Saturday, May 1, 2010

“keepin’ it REAL”: Why D.A.R.E. Has Failed American Teens And What We Should Do Instead – Catherine Mezzacappa

D.A.R.E.

In 1983, facing drug-related crimes, Los Angeles Police Chief Daryl Gates founded D.A.R.E. (Drug Abuse Resistance Education) with the Los Angeles Unified School District (LAUSD), which would later go on to become D.A.R.E. America, a national non-profit organization in 1989 (1,2). D.A.R.E. aims to address the issues of drugs and their effects, peer pressure, decision-making, violence and gangs (1). The D.A.R.E. curriculum, which is comprised of seventeen forty-five minute to one hour sessions, includes both didactic lessons and interactive role play. Lessons are delivered by uniformed local law enforcement officers, who undergo 80 hours of training before initiating as D.A.R.E. officers. D.A.R.E. is now primarily funded by license royalties, contributions and fundraising events, but is also supported by grants and contracts through the federal government (2). It is now taught by law enforcement officers in all 50 states and in most school districts (2).

Restraint Bias

D.A.R.E. lessons are delivered to students in the classroom during regular school hours. D.A.R.E. places law enforcement officers in the role of educator because the program’s founders believed that kids would see the officers as the most credible source of information based on their exposure to the consequences of drug abuse (2). However, the use of police officers in the classroom limits the effectiveness of D.A.R.E. in several ways. First, students are being exposed to drug-resistance methods and techniques in a “cold” state. In the classroom and in the presence of an authority figure, they are not operating under the social conditions, peer pressure and herd mentality under which they will ultimately be making choices about drug use. Thus, measurements of students’ attitudes toward cigarettes, drugs and alcohol will be affected by Restraint Bias, the tendency of individuals to overestimate their ability to resist harmful health behaviors while in a “cold” state (3).

The D.A.R.E. curriculum relies heavily on the “officer as expert”, which has been shown to be a less successful teaching model than programs that focus on interactive learning (4). Uniformed law enforcement officers have little if any similarity to the middle school students they are trying to reach, so the messages they deliver about cigarette, alcohol and drug use are more likely to lead to reactance and cause a “boomerang effect”, the seeking out of forbidden activities, among students (5). Further, using law enforcement officials adds to the stigmatization of the behaviors taught against by D.A.R.E. Using police officers to speak about the harms of drug use emphasizes the shame attached to using, delivering the underlying message that not only is using bad for you, but it makes you a delinquent and a criminal. Adding this layer to the negative label applied to drugs and their users by D.A.R.E. makes it even harder for kids to break away from it once they have been stamped.

Labeling Theory

In their 2008 Annual Report, D.A.R.E. America included the following in a text box: “Do bad kids do drugs, or does doing drugs make kids bad? Yes.” (2). They went on to describe the results of a study that identified drinking and using marijuana before age 15 as risk factors of early pregnancy, failing in school, addiction, sexually transmitted disease and criminal acts (2, 6).

D.A.R.E.’s approach to drug use and unilaterally negative labeling of the behavior is harmful to students. Through its sweeping zero tolerance policy towards drugs and alcohol, the D.A.R.E. curriculum labels students who experiment with or use them as “bad”. This is because, as Frank Tannenbaum described in his concept of the “dramatization of evil”, an act defined as bad or “evil” is transformed into the labeling of the actor him or herself as “evil” (7). Societal Reaction Theory and Labeling Theory, which were both developed to understand the interactions between society and the individual in producing “deviant” behavior, demonstrate that by placing cigarette, alcohol and drug users in “bad” and “criminal” categories, D.A.R.E. makes it even more difficult for at-risk teens to choose to avoid these exact behaviors. According to these theories, once labeled, individuals are more likely to accept that label as part of themselves and more likely to continue or repeat the behaviors that brought about the label in the first place (8,9).

By tagging them as corrupt and immoral and D.A.R.E. alienates students who have already tried drugs or alcohol, or who go on to experiment with these substances. Already labeled as “bad” and destined for failure by the bleak messages delivered by the D.A.R.E. program, these kids have no reason to engage in the curriculum or attempt to change their behavior for the future. While negative labeling is a major shortcoming of D.A.R.E., it is only one of many limitations of the program. Even if students were not discouraged from participating in the D.A.R.E. curriculum by the use of police officers and negative labeling, the program still would not bring about the behavior changes it aims to achieve because its curriculum is fundamentally flawed. The ideology that underlies the entire D.A.R.E. curriculum is based on the logic of traditional social cognition models, which have been shown to be poor predictors of actual behavior change (10).

Traditional Behavior Models and the Importance of Context

The foundation upon which the D.A.R.E. curriculum is built relies heavily on the paradigm behind traditional behavioral models, specifically the Health Belief Model and Theory of Reasoned Action. The Health Belief Model is a value expectancy model: people will choose to engage (or not engage) in a certain behavior if they value the outcome (being healthy) and they think the behavior is likely to lead to that outcome (11, 12). Based on a rational cost-benefit analysis, the individual then sets his or her intention and acts accordingly. This simplistic model ignores the context of decision-making, group behavior, and any potential benefits of a behavior choice that are unrelated to health. The D.A.R.E. program’s reliance on this kind of traditional thinking about behavior change is its most serious pitfall.

The largest limitation of the D.A.R.E. curriculum and youth drug prevention programs in general is the “user accountability” paradigm - the central assumption that “drug use reflects bad decisions by individuals with free wills” (13). D.A.R.E. is based on the philosophy that through awareness of the harmful sequelae of drug use, individuals can be encouraged to make the “right choices” (13). D.A.R.E.’s curriculum relies on the principles of free will and user accountability, and therefore aims to intervene on the decision-making processes of individual students. Because its curriculum is strictly limited to student’s individual choices, D.A.R.E. fails to address the role of structural factors in the etiology of drug use (14). “In the face of extensive sociological research supporting [the deterministic impact of social structures on social behavior], D.A.R.E.’s assumption that drug-related attitudes and behavior can be significantly influenced over the long-term by a relatively brief exposure to a persuasive communication program appears to be rather naïve.” (14).

Social influences are extremely salient in the decision-making practices of young teenagers and are described by Thaler and Sunstein as being made up of two factors. First, the thoughts and actions of those around you inform convey information about what you should think or do. Second, if you care about what other people think of you, which young teens do very much, you will be inclined to go along with the crowd, both to avoid conflict and to gain popularity (15). Humans are easily influenced by other humans (15). Teens are especially vulnerable to the influences of others because of their exaggerated perceptions of the “spotlight effect”, the perception that others are closely paying attention to what you are doing and the subsequent desire to conform to others’ expectations (15, 16). The failure of the D.A.R.E. program to recognize the importance of context has contributed to its consistent failure to create real change among students (14).

The U.S. General Accounting Office reviewed six long-term evaluations of D.A.R.E.’s elementary school curriculum, none of which found a significant difference in illicit drug use between students who received D.A.R.E. and students who did not (17). The D.A.R.E. program has been repeatedly shown not to impact cigarette, alcohol and illicit drug use in children (4, 18-25).

Proponents of D.A.R.E. argue that regardless of these results, the program has been successful because of observed improvements in students’ attitudes’ towards drugs and estimated level of drug use by peers (17, 18, 22, 23, 26). However, viewing these measures as markers of success is rooted in the faulty logic underlying traditional behavioral models, particularly the Theory of Reasoned Action (12, 27). According to this behavioral model, individuals weigh their attitudes towards the outcomes of a behavior and what they perceive of the subjective social norms regarding that behavior to establish their intention. Intention to perform an action is believed to be highly predictive of behavior change (12, 27).

This kind of uninterrupted link from intention to behavior is not the reality observed in young teens. In a meta-analysis of eight prior studies on D.A.R.E., Ennett et al. reported statistically significant mean effect sizes for knowledge about drugs and attitudes about drug use among students who underwent the D.A.R.E. curriculum, but no difference in terms of drug use (4). Even the observed intermediate benefits do not appear to be long-lived, as the positive effects of D.A.R.E. on attitudes towards drug use have been observed to diminish over time (4, 17-25).

keepin’ it REAL

D.A.R.E. America licensed and adapted the “keepin’ it REAL” (kiR) curriculum developed by researchers at Penn State and Arizona State Universities to be used as the project’s junior high (middle school) curriculum starting in September, 2009 (1). The word REAL in the curriculum’s title is an acronym that stands for Refuse, Explain, Avoid and Leave – the resistance strategies taught to 7th and 8th graders by the program. Curriculum developers argue that the REAL strategy prepares kids to act “decisively and comfortably in difficult situations” (28, 29). However, these strategies, like the old D.A.R.E. program, rely on traditional assumptions about human behavior.

Proponents of keepin’ it REAL argue that, unlike the original D.A.R.E. program, kiR was built from the “ground up” and delivers teens effective ways to stay away from drugs “straight from other teens” through its use of videos in which other teens deliver the anti-drug messages (28, 29). However, examining the core message of keepin’ it REAL it becomes clear that the strategies promoted in keepin’ it REAL do not truly differ meaningfully from older strategies like the War on Drugs’ and First Lady Nancy Reagan’s “Just Say No” campaign. In fact, the REAL strategy arguably conflicts even more directly with the core values of adolescents.

Beyond refusing drugs, the keepin’ it REAL curriculum teaches kids to explain why they are refusing drugs. Adolescents turning down cigarettes, alcohol or drugs in a social situation are already exposing themselves by not conforming. The expectation that middle schoolers should then go on to explain their reasoning to their friends and peers who are in that very moment using the drug they have just refused is unrealistic.

The other tactic offered to teens through keepin’ it REAL is to avoid situations where drugs will be present, or to leave. This second arm of the REAL strategy does not take into account the core values of the young teenager. The desire for belonging, popularity, and acceptance drive the social behaviors of young teenagers. Avoiding or leaving parties and other group settings is a drug-avoidance strategy that is unlikely to take in this group. Drug and alcohol use among young teens reflect “conformity to peer-enforced norms that are part of the adolescent subcultural context.” (14).

Using alcohol and drugs simultaneously satisfies two of the major core values among youth: rebellion and belonging, and therefore giving up this behavior will come at a high cost. These behaviors carry an extraordinarily high value among young teens because they are a “means of validating membership in and allegiance to the adolescent subculture while at the same time demonstrating a rejection of remote and alienating adult authority structures.” (14).

Keeping the core values of youth in mind, it is clear that the keepin’ it REAL curriculum offers students two drug-resistance strategies that are undoubtedly unsavory to their target audience: just say no (and then further ostracize yourself by explaining why) or miss out on the fun. The core message of the keepin’ it REAL campaign fails to recognize the intrinsic value that drugs and alcohol hold for the program’s target audience. In order to effectively reduce drug and alcohol use among young teens, it is necessary to operate within the context of teens’ underlying motivations and offer an alternative to drug and alcohol use that satisfies these needs.

Break Out!

As an alternative to D.A.R.E. and the keepin’ it REAL curriculum, I propose Break Out!, a teen-led intervention to be offered to middle-schoolers. Break Out! is rooted in the conviction that in order to prevent drug use among middle schoolers and as they continue on through high school it is necessary to provide them with an alternative means to achieve the same sensations of belonging among their peers and rebellion against adults that using cigarettes, alcohol and illicit drugs offers. The central message of Break Out! is not explicitly one against drug use. The primary objective of Break Out! is not to educate youth about the negative consequences of drug use, but rather to give them a space in which to inhabit the roles of “member” and “rebel” through means other than traditionally conformative and rebellious behaviors like alcohol and drug use.

Break Out! creates this opportunity for middle schoolers by recruiting and training high school juniors and seniors who excel in a particular field to lead activity-centered clubs. In Break Out!, clubs are not limited to traditional activities. Rather, they will be tailored to what is relevant to students in each school district by relying on current high schoolers’ hobbies and skills. Clubs could be based on activities like skateboarding, hunting and fishing, fashion and shopping, travel, wakeboarding, or movie-going, in addition to more traditional activities like football, soccer, writing for the school newspaper, and theatre. High schoolers are offered community service credits and a small stipend for leading these clubs. Leading a Break Out! club is also an opportunity for high schoolers to gain leadership experience while simultaneously further developing their skill sets. This is attractive to high school juniors and seniors who are thinking of life post-graduation and applying to college or for jobs.

By middle school, kids have developed individual interests and self-identify with how these activities define them. High schoolers who have more advanced abilities and skills in those same interest areas can therefore act as opinion leaders among the middle schoolers in their clubs. According to marketing theory and the Diffusion of Innovations, the opinion of an entire group can be swayed by a few influential adopters of a behavior or thought process (30). Club leaders will therefore have the ability to influence entire groups of middle schoolers, rather than focusing on one student at a time.

The underlying ideology presented by Break Out!’s club leaders will be an activity-centered message of “I’d rather be…”, not a didactic lesson on the harms of drug and alcohol use. Because they have so much more in common with the students they are trying to reach, messages delivered by high school-aged club leaders will be much better received by the middle schoolers (5). They are experts and models of success to the middle schoolers who are interested in the same activities, so the attitude presented by Break Out!’s club leaders will be more relevant than a didactic message presented by an external authority figure.

Break Out! creates a sense of group unity and achieves its drug use prevention aims by requiring club members to demonstrate a high level of commitment to their club(s) of choice. Students at the middle school age desire to belong, but also to differentiate themselves from their peers and be recognized as exceptional. By challenging students to really commit themselves to pursuing an activity of their choice, Break Out! gives them the opportunity to do both. Committing to an activity also offers middle schoolers the chance to break away from the mundane and everyday.

Break Out! clubs meet regularly to participate in activities off of school grounds developed by their high school leaders. The idea behind the activities held by Break Out! groups is to develop the skills of its members – to specialize and become elite. An essential component to Break Out! is the development of off-campus and overnight trips and activities that take the middle schoolers outside of the supervision of school authorities and parents. These trips will be opportunities to engage the students’ interests to a degree that would not be possible at school. For example, a skateboarding club could travel to a major skate park or an art club could visit non-traditional galleries or museums. However, because these kinds of trips require that parents and adults place trust in the Break Out! program, they also serve as an opportunity for club leaders to require certain standards of behavior from their members.

Break Out! clubs will utilize student-developed contracts that all members sign upon joining that delineate their responsibilities to themselves and the group. The club leaders will be trained to include as part of the contract a symbol of dedication to the club’s activity through a promise against drug and alcohol use. This promise is presented as a measure to protect the club’s ability to exist without supervision by adult authorities – if group members are caught using, the club will no longer be allowed to operate independently of adults. This frames the club as a means of rebellion against authority and escape from the scrutiny of adults, and the individual students as members of this movement.

D.A.R.E. and keepin’ it REAL target individual middle schoolers and their decision-making processes, which removes decision-making about drug use from its social context and ignores the phenomenon of herd behavior. Through the use of clubs, opinion leaders and contracts, Break Out! targets its interventions to the group level and recognizes the importance of congruence with peer behaviors to its target audience. Social Network Theory has shown that people change their behaviors in groups, not as individuals (31, 32). The clubs created by the Break Out! program will create new and stronger social networks for their members, and under the positive influence of club leaders middle schoolers will adopt healthy behaviors as groups. Students are influenced by their beliefs about what other students do (15), so if students believe that their peers are not using because they have all made the same pledge against doing so, their own promise not to use will be reinforced. Break Out! uses the “social norms” approach to its advantage by socializing the non-use of cigarettes, alcohol and drugs in its clubs. Further, because students are aware that their peers have an investment in their personal choice to abstain, Break Out! also uses the “spotlight effect” to its advantage (15, 16).

Break Out! also uses positive labeling by providing middle schoolers the opportunity to become specialists and experts, to identify as the best at what they do among their peers and in their community. While D.A.R.E. and keepin’ it REAL label alcohol, drugs and kids who use them as “bad”, Break Out! avoids negative labeling all-together and instead hones in on the potential of middle schoolers to develop into real experts. By giving middle schoolers ownership over their own potential and providing the space in which to grow into experts, Break Out! labels students as successes. Moving on from middle school, students who already identify as successful and specialized will be much more inclined to remain devoted to the activity that brings them positive recognition. This method implicitly encourages these student successes to affirm their positive label and choose to further invest themselves in constructive activities rather than use alcohol and drugs (8, 9).

Break Out! recognizes that in order to reach middle schoolers, it is necessary to sell their program as a means to the core values and deepest motivations of young teens (33). By acknowledging the importance of social context and pressures and giving middle schoolers an alternative means through which to achieve belonging, individuality, and rebellion, Break Out! provides a more promising drug use prevention model than D.A.R.E. and keepin’ it REAL.

REFERENCES

1. D.A.R.E. America. The Official D.A.R.E. Website. Los Angeles, CA: D.A.R.E. America. http://www.dare.com/home/default.asp.

2. D.A.R.E. America. 25 Years: 2008 Annual Report. Los Angeles, CA: D.A.R.E. America, 2008.

3. Nordgren, LF, van Harreveld F, van der Pligt J. The restraint bias: how the illusion of self-restraint promotes impulsive behavior. Psychological Science 2009; 20(12):1523-1528.

4. Ennett ST, Tobler NS, Ringwalt CL, Flewelling RL. How effective is Drug Abuse Resistance Education? A meta-analysis of Project DARE outcome evaluations. American Journal of Public Health 1994; 84(9):1394-1401.

5. Silvia PJ. Deflecting reactance: the role of similarity in increasing compliance and reducing resistance. Basic and Applied Social Psychology 2005; 27(3):277-284.

6. Drug Free America Foundation. The Drug Free America Report 2008; 2(22).

7. Tannenbaum F. Crime and Community. Boston, MA: Glinn, 1938.

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13. National Drug Control Strategy. Washington, D.C.: The U.S. Government Printing Office, 1992.

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17. Kanof ME. Youth Illicit Drug Use Prevention: DARE Long-Term Evaluations and Federal Efforts to Identify Effective Programs. Washington, D.C.: General Account Office, 2003.

18. Clayton RR, Cattarello AM, Johnstone BM. The effectiveness of Drug Abuse Resistance Education (Project DARE): 5-year follow-up results. Preventive Medicine 1996; 25:307-318.

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27. Fishbein M, Ajzen I. Belief, Attitude, Intention, and Behavior: An Introduction to Theory and Research. Reading, MA: Addison-Wesley, 1975. http://www.people.umass.edu/aizen/f&a1975.html

28. Keepin’ it REAL. Keepin’ it REAL. The Pennsylvania State University. http://www.kir.psu.edu/.

29. Keepin’ it REAL. Research. The Pennsylvania State University. http://www.kir.psu.edu/research/index.shtml

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31. Newman MEJ. The structure and function of complex networks. SIAM Review 2003; 45:167-256.

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33. Siegel M, Doner L. Marketing public health – an opportunity for the public health practitioner (pp. 127-152). In: Marketing Public Health: Strategies to Promote Social Change. Sudbury, MA: Jones & Bartlett Publishers, Inc., 2007.

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1 Comments:

At May 3, 2010 at 5:58 PM , Anonymous Jason Blanchette said...

You make some nice points against the curriculum, Catherine. Most of the of the toughest situations officers have to deal with - violence, neglect, etc. - involve others abusing drugs and alcohol. So I think they're conditioned to provide "scare tactic" approaches when in a classroom teaching role because of the strong correllation they see every day between substance abuse and bad outcomes. I was a drug prevention coordinator for Mason County, IL where originally I wanted to see if I could bring in a more evidence based curriculum, that was until I saw for the first time the kids interacting with the D.A.R.E. officer calling him by name outside of the classroom and were happy to see him. A police chief in another community confirmed for me that the relationships built with these youth are invaluable when they're all back out on the streets. And there is a ton of evidence in the literature supporting that youth who feel more connected to their schools, their communities, their police departments, their families, etc., develop into healthier and more competent young adults and make better choices. I think your proposed curriculum does a fantastic job addressing healthy adolescent development, and essentially getting to the core of what we need to worry about. But I wonder if there's a more appropriate role for officers to connect with the youth, and one that maybe officers will feel more comfortable in and where they won't label anyone as "bad."

 

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