a Drug-Free America is attempted to prevent kids from using drugs though television, magazine, and newspaper ads. These which often feature scare tactics, do not tackle the issues of alcohol, tobacco or pharmaceutical. This notable absence may be partially explained by the fact that Anheuser-Busch, Philip Morris, RJR Reynolds, Hoffman-LaRoche, and SmithKline Beecham are some of the companies who have generously bankrolled the slick and often controversial Partnership ads attacking non-sanctioned drugs not manufactured by them (Baum 1996; Blow 1991; Cotts 1992; Mcshane 1992; Miller 1996; Reeves and Cambell 1994).
The continued rise in youthful drug use during the 1990s has done much to temper the considerable optimism among Just Say No approaches, which had accumulated as a result of steady declines in use observed during the previous decade. Johnston and colleagues, who conduct the annual federally funded Monitoring the Future survey of students across the country, account for the contemporary resurgence by noting that: we may be seeing the beginning of a turnaround in the drug abuse situation more generally among our youngest cohorts—perhaps because they have not had the same opportunities for vicarious learning from the adverse drug experiences of people around them and people they learn about through media. Clearly, there is a danger that, as the drug epidemic has subsided considerably, newer cohorts have far less opportunity to learn through informal means about the dangers of drugs. This may mean that the nation must redouble its efforts to be sure that they learn these lessons through more formal means- from schools, parents, and focused messages in the media, for example-and that this more formalized prevention effort become institutionalized so that it will endure for the long term. (Johnston, O’Malley, and Bachman 1994, 24)
Although the call for more comprehensive and consistent drug in American schools and society is appealing, what is needed is something qualitatively different from the status quo. With few exceptions, comprehensive evaluations and metaevaluations of current prevention efforts have generally revealed nonexistent or negligible effects in affecting illicit drug use among target populations (Bangert-Drowns 1988; U.S. General Accounting Office 1991; Gerstein and Green 1993; Gorman 1995; Hansen 1992; Klitzner 1987; Moskowitz 1989; Schaps et al. 1981; Tobler 1986).
As in the past, the moral certainties driving the current drug war continue to take precedence over objective niceties, ensuring that truth is once again a frequent casualty in drug "education" campaigns. The disconcerting observation made a quarter of a century ago is all too apt in describing our current state of affairs: ‘We have become so convinced of the nobility of our objectives that we easily rationalize our deceit and dishonesty" (Fulton 1972, 37).
If this is indeed the case,
then simply "redoubling" what we currently call "drug education" as a means
of correcting youthful ignorance about the dangers posed by nonsanctioned
drugs is more likely to prove counterproductive, as suggested by the 1960s
experience. We should remain deeply concerned about the quality and accuracy
of information conveyed within the current Just Say No climate. Unfortunately,
for far too long, drug education has been "little more than a frantic search
for the best method for persuading youths to abstain" (Chng 1981, 14).
So long as this state of affairs continues, one can anticipate continued
overreliance on what youthful target audiences dismiss as scare tactics
propaganda. Ironically, the resulting "credibility gap" aptly illustrates
how such efforts can indeed "send the wrong message," ultimately fostering
widespread distrust and discounting of all messages—no matter how credible.
The need for evaluation of school-based drug education was first voiced by the Physiological Subcomnittee of the Committee of Fifty back at the turn of the century (Bowditch and Hodge 1903, 43). In answer to their query as to whether the WCTU possessed "any data from any state showing decrease in consumption of alcoholic drinks since the passage of temperance laws," Mary Hunt responded by citing an increase in longevity among the American population observed during this time. She also went on to note that the gain in per capita use of alcoholic liquors throughout the country during the past 11 years was only a third as great as the previous 11-year period when scientific temperance instruction was being first introduced. Finally, she cited the widespread recognition by other countries that the increasingly abstinent American workplace was largely responsible for the phenomenal success of the nation. In concluding her "evaluation" Hunt bluntly states "If the Sub-Committee deny that this education has been a factor in securing the above results, here stand the facts" (Hunt 1904, 9).
In reality, little formal evaluation of drug education was done until the 1970s (Boldt, Reilly, and Haberman 1973; de Lone 1972; Richards I972). Despite calls for formal evaluations voiced by government and other entities since the advent of the youthful drug explosion in the 1960s, funding and leadership in promoting such efforts was lacking. In fact, the first systematic guidelines for evaluating drug education programs did not appear until 1973 and were sponsored by the privately supported Drug Abuse Council (Abrams, Garfield,and Swisher 1973).
Ealuations of cognitive or informational drug education programs typically revealed significant gains in knowledge among program participants. However, such efforts were almost invariably found to be ineffective in either reducing illicit drug use or generating "better" attitudes toward unsanctioned substances (Goodstadt 1980; Schaps et al. 1981).
In a few notable instances, evafuative studies even revealed rnodest increases in experimentation following the 1970s drug education programs. In one of the first in-depth evaluations of a particular harm reduction program, Stuart unexpectedly found the only changes between the experimental and control groups to be slightly significant increases in the use of LSD and marijuana among those hearing the informational presentation. Stuart attributed these modest effects to curiosity and /or allayed fears resulting from the demythologizing of these two particularly demonized substances (Stuart 1974).
Such evaluation findings led some in the prevention field to call into question the belief that information provision is a necessary component of substance abuse prevention. Recalling similar concerns voiced by Anslinger and other authorities in the past, information-based approaches have been repeatedly taken to task and dismissed for arousing curiosity among youths and introducing them to new and stronger ways of getting high (Stickgold and Brovar 1978; Stuart 1974).
Despite the continued failure of current Just Say No programs, evaluators and other researchers in the substance abuse field remain highly susceptible to governmental pressure to avoid evaluating current policies and practices under the guise of threatening the "united front" deemed necessary to"win the war" (Brown and Horowitz 1993; Zinberg 1984).
The above concerns notwithstanding, support for the abstinence-only edict has not been without criticism from within the government itself, as evidenced by the sharp critique issued by the General Accounting Office (GAO) in its evaluation of mandated prevention objectives during the Reagan-Bush Administrations (U.S. General Accounting Office 1991). Calling into question the rigid adherence to abstinence-only approaches and other dogmatic dictates, the GAO report focused on what it believed to be the urgent need for research evaluating the efficacy of what were argued to be more realistic "Responsible use approaches (which)... may try to reduce the riskiest forms of use (such as drinking and driving) or encourage current substance users to cut down." (U.S. General Accounting Office 1991).
The analysis of the GAO,
and America’s history of drug prevention education, call for the formulation
and evaluation of new harm-reduction strategies. In this regard,
much can be learned from careful study of harm-reduction efforts carried
out in the United States during the I 970s as well as similar approaches
currently gaining in popularity overseas (Advisory Council on the Misuse
of Drugs 1993; Bagnall and Plant 1987; Beck 1980; CIements, Cohen, and
Kay 1990; Cohen 1989, 1993; DeHaes 1987; Duncan et al. 1994; Miller
A number of harm-reduction drug education approaches have emerged as worthy candidates to choose from during the past three decades. Because drug issues often involve highly emotional individual feelings, group interactions, and charged social contexts, researchers have argued that prevention efforts must take effective domains and environmental conditions into account (Dembo 1979). Although the focus of this article is on cognitive drug education, it is important to note that attempts are underway to create multidimensional programs and accompanying evaluation models which use what we know about the inextricable links between feeling, thinking, and learning (Horowitz and Brown 1996; Skager and Brown forthcoming).
One cognitive harm-reduction program that will be the focus for the remainder of this analysis is the Drug Consumer Safety Education program developed by Mark Miller and staff at the University of Oregon Drug Information Center in the 1970s (Miller 1975). This approach provides age-appropriate instruction in conveying thorough drug knowledge and discrimination skills. In so doing, this program emphasizes the importance of each individual becoming an informed, analytic consumer of all substances, ranging from prescription, over-the-counter, industrial chemicals and herbals, as well as the usual legal and illegal drugs specifically targeted by traditional drug education (Beck 1980; Burbank and Miller 1995; Miller 1975; Miller and Burbank 1997). In addition to providing information effects of various substances and the ways to prevent harm if with substances, the program provided information regarding treatment to those in need. With a well-documented history revealing that drug education has "failed" if its primary or only objective is to reduce illicit drug use, it becomes important to consider whether more modest and realistic goals are attainable and desirable. In contrast to traditional abstinence-oriented approaches, the Drug Consumer Safety program strives to reduce potential harm resulting from the unintentional misuse of various substances. In this conception, the term misuse refers to instances in which individuals may be susceptible to potential harm as a result of inadequate knowledge about the substance(s) they are using, whether licit or illicit. From this framework, drug misuse can be seen as a major problem affecting all parts of society, not just youth. The vast majority of people go through life with little understanding of the and powerful and complex substances they use for a variety of recreationaland palliative purposes (Beck 1980; Miller 1975).
Evaluation of harm-reduction education approaches such as that described above calls for innovative research design and instrumentation. Accomplishing such an endeavor requires abandoning the unrealistic assumptions and rigid precepts that have effectively constrained acceptable prevention research and practice since the early 1980s (Brown and Horowitz 1993; Clements, Cohen, and Kay 1990; Dorn and Murji 1992; Duncan1992; Goodstadt 1989; 1989; Marlatt and Tapert 1993; Mooree and Saunders 1991; Rosenbaum 1996; Worden 1979). The development of a proper evaluation technique is necessary for convincingly devising a means to assess the overall efficacy of such programs in reducing potential (or real) drug misuse. This is understandably a more modest but, ultimately, more realistic goal for short-term school-based drug education than the traditional objective of reducing use (Beck 1980, 1986).
An essential first task involved in such an undertaking would be the development of an instrument that strives to assess potential drug misuse among target populations. As such, the instrument would necessarily include both a survey gauging frequency of use for various substances and an extensive drug knowledge questionnaire. I am not aware of any drug knowledge questionnaires employed for evaluative purposes that have been specifically designed to assess potential misuse. To remedy this, the knowledge questions utilized in this questionnaire (to be answered both pre and postintervention) would be carefully chosen for their ability to gauge potentially serious drug misuse problems. That is, if a user (or prospective user) of a particular drug does not know the correct answers and/or believes incorrect answers to questions concerning that substance, this ignorance could arguably prove to be harmful at some point in time. Special attention would be focused on heavy users of particular drugs, since faulty or incomplete knowledge among these groups would predictably result in a greater incidence of drug misuse than for less frequent users or abstainers.
Given the considerable differences of opinion that exist regarding the "known" dangers or risks associated with use of various drugs (particularly illicit ones), considerable attention must be given to how best to design a knowledge questionnaire of defensible validity. To achieve this goal, a team of carefully chosen substance abuse experts might be consulted in determining the most crucial (as well as acceptable) questions to ask about each drug.
What such a drug knowledge
questionnaire would hope to gauge is illustrated by the following questions
pertaining to alcohol use. For instance, do frequent users of alcohol actually
know how many beers or drinks it takes within a set period of time to become
legally intoxicated? Are they aware of the myths and realities concerning
ways of reducing alcohol intoxication? Are users cognizant of the many
potentially hazardous interactions that exist between alcohol and such
common over-the-counter or prescription remedies as tranquilizers, antihistamines,
aspirin, or acetaminophen? Whether out of ignorance or under the influence
of prevailing misconceptions, the potential for misuse and actual harm
is heightened among alcohol users (or prospective users) unable to correctly
answer one or more of the above questions. Similarly, the level of risk
is even further accentuated among frequent or binge drinkers in the sample
(Beck 1980, 1986).
A careful review of the American drug education experience during the past century allows a better appreciation of the inherently political nature and troubling implications of the Just Say No perspective that has predominated throughout this time. Perhaps most significantly, we can see how the dangers of moralistic absolutism have all too often substituted indoctrination for real education in attempting to frighten youth away from using certain condemned drugs. As revealed in this review, although the particular substances targeted by such efforts have changed over time, the approaches employed to dissuade their use have remained remarkably the same.
As described throughout much of this article, two fundamentally opposed perspectives toward school-based drug education have vied for legitimacy during the past cerntury. Although each stance has been characterized by any number of names, they can essentially be juxtaposed as Just Say No versus Just Say Know. The first of these conveys a strict no-use or abstinence message regarding targeted substances or activities. In contrast, the second perspective focuses on fostering informed choices or decision making within a harm- or risk-reduction framework.
Although strict abstinence or no-use approaches have been thepredominnant form of school-based drug education during the past century, informed choice perspectives have also been apparent, particularly in the form of alcohol education since the repeal of prohibition, the growing acceptance of such approaches in America during a brief period in the 1970s, and past and present examples overseas.
Almost from the beginning, both perspecives have invoked science to justify their respective positions on school-based drug education. This was first shown in the justifiable attack on the WCTU’s "scientific temperence instruction" by a large number of respected scientists and academics in the waning years of the 19th century.
The historical Iessons revealed in the 100 years of drug education since that time further implicate the shortcomings of absolutist stances, which brought no alternative or ambiguous views, regardless of scientific merit, in attempting an unambiguous no-use message. As a consequence of knowing, a prioro, the truth about certain "bad drugs," school-based prevention easily falls prey to reliance on select and suspect scientific "facts" for the purposes of indoctrination more than true education. In addition, whereas I00 years ago, the WCTU waged a moral war against the inherent evils posed by all intoxicants, well-entrenched interests have managed to muddy up contemporary waters with mixed messages in diligently waging a selective and confusing "war on some drugs."
Among the troubling connotations of current drug education, the strict abstinence dictates mandated by the government have resulted in prevention campaigns all too frequently relying on deservedly maligned scare tactics to convey a strong no-use message. Despite ever-increasing expendatures devoted to drug abuse prevention in America, a resurgence in youthful substance use has continued relatively unabated throughout the 1990s. Once again, American youth appear to be serving ample notice of a growing rejection of what many dismiss as Just Say No propaganda. Perhaps the most alarming casualty of this approach has been the substantial loss in credibility inevitably fostered by such "drug education." Particularly among target populations possessing considerable drug experience, reliance on disinformation should be regarded as contraindicated.
Unfortunately, the objectives of prevention efforts are all too frequentIy stated in a general fashion that places too much faith or hope in the ability of drug education to reduce unsanctioned substance use. In doing so, the powerful influences of family, peers, and the mass media, among other societal pressures, are virtually ignored or disregarded. A more balanced perspective regarding the potential value of drug education would reduce expectations to better acknowledge the realities of competing forces and the importance of time and normal development. Drug education programs should focus on preventing problems associated with drug use. For some students, that may mean the ability to develop decision-making skills that lead them to avoid alcohol, tobacco, and illegal drugs completely; for other students, that might mean being more careful than they previously were when they are experimenting with substances; for others, that might mean making the decision to get help for a substance abuse problem. A harm-reduction program does not advocate substance use, but it does advocate the health of youth.
Drug education should focus on the learning of decision-making skills in hopes of generating more responsible, informed consumers whose choice to use particular substances would pose less problematic potential than if Ihey were instructed to simply Just Say No or told nothing at all. To successfully accomplish this task, school-based programs must provide accurate, age-appropriate infomation concerning all drugs, not just the illicit ones. Therefore, it is essential to adopt what are arguably more modest, but realistic, goals that resonate with the objectives of harm-reduction perspectives.
This article has argued for a deeper understanding of how historical development in drug education shapes current evaluation models. An important albeit often ignored consideration in drug education research is as the U.S. General Accounting Office (1991) noted: the limited effectiveness of program evaluation itself. Due to the various social historical movements described in this article, drug education evaluation research has primarily determined program success based on limited aspects of Just Say No, rather than Just Say Know types of drug education. As a consequence, evaluation researchers may have deemed affective programs failures when they were not, while at the same time capturing incomplete or irrelevant information from Just Say No programs and deeming these findings as indexes of success. Historical evidence suggests that it is time to develop evaluation methodologies reflecting promising alternatives such as harm reduction. Such methods would capture salient information in cognitive, affective, and contextual domains. During this critical period in drug education, historical patterns provide us with the opportunity to expand our programmatic and evaluation horizons from Just Say No to a more informed Just Say Know. It is hoped that this historical evidence will be used to create positive programs and, in the process, break the cycle of condemnation toward repetition of past mistakes.
1. For a copy of an 1882 temperence education map of the United States and territories, contact Jerome Beck at the Center for Educational Research and Development.
2. AUTHORS NOTE: The
author wishes to acknowledge the many constructive comments provided by
Marianne Apostolides and three reviewers of earlier drafts of this article.
In addition, thanks go to Mr. and Mrs. Beatty of the Frances E. Willard
Memorial Library in Evanston, Illinois for their gracious hospitality in
assisting the author through the voluminous Woman’s Christian Temperance
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