Experts Divided on Ways to Attack
Increased Teen Drug Use
By GINA KOLATA
NEW YORK TIMES, SEPTEMBER 18, 1996
As drug use among teen-agers begins to rise sharply after years of decline, erperts in drug abuse say there is an opportunity to halt the incipient epidemic in its tracks. But they disagree on the right remedy.
The most popular anti-drug program is DARE, for Drug Abuse Resistance Education, which is used in nearly 75 percent of the nations school systems. But several leading academic experts, supported by the National Institute on Drug Abuse, say that DARE does not work, and that other programs that have been proved effective are not being used. DARE supporters, on the other hand, note the widespread acceptance of their program. And few if any schools have yet adopted the programs tavored by the academic experts.
There is little question that drug abuse among adolescents is increasing dramatically, according to national surveys. For example, Dr Lloyd D. Johnston of the University of Michigan found
that the number of eighth-graders trying any illicit drug. nearly doubled, from 11 percent in 1991 to 21 percent in 1995.
with the release of the latest survey data by Johnston and others, drug abuse has become an issue in the presidential campaigns. Bob Dole is blaming the increase on President Clinton, and Clinton is saying that the trend began in the Bush administntion. But both political parties and drug abuse experts say that something must be
done.
Of drug use levels are still far below what they were at the peak of the last epidemic, and not everyone agrees that the present upturn in drug use signals a new epidemic.
Dr. David Musto, a historian of medicine at Yale Univenity, notes that it is possible that drug use has blipped up and then gone down in the past without turning into an epidemic. But, be said, since drug use has never before been so carefully watched, there is no way of knowing how significant the current drug use pattern is.
But drug use today certainly falls far short of what it was at the peak of the last epidemic, he pointed out. In 1979, for example, more than half of the high school seniors in Johnston's survey, which began in 1975, said they had used an illicit drug in the last 12 months.
But, said Dr. Herbert Kieber, who directs the Center on Addiction and Substance Abuse at Columbia University, "What's scary is not simply that the carve is rising but that it's rising exponentially, it's a steeply rising curve."
Dr. Richard R. Clayton, director of the Center for Prevention Research at the University of Kentucky, also worries that an epidemic is nigh. And, he said, the increasing drug use coincides with a "demographic explosion." He explained: "By 2010 we will have more teenagers than at anytime in history We are at the front end of what could be a disaster for the whole society."
In past epidemics, researchers say. drug use peaked, then dropped of its own accord as peopie who once thought drugs glamorous saw first hand their dark side.
So when a new naive group of adolescents starts experimenting with drugs, there art two courses of action, Johnston said, "You can let nature run its course," he said. and let the teenagers learn through experience or by watching their friends experiment that drug abuse is abhorrent. Or, through education programs and other efforts, perhaps an epidemic can be stopped. Most school systems are taking the second route - trying to stop drug use through education. But a vigorous dispute has developed over what anti-drug programs are effective. Several academic experts say the DARE program has no lasting effect, a view that DARE supporters deny
The DARE program is taught by specially trained police officers who come into the schools and teach children how to resist drugs.
DARE was developed in los Angeles in 1983,under former Los Angeles Police Chief Daryl Gates. along with the Los Angeles Unified School District. Aggressively marketed, DARE was there,
in the right place at the right time," said Clayton, and quickly filled an educational void. It was attractive to school systems because the money for DARE programs came out of a city's
administrative funds, to pay for the police officer, and not out of the school budget. There was no need for teacher training - the police officers did it all.
And parents, school systems and police departments loved it. Dr. Joseph F Donnerneyer of Ohio State University, who recently surveyed parents and teachers in Ohio, said he ws struck by their enthusiastic support for DARE.
Glenn Levant, the president of DARE America, a private, nonprofit corporation in Los Angeles, said New York City has just signed on to the program and this month sent lOO police officers for training.
But academic researchers are more critical. They say DARE has failed the acid test of science. "DARE has beeen evaluated in a reasonably rigorous way by 5 to 10 different researchers in diffferent parts of the country," said Clayton, the author of one of these studies. Researchers asked whether children who had been through DARE were less likely to smoke, drink, or use drugs
than those who had not had the program but "failed to find lasting effects," Clayton said.
Mathea Falco, whose group scrutinized all the published studies of prevention programs, said DARE is "remarkably effective about marketing. But, she said, "the DARE evaluations did not show behavioral change."
Although no one knows for sure why DARE has not caused lasting behavioral changes, Clayton said, it makes some assumptions that are not backed by research. For example, one lesson is devoted to self-esteen. And yet, Clayton said, researchers have found "very little correlation between drug use and self esteem." Another possible problem, said Dr. Gilbert J. Botvin, who directs the Institute for Prevention Research at Cornell University Medical College, is that police officers - authority figures - might not be the right people to teach adolescents that drug use is not cool.
Levant said DARE does work. Although he could not point to a large prospective study of DARE with a control group, the kind of test favored by the academic experts, be said that he knows of about 70 evaluations of DARE and that "all of the evaluations talk about the positive benefits of the program."
Kieber, who is the head of DARE's scientific advisory board, said that DARE evolved and improved over time, but that the available assessments looked only at the old DARE model. For example, he said, DARE originally was offered in 5th and 6th grade. Now it is a pragrarn that goes from kindergarten through 12th grade.
"If there's anything we know, it's that one snot doesn't work," in preventing drug abuse, Dr. Kleber said. But the revised DARE program is too new to have been evaluated in longterm studies. Yet, academic scientists say, there are alternative programs that have been proved to work, but that are virtually unknown, not marketed, and ignored.
For example, Borvin developed and tested a program, called Life Skills Training. It has undergone 10 rigorous evaluations, the largest involving 4,466 seventh-graders who were followed until the end of high school. Behavioral changes initiated by the program lasted the entire six years of the study. The use of cigarettes,
alcohol, and marijuana among teen-agers who had had the program was half that of similar teen-agers who had not had the program.
Botvin said that he was unaware of any wide-spread use of his program, and that he himself was not marketing it.
"Researchers are not good at disseminating findings," he said. "A lot of it is published in scientific journals, that's the currency of our careers. There isn't any incentive to publish in places that practitioners are likely to read," he said.
Kleber said that alternatives to DARE may look good when they are tested by their proponents but that they have not undergone the sort
| CASE STUDIES
Anti-Drug Programs: a Comparison
In a guide to school drug programs called "Making the Grade,"
Drug Strategies
Here is how the most widely used program, Drug Abuse Resistance Education, or DARE, compared with Life Skills Training, a program that several studies have found to be effective. |
|
DARE |
Life Skills Training |
|
Where Used |
In nearly three-quarter of the nation's schools |
In very few school systems |
|
Grade levels |
K-l2 |
6-8 or 7-9 |
|
Change in Drug Use |
Numerous studies have yielded inconsistent findings. |
Smoking, alcohol and marijuana use by 7th
graders reduced between 50-75 percent after the test. By the end of high school, results eroded only slightly. |
|
Comments |
No consistent results. Some studies showed impact on knowledge
and attitudes about
tobacco, alcohol and drugs, and more
favorable attitudes
toward police. |
Significant impact on knowledge and attitudes about tobacco, alcohol and durgs after 3 years; (6 year data on knowledge and attitudes not yet analyzed. |
|