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‘Everyone’s not doing it’ message offers hope for prevention

Science is littered with shining discoveries which became tarnished as accumulating data forced a reappraisal. In substance misuse, ‘normative education’ retains some of its shine, but what seemed the great hope for school- and college-based prevention now seems a tactic of limited application and inconsistent impact. The approach relies on the common (but perhaps at not as common as believed below) overestimation by pupils and students of how many of their peers use substances and how much they use and/or (less commonly) overestimation of the acceptability of substance use among their peers. Corrective survey data is expected to reduce substance use because it no longer seems ‘normal’ and ‘what everyone my age does’. For more on the thinking and research behind this strategy, see this presentation from John McAlaney of the University of Bradford.

Important recent implementations include the seven-nation EU-Dap European drug education trial and the English Blueprint trial. The former’s results were patchy, the latter’s, if anything, in the wrong direction, perhaps partly because pupils often simply did not believe the results of the surveys of their peers they were presented with. So unconvincing have results been at US colleges that some suspect the drinks industry supports normative campaigns because they divert colleges from imposing restrictions which really would cut consumption. However, there have been notable successes (for example, 1 2) which found not just substance use reductions, but related these to normative beliefs.

Incorporated in effective alcohol harm reduction curricula

One possibility is that normative approaches falter sometimes because they are embedded in programmes which unrealistically aim to prevent any substance use rather than to reduce harmful consequences (1 2), particularly applicable to alcohol in countries where its use is widespread and accepted, even among teenagers. As in Australia, in Northern Ireland an alcohol harm reduction curriculum which incorporates normative education as an important component curbed the growth in alcohol-related problems in secondary schools and also meant pupils drank less. Also in Australia, another similar curriculum with normative elements curbed age-related growth in alcohol consumption, in drinking in order to get drunk, and in alcohol-related social or health harms.

Perfect for computerised programmes

As a review for NHS Health Scotland observed, normative approaches lend themselves to computerisation and have become the mainstay of web-based interventions for people concerned about their drinking. Typically the site user completes a brief assessment of their drinking. This is then automatically compared with the corresponding sector of the general population and the results fed back to the user, accompanied by computer-generated advice tailored to data about themselves input by the user. UK-based examples include the Down Your Drink site and the Drugs Meter, which covers illicit drugs as well as alcohol.

These therapeutic applications targeting problem users are addressed by another hot topic, but the same technique can be used as a preventive tool in educational settings and for students in general. Tried in a US university which required new students to undergo alcohol education before moving into student accommodation, the results were promising; compared to just being assessed, one of the two tested programmes led to significantly fewer adverse alcohol-related consequences, largely because it prevented escalation of drinking after starting college. In contrast, at British universities where alcohol education is not mandatory, a trial of another web-based intervention based on correcting normative beliefs produced unconvincing results, partly because so few students responded to the attempt to re-assess their drinking. More convincing was not the results of being given normative feedback, but of having one’s drinking spotlighted by joining the study and completing the initial assessment.

Why the patchy record?

Part of the reason for the inconsistency in findings seems to be that more distant (eg, ‘Pupils of my age in this country’) comparators are less influential than closer ones (eg, ‘My closest friends’). Yet youngsters who drink, smoke or use drugs probably do have friends who do much the same. There is also the risk that cliques which pride themselves on prodigious consumption will feel validated rather than mortified to hear that the ‘typical’ student is more restrained. And many college students under-estimate heavy drinking among their peers; telling them the truth could be counterproductive.

One freely available critique has addressed the evidence for whether young people really do generally overestimate the substance use of their peers. If they do not, the foundation for normative education crumbles and with it the rationale for the approach being effective. It judges the phenomenon probably real, but that its prevalence and magnitude and therefore its influence are all much less than some research findings imply. Among the factors casting doubt on these implications are: the tendency of young people to say they drink or use drugs less than they do, creating the false impression that they believe other youngsters use more; methodological limitations meaning the survey results against which normative beliefs are compared may themselves underestimate substance use, and young people may be right in believing their peers use more than the surveys suggest; that youngsters who tend to be seen as ‘friends’ by other youngsters may really drink and use drugs more than youngsters less commonly seen as friends; many youngsters have (unless this is demanded of them by a question set by researchers) no idea how much a typical student drinks or uses drugs, and when asked, the meaning they ascribe to ‘typical’ may not match the researcher’s intention; being asked about their own substance use primes youngsters to exaggerate the use of their peers in order not to appear out of line.

The critic’s conclusions were strongly contested, but in a freely available reply she stuck to her guns, and made the further point that few high quality studies have supported normative approaches, perhaps because to the extent that young people do overestimate the substance use of their peers, their do so in respect of groups not socially close to them, and therefore least likely to influence their behaviour.

Normative education has not turned out to be a preventive ‘silver bullet’, but neither is it a dud – just more complicated and more limited than at first it seemed. See what you think after running this hot topic search.

Last revised 02 January 2015. First uploaded 01 May 2010

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