School-based programmes that seem to work: Useful research on substance use prevention or suspicious stories of success?
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School-based programmes that seem to work: Useful research on substance use prevention or suspicious stories of success?

Pape H.
Nordic Studies on Alcohol and Drugs: 2009, 26(6), p. 521–535.
Unable to obtain a copy by clicking title? Try asking the author for a reprint by adapting this prepared e-mail or by writing to Dr Pape at You could also try this alternative source.

According to a commentator, this "trenchant critique" of the evidence for school-based alcohol and drug prevention curricula is "unfortunately, largely on target". The focus is on methodological concerns which might undermine positive findings, and on whether these survive a programme's transplantation to real-world conditions.

Summary School-based prevention programmes targeted at adolescent substance use rarely seem to have the desired effects on behaviour, but a few outcome studies do conclude that such programmes have been successful. Nevertheless the body of published research in this field may be a source of greater optimism than is justified due to underreporting of studies which found no effects or counterproductive effects, and publication bias in favour of positive findings.

Nearly all the studies have been carried out by programme developers; as is well known, researchers with vested interests are more likely to bring 'good news' than independent researchers. Rather than approaching the field with critical reflection, some evaluators have intended to prove that school-based prevention works and have conducted their research accordingly. Examples of questionable analytical approaches and selective reporting of positive findings are consequently not hard to find.

The applicability to routine practice of evaluation studies with apparently favourable outcomes is often questionable, because almost exclusively they have assessed the effects of programmes delivered under optimal rather than real-life conditions.

In conclusion, the empirical 'evidence' in favour of school-based substance use prevention programmes is generally weak and does not permit a recommendation for the widespread dissemination of any specific programme. School-based programmes might instead be diverted from the unrealistic objective of reducing pupils' substance use to factual teaching. A more appropriate target for education which seeks to reduce alcohol-related harm might be to engender support for truly effective prevention policies such as raising prices and restricting availability.

Findings logo commentary In one easy-to-read article, the author from the Norwegian Institute for Alcohol and Drug Research brings together the most telling methodological criticisms of research on the effectiveness of school-based substance use prevention programmes. The same issue of the journal included commentaries on the article and the author's reply. Despite the more or less accepted weaknesses of the research base, neither these nor the original article argue for school-based drug education to be abandoned, either because programmes might really be effective yet not so far shown to be by robust research, improvements might create more effective programmes, and/or because education has roles other than prevention.

While findings on substance use education programmes of the kind usually researched have been disappointing and subject to methodological concerns, it remains possible that the results of other school-based prevention programmes will prove more robust. Among these may be:
Counselling pupils identified at school as using substances.
• Education focused mainly on reducing harm from substance use rather than or as well as delaying use.
• Generic child development and classroom management programmes, including some conducted at school in the early years.

Also, while it does seem that the research does not support widespread deployment of alcohol/drug education in schools as a use prevention strategy, it has still been recommended by Britain's National Institute for Health and Clinical Excellence for potentially important roles including increasing knowledge, exploring attitudes, and developing decision-making, social and other life skills.

Among the specific targets of the featured critique are the following issues also addressed in Effectiveness Bank analyses:
• Questions over the supposed superiority of drug education programmes delivered through interactive teaching methods.
• Limitations of research on the Life Skills Training curriculum, widely considered the most securely evidenced substance use education programme for schools.
• Findings that trials conducted by independent researchers do not replicate the more positive findings from research conducted by the developers of school-based substance use prevention programmes (1 2).
• When more widely disseminated in more real-world conditions, programmes found effective in small studies in selected schools with highly trained and supervised teachers or external specialists have sometimes not maintained their promise.
• Sometimes the above two limitations go together, more real-world studies by independent researchers failing to replicate the more positive findings of research conducted by the developers in smaller studies under optimal conditions.

See also this Effectiveness Bank hot topic for a discussion of drug education in general.

Thanks for their comments on this entry in draft to research author Hilde Pape of the Norwegian Institute for Alcohol and Drug Research. Commentators bear no responsibility for the text including the interpretations and any remaining errors.

Last revised 09 October 2013. First uploaded 30 September 2013

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