Thursday, May 6, 2010

The Drug Abuse Resistance Education Program (D.A.R.E.): A Critique of the Drug Abuse Intervention – Alexander Musallam

The United States population, each year, loses thousands of people from alcohol and drug related death. This ranks as one of the most prominent forms of preventable death in the US.(1) The issue of drug abuse has always been important in society. While types of drugs and methods of drug usage may have changed, the concern has been constant. The important foundations of the drug and alcohol abuse problem center around the health and development, both psychological and physical, of the individual.(2) Within the US, policies and laws have been in place for decades to prohibit illicit drug use and possession of an illegal substance, as well as to restrict alcohol use. Many organizations monitor drug and alcohol use including, but not limited to, the United States Department of Health and Human Services and The National Institute on Drug Abuse (NIDA).(3)(4) NIDA reported “in 2008, an estimated 20.1 million Americans aged 12 or older were current (past month) illicit drug users and more than half of Americans aged 12 or older reported being current drinkers of alcohol (51.6 percent). This translates to an estimated 129.0 million people”.(5) Various theories on drug use accredit multiple areas of the human psyche as well as social, environmental, and genetic factors as reasoning for initiating and continuing drug use behavior and accounting for these statistics.
The susceptibility factor of drug and alcohol abuse does not discriminate. All ethnicities and genders are affected, however, age of drug abuse has become an issue of importance in prevention. In the 2001 National Household Survey on Drug Abuse, performed by the Substance Abuse and Mental Health Services Administration, the data showed a trend of drug use in youths that was higher then that of adults. This study observed, “about half (51 percent) of current illicit drug users were aged 12 to 25.”(6) This data is staggering. Young Americans are initiating in drug use at very young ages, though society has fought to protect is populations through health interventions and prevention in order to affect these growing numbers.
The topic of prevention is of utmost importance when assessing the question of, “How to reduce drug use in society?” The National Institutes for Health state, “Drug addiction is a preventable disease. Results from NIDA-funded research have shown that prevention programs that involve families, schools, communities, and the media are effective in reducing drug abuse.”(3) Such programs have been implemented both through out the US and throughout the world. Governmental and privately funded programs exist in the US, that utilize various behavioral change methods and theories as the backbone for their intervention strategies. One such program, which has been widely used, is the D.A.R.E. Program.

The D.A.R.E. Program.
The Drug Abuse Resistance Education program, otherwise known as D.A.R.E., may be one of the most well known drug prevention programs in the United States. The program is also one of the oldest and longest running programs. “D.A.R.E. was founded in 1983 in Los Angeles.” It is now being implemented in 75 percent of our nation's school districts and in more than 43 countries around the world.”(7) “The program receives $1.7 million directly from the U.S. Department of Justice Bureau of Justice Assistance, which covers the cost of D.A.R.E.’s five regional training centers; $15 million a year from corporate sponsors; and $215 million in indirect benefits from the salaries that communities pay the thousands of police officers who take part in the program.”(8) The program spans grades K-12 in public school systems across the United States and is taught to millions of US students each year. The program’s primary mission is to provide children with the information and skills they need to live drug-and-violence-free lives by “equipping kids with the tools that will enable them to avoid negative influences and instead, allow them to focus on their strengths and potential.”(7)
D.A.R.E. focuses on education as its primary method of behavior change. The D.A.R.E. program utilizes a core curriculum consisting of hour- long weekly lessons taught to fifth and sixth graders. The program spans over 17 weeks.(9) The teaching and curriculum is presented through a collaboration of law enforcement and public school system in which law officers are trained and certified to teach the program’s curriculum. More than 50,000 local law enforcement officers are certified to teach the D.A.R.E. program.(7)

Critique of the Program.
D.A.R.E. is a prominent program in today’s society that who’s message, as stated previously, has been and will be heard by millions of young Americans each year. It’s objective is one of immense importance and has been praised by many for aiding in protecting the nation’s youth from the effects of drugs and alcohol. However, as with many programs its overall effect and importance has constantly been an issue of debate and speculation. Numerous articles and reports have been written and presented on the ineffectiveness of the D.A.R.E. program and some school districts have even “pulled the plug” on the program as a whole for its students.(8) Some claim that not only is the program ineffective but that it also has counteractive results on those it is trying to affect. (10) As a result many have argued that D.A.R.E.'s limited influence on adolescent drug use behavior contrasts with the program's popularity and prevalence and that this ineffective program could be taking the place of another effective program in today’s schools.
This paper describes and critiques three of the many critical flaws of the D.A.R.E. program for a better understanding of its ineffectiveness. The three flaws are; First, the program’s ineffective method of behavior change assumes individual behavior change without accounting for irrational behavior; Second, the program fails to take into account external factors and causes necessary to understand and prevent drug use; Lastly, the program utilizes a flawed method of message and curriculum deliver through the use of law enforcement.
Behavioral health theories are currently incorporated in a multitude of health behavior research programs as well as numerous health intervention programs that are currently being utilized in society.(11) These theories often provide structure to the methodologies employed in creating behavior change.(12) While many interventions do not publicize the strict use of behavioral health theories and models, their practice can often be consistent with one or more of these theories. Among these programs and interventions is the D.A.R.E. program. While not strictly adhering to one single theory, the D.A.R.E. program’s characteristics is consistent with the understandings of the Health Belief Model and Theory of Reasoned Action, and retains the same major flaws associated with both.(13)(14)
The health belief model states that people act based on a series of understandings each individual assesses prior to action or behavior change.(14) These understandings are perceived susceptibility, perceived severity, perceived benefits, and perceived barriers.(15) Unlike some programs structured through this method, the D.A.R.E. program itself hopes to address these understandings of drug use prior to an individual engaging in the action of drug use. The theory of reasoned action assumes that “attitudes toward behavior are shaped by beliefs about what is entailed in performing the behavior and outcomes of the behavior. “(15) This understanding applies to the D.A.R.E. program due to the dare program incorporating the same understanding. Through education, D.A.R.E. attempts to alter these “attitudes” and “beliefs” towards behavior of drug and alcohol use prior to them occurring. Both of these models and theories are all regarded as social cognition theories that aim to predict health related behavior from an analysis of people’s beliefs and attitudes.(16) They have been shown to explain and predict behavior with varying degrees of precision (depending on the situation), however, these theories also have many limitations and flaws. The most striking of these flaws is the idea that behavior is rationally thought out and regulated. This idea ignores emotional, habitual, and external influences of healthy behavior. (16)
Irrationality of human behavior makes it understandably difficult to assume that by affecting the knowledge base of a young student he or she will utilize this knowledge in his or her decision-making. This factor is especially true in the use of drugs, alcohol and other addictive substances. Many studies have shown that combined features of the addictive characteristics of these substances and behavioral human nature, makes it difficult to fully affect the behavioral change. (17)(3) When viewing the health belief model and theory of reasoned action it can be understood that with out the variable of rational thought it is impossible to assume that through education a young child will reason his behavior prior to the behavior occurring. Therefore, the assumptions utilized in the D.A.R.E. program are those that can cause its failure, as education on drug use when combine with irrational behavior is nearly improbable to cause effects. Results from these types of interventions often show an increase in knowledge, however, a low effect of behavior change. (18)
A second flaw of the D.A.R.E. program, is the type of teachings being administered to those partaking in the program. Many believe that the DARE approach “has been an amalgam of different messages about drug abuse and violence” and that “at its core it involves police officers visiting elementary school classrooms to tell students about the dangers of drugs and the importance of self-esteem, and offering them different ways to say ‘No’ “(19). Several outside influences can often affect an individual’s choice say “No”. “Factors such as peer pressure, physical and sexual abuse, stress, and parental involvement” all have been shown to have an influence on ‘destructive’ behavior such as drug use.(3) While claims of addressing these issues with a new “improved” program methods that include more interaction of student (7), research has shown that D.A.R.E. fails to focus on the causes of drug use. D.A.R.E. publicizes providing skills necessary to deal with the pressures that cause them to experiment with drugs. (7) However, according to the Surgeon General’s report, the program is “most commonly criticized for its limited use of social skills training.”(20) The National Institute on Drug Abuse states “that prevention planners need to choose programs that strengthen protective factors.” The report goes on to state that these protective factors stem from an understanding of the causes. (21) The report by the Surgeon General stresses the need for proper implementation of better preventative measures. This can be aided by removal of ineffective methods of teaching diverse populations of students and the need for appropriate teachings for the various demographics.(20)(3) Due to differences in gender, ethnicity, race, and most importantly age (since the program spans K-12), this is very important. By failing to understand the factors affecting the population, the program will fail to prevent the behavior.
Lastly, the D.A.R.E. program utilizes an improper presentation of its message and information. The program employs the use of police officers to teach and present the material contained in its curriculum. The organization behind D.A.R.E. reports, in combination with the United States Department of Justice, that this method of intervention leadership is retained in order to “humanize the police so that young people can begin to relate to officers as people and permits the student to see the officer’s in a helping role not just an enforcement role.” (7) D.A.R.E. also utilizes the officers in order to open lines of communication between law enforcement and youth, [creating] dialogue between school, police and parents.”(7) Officers are also supposed to “serve as conduits to provide information beyond drug-related topics.”(7) According to a service of the National Institutes of Health, in a report on adolescent development, adolescents constantly challenging authority figures. Other studies show that this trend is global among adolescents and that “despite holding different beliefs about authority and individual autonomy, adolescents from all generations and cultural backgrounds reported similar levels of conflict and cohesion with their parents or authority.”(22) This shows this issue is universal and that it can be generalized to almost all adolescents. Therefore, it is difficult to understand why D.A.R.E. utilizes a law enforcement in its primary method of presentation, if this extreme authority figure in society is at risk of causing challenging thought process and behavior. This could account for the lack of effect found in many studies and even a counterproductive effect from those feeling the need to rebel against the authority.

Proposed Intervention Changes.
Health intervention programs are constantly being changed and altered to assess and account for ineffective methods and strategies as well as changing ideas and understandings of health promotion. Many of these changes occur as a result of program evaluation. Time period also comes into question when programs have had widespread implementation over a long period of time. This is the case with the D.A.R.E. program. This program has outlasted many other programs of its type, and yet its methodologies have been proven to show very small to no effect. Change is an important factor to consider when assessing this program. The three critiques described in this paper all show the importance of evaluating performance of health intervention strategies. A new program can come about from the understandings attained from the D.A.R.E. program, by altering the various components of the program that cause the flaws. Looking at effective methods of health promotion and behavior change found in other programs can aid in this assessment.
While the ideals and purpose of the D.A.R.E. program are essential in today’s society, the program needs alterations in order to cause more effective beneficial outcomes. Rather than completely eradicate the program, adjustment could be made and new methods could build upon the old. The program’s current implementation location of schools is an important population to affect. This is due to the consistency and stability of population. Therefore, the program would still be implemented in schools; however, utilization of the marketing theory would be implemented through a media campaign to affect the group level understanding of the area’s general population. Also creating enhanced population demographic appropriate teachings, would aid in better program implementation. Improving understanding of students (program participants) by incorporating social teachings and communication into the course and changing the method of delivery would both be beneficial implementations of the D.A.R.E. health intervention program. This would occur through more demographic appropriate teachings as well as implementation of peer-based education.
Assessing the D.A.R.E program in relation to theories of social behavioral sciences allows for a different understanding of effective methodologies for program implementation. As described previously, the D.A.R.E. program’s characteristics are consistent with the health belief model and theory of reasoned action. These theories’ ideals can be found in many education-based programs. A characteristic of these theories, and subsequently the program, is the focus on behavioral change in the individual and the assumption of rational behavior. When assessing group level health intervention models, one of the more modern models is social marketing theory.
The characteristics of social marketing utilize understandings found in consumer retail research by marketers attempting to account for human behavior. “Social marketing is typically defined as a program-planning process that applies commercial marketing concepts and techniques to promote voluntary behavior change.”(23) One study describes the relationship between marketing theory and health behavior as; “Marketers seek to influence consumer behavior. Much ill health and many social problems are caused by human behavior. Social marketing puts these two phenomena together and uses marketing insights to address social behaviors.”(24) Through understanding the factors that influence behaviors in the population of adolescents at risk of engaging in drug use, the program becomes more effective. The social marketing theory then address “needs, wants, lifestyles, behavior, and values that make them likely to respond.”(23) This is done in order to appeal and relate to the population. The D.A.R.E. program could utilize a message of freedom, rebellion, or empowerment, and most importantly control through abstaining from drug use. This draws the population in and allows them to properly receive the message by appealing to their views. There are various methods of message presentation that are often specific to the population being affected. In the case of the population of the D.A.R.E. program, media and technology should be the appropriate method of present information. Effective programs, such as VERB and the “truth” campaign, which incorporate the marketing theory, have often focused on television commercials, radio, and other media messages.(25)(26) Such outlets would also be appropriate for the D.A.R.E. program. These methods of propaganda would not only aid in message presentation but could also gain a more passionate following for the D.A.R.E. program itself.
In conjunction with a better understanding of the general population through group level program implementation, the creation of more appropriate school-based teachings for the various demographics would be necessary for the program to become more effective. Currently the D.A.R.E curriculum is universally disseminated among all populations of the US. This assumes a homogeneous distribution of population demographics across the country. This, however, is not the case with the diverse US population. The National Institute of Health provides guidelines for a prevention program that overemphasize the need to make programs specific for the community in which the program is being implemented. (27) Therefore, the D.A.R.E. program needs to undergo a process of reinventing the curriculum and teaching methods using factors of age, sociocultural factors, and environmental features specific to the community.(28) An effective way of accomplishing this is to survey the students and families to find out what affects their lives the most. These surveys would focus on, but not be limited to, known risk factors of drug and alcohol abuse, such as peer-pressure, stress levels and stressors, economic issues, and rate of violence.(29) Once a proper assessment has been made for the community and the program’s teaching content and style altered appropriately then there could be more probability of successful outcomes.
Lastly, a change would be to affect the method of presentation in the school based teachings. Currently the police officer based teaching is the driving method of information distribution in the D.A.R.E. program. However, “the design of the program does not take into account the fact that the presence of an uniform police officer may actually do more harm then good in the classroom. Some adolescents may be intimidated by the presence of the officer, which may affect their performance in the program.”(18) Therefore, new more engaging programs would need to be implemented. One such program could be peer based interactive learning, in which same age or same background educators would be used to convey educational messages to a target group. (30) This method of drug education has been endorsed by the United Nations, Office on Drugs and Crime. In a publication produced by the UN, a ‘peer-to-peer’ intervention plan is more effective for adolescence “since young people have best knowledge of their lives, situations and contexts, they speak the same language in the same way and identify with the same cultural shorthand that often delineates the margins of a subculture”(30) Providing relatable peers producing messages of antidrug use, the social norms theory is also utilized.
Social norms theory states, “much of people’s behavior is influenced by their perception of how other members of their social group behave. According to this theory, people tend to misperceive, i.e., exaggerate, the negative health behavior of their peers.”(31) By providing a peer teaching and living a drug free lifestyle you affect the understanding of normal behavior, and in this case health behavior. If this idea normal health behavior adheres to the individual or more importantly the group then a proper behavioral change can be made. Implementing this and the other changes outlined a more effective D.A.R.E. program may be produced. This program could then be evaluate and continually altered to ensure efficiency.

The Drug Abuse Resistance Education program has become a renowned drug intervention program over its lifetime. Since its inception in 1983, the program, more popularly known as D.A.R.E., has been taught to millions of adolescents each year in the United States. Its iconic symbol can be recognized by most; however, over the years many parents, institutions, and governmental organizations have criticized its methods and effects. Many studies have shown its lack of effect on the students who participate, and some even show a counterproductive effect, through increased rates of drug and alcohol use among the participants. Several institutions have removed the program from their schools as a result of the findings. After studying the program itself, many critique can be made of the various aspects and characteristics of D.A.R.E.. This paper outlines three of these critiques. First, the program utilizes the health belief model as well as the theory of reasoned action as its underlying theoretical beliefs in its process of behavioral change. Second, the program does not take into account social and environmental factors in its methods of presenting information as well as its content causing barriers to its message. Lastly, the program utilizes a police officer to teach and portray its message causing a disconnect and chance for rebellious ideas and actions among participants. These critiques were then assessed and accounted for with the proposal of a new D.A.R.E. program. This program utilizes the marketing theory, peer-based education, and population demographics to correct some of the flaws of the program. The D.A.R.E. program’s purpose and message are important in society and for the future of America Through evaluation, critique, and program correction, a better D.A.R.E. program can surface to serve adolescents of America and combat drug alcohol abuse.

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