Challenging Dogma - Fall 2009

Thursday, December 17, 2009

DARE to Tell the Truth: The Story of an Ineffective Drug Intervention- Affan Ghaffari

I Introduction and Thesis
Since 1983, there has been a substance abuse program named DARE (Drug Abuse Resistance Education) that has littered middle schools and high schools across America costing 1-1.3 billion dollars per year (Shepherd, 2001). DARE has been excoriated by the U.S. Surgeon General (placing it under the category of ineffective programs), the National Academy of Sciences, and the Department of Education (Kalishman, 2003). There are three key reasons for failure of the program: its desultory and baffling underlying messages to youth, the iatrogenic effects of its multi-drug approach and its utilization of faulty scientific principles.
IA: What Is the DARE Program?
Before this paper delves into the criticisms of DARE, it is imperative to understand the DARE program and what it is about.
DARE is used in nearly 80% of the school districts in the United States and 54 other countries around the world educating 36 million children each year. DARE entails police officer conducting series of classroom lessons teaching children from kindergarten through 12th grade about how to resist peer pressure and live drug and violence-free lives. The DARE curriculum is designed to be taught by police officers whose training and experience supposedly gives them the background needed to answer the complex questions asked by school children concerning drugs and crime. Prior to entering the DARE program, officers undergo 80 hours of special training in areas such as child development, classroom management, teaching techniques, and communication to prepare them to teach the high school curriculum (
Moreover, the General Accounting Office (investigative arm of Congress) documented six different studies in three different locations concerning the effectiveness of the DARE campaign with middle school and high school children: Lexington (KY), Colorado Springs (CO), and Chicago (IL).
The three studies in Lexington were conducted between 1991 and 1999 in which the researchers were assessing the DARE program’s impact on marijuana use. In all three studies, there was no statistically significant difference between the DARE intervention and control group in terms of marijuana utilization.
The two studies in Colorado Springs took place between 1996 and 1997 and included behavioral and non-behavioral measures. In both the three and six year follow up studies, no statistically significant differences were found between the DARE intervention group and the control in use of illicit drugs, delay of experimentation with illicit drugs, self-esteem, and resistance to peer pressure.
The study in Chicago culminated in 1998 in which 18 schools received the DARE intervention and the other 18 did not receive the DARE intervention. There were no statistically significant differences between the groups in the actual use of illicit drugs in the one and six year follow ups, but those who utilized the DARE program reported more negative attitudes towards drugs, higher peer pressure resistance, and greater self esteem for the one year follow up, but these attitudes eroded in the six year follow up in which there was no statistically significant difference between the two groups in terms of attitudes towards drugs, peer pressure resistance, and self esteem. This clearly demonstrates the DARE program’s inability to precipitate strong long term effects in preventing alcohol and drug use.
In addition, a retrospective study was done at Kent State University assessing the long term effects of the DARE program on substance abuse amongst college undergraduates. The results from the multiple discriminant analysis utilized by this study found there were no substantial differences in substance use(alcohol, cigarette, marijuana) between individuals exposed to the DARE program and those who had no exposure to the DARE program in their K-12 environment (Thombs, 2002).
The 6 different studies and the retrospective study at Kent State University all illustrate DARE’s holistic inefficacy in attempting to curb alcohol and drug use in youth.
II Messages of DARE
The first underlying criticism of the DARE program resonates in the desultory and ineffectual manner in which their messages are framed. There are two messages in particular that severely enervate any credibility of the DARE program with their target adolescent audience. The first message involves the central slogan of DARE promulgating the adolescents’ “Right to Say No.” This “Right to Say No” further connotes the right to say yes, thereby nullifying the intended purpose of delivering this particular message. By utilizing vague terminology such as “right”, DARE clearly absolves adolescents from obligating themselves to abstain from drug use. Instead, this message merely suggests their decision to utilize drugs is voluntary. According to the Drug Reform Coordination Network, this message can only be viewed as “confused and muddled” as it does not categorically discourage kids to refrain from using drugs (DRCN, 2008). The danger of such vague language can be illustrated by the framing effect considering DARE’s formulation of a “right to say no” suggests that adolescents have a choice as to whether they should engage in drug utilization. The framing effect suggests the frame that a decision maker adopts is controlled partly by the formulation of the problem and by the norms, habits, and personal characteristics of the decision maker (Tversky & Kahneman, 1981). DARE formulates its own picture of the norms and habits of normal citizens in its video titled “Land of Decisions and Choices” in which all of the adults shown in the video are depicted as drunkards and substance abusers(DRCN, 2008). Since the adolescents are exposed by DARE’s perception of the norm in which people are generally alcohol and substance abusers, the individual adolescent will consider their “Right to Say No” and ultimately decide to engage in drugs due to the frame created by DARE in which the norm suggests one should succumb to drug use. Thus, the combination of DARE’s central slogan of the “right to say no” and the depiction of the norm in “Land of Decisions and Choices” serves to baffle adolescents on the actual implications of drug use, which may serve to elicit the counterproductive effects discussed later in this paper.
Another overarching flaw in DARE’s dissemination of its message on drug use resonates in its superfluous emphasis on long term and negative effects of alcohol use as well as smoking. The DARE curriculum as inculcated in public schools across the country tend to overemphasize long term effects of alcohol such as alcoholism, cirrhosis, and damage to the brain and interventions that emphasize these negative consequences tend to be ineffective in reducing alcohol use (D’Amico and Fromme, 2002). A study on alcohol related outcomes underscored the importance of framing messages on alcohol related outcomes in the immediate future versus the long term future. The study involved four different frames: gain and short term consequences (avoid immediate negative health consequences), gain and long term consequences (avoid long term negative health consequences), loss and short term consequences (experience immediate negative health consequences), and loss and long term consequences (experience long term negative health consequences). The results of the study indicated that when participants were edified with the short term consequences of alcohol, the participants exposed to a gain frame message reported lower alcohol use than those in the loss frame message. On the other hand, when participants were enlightened with the long term consequences of alcohol, there was no significant difference in alcohol use reported between participants in the gain and loss frame. Furthermore, those participants exposed to immediate benefits of limited alcohol use reported drinking fewer alcoholic beverages per occasion, drinking less frequently, and engaging in less binge drinking during the course of the one month follow up. Ergo, the results of the study indicate that asking people to consider the benefits associated with avoiding a risky health behavior is more effective than asking them to consider the costs of that risky health behavior, but only when these health outcomes occur within a short term framework (Gerend&Cullen, 2008).
A similar result was obtained when comparing short (stained teeth and hands, bad breath, burdensome financial expenses associated with cigarette smoking) and long term frames (lung cancer) of smoking consequences in which programs emphasizing short term consequences of smoking were significantly more efficacious in curbing both cigarette utilization and addiction than programs emphasizing long term consequences of smoking (Mahler et al, 2003). Thus, the framing effect consummately exposes the inherent flaws associated with the rhetoric of the DARE intervention.

III Inefficacy of DARE Multi-Drug Approach
The second component of DARE that warrants criticism concerns the extraneous number and variety of drugs the intervention targets and how the messages in this multi-drug approach seem to cancel each other out serving to indirectly increase cigarette and alcohol use.
On the DARE website the kinds of drugs included in their curriculum are explicitly outlined and include the following: alcohol, cocaine, crack-cocaine, ecstasy, GHB, heroin, inhalants, LSD tablets, marijuana, methamphetamine, Ritalin, tobacco, and Yaba ( All of the drugs on this list (sans alcohol and tobacco) fall under one or more of three categories: over the counter drugs, controlled substances, or categorically abrogated substances. This means there is less access and less use of these substances in relation to alcohol and cigarette smoking, yet DARE chooses to invest a disproportionate amount of curriculum time to these substances when they clearly pose a significantly smaller danger to adolescents than cigarettes and alcohol in terms of their availability.
Furthermore, there is research suggesting that participation in the DARE program has resulted in negative effects including a surge in alcohol and drug use and a heightened misconceived perception of alcohol use by peers as a result of this multi-drug intervention approach utilized by programs such as DARE (Werch and Owen, 2002). Werch and Owen asserted that entertaining multiple drugs in the same intervention possibly generated iatrogenic (negative medical conditions caused by proposed treatment or intervention) outcomes as the multiple drug messages may have cancelled each other out and the use of relatively less severe drugs (such as cigarettes and alcohol) may have been perceived to be more commonplace and salubrious in comparison to the multitudinous array of illicit drugs DARE chooses to highlight in its fight against drug use. Thus, the DARE program once again engenders a counterproductive frame in which the perceived hazards of cigarette smoking and alcohol are ultimately mitigated when considering the larger scope of substance use.
IV DARE’s Faulty Science
Finally, the component of DARE that warrants further criticism involves its use of faulty science through outmoded theoretical models as well as scientifically inaccurate statements concerning self esteem and its relation to the rationale behind why people choose to smoke.
This faulty science can first be explained by superannuated theoretical models. The underlying principles forming the foundation for DARE’s teachings come from Maslow’s hierarchy of needs theory as evident to the primacy given to the self esteem needs en route to the “self actualization” reached in one’s ability to resist peer pressure and drug use(Hanson, 2007). In a critical analysis of Maslow’s theory, a few limitations in Maslow’s theory of hierarchy. The critical analysis noted how Maslow's emphasis on a strict hierarchical ordering of human needs has been disputed because it has never been empirically tested on a satisfactory basis and the connections between motivation and external behavior in human beings are more complex than Maslow’s explanation in the cursorily defined stages of his theory(Reed-Cunningham,2008). Another staunch criticism of the theory according to Reed is its ostensible negligence of contextual cues as individuals tend to concurrently satisfy needs for love, safety, and self esteem. Moreover, people who have their "lower" needs satisfactorily met do not necessarily attempt to satiate "higher" needs, as evident thru the behavior of many affluent individuals. For some people, love, safety, and security evince core values while others are motivated by an urge to obtain power and dominance. The most pressing criticism Reed offers for Maslow’s theory involves its ethnocentric approach to defining human experience as it reflects the values of 20th century Western middle class males, which may be a little problematic considering the public schools the DARE program cater to are laden with females and people associated with multitudinous ethnic and socioeconomic backgrounds whose experience Maslow’s parochial model may ignore. Human beliefs are conditioned significantly by their cultures as cultures differ widely in the sets of values that they inculcate to their individuals. Reed contends the concept of “self” as delineated by Western societies is chiefly individualistic while the concept of the “self” in Hispanic and Asian cultures (groups that are rapidly increasing in the composition of American society) incorporate family relationships in addition to the individual “self.” Thus, Maslow’s theory is narrow in its scope for a DARE program that is broad in scope in terms of the multi-cultural society it wants to engage.
In addition, DARE makes use of science that overemphasizes the role of self esteem in determining whether an individual will utilize drugs without regard to gender differences. According to Drug Reform Coordination Network, DARE’s most notorious assertion is that the utilization of drugs is directly related to low self esteem. Thus, a key component of DARE’s program involves self esteem building activities and exercises. According to a research with Calgary school children grades 6 through 9 documented by psychologist Thomas Abernathy and his group concerning self esteem and use of drugs, the relationship between self-esteem and smoking differed significantly between males and females. Among males, there was little to no association between reported self-esteem status in grade 6 and subsequent smoking in grades 6 through 9. However, there was a strong association ascertained in females between self esteem in grade 6 and smoking in later years. In fact, the study documented the chances of a female with low self-esteem in sixth grade smoking in any given year in grades 6-9 is between 2.5 to 3.5 times greater than a female with relatively high self esteem (Abernathy et. al, 1995). The problem with DARE’s approach to self esteem is that it assumes that self esteem is uniform across gender, thus they proceed in attempting to develop self esteem for the entire adolescent population. Ultimately, the failure in these “self esteem” building programs of DARE resonates in their lack of regard and appreciation for differences in gender experience.
V Proposed Interventions to DARE program
Three different interventions can specifically address the three different criticisms of the DARE program presented earlier in this paper including poorly framed underlying messages, multiple drug approach, and its faulty use of science and educational models.
VI Proposed Intervention to Improve the Efficacy of DARE’s underlying messages
An intervention to address the ineffectual underlying messages of DARE would involve establishing a more direct approach in reproaching the behavior of substance abuse.
Instead of telling school children they have a “right” to say no, the intervention would take an ardent stance against drug use within the constraints of current scientific knowledge. For example, the direct approach has been utilized in terms of emphasizing the use of safety belts utilizing slogans such as “No Excuses: Just Buckle Up” and “Click it or Ticket” to warn of possible repercussions in failing to fasten one’s seat belt. In the case of cigarette smoking, an effective intervention would utilize an ad campaign with slogans such as “Just Say No to Bad Breath” showing a slimy odor coming out of the mouth of the individual offering a cigarette. This kind of campaign would convey a potent anti-drug message directed towards the youth in a lucid manner compatible with facile concepts that all youth can appreciate such as the detriment of a putrid odor emanating from one’s mouth. Many adolescents can understand the importance of fresh breath when trying to impress someone they might have a crush on. If the intervention utilizes simple messages on how alcohol and smoking adversely affects their social status within the school, it will elicit more effectiveness than just lecturing them about innumerable cancers and diseases associated with alcohol and cigarette use that school children will most likely dismiss as adult problems irrelevant to their experience.
In lieu of the findings of the Gerend study involving the gain and loss frames in short and long term effects of drug use, an effective intervention would highlight the short term positive effects of abstaining from alcohol and cigarette smoking such as utilizing the money spent on drugs and alcohol on more useful activities such as enjoying electronic items, music videos, video games, arcades, movies, concerts, sporting events, and other leisurely activities actively pursued by young adolescents. An effective intervention can also underscore the benefits of alcohol and cigarette abstinence on one’s physical appearance as their body and the clothing they wear will be free from the putrid odor associated with alcohol and cigarettes. Thus, they are likely to appear more attractive to their peers and will increase their prospects of social competence within their network. The underlying feature of any drug intervention dealing with adolescents is to describe the benefits of alcohol and drug abstinence in terms that adolescents themselves will readily appreciate. The problem with DARE and interventions of its ilk is that they force feed their own values concerning drug use when they should be catering to the values and normative beliefs of au courant adolescents. The intervention should be of adolescents, for adolescents, by adolescents and the emphasis of short term positive effects of drug abstinence will competently galvanize the interest of adolescents.

VII Proposed Intervention to DARE’s multiple drug approach
In order to improve the overall efficacy of DARE and programs of its kind, an effective public health intervention would incorporate the Social Norms Marketing Approach. According to David Hanson, the Social Norms Marketing Approach has proven effective in curbing the use and abuse of alcohol among young people to the extent that the U.S. Department of Education has identified three programs utilizing this model as efficacious for target groups: Life Skills Training Program, Project Alert, and Strengthening Families Program.
The Social Norms Marketing Approach can be utilized in the case of alcohol by quelling the misconception of frequent drinking amongst adolescents and their peers. Since adolescents typically believe that alcohol use is common, they typically drink and may superfluously drink (e.g. engage in party games) in order to fit in with the norm. The Social Norms marketing approach would combat this activity by the implementation of credible surveys demonstrating the realistic and significantly smaller rates of alcohol use. Subsequently, the results of this survey should be heavily publicized, advertised, and marketed to the target audience of adolescents further dispelling the misconceived perceptions concerning the social pressures of drinking alcohol. As a result, alcohol use and abuse may mitigate significantly over time and the idea of binge drinking may lose flavor with the adolescent masses.
In addition to the Social Norms Marketing Approach, an effective intervention would incorporate a more specialized focus on alcohol and cigarette smoking rather than controlled substances(such as marijuana and heroin) to control for possible iatrogenic effects. The specialized focus on alcohol and cigarette smoking would generate a more organized approach in combating drug use as adolescents would receive specific messages tailored to the major drug problems rather than being subjected to a diluted message when mentioning the “hard drugs.” As pernicious as they may be, alcohol and cigarettes are legal when an individual reaches a certain age. However, when school age children are exposed to specific messages of alcohol and cigarette smoking, they will understand these to be potentially harmful rather than just legal alternatives to the illegal drugs DARE seemed to hammer more frequently.
VIII Proposed Intervention to DARE’s faulty science
In order to address the scientific inconsistencies of the DARE program, a proficient intervention would abrogate the use of Maslow’s model in favor of social models that incorporate ideas of cultural relativism. Contrary to popular belief, a drug and alcohol intervention cannot be color blind and certainly cannot assume that the experiences of individuals of all races are similar even if all the school children grew up in America. The first step of this intervention would involve assessing the social and economic context behind why certain ethnicities may be more affected by cigarette smoking and alcohol use than others. This would involve building outreach centers in underserved populations in which information about drug and alcohol abuse is readily available as well as professional help for diagnosing and dealing with an addiction relating to alcohol and drugs. One cannot expect programs such as DARE to serve as a panacea inhibiting drug and alcohol use with a simple weekly lesson plan that has proven to be ethnocentric. An effective public health intervention will deploy resources directly towards underserved populations to convince these groups that their needs are certainly pertinent to the greater good.
In addition, an effective intervention will involve formulating a separate intervention for boys and girls in which self esteem building can be specifically emphasized in girls in lieu of the findings of the Abernathy study documenting a strong link between self esteem and future drug use in girls. Girls need to be educated about the cosmetic drawbacks associated with alcohol and cigarette use and how these agents may stunt their attractiveness thereby affecting their long term self concept. With boys, the intervention should stress fun and thrill seeking alternatives to cigarette smoking and alcohol and the importance of forming tightly knit social networks encouraging one another to abstain from deviant activities. It is of paramount importance to appreciate the differences in male and female experiences and cater to specific interests across genders.
IX Conclusion
In culmination, the DARE program contains three key flaws affecting its efficacy including its desultory and baffling underlying messages to youth, the iatrogenic effects of its multi-drug approach and its utilization of faulty scientific principles. The proposed interventions to each component are as follows: more direct messages and emphasis of short term positive consequences stemming from abstinence of drugs and alcohol in response to its desultory and baffling underlying messages to youth, social norms marketing approach and specialized focus on cigarette smoking and alcohol in response to the iatrogenic effects of its multi-drug approach as well as incorporating models that take into account differences across race and gender in response to its utilization of faulty scientific principles and models.

X: References
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