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It’s magic: prevent substance use problems without mentioning drugs

Not magic at all of course, but a consequence of the fact that substance use problems are closely related to other problems which often develop at early ages when substance use is just not on the agenda. The 2010 English national drug strategy and corresponding public health plans seemed to recognise this, breaking with previous versions to focus attention on early years parenting in general, and particularly among vulnerable families.

Though studies are few compared to approaches such as drug education in schools, this renewed emphasis on the early years has a strong theoretical rationale and some research backing. Child development and parenting programmes which do not mention substances at all (or only peripherally) have recorded some of the most substantial prevention impacts. Though mainly targeted at the early years, some extend to early teenage pupils and their families. The rationale for intervention rests partly on strong evidence that schools which develop supportive, engaging and inclusive cultures, and which offer opportunities to participate in school decision-making and extracurricular activities, create better outcomes across many domains, including non-normative substance use. As well as facilitating bonding with the school, such schools are likely to make it easier for pupils to seek and receive the support they need.

Understandably, such findings do not derive from random allocation of pupils to ‘good’ versus ‘bad’ schools, so are vulnerable to other influences the study was unable to account for. More convincing if more limited in intervention scope are studies which deliberately intervene and test what happens among young people randomly allocated to the focal intervention versus a comparator. An early example was a seminal Dutch drug education study of the early ’70s which had a profound impact in Britain. For the practitioners of the time, it was a warning about the dangers of the dominant ‘scare them’ approach, but it might as well have been a lesson about the approach which outperformed the warnings – classroom discussions which simply gave teenage pupils a structured chance to discuss the problems of adolescence, leaving it up to them whether drugs cropped up.

Good Behavior Game rules displayed on the classroom wall and to the left a poster with names of children assigned to each team

Among the most prominent and promising of current approaches is the Good Behavior Game classroom management technique for the first years of primary schooling illustration. Well and consistently implemented, by age 19–21 it was estimated that this would cut rates of alcohol use disorders from 20% to 13% and halve drug use disorders among the boys. In the Effectiveness Bank you can read about the study and read a practitioner-friendly account of the research from the researchers themselves. The same programme has been combined with parenting classes, leading to reductions in the uptake and frequency of substance use over the next three years.

Another primary school example is the Positive Action programme which focuses on improving school climate and pupil character development. In Hawaii and then the more difficult schools of Chicago, it had substantial and, in Chicago, lasting preventive impacts.

In Britain perhaps best known is the Strengthening Families Programme, a family and parenting programme which in the early 2000s impressed British alcohol prevention reviewers. It features parent-child play sessions, during which parents are coached in how to enjoy being with their children and to reinforce good behaviour. At first the accent is on building up the positives before tackling the more thorny issues of limit-setting and discipline. Though the potential seems great, later research has not been wholly positive, and the earlier results derived from the minority of families prepared or able to participate in the interventions and complete the studies.

A final example comes from Norway, where a study raised the intriguing possibility that taking measures to effectively reduce bullying in schools helps prevent some of the most worrying forms of substance use.

Isolating these and other similar studies is not possible via our normal search facilities, so we have specially identified and coded them. They may prove to be the future for drug prevention, as traditional drug education struggles for credibility as a prevention tool. See how this future is shaping up today by running this hot topic search.

Last revised 03 March 2015. First uploaded 01 March 2010

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