International Journal of the Addictions
ISSN: 0020-773X (Print) (Online) Journal homepage: http://www.tandfonline.com/loi/isum19
Research Design in Drug Abuse Prevention: Review and Recommendations Brenna H. Bry To cite this article: Brenna H. Bry (1978) Research Design in Drug Abuse Prevention: Review and Recommendations, International Journal of the Addictions, 13:7, 1157-1168, DOI: 10.3109/10826087809039333 To link to this article: http://dx.doi.org/10.3109/10826087809039333
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The lnternational Journal of the Addictions, 13(7), 1157-1 168, 1978
Research Design in Drug Abuse Prevention: Review and Recommendations Brenna H. Bry,” Ph.D. Monmouth County Board of Drug Abuse Services West Long Branch, New Jersey 07764
Abstract
This paper highlights the strengths and notes the deficits in recent drug abuse prevention research design. Then it recommends that future studies include: .(1) a longer follow-up period than 2 years, (2) a population “at risk” for drug abuse, (3) a “natural setting,” (4) random assignment to program and nonprogram groups, and ( 5 ) objective drug use interviews along with unobtrusive measures of the correlates of drug abuse. The rationale behind each recommendation is discussed. Research design in drug abuse prevention has become more sophisticated every year. This paper will analyze the design features of significant studies, make recommendations regarding the design of future studies, and explain the rationale behind those recommendations. *Present address: Graduate School of Applied and Professional Psychology, Rutgers University, P.O. Box 819, Piscataway, New Jersey 08854. 1157 Copyright @ 1978 by Marcel Dekker, Inc. All Rights Reserved. Neither this work nor any part may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, microfilming, and recording, or by any information storage and retrieval system, without permission in writing from the publisher.
BRY
I ISX
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RECENT STUDIES Tahles 1. 2. and 3 summarize the research design features of sehei-al studies into the effects of drug abuse prevention programs. Swisher and his colleagues published the first series of experiments (Swisher and (’rawford. 1971; Swisher et al., 1972; Warner et al., 1973).They are known for having added the feature of random assignment to research design in drug abuse prevention. They found that each program that they studied (including regular health classes) significantly affected either the knowledge or attitudes of students, but no program affected reported drug use. They suggested that further research should have a longer follow-up period. The research group also suggested two further reasons why their programs produced no socially relevant results. First, the groups that AI ere formed for the 5 to 6 week prevention programs contained students who did n o t know each other and may never have seen each other again. Second. the prevention programs were conducted by strangers with insufficient training that the students would never see again instead of by counselors practicing in the schools. Blum and Associates (1975) corrected the “artificial student groupings” and the “short time” features of Swisher’s work. Blum et al. rnndomly assigned whole, intact classrooms to their three experimental programs, each of which lasted from 1 to 23 years. The researchers found that more students who had been in their two comprehensive prevention programs (vs those students in mere health classes) increased their drug use slightly during the study. On the other hand, more of the control group (health classes) students increased their drug use to an estremr degree than did the students who had had the more comprehensive programs. Thus Blum’s conclusion is that perhaps prevention programs stimulate a small increase in drug use, but they reduce the chance of students increasing their drug use to a great degree. It would be very inliresting to follow those students for a longer period of time and study IIG:L\ many in each group actually begin abusing drugs to the degree that thcir life functioning becomes impaired. An anecdote in Blum et al.’s report (1975), however, suggests that their programs may not apply to some of the students who have the greatest chance of abusing drugs. It is known that high absenteeism and school dropout correlate with drug abuse (Jessor, 1976: Kandel. 1975b; Winburn and Hays, 1974). Yet Blum states that students with high
RESEARCH DESIGN IN DRUG ABUSE PREVENTION
1159
Table 1 Past Studies of Effects of Drug Prevention Programs (see also Tables 2 and 3 ) Types of subjects
Number of subjects
Types of programs
Swisher and Crawford (1971)
All students in a private high school (9-12 graders)
207
Swisher et al. (1972)
9th and 1l t h graders
216
Warner et al. (1973)
9th graders
119
Visco and Finotti (1974)
10th and 11th graders from 3 urban high schools who had adjustment problems 7-10th graders in many kinds of schools
600
(a) 9th grade-3 one-hour small group discussions (b) 10th and 1I th grades-] information session and then 1 two-hour small group discussion (c) 12th grade-1 ex-addicts session and then 1 two-hour small group discussion Once a week group meetings of 4 different types: reinforcement counseling with nondrug abusing models, reinforcement counseling with exdrug-abusing role models, relationship counseling, and control (regular health class) Once a week group meetings of 4 different types : behavioral counseling, cognitive dissonance, placebo, and control (regular health class) Establishment of an intervention center in the school with once a week student group meetings, student activities, and outreach programs for parents and teachers
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Investigators
Kleber et al. (1 975)
Blum and Associates (1975) Bry and George (1977a)
2-10th graders in different schools 7th graders “at risk” in two suburban middle schools
4,500
2,908
40
Assemblies Regular classwork Special course Staff training Staff training plus at least two of the above Absence of each type of program Didactic information Values clarification and discussion Control (regular health classes) Once a week small group meetings where students discuss and earn points for behaviors which are alternatives to drug abuse. Parents and teachers are kept continually informed (continued)
BRY
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Table 1 (continued) -
Investigators
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Bry and George ( I 977b)
Types of subjects 7th graders "at risk" in large urban junior high school
Number of subjects
Types of programs
40
Once a week small group meetings where students discuss and earn points for behaviors which are alternatives to drug abuse. Parents and teachers are kept continually informed
Table 2 Past Studies of Effects of Drug Prevention Programs Who implemented programs
Length of programs
Swisher and Crawford (1971) Swisher et al. ( 1972)
School personnel
3 hours
Pre vs post scores within and between program groups
Investigators
6 weeks
Warner et al. (1973)
Investigators
6 weeks
Viscn and Finotti ( 1974)
School personnel
2 years
Kleber et al. (1975)
School personnel
Varied
Bluni and Associates (1975)
Investigators
Bry and George (1977a) Bry and George (1977b)
Investigators
(a) 1-2& years (b) 1-24 years (c) 3 classes per year 2 years
Random assignment to 4 different programs (including regular health class) Random assignment to 4 treatments, including placebo and control (health classes) Program subjects were self-selected and compared with post-hoc comparison group identified by 1 to 1 matching o n premeasures Quasi-experimental pre-post comparisons over a 2-year period among participants in 5 types of drug education programs vs the absence of those programs Random assignment of whole classrooms among 2 prevention programs and control condition (health classes) Random assignment to program and control groups
Investigators
2 years
Investigators
Research design
Random assignment to program and control groups
1161
RESEARCH DESIGN I N D R U G ABUSE PREVENTION
Table 3 Past Studies of Effects of Drug Prevention Programs Investigators
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Swisher and Crawford (1971)
Swisher et al. (1 972)
Warner et al. (1973)
Visco and Finotti (1 974)
Kleber et al. (1975)
Blum and Associates (1975)
Significant findings
Study limitations
All programs increased knowledge; n o programs changed attitudes or drug behavior
No control group; programs too short; programs not designed for students “at risk”; paper and pencil measure of drug behavior; no unobtrusive measures of behavioral correlates of drug abuse; no long-term follow-up All 4 programs inPrograms too short; programs not designed creased knowledge ; for students “at risk”; paper and pencil no programs changed measure of drug behavior; n o unobtruattitudes or drug sive measures of behavioral correlates of behavior drug abuse; programs not part of “natural setting”; no long-term follow-up Behavioral counseling Programs too short; programs not designed produced significantly for students “at risk”; no measure of drug behavior; no unobtrusive measures greater increase in positive attitudes of behavioral correlates of drug abuse; toward alternatives to programs not part of “natural setting”; no long-term follow-up drug abuse than did cognitive dissonance or placebo, but behavioral counseling showed no dilqerences from the control condition No randomly assigned control groups; no Program students showed less druglong-term follow-up related referrals ; less antisocial behavior ; fewer absences ; higher grades All programs prevented No randomly assigned control groups; some programs too short; programs not large increases in designed for students “at risk”; paper drug use among older and pencil measure of drug behavior; n o students; all prounobtrusive measures of behavioral grams increased drug correlates of drug abuse; no long-term use among 7th follow-up graders Programs not designed for students “at Both didactic and risk“; paper and pencil measure of drug values discussion probehavior; no unobtrusive measures of grams produced more behavioral correlates of drug abuse; n o slight change in drug (continued)
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Table 3 (continued) Investigators
Significant findings
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~
Study limitations ~~
Bry and George (1977a) Bry and George (1977b)
use than control condition did, but they prevented more students from increasing their drug use to a great extent than the control condition did Program prevented deterioration in attendance and improved grades Program prevented deterioration in attendance and grades
~
~~
~
long-term follow-up
No measure of drug behavior; program not part of “natural setting”; no longterm follow-up No measure of drug behavior ; program not part of “natural setting”, no longterm follow-up
absenteeism did not experience the full prevention programs, and students w h o dropped out of school before the end of the study were not included in the school-based data collection at all. The atudy that was completed by Kleber et al. (1975) had the same limitation. Kleber et al.’s study (I975j did include an important feature that none of the above studies had; they studied the effects of programs in their “natural settings.” With relevance, however, come research design difficulties. Kleber et al. (1975) were not able to randomly assign schools and grades to experimental and control conditions, for the schools had dccided themselves whether or not they were going to offer a particular prevention program to a particular grade level. Thus, whereas Kleber et al.‘s results appear to indicate that prevention programs slow the normal increase in drug use among older students, there is no guarantee that their results could not be accounted for by differences between the program and nonprogram schools before the programs were implemented. Visco and Finotti (1974) conducted another “natural setting“ in\ tstigation where random assignment was not possible. They conducted a n evaluation of the SPARK program. They tried to overcome the fact that they could not randomize by matching every program student in the study with a nonprogram student who had had similar scores on the dependent variables before the program began. These variables were
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RESEARCH D E S I G N I N D R U G ABUSE P R E V E N T I O N
1163
attendance, grades, “acting out” events in the school records, and drugrelated referrals-all correlates of drug abuse. These measures are very unobtrusive (Webb et al., 1966) compared with the measures used !i the above studies. Visco and Finotti did not have to rely upon self-report, nor could their data be affected by the presence of program personnel. These researchers had one other advantage over the above investigators. Because their program was designed for students “at risk” for drug abuse, the expected rate of drug abuse was much higher in Visco and Finotti’s population, so they could measure program effects against a very substantial baseline. The preliminary results of the SPARK program looked so promising (Buder, 1973) that Bry (1974) began a research effort designed to provide a more controlled test of such a program’s effects. Her true experimental design led to high levels of confidence in the results obtained. Nonparametric tests showed that the programs slowed or prevented the natural increase in the correlates of drug abuse among students “at risk” in both suburban and urban settings (Bry and George, 1977a, 1977b). Her studies lacked evidence, however, about the effect of the prevention programs upon drug use itself. Her populations were too young at the end of the two years to have a significant base rate of drug abuse. Her studies also lacked the “natural setting” feature that some of the other studies had; her programs were conducted by research personnel.
R ECO M M EN DATlO N S Consequently, it is recommended that the next studies in drug abuse prevention include the following features: 1. A follow-up period longer than 2 years. 2. A population that includes students who are absent often and young people who have dropped out of school. 3. A “natural setting,” i.e., a program that has been adopted by school personnel who have been trained for the purpose of long-term service, not research. 4. Random assignment of students to program and nonprogram groups. 5 . Drug use interviews by someone not connected with the prevention program along with unobtrusive measures of the correlates of drug abuse.
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RAT I0NA L E
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Why Study the Long-Term Effects of a Program?
The long-term effects of a program can be entirely different than the short-term effects. For instance, Kelly and Baer (1969) reported significant positive short-term effects from placing juvenile delinquents in the Outward Bound program. A five-year follow-up (Baer et al., 1975) revealed, however, that 40:;) of the delinquents were back in penal institutions or training schools. Jackson et al. (1975) had the opposite experience. Whereas their elementary school early identification and counseling project showed only weak etrects at the end of 24 years, an %year follow-up revealed several socially significant effects. Cantoni (1955) and Campbell (1965) have also reported long-term program effects that were not evident when short-term effects were examined. Why Focus on Students with School Adjustment Problems?
Enough is known about the correlates of drug abuse now that prevention programs can be more efficiently focused than they were when they were directed at the whole student body. According to 1974 data from Sail Mateo, California (Blackford, 1974), between 56 and 60"!,, of high school juniors were not using marijuana, amphetamines, or LSD significantly (on more than 9 and 2 occasions during the year, respectively) and Lewis (1973) reports that only 57; of drug users became drug abusers. Thus the majority of young people do not need a drug abuse prevention program. These data also imply that a researcher who includes a whole student body in the control group will have very low base rates of drug abuse against which to compare the effects of a prevention program. The students who should be included in drug abuse prevention programs have been described by many researchers who have studied the correlates of drug abuse. Low academic attendance, motivation. and achievement correlate with drug abuse (Gossett et al., 1972: Jessor, 1976: Kandel. 1975b: Smith and Fogg. 1974: Streit and Oliver, 1972). Drug abusers also have longer discipline records in schools and are more rebellious (Cockett, 1971; Smith and Fogg, 1974). Family foundation correlates with drug abuse too. Drug abusers do not feel as close to their families as do other youth (Jessor, 1976; Streit and Oliver, 1972: Tec, 1970). Some have older siblings with significant problems (Rosenberg,
RESEARCH DESIGN IN D R U G ABUSE PREVENTION
1165
1971), and the parents of some abusers use and misuse drugs and alcohol themselves (Blum and Associates, 1972; Haastrup and Thomsen, 1972). Consequently the long-term effects of a drug abuse prevention program upon students with these characteristics should be studied.
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Why Is It Important to Study the Effects of a Program in a “Natural Setting”?
As Miran et al. (1974) show, the context of a school-based program is probably more important in determining the long-term effects of a program than program content. Their program had significant short-term effects, but lack of acceptance of the program by the school system led to a reversal of the effects. Thus it is important to study the effects of a program that has been “institutionalized” in a school system rather than one developed only for the purpose of research. Why Is a Randomly Assigned Control Group Important?
Interpreting the results of any quasi-experimental design is difficult because there is always the possibility that an extraneous variable accounts for group differences instead of the presence or absence of a program. Another very important reason for having a control group in drug abuse prevention research is that program effectiveness often is represented by pre-post measures staying the same (Bry and George, 1977a) or even by pre-post measures deteriorating a small amount instead of a large amount (Blum and Associates, 1975; Bry and George, 1977a, 1977b). Such results would be interpreted as “no effects” or “detrimental effects” if it were not for control group data showing that the pre-post measures would have deteriorated to an even larger extent if subjects had not been in a program. Why Should Program Effects Be Assessed by Both Interviews and Unobtrusive Measures?
Drug abuse programs are established to reduce the amount of drug abuse. The common definition of drug abuse is drug use correlated with impaired personal functioning. In the absence of drug abuse, a prevention program tries to reduce the correlates of drug abuse, i.e., tobacco and alcohol use (E‘rendergast et al., 1973; Backhouse and Pierce, 1969), antisocial behavior (Milman, 1969; Wechsler and Thum, 1973), poor
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scliool achievement and attendance (Blum and Associates, 1975; Smith and Fogg, 1974), poor employment achievement and attendance (Joe, 1975). and lack of organized leisure activities (Freedman and Brotman. 1969: Jessor, 1976). Thus drug use plus each of the above-mentioned correlates should be measured in studying the long-term effects of drug Libuse prevention. There are several excellent reviews on how to construct and administer interviews about sensitive information such as drug use (Abrams et 211.. 1 9 3 : Kandcl. 1975a: Richards and Cisin. 1975; Weiss. 1975).It is importaiit to usc interviews rather than paper and pencil questionnaires for at least txn reasons. First, Luetgert and Armstrong (1973) report that more usc is reported in interviews than on questionnaires. Also, the reading level (or motivation) o f some students “at risk” is so low that the rcliabilit? of their answers on a paper and pencil test is low. REFERENCES
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CANTONI, L.J. Long-term effects of the Flint, Michigan guidance experiment. Psychol. Rep. 1: 359-362, 1955. COCKETT, R. Drug Abuse and Personaliry it7 Young Offenders. New York: AppletonCentury-Crofts, 1971. FREEDMAN, A.M., and BROTMAN, R.E. Multiple drug use among teenagers: Plans for action-research. In J . R. Wittenborn, H. Brill, J. P. Smith, and S. A. Wittenborn (eds.) Drugs and Youth. Proceedings of the Rutgers Symposium on Drug Abuse. Springfield, Illinois: Thomas, 1969, pp. 335-344. GOSSETT, J.T., LEWIS, M.J., and PHILLIPS, V.A. Psychological characteristics of adolescent drug users and abstainers. Bull. Menninger Clin. 36: 425-435, 1972. HAASTRUP, S., and THOMSEN, K . The social backgrounds of young addicts as elicited in interviews with their parents. Acra P.qdiiatr. Scand. 48: 146-173, 1972. JACKSON, R.. CLEVELAND. J.. and MERENDA. P. The longitudinal effects of early identification and counseling of underachievers. J . Sch. Psychol. 13: 119-128, 1975. JESSOR, R. Predicting time of onset of‘ marijuana use: A developmental study of high school youth. J . Consult. Clin.Psychol. 44: 125-134, 1976. JOE, G.W. A Reanaly.~isqf Robins’s Data. Paper presented at the meeting of the Alcohol and Drug Abuse Problems Association, Chicago, September 1975. KANDEL, D. The measurement of “ever use” and “frequency-quantity” in drug use surveys. In J. Elinson, and D . Nurco (eds.) Operationu1 Definitions in Socio-hrhuI’iord Drug L’se Resecrrc/r. Rockville, Maryland: National Institute of Drug Abuse, 1975a. KANDEL. D. Reaching the hard-to-reach: Illicit drug use among high school absentees. Addict. Dis. 1 : 405 480. 1975b. KELLY. F.J., and BAER, D.J. Jesness Inventory and self-concept measures for delinquents before and after participation in Outward Bound. Psychol. Rep. 25: 719-724, 1969. KLEBER. H.D., BERBERIAN, R.M., GOULD, L.C., and KASL, S.V. Evaluatior7 o f u n Adolescent Drug Education f r o g r u m (Final Report of NIDA Grant No. DA-00055). Rockville, Maryland: National Institute of Drug Abuse, 1975. LEWIS, J.M. The multiple drug user. T i ~ zMed. . 69(10): 59-62, 1973. LUETGERT, M.J., and ARMSTRONG. A.H. Methodological issues in drug usage surveys: Anonymity, recency, and frequency. Int. J . Addict. 8: 683-689, 1973. MILMAN, D.H. The role of marihuana in patterns of drug abuse by adolescents. J . Pediutr. 74: 283 - 290, 1969. MIRAN. M., LEHRER, P.M., KOEHLER, R., and MIRAN, E. What happens when deviant behavior begins to change? The relevance of a social systems approach for behavioral programs with adolescents. Community Psychol. 2: 370-375, 1974. PRENDERGAST, T.J., PREBLE, M.R., and TENNANT, F.S. Drug use and its relation to alcohol and cigarette consumption in the military community of West Germany (drugs, alcohol, cigarettes in a military setting). h i t . J . Addict. 8: 741-754, 1973. RICHARDS, L., and CISIN, I. Measures of currency or recency of drug abuse. In J. Elinson, and D . Nurco (eds.) Operational Definirions ii7 Socio-behavioral Drug Use Resecrrch. Rockville, Maryland: National Institute of Drug Abuse, 1975. ROSENBERG, C. The young addict and his family. Br. J . Psychiarry 118: 469-470, 1971. SMITH, G.M., and FOGG, C.P. Teenage Drug Use: A Search for Ctruses and Conscquences. Paper presented at the meeting of the American Psychological Association, New Orleans, September 1974. STREIT, F., and OLIVER, H.G. The child’s perception of his family and its relationship to drug use. Drug Forum 1: 283-289. 1972.
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I IhS
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SWISHEK. J.D., and C R A W F O R D . J.L., J R . An evaluation of a short-term drug education program. Sdi. Counselor March: 265- 272, 1971. SWISHER. J.D.. W A R N E R , R.W., JR., and H E R R , E.L. Experimental comparison o l f o u r ,ipproaches 10 drug abuhe prevention among ninth and eleventh graders. J . C ' o r r r r w l . P\I.
ISSN: 0020-773X (Print) (Online) Journal homepage: http://www.tandfonline.com/loi/isum19
Research Design in Drug Abuse Prevention: Review and Recommendations Brenna H. Bry To cite this article: Brenna H. Bry (1978) Research Design in Drug Abuse Prevention: Review and Recommendations, International Journal of the Addictions, 13:7, 1157-1168, DOI: 10.3109/10826087809039333 To link to this article: http://dx.doi.org/10.3109/10826087809039333
Published online: 03 Jul 2009.
Submit your article to this journal
Article views: 3
View related articles
Citing articles: 3 View citing articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=isum19 Download by: [UNSW Library]
Date: 25 April 2016, At: 18:49
Downloaded by [UNSW Library] at 18:49 25 April 2016
The lnternational Journal of the Addictions, 13(7), 1157-1 168, 1978
Research Design in Drug Abuse Prevention: Review and Recommendations Brenna H. Bry,” Ph.D. Monmouth County Board of Drug Abuse Services West Long Branch, New Jersey 07764
Abstract
This paper highlights the strengths and notes the deficits in recent drug abuse prevention research design. Then it recommends that future studies include: .(1) a longer follow-up period than 2 years, (2) a population “at risk” for drug abuse, (3) a “natural setting,” (4) random assignment to program and nonprogram groups, and ( 5 ) objective drug use interviews along with unobtrusive measures of the correlates of drug abuse. The rationale behind each recommendation is discussed. Research design in drug abuse prevention has become more sophisticated every year. This paper will analyze the design features of significant studies, make recommendations regarding the design of future studies, and explain the rationale behind those recommendations. *Present address: Graduate School of Applied and Professional Psychology, Rutgers University, P.O. Box 819, Piscataway, New Jersey 08854. 1157 Copyright @ 1978 by Marcel Dekker, Inc. All Rights Reserved. Neither this work nor any part may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, microfilming, and recording, or by any information storage and retrieval system, without permission in writing from the publisher.
BRY
I ISX
Downloaded by [UNSW Library] at 18:49 25 April 2016
RECENT STUDIES Tahles 1. 2. and 3 summarize the research design features of sehei-al studies into the effects of drug abuse prevention programs. Swisher and his colleagues published the first series of experiments (Swisher and (’rawford. 1971; Swisher et al., 1972; Warner et al., 1973).They are known for having added the feature of random assignment to research design in drug abuse prevention. They found that each program that they studied (including regular health classes) significantly affected either the knowledge or attitudes of students, but no program affected reported drug use. They suggested that further research should have a longer follow-up period. The research group also suggested two further reasons why their programs produced no socially relevant results. First, the groups that AI ere formed for the 5 to 6 week prevention programs contained students who did n o t know each other and may never have seen each other again. Second. the prevention programs were conducted by strangers with insufficient training that the students would never see again instead of by counselors practicing in the schools. Blum and Associates (1975) corrected the “artificial student groupings” and the “short time” features of Swisher’s work. Blum et al. rnndomly assigned whole, intact classrooms to their three experimental programs, each of which lasted from 1 to 23 years. The researchers found that more students who had been in their two comprehensive prevention programs (vs those students in mere health classes) increased their drug use slightly during the study. On the other hand, more of the control group (health classes) students increased their drug use to an estremr degree than did the students who had had the more comprehensive programs. Thus Blum’s conclusion is that perhaps prevention programs stimulate a small increase in drug use, but they reduce the chance of students increasing their drug use to a great degree. It would be very inliresting to follow those students for a longer period of time and study IIG:L\ many in each group actually begin abusing drugs to the degree that thcir life functioning becomes impaired. An anecdote in Blum et al.’s report (1975), however, suggests that their programs may not apply to some of the students who have the greatest chance of abusing drugs. It is known that high absenteeism and school dropout correlate with drug abuse (Jessor, 1976: Kandel. 1975b; Winburn and Hays, 1974). Yet Blum states that students with high
RESEARCH DESIGN IN DRUG ABUSE PREVENTION
1159
Table 1 Past Studies of Effects of Drug Prevention Programs (see also Tables 2 and 3 ) Types of subjects
Number of subjects
Types of programs
Swisher and Crawford (1971)
All students in a private high school (9-12 graders)
207
Swisher et al. (1972)
9th and 1l t h graders
216
Warner et al. (1973)
9th graders
119
Visco and Finotti (1974)
10th and 11th graders from 3 urban high schools who had adjustment problems 7-10th graders in many kinds of schools
600
(a) 9th grade-3 one-hour small group discussions (b) 10th and 1I th grades-] information session and then 1 two-hour small group discussion (c) 12th grade-1 ex-addicts session and then 1 two-hour small group discussion Once a week group meetings of 4 different types: reinforcement counseling with nondrug abusing models, reinforcement counseling with exdrug-abusing role models, relationship counseling, and control (regular health class) Once a week group meetings of 4 different types : behavioral counseling, cognitive dissonance, placebo, and control (regular health class) Establishment of an intervention center in the school with once a week student group meetings, student activities, and outreach programs for parents and teachers
Downloaded by [UNSW Library] at 18:49 25 April 2016
Investigators
Kleber et al. (1 975)
Blum and Associates (1975) Bry and George (1977a)
2-10th graders in different schools 7th graders “at risk” in two suburban middle schools
4,500
2,908
40
Assemblies Regular classwork Special course Staff training Staff training plus at least two of the above Absence of each type of program Didactic information Values clarification and discussion Control (regular health classes) Once a week small group meetings where students discuss and earn points for behaviors which are alternatives to drug abuse. Parents and teachers are kept continually informed (continued)
BRY
I I60
Table 1 (continued) -
Investigators
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Bry and George ( I 977b)
Types of subjects 7th graders "at risk" in large urban junior high school
Number of subjects
Types of programs
40
Once a week small group meetings where students discuss and earn points for behaviors which are alternatives to drug abuse. Parents and teachers are kept continually informed
Table 2 Past Studies of Effects of Drug Prevention Programs Who implemented programs
Length of programs
Swisher and Crawford (1971) Swisher et al. ( 1972)
School personnel
3 hours
Pre vs post scores within and between program groups
Investigators
6 weeks
Warner et al. (1973)
Investigators
6 weeks
Viscn and Finotti ( 1974)
School personnel
2 years
Kleber et al. (1975)
School personnel
Varied
Bluni and Associates (1975)
Investigators
Bry and George (1977a) Bry and George (1977b)
Investigators
(a) 1-2& years (b) 1-24 years (c) 3 classes per year 2 years
Random assignment to 4 different programs (including regular health class) Random assignment to 4 treatments, including placebo and control (health classes) Program subjects were self-selected and compared with post-hoc comparison group identified by 1 to 1 matching o n premeasures Quasi-experimental pre-post comparisons over a 2-year period among participants in 5 types of drug education programs vs the absence of those programs Random assignment of whole classrooms among 2 prevention programs and control condition (health classes) Random assignment to program and control groups
Investigators
2 years
Investigators
Research design
Random assignment to program and control groups
1161
RESEARCH DESIGN I N D R U G ABUSE PREVENTION
Table 3 Past Studies of Effects of Drug Prevention Programs Investigators
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Swisher and Crawford (1971)
Swisher et al. (1 972)
Warner et al. (1973)
Visco and Finotti (1 974)
Kleber et al. (1975)
Blum and Associates (1975)
Significant findings
Study limitations
All programs increased knowledge; n o programs changed attitudes or drug behavior
No control group; programs too short; programs not designed for students “at risk”; paper and pencil measure of drug behavior; no unobtrusive measures of behavioral correlates of drug abuse; no long-term follow-up All 4 programs inPrograms too short; programs not designed creased knowledge ; for students “at risk”; paper and pencil no programs changed measure of drug behavior; n o unobtruattitudes or drug sive measures of behavioral correlates of behavior drug abuse; programs not part of “natural setting”; no long-term follow-up Behavioral counseling Programs too short; programs not designed produced significantly for students “at risk”; no measure of drug behavior; no unobtrusive measures greater increase in positive attitudes of behavioral correlates of drug abuse; toward alternatives to programs not part of “natural setting”; no long-term follow-up drug abuse than did cognitive dissonance or placebo, but behavioral counseling showed no dilqerences from the control condition No randomly assigned control groups; no Program students showed less druglong-term follow-up related referrals ; less antisocial behavior ; fewer absences ; higher grades All programs prevented No randomly assigned control groups; some programs too short; programs not large increases in designed for students “at risk”; paper drug use among older and pencil measure of drug behavior; n o students; all prounobtrusive measures of behavioral grams increased drug correlates of drug abuse; no long-term use among 7th follow-up graders Programs not designed for students “at Both didactic and risk“; paper and pencil measure of drug values discussion probehavior; no unobtrusive measures of grams produced more behavioral correlates of drug abuse; n o slight change in drug (continued)
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Table 3 (continued) Investigators
Significant findings
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Study limitations ~~
Bry and George (1977a) Bry and George (1977b)
use than control condition did, but they prevented more students from increasing their drug use to a great extent than the control condition did Program prevented deterioration in attendance and improved grades Program prevented deterioration in attendance and grades
~
~~
~
long-term follow-up
No measure of drug behavior; program not part of “natural setting”; no longterm follow-up No measure of drug behavior ; program not part of “natural setting”, no longterm follow-up
absenteeism did not experience the full prevention programs, and students w h o dropped out of school before the end of the study were not included in the school-based data collection at all. The atudy that was completed by Kleber et al. (1975) had the same limitation. Kleber et al.’s study (I975j did include an important feature that none of the above studies had; they studied the effects of programs in their “natural settings.” With relevance, however, come research design difficulties. Kleber et al. (1975) were not able to randomly assign schools and grades to experimental and control conditions, for the schools had dccided themselves whether or not they were going to offer a particular prevention program to a particular grade level. Thus, whereas Kleber et al.‘s results appear to indicate that prevention programs slow the normal increase in drug use among older students, there is no guarantee that their results could not be accounted for by differences between the program and nonprogram schools before the programs were implemented. Visco and Finotti (1974) conducted another “natural setting“ in\ tstigation where random assignment was not possible. They conducted a n evaluation of the SPARK program. They tried to overcome the fact that they could not randomize by matching every program student in the study with a nonprogram student who had had similar scores on the dependent variables before the program began. These variables were
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attendance, grades, “acting out” events in the school records, and drugrelated referrals-all correlates of drug abuse. These measures are very unobtrusive (Webb et al., 1966) compared with the measures used !i the above studies. Visco and Finotti did not have to rely upon self-report, nor could their data be affected by the presence of program personnel. These researchers had one other advantage over the above investigators. Because their program was designed for students “at risk” for drug abuse, the expected rate of drug abuse was much higher in Visco and Finotti’s population, so they could measure program effects against a very substantial baseline. The preliminary results of the SPARK program looked so promising (Buder, 1973) that Bry (1974) began a research effort designed to provide a more controlled test of such a program’s effects. Her true experimental design led to high levels of confidence in the results obtained. Nonparametric tests showed that the programs slowed or prevented the natural increase in the correlates of drug abuse among students “at risk” in both suburban and urban settings (Bry and George, 1977a, 1977b). Her studies lacked evidence, however, about the effect of the prevention programs upon drug use itself. Her populations were too young at the end of the two years to have a significant base rate of drug abuse. Her studies also lacked the “natural setting” feature that some of the other studies had; her programs were conducted by research personnel.
R ECO M M EN DATlO N S Consequently, it is recommended that the next studies in drug abuse prevention include the following features: 1. A follow-up period longer than 2 years. 2. A population that includes students who are absent often and young people who have dropped out of school. 3. A “natural setting,” i.e., a program that has been adopted by school personnel who have been trained for the purpose of long-term service, not research. 4. Random assignment of students to program and nonprogram groups. 5 . Drug use interviews by someone not connected with the prevention program along with unobtrusive measures of the correlates of drug abuse.
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RAT I0NA L E
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Why Study the Long-Term Effects of a Program?
The long-term effects of a program can be entirely different than the short-term effects. For instance, Kelly and Baer (1969) reported significant positive short-term effects from placing juvenile delinquents in the Outward Bound program. A five-year follow-up (Baer et al., 1975) revealed, however, that 40:;) of the delinquents were back in penal institutions or training schools. Jackson et al. (1975) had the opposite experience. Whereas their elementary school early identification and counseling project showed only weak etrects at the end of 24 years, an %year follow-up revealed several socially significant effects. Cantoni (1955) and Campbell (1965) have also reported long-term program effects that were not evident when short-term effects were examined. Why Focus on Students with School Adjustment Problems?
Enough is known about the correlates of drug abuse now that prevention programs can be more efficiently focused than they were when they were directed at the whole student body. According to 1974 data from Sail Mateo, California (Blackford, 1974), between 56 and 60"!,, of high school juniors were not using marijuana, amphetamines, or LSD significantly (on more than 9 and 2 occasions during the year, respectively) and Lewis (1973) reports that only 57; of drug users became drug abusers. Thus the majority of young people do not need a drug abuse prevention program. These data also imply that a researcher who includes a whole student body in the control group will have very low base rates of drug abuse against which to compare the effects of a prevention program. The students who should be included in drug abuse prevention programs have been described by many researchers who have studied the correlates of drug abuse. Low academic attendance, motivation. and achievement correlate with drug abuse (Gossett et al., 1972: Jessor, 1976: Kandel. 1975b: Smith and Fogg. 1974: Streit and Oliver, 1972). Drug abusers also have longer discipline records in schools and are more rebellious (Cockett, 1971; Smith and Fogg, 1974). Family foundation correlates with drug abuse too. Drug abusers do not feel as close to their families as do other youth (Jessor, 1976; Streit and Oliver, 1972: Tec, 1970). Some have older siblings with significant problems (Rosenberg,
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1971), and the parents of some abusers use and misuse drugs and alcohol themselves (Blum and Associates, 1972; Haastrup and Thomsen, 1972). Consequently the long-term effects of a drug abuse prevention program upon students with these characteristics should be studied.
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Why Is It Important to Study the Effects of a Program in a “Natural Setting”?
As Miran et al. (1974) show, the context of a school-based program is probably more important in determining the long-term effects of a program than program content. Their program had significant short-term effects, but lack of acceptance of the program by the school system led to a reversal of the effects. Thus it is important to study the effects of a program that has been “institutionalized” in a school system rather than one developed only for the purpose of research. Why Is a Randomly Assigned Control Group Important?
Interpreting the results of any quasi-experimental design is difficult because there is always the possibility that an extraneous variable accounts for group differences instead of the presence or absence of a program. Another very important reason for having a control group in drug abuse prevention research is that program effectiveness often is represented by pre-post measures staying the same (Bry and George, 1977a) or even by pre-post measures deteriorating a small amount instead of a large amount (Blum and Associates, 1975; Bry and George, 1977a, 1977b). Such results would be interpreted as “no effects” or “detrimental effects” if it were not for control group data showing that the pre-post measures would have deteriorated to an even larger extent if subjects had not been in a program. Why Should Program Effects Be Assessed by Both Interviews and Unobtrusive Measures?
Drug abuse programs are established to reduce the amount of drug abuse. The common definition of drug abuse is drug use correlated with impaired personal functioning. In the absence of drug abuse, a prevention program tries to reduce the correlates of drug abuse, i.e., tobacco and alcohol use (E‘rendergast et al., 1973; Backhouse and Pierce, 1969), antisocial behavior (Milman, 1969; Wechsler and Thum, 1973), poor
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scliool achievement and attendance (Blum and Associates, 1975; Smith and Fogg, 1974), poor employment achievement and attendance (Joe, 1975). and lack of organized leisure activities (Freedman and Brotman. 1969: Jessor, 1976). Thus drug use plus each of the above-mentioned correlates should be measured in studying the long-term effects of drug Libuse prevention. There are several excellent reviews on how to construct and administer interviews about sensitive information such as drug use (Abrams et 211.. 1 9 3 : Kandcl. 1975a: Richards and Cisin. 1975; Weiss. 1975).It is importaiit to usc interviews rather than paper and pencil questionnaires for at least txn reasons. First, Luetgert and Armstrong (1973) report that more usc is reported in interviews than on questionnaires. Also, the reading level (or motivation) o f some students “at risk” is so low that the rcliabilit? of their answers on a paper and pencil test is low. REFERENCES
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CANTONI, L.J. Long-term effects of the Flint, Michigan guidance experiment. Psychol. Rep. 1: 359-362, 1955. COCKETT, R. Drug Abuse and Personaliry it7 Young Offenders. New York: AppletonCentury-Crofts, 1971. FREEDMAN, A.M., and BROTMAN, R.E. Multiple drug use among teenagers: Plans for action-research. In J . R. Wittenborn, H. Brill, J. P. Smith, and S. A. Wittenborn (eds.) Drugs and Youth. Proceedings of the Rutgers Symposium on Drug Abuse. Springfield, Illinois: Thomas, 1969, pp. 335-344. GOSSETT, J.T., LEWIS, M.J., and PHILLIPS, V.A. Psychological characteristics of adolescent drug users and abstainers. Bull. Menninger Clin. 36: 425-435, 1972. HAASTRUP, S., and THOMSEN, K . The social backgrounds of young addicts as elicited in interviews with their parents. Acra P.qdiiatr. Scand. 48: 146-173, 1972. JACKSON, R.. CLEVELAND. J.. and MERENDA. P. The longitudinal effects of early identification and counseling of underachievers. J . Sch. Psychol. 13: 119-128, 1975. JESSOR, R. Predicting time of onset of‘ marijuana use: A developmental study of high school youth. J . Consult. Clin.Psychol. 44: 125-134, 1976. JOE, G.W. A Reanaly.~isqf Robins’s Data. Paper presented at the meeting of the Alcohol and Drug Abuse Problems Association, Chicago, September 1975. KANDEL, D. The measurement of “ever use” and “frequency-quantity” in drug use surveys. In J. Elinson, and D . Nurco (eds.) Operationu1 Definitions in Socio-hrhuI’iord Drug L’se Resecrrc/r. Rockville, Maryland: National Institute of Drug Abuse, 1975a. KANDEL. D. Reaching the hard-to-reach: Illicit drug use among high school absentees. Addict. Dis. 1 : 405 480. 1975b. KELLY. F.J., and BAER, D.J. Jesness Inventory and self-concept measures for delinquents before and after participation in Outward Bound. Psychol. Rep. 25: 719-724, 1969. KLEBER. H.D., BERBERIAN, R.M., GOULD, L.C., and KASL, S.V. Evaluatior7 o f u n Adolescent Drug Education f r o g r u m (Final Report of NIDA Grant No. DA-00055). Rockville, Maryland: National Institute of Drug Abuse, 1975. LEWIS, J.M. The multiple drug user. T i ~ zMed. . 69(10): 59-62, 1973. LUETGERT, M.J., and ARMSTRONG. A.H. Methodological issues in drug usage surveys: Anonymity, recency, and frequency. Int. J . Addict. 8: 683-689, 1973. MILMAN, D.H. The role of marihuana in patterns of drug abuse by adolescents. J . Pediutr. 74: 283 - 290, 1969. MIRAN. M., LEHRER, P.M., KOEHLER, R., and MIRAN, E. What happens when deviant behavior begins to change? The relevance of a social systems approach for behavioral programs with adolescents. Community Psychol. 2: 370-375, 1974. PRENDERGAST, T.J., PREBLE, M.R., and TENNANT, F.S. Drug use and its relation to alcohol and cigarette consumption in the military community of West Germany (drugs, alcohol, cigarettes in a military setting). h i t . J . Addict. 8: 741-754, 1973. RICHARDS, L., and CISIN, I. Measures of currency or recency of drug abuse. In J. Elinson, and D . Nurco (eds.) Operational Definirions ii7 Socio-behavioral Drug Use Resecrrch. Rockville, Maryland: National Institute of Drug Abuse, 1975. ROSENBERG, C. The young addict and his family. Br. J . Psychiarry 118: 469-470, 1971. SMITH, G.M., and FOGG, C.P. Teenage Drug Use: A Search for Ctruses and Conscquences. Paper presented at the meeting of the American Psychological Association, New Orleans, September 1974. STREIT, F., and OLIVER, H.G. The child’s perception of his family and its relationship to drug use. Drug Forum 1: 283-289. 1972.
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SWISHEK. J.D., and C R A W F O R D . J.L., J R . An evaluation of a short-term drug education program. Sdi. Counselor March: 265- 272, 1971. SWISHER. J.D.. W A R N E R , R.W., JR., and H E R R , E.L. Experimental comparison o l f o u r ,ipproaches 10 drug abuhe prevention among ninth and eleventh graders. J . C ' o r r r r w l . P\I.
