Sunday, May 9, 2010

The D.A.R.E. Program for Adolescents: Ineffective Long-Term Intervention – Jackie Liu

Drug use, as well as abuse, among adolescents and young adults remains a major public health issue in the United States. Over 20% of 8th graders and 9th graders and over 30% of 10th-12th graders have reportedly used drugs at least once in their lifetime. In 2006, an estimated 38,396 deaths were caused by substance abuse in the U.S. and has increased from previous years (5). Although there has been slight declines in use of certain drugs such as alcohol, hallucinogens, LSD, and even marijuana, prevalence rates for use of prescription drugs has increased because they are deemed the safer drugs by adolescents (9). The fact that a portion of adolescents continue to or are starting to use drugs at as young as 12 years of age suggests that current interventions may not be sufficient.
Drug abuse can lead to deaths from motor vehicle accidents, suicidal actions, intoxication, etc. It can cause negative behavioral changes, mental retardation, psychological disorders, and further permanent distresses that may impair the quality of life. The younger a person starts using drugs, the likelier it is that he/she will have developmental problems (9). Various studies indicate that adolescents who use and abuse drugs are more likely to exhibit deviant attitudes, drop out of school, and become delinquent. Because this is an issue that can have detrimental effects on the functional abilities of the young generations who will be the future, it is crucial that effective public health interventions be in place.
Although there have been numerous campaigns targeted towards the prevention of drug use and abuse among individuals of all ages, statistics as aforementioned over the years indicate only a slight decline in prevalence rates among high school students. Despite the law enforcements in prohibiting the distribution of drugs, individuals under the age of 18 continue to have access to legal and illegal drugs. Adolescents have access to drugs through friends who have access, drug stores, older siblings, parents who use drugs, the internet, etc. Today, approximately 5.3 million Americans from age 12 and over have abused cocaine in their lifetimes (9). Access has definitely increased, and the effected population has increased and is beginning to include much younger children. The effects of drugs are endless and can be detrimental to a child’s physical and mental development, especially when introduced at an early age (9). Again, the prevalence of drug abuse among adolescents emphasizes the need for effective public health interventions in this area. It is critical to educate adolescents on the consequences of drug use and abuse. This is the exact reason for the development of the well-known Drug Abuse Resistance Education (D.A.R.E.) program whose mission is to “provide children with the information and skills they need to live drug-and-violence-free lives” (4) and to help children avoid actions that will lead to drug use.
The D.A.R.E. program was founded in 1983 in Los Angeles and since then has undergone multiple revisions as studies continue to suggest that it is ineffective in decreasing the prevalence of drug use in teenagers (4). Regardless of any negative results from studies, the program has increasingly been implemented in secondary schools in an attempt to intervene drug use with the younger population. It is a program that brings together law enforcement and schools. It is incorporated into the school curriculums to teach young students about the consequences of drug use, how to avoid involvement with drugs, and what appropriate actions to take when in a peer-pressured environment (4). The involvement of law enforcement allows the students to have immediate answers to their questions related to drugs and violence. The program’s curriculum consists of a series of lessons taught over the span of 10 weeks, one class per week, and focuses on understanding the consequences of drug use, examining the students’ beliefs regarding drug use, developing communication and resistance skills, and making good life choices (3). The lessons are typically taught by police-officers who are able to respond to students’ questions about crime and drugs. The officers are required to undergo 80 hours of training in child development, classroom management, and communication skills prior to working for the D.A.R.E. program (4).
Although this program has been implemented into roughly 80% of the school districts in the country, it does not show promising results in positively changing the perspectives adolescents have on drugs. One article compiled results from multiple studies and concluded that while the D.A.R.E. program may reduce drug use in its students, the effects do not last (1). The revised program remains flawed because it instructs adolescents and young adults on what not to do, it ineffectively delivers its intended message, and it fails to consider the background of its audiences. When reviewing the program and its structure, it is obvious that several social health theories are already violated by the curriculum itself. Further examination of the program in the context of these theories may provide a better solution to revising and improving the program for future generations of adolescents and young adults.
The D.A.R.E. program simply educates the adolescents and young adults by using their curriculum to introduce the horrors of drug use and abuse and to show how to say “no” to drugs. Ironically though and of course, unintentionally, it dares its students to try drugs and to think about drugs because the program is saying their bodies will not tolerate the effects (8). Though the program’s abbreviation was likely meant to be used in slogans such as “DARE to resist drugs and violence”, that one word could also be easily manipulated by high school students to “DARE to use drugs”. To the targeted population, the lessons may seem as an effort to take away their potential freedom. Before attending any D.A.R.E. lectures, they may probably have never been exposed to drugs or information about drugs. In those situations, the program would be essentially teaching the students what drugs are, what the effects are and then telling them that is what they should stay away from. For those who have already been exposed to drugs, the program may be completely ineffective. Drug users have personally experienced the effects of drugs and believe the drugs help them feel happier, more confident, and have more control. The program’s messages of staying away from drugs would therefore be interpreted by that particular group as taking away their freedom and enjoyment.
The psychological reactance theory states that an individual will rebel against an instruction if it threatens to take away their freedom (13). This is exactly what the D.A.R.E. program does. It instructs the students on what not to do. The theory also implies that a person will rebel against what they are being told to do by doing the opposite, which in this case would be to use drugs (13). The program would seem to take away the freedom for not only the current drug users but also the newly informed. Adolescents do not enjoy being told what to do and so by teaching them to stay away from drugs, it is taking away their freedom to decide on their own. Even at a young age, children become more curious and interested in what they are not allowed to do and will find ways to do it secretly. They are unlikely to consider the consequences of their “banned” action because they are still at a developmental stage during which they are curious about everything. The organization of the D.A.R.E. program completely violates the psychological reactance theory and studies evidently show how drug use has increased among this young population (8).
At their age, it is unlikely that these adolescents have ever been exposed to drugs. The D.A.R.E. program may actually be the first exposure and leads them to thinking more about drugs. Most people will not look into something unless they were exposed to it. Adolescents today are not going to randomly search a topic online unless they heard about it on the media or from their friends. By informing them about drugs at an early age will only stimulate their curiosity about the issue and cause them to conduct their own research via friends or online. Their understanding will then be corrupted if their friends mention anything positive about using drugs such as increased popularity in school or the feeling of freedom and control. The D.A.R.E. program is flawed in the sense that it initiates its efforts at the wrong time and its target population may not be ready for the information it delivers (1).
For middle school and high school students, role models are usually their older siblings, parents, and occasionally teachers. Any officer in law enforcement is probably the last person these students will look up to because of the association with crime and punishment. This structural part of the program can be related to the marketing techniques of businesses. The basic marketing theory states that you must first recognize your target population as a collection of people, rather than many individuals (15). The D.A.R.E. program does approach groups of students and attempts to change the “herd” at the same time, but like most public health interventions, it is thrusting upon the students a product and trying to sell it. It attempts to sell “anti-drug actions” but it is unsuccessful because it is not what the students want at that age. Businesses successfully sell their products by first figuring out what their target consumers are interested in and what product they can develop to sell to these consumers. The D.A.R.E. program needs to do more research on the adolescents and young adults before trying to tell them what not to do.
In terms of marketing, the D.A.R.E. program fails to convey the message in a way that appeals to its audience, the students. Having a lecture presented by a uniformed police officer may not be the best idea because it gives them the feeling that they have done something bad (1). Furthermore, if it is the first time a student is hearing about drugs, it is unlikely he/she will care, and the lack of any interaction during the lessons simply adds to the boredom among the students (1). As mentioned in an article about the ineffectiveness of this program, the students will probably “tune out” the words coming from the authoritative officer (1). Therefore, having a police officer present the information is not the best way to market their product of not using drugs.
In middle and high school, students are concerned about not having friends and not fitting in with the right groups. Short-term or long-term health is probably the least of their worries. Chances are they do not even know what simple diseases are. The program is being implemented in the wrong setting. Interventions should be designed with the needs of the population in mind. Schools are using the program as a way to intervene and prevent drug abuse in young adults by educating them about the terrifying consequences before they consider using drugs. But the problem is the program facilitators are not doing prior research on what it is the students are interested in at their age. Sure, the program tries to respond to the peer pressure and the need to fit in by emphasizing that it is OK to say no to drugs, but this fails to solve the problem of peer pressure which is prevalent in all environments and especially important during secondary school.
Adolescents who refuse to use drugs and are able to escape peer pressure may not be able to escape any bullying due to their refusal (6). Safety in this case is a major concern that the program neglects to consider for those who do in fact say no to drugs. It does not address the current needs of these children, adolescents, and young adults. Needs of each different age group will vary and the curriculums should not be the same for everyone. According to the Maslow’s hierarchy, safety of one’s own body is on the same level as one’s health (14). Peer pressure threatens the immediate health of one’s body and yet, the D.A.R.E. program warns that drugs threaten the long-term health of one’s body. It is not hard to conclude that adolescents will probably be more concerned about their current health when they encounter peer pressure.
Certainly, the program does not consider the various backgrounds of these young individuals when telling them to stay away from drugs. A majority of the adolescents who use drugs come from families with low-income, unstable families, and other settings that may contribute to depression and lead to use of drugs as the solution to their problems.
The D.A.R.E. program’s past revisions were a response to the studies that proved its ineffectiveness in minimizing drug abuse and use in children and adolescents. The program remains flawed as the prevalence of adolescents using drugs has not diminished across the country. Some studies even suggest that the programs might have actually increased the use of certain drugs because it increased the students’ curiosity about drugs and resulted in earlier experimentation with drugs (12). It seems that even a new addition known as D.A.R.E. Plus program has not yet shown improvements, except that it was more effective than the original D.A.R.E. program in reducing tobacco use (10). However, based on the aforementioned social theories, the program can be further modified for the better and perhaps become a strong contributor in preventing drug use and abuse in children and young adults.
A main modification to the current D.A.R.E. programs across the country that should be considered is the entire curriculum and how it is executed. By correctly interpreting and applying the psychological reactance theory to the structure of the curriculum, the program would be able to better grasp the attention of its students. The purpose of the lessons should not be to lecture adolescents and young adults on what not to do, but rather to tell them what they should do. Currently, the lessons emphasize the intolerance of drugs by the adolescents, which can make them rebel and want to prove that they can tolerate the effects of the drugs (8).
The program should also employ the marketing and advertising theories in order to make its product appealing to the middle-school and high-school students. Thorough research should be conducted to figure out what it is these students at their age want and will accept. For example, it would be helpful to learn what they are interested in, their family backgrounds (general idea), and the ways in which they fulfill their needs. The program is promoting health and long life, which are not necessarily the most important things in an adolescent’s life. The D.A.R.E. program should also structure their curriculums by the age groups or grades, because each age group is on a different developmental stage and their thoughts and interpretation of one simple message may differ. For instance, eighth graders are going to think differently than ninth graders even if the age gap is small simply because they are in two separate environments. A message that may seem straightforward and easy to follow for one group may seem complex and overwhelming for another.
When a company markets its new products, they create numerous unique advertisements and commercials depending on who their targeted consumers are. They are not promoting their products with just one universal advertisement. Another reason the D.A.R.E. program curriculums should be different for the grades is most students attend the same middle school for 6th, 7th, and 8th grades and if the program runs for all three groups, most students would be sitting through the same presentation three times. By the second and third time, they already know what the presentation is about and the communication becomes less effective. One study that focused on the effectiveness of the D.A.R.E. and D.A.R.E. Plus programs in middle and junior high school found that more than 94% of the students had already been exposed to the program’s curriculum, which could explain the lack of changes in drug use and violence in the schools studied (10). In contrast, successful companies typically design new advertisements and commercials periodically to keep their consumers attentive. This is a technique that may benefit the D.A.R.E. programs since it is taught starting from the 5th grade through high school.
Another modification that could be increase the effectiveness of the program is the gap between the lecturer and the students. The idea of having an officer deliver the important message of “Don’t use drugs” is not going to appeal to all the adolescents and young adults. The information should be provided by someone who the students will listen to and can relate to, especially at their age. The design of the lessons and the messenger who communicates the information are all part of the marketing concept of packaging and putting things together (15). Imagery is a powerful tool that, when applied at the right time and place, can change the way groups of people react to a product. It is a concept that is ubiquitous in the business world and has proven successful. For example, Nike’s commercials often features sports celebrities, commercials for beauty products typically include famous actresses, etc. These are the ways in which brand name companies gain new consumers and keep current and past consumers. The consumers are interested in what the company has to offer because of the core values associated with the products. Again, the D.A.R.E. program promotes health to adolescents whose most important core values probably do not include good health. The current D.A.R.E. programs should be redesigned to tell these young individuals what to do rather than what not to do, to focus not so much on the “zero-tolerance” and also to tell them through the voice of an influential person (10). For high school students, the program could recruit current high school students who have successfully quit the use of drugs and who are able to relay the D.A.R.E. message to students of their own age.
The last area in which the D.A.R.E. program is flawed is its attention to the peer pressure that exists in schools today. Peer pressure is almost always a challenge for adolescents and young adults. Students in both middle and high schools ridicule their peers for being different, smart, poor, overweight, etc. Thus it is not surprising that kids would get teased by their peers after refusal of using drugs. The lessons on peer pressure advise the adolescents to report any abuse from their peers to authoritative personnel but that is something most adolescents will not do, especially if they know they will only get into more trouble with their peers if they tell. Bullying in school is another issue that cannot go unnoticed. Adolescents are highly susceptible to the psychological effects of verbal bullying, which very often results in deaths (11). Hence, drug abuse prevention programs like D.A.R.E. must take into account the obstacles that a student must face before they tell a student it is ok to say no.
The D.A.R.E. program should be modified and continue to be used because it has already established its name in most of the school districts in the U.S. It is a program that is well-known and if a revised version becomes effective, it can easily be used in the schools. The problem with the current programs is not that they lack the resources or research; there is definitely a vast amount of literature available on it. The problem is they are not able to translate the results into the implementation of a program that actually works. They are also not reaching the targeted population the right way. In other words, research results are not effectively taken into account in the clinical settings. Nevertheless, if the D.A.R.E. programs were to be reconstructed for each grade level, then more research may need to be performed. Public health interventions should conduct research among each and every grade in middle school and high school and then go onto constructing a program that is tailored to each groups’ needs rather than putting together a program first. Changing this long-term drug abuse prevention program so that it has customized curriculums for each grade may be time-consuming and challenging but would be a worthwhile investment. This particular drug abuse prevention program remains ineffective but can benefit from the psychological reactance theory and use of the marketing techniques that have worked for most successful companies.

1. Botvin, GJ. Preventing drug abuse in schools: social and competence enhancement approaches targeting individual-level etiologic factors. Addictive Behaviors 2000; 25, 6:887-897.
2. Carney, JV. Bullied to death: perceptions of peer abuse and suicidal behavior during adolescence. School Psychology International 2000; 21, 2:213-223.
3. D.A.R.E. Massachusetts. Malden, MA: D.A.R.E. Massachusetts.
4. Drug Abuse Resistance Education. The D.A.R.E. Mission. Log Angeles, CA: D.A.R.E. America.
5. Heron, M., Hoyert, DL., Murphy, SL., et al. Deaths: Final Data for 2006. National Vital Statistics Reports 2009; 57, 14:1-136.
6. Kheswa, JG. A descriptive analysis of alcohol and drug use amongst adolescents in Soweto. University of Johannesburg 2008.
7. Lloyd, JD., O’Malley, PM., Bachman, JG., et al. Monitoring the future: national results on adolescent drug use. Overview of key findings. National Institutes of Health 2006.
8. Marlatt, GA. & Witkiewitz, K. Harm reduction approaches to alcohol use: health promotion, prevention, and treatment. Addictive Behaviors 2000; 27:867-886.
9. National Institute on Drug Abuse. Drugs of Abuse/Related Topics. Washington, DC: National Institutes of Health.
10. Perry, CL., Komro, KA., Mortenson, SV., et al. A randomized controlled trial of the middle and junior high school D.A.R.E. and D.A.R.E. plus programs. Archives of Pediatrics & Adolescent Medicine 2003; 157:178-184.
11. Saluja, G., Iachan, R., Scheidt, PC., et al. Prevalence of and risk factors for depressive symptoms among young adolescents. Archives of Pediatrics & Adolescent Medicine 2004; 158;760-765.
12. Wysong, E., Aniskiewicz, R., Wright, D. Truth and dare: tracking drug education to graduation and as symbolic politics. Social Problems 1994; 41, 3;448.
13. Burgoon, M., Alvaro, E., Grandpre, J. et al. Revisiting the Theory of Psychological Reactance (pp. 213-232). In: Dillard, JP. & Pfau, M. The Persuasion Handbook. Developments in Theory and Practice. Thousand Oaks, CA: Sage Publications, Inc., 2002.
14. Hawley, PH. Social Dominance in Childhood and Adolescence: Why Social Competence and Aggression May Go Hand In Hand (pp. 1-30). In: Hawley, PH., Little, TD., & Rodkin, PC. Aggression and Adaptation: The Bright Side to Bad Behavior. Mahwah, NJ: Lawrence Erlbaum Associates, Inc., 2007.
15. Hastings, G., Saren, M. The Critical Contribution of Social Marketing. Theory and Application 2003; 3, 3:305-322.

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