Challenging Dogma - Fall 2009

Monday, December 21, 2009

Doing a Better Job of Keeping Kids Off Drugs: A Critique of Drug Abuse Resistance Education (D.A.R.E.)

– Sara O’Brien

I. Introduction
Drug Abuse Resistance Education, known by its acronym D.A.R.E, has been implemented in seventy five percent of all schools in the United States and is currently in 43 countries (1). D.A.R.E. was the result of the collaboration of the L.A. Police Department and the L.A. Unified School District that came out of the federal government’s proclamation of a “War on Drugs” in 1983 (2). The main objective of the D.A.R.E. curriculum is to impart to students in the fifth or sixth grade the knowledge and skills about how to abstain from drugs (2). The D.A.R.E. program involves anti-drug lessons taught in the classroom by a trained uniformed D.A.R.E. police officer for one hour a week for 10 consecutive weeks (1).

With the high percentage of program implementation nationwide, D.A.R.E. would appear to be an effective program. However, studies have shown that D.A.R.E. at 1 year, 5 years, and 10 years after completion of the program is not effective in decreasing drug use (3-8). There are three main reasons D.A.R.E. is ineffective. First, D.A.R.E. assumes that children behave rationally. Second, D.A.R.E. violates marketing theory by misunderstanding the target audience and offering a bad promise. Finally, D.A.R.E. is ineffective because it was developed at the individual level and does not take into account social and environmental factors that affect a student’s ability to stay off drugs. The development of an anti-drug intervention that takes into account that children behave predictably irrational, utilizes marketing theory, understands its target audience, and functions on the group level will be presented in contrast to the D.A.R.E. program.

II. Critique of the D.A.R.E. Program

II a. The D.A.R.E. Program assumes rational behavior
A main objective of the D.A.R.E. program was to increase the knowledge of the consequences of drug abuse (2). The theory that D.A.R.E. applied was that the increase in knowledge of drug consequences would lead to attitudinal changes about drugs that would lead to an increased resistance to drug use (9). The set up of the D.A.R.E. program assumes that a barrier to anti-drug behavior is a lack of knowledge. Assuming that this path from knowledge to behavior occurs demonstrates that the D.A.R.E. program was designed based on the belief that rational behavior would occur.

Study results show that D.A.R.E. did cause an increase in drug consequence knowledge in students, but did not have any significant effect on drug use demonstrating that rational behavior did not occur. At one year post completion of the D.A.R.E. program, no significant impact on students’ drug use was found (3). D.A.R.E. students one year after completion were significantly better able to identify the media portrayal of beer drinking, but no significant effect on alcohol use was found (3). Five years after the completion of the D.A.R.E. program it was found that there was a 42% increase in knowledge, 19% increase in social sills, 13% increase in positive attitudes toward police, 11% increase in negative attitudes about drug use, and a 6% increase in self esteem (4). However, the rate of drug use at 5 years was not statistically significant and all significant results for D.A.R.E. were found to be statistically less than interactive drug programs they were compared with (4).
D.A.R.E. participants were monitored for 10 years and it was found that the pre-D.A.R.E. levels of drug use and belief of negative effects of drugs were significantly related to student drug us at 10 years, but not their D.A.R.E. status (5). This effect was found to be true for cigarettes, alcohol, marijuana, and other illicit drugs (5).

Further evidence that drug consequence knowledge does not affect individual behavior was found using a meta analysis. The overall weighted effect size for the D.A.R.E. program creating better outcomes for D.A.R.E. participants in relation to drug use was 0.011 (6). This overall effect was not significant and would need to be 20 times larger to mathematically be considered small (6, 7).

The D.A.R.E. scale is an assessment tool developed by D.A.R.E. to demonstrate the effect the program is having on the students. The D.A.R.E. scale involves 19 questions about drug knowledge and attitudes. The scale was given to a group of D.A.R.E. and non-D.A.R.E. participants at the completion of the seventh grade and again at the end of their senior year of high school. It was found that both groups had the same average response at both testing points (8). It was shown that in both groups of seniors who gave the average (which was the correct) responses to the majority of the items on the scale were also reported to be using various drugs (8). The D.A.R.E. scale is a flawed assessment tool of how well the D.A.R.E. program is functioning as it is only showing the ability of students to regurgitate information, not their ability to abstain from drugs (8). Using the D.A.R.E. scale will give schools the incorrect belief that the program is keeping their students off drugs.

II b. The D.A.R.E. program violates marketing theory
The D.A.R.E. program was set up using the public health paradigm, which violates marketing theory (10). D.A.R.E. started with a product that the police officers and school administrators wanted the students to want, not a product that the students had a desire for. The D.A.R.E. program tried to sell the program to the students by appealing to the students’ desire for health (10). Marketing theory demonstrates that health is not a core value that people respond to, let alone children who have the majority of their lives ahead of them (10).

The soul of any campaign is the promise and for the D.A.R.E. program the promise is an expected message from an authority figure (11). The D.A.R.E. promise is that only total abstinence on all types and forms of drugs legal or illegal is acceptable (8). The D.A.R.E. program equates drug experimentation with drug abuse and has a zero tolerance rule. This promise is not going to appeal to the curious nature of children as they grow. Telling children to squash any curiosity is unrealistic, especially when some of the drugs are legal and possibly being used by people they know. Research on the adolescent market found that adolescents want any message besides “don’t”, and the main message being sent from the D.A.R.E. program is “don’t” (12). D.A.R.E. is set up with the promise of “don’t” and uses teaching of the negative consequences that occur with drug use as support. The D.A.R.E. program uses the promise of not trying drugs to not get addicted to drugs to not become sick. This again is a negative message. The key word in the D.A.R.E. program is “no” and D.A.R.E. teaches eight ways to say “no” (2). The D.A.R.E. program’s support for its promise is the continued use of the word “no”. D.A.R.E. uses stories and examples for support and then offers interactive sessions for students to demonstrate how to say “no” in the specific situation (1). A negative promise with negative support will have a hard time finding any audience (13).

A main characteristic of the D.A.R.E. program’s target audience, individuals approaching or in adolescence, is their need for independence and rebellion (12). The choice of a police officer, an ultimate authority figure, as the individual to deliver the message of “don’t” would cause the audience to tune out the message. A qualitative assessment of D.A.R.E. revealed that the choice of police officer to teach the D.A.R.E. program made the students feel as if their perceptions had been ignored (8). The general feeling of the D.A.R.E. participants was that it was not important what they thought, that the D.A.R.E. police office just wanted the participants to do what they were told (8). The D.A.R.E. participants felt as if the officer was unable to bring themselves to the level of the students (8). These feelings often led to students undermining the teachings of the D.A.R.E. officer, which would be expected because of reactance theory (14). In reactance theory it is expected that students would hear the message and then do the exact opposite of the message (14). For D.A.R.E. found to be true because reactance led to a significant increase in hallucinogenic drug use and an increase in crimes committed by the D.A.R.E. participants (8, 15).

The D.A.R.E. program targets children of all genders, but was set up using the male treatment model (16). It was assumed that sufficient similarities exist between the genders that using this model would be appropriate (16). Improving drug specific refusal skills is more useful for adolescent males because of the different ways in which males and females assess peer pressure; therefore sexism is built into D.A.R.E. (16). Among boys, those who participated in D.A.R.E. were less likely to show an increase in alcohol behavior and intentions, alcohol use, smoking and victimization (17). There was no significant difference in behaviors between girls who did and did not participate in D.A.R.E. (17).

II c. The D.A.R.E. program was developed at the individual level
The D.A.R.E. program was designed to develop an individual’s resistance skills and their self esteem (2). However, by focusing the program at an individual level the D.A.R.E. program did not take into account environmental and social factors. The D.A.R.E. program was designed by the L.A. Police Department and the L.A. Unified School District, which is an urban area and the program does not account for different environmental settings. For example, D.A.R.E. was more successful with urban students then rural students in teaching them to understand the media influence regarding beer and cigarettes (3). Urban students had 13% greater odds of identifying the media influence then those enrolled in rural D.A.R.E. programs (3). When cigarette use and frequency was compared from Montana, a predominately rural state, to the city of L.A., 8.1% of students from Montana compared with 2.6% from L.A. students were found to have used cigarettes at least 20 of the last 30 days. (18). In Montana a significantly greater number of students were found to have tried alcohol (77.8% vs. 71.2%) and to have consumed more than 5 drinks in a row in the past 30 days (32.4 % vs. 24.6%) then students in Los Angeles (18). These significant differences in drug use between the two communities demonstrate the need for a difference in the method the lessons are presented as well as the type of drug presented.

The D.A.R.E. curriculum which is used in seventy five percent of the schools in the United States is written very specifically with examples to use during role play and games. However, some of the examples that are given are specific to urban areas. For example, asking students for a response when friends are “huffing glue behind the quik-e-mart” or what do when “walking home in the alley behind your house” (19). These lessons lose some of their effect because they are unidentifiable to non-urban students and students may feel that the program does not understand where they are coming from (8).

Drug use, particularly inhalants, is strongly influenced by proximal social contacts and children with friends or siblings who used inhalants were 3.33 times more likely to report a higher likelihood of future inhalant use (20). These findings demonstrate that drug use spreads through groups and therefore focusing on the individual level, and teaching an individual ways to say no, would be ineffective. Because drug use moves through a social network, this means drug resistance is a group decision and not an individual’s choice (21). D.A.R.E. tries to create a vacuum for individuals and teach them how to resist against outside forces. By ignoring the outside forces and the fact that drugs move through a social network makes D.A.R.E. an ineffective anti-drug program.

III. The Freestyle program is an improved D.A.R.E. program
The Freestyle program is a school based drug resistance program that is based on the group level, assumes irrational behavior from participants and uses marketing theory to increase buy-in to the program. Freestyle draws upon children’s preexisting interests and social groupings and partners with the town’s recreation department to create activities for children to experience in drug free environments. Freestyle will involve sports teams, art groups, music groups and other group based activities. Each group will be identified and these groups will have anti-drug lessons and activities intertwined with their recreation activity. Each group will be age based so there will be a built in peer group in the activity group. Once a month a classroom based activity will occur to foster identity as drug free individuals and to continue the effective teachings of media influence from D.A.R.E..
Each student, from elementary school through middle school, will enroll in a club for a semester and these clubs will then take their anti-drug lesson classes together. Each club will have a coach or director, who will be an adult within the community. The coaches and directors will receive training on being a positive adult role model as well as how to deliver the anti-drug lessons. The anti drug lessons are much more focused on building a group identity of non-drug users than giving drug use consequence knowledge. However, within each lesson some information about drug consequences will be given. The knowledge will be presented within the context of the lesson and the type of drug presented will depend on the regional drug use statistics.

III a. Freestyle uses predictably irrational behavior
Freestyle is not based on the principle that knowledge leads to behavior, instead it will use predictably irrational behavior in the form of expectations, ownership and self control to establish an effective anti-drug program. A main goal of Freestyle is getting students to label themselves as non-drug users, and to affiliate it with the club they have chosen to be involved with. For example, someone enrolled in the soccer program would see themselves as a non-drug using athlete or someone else in a painting program as a non-drug using painter. Labels are effective tools, as when someone is labeled by themselves or others they will fulfill the expectation that the label has given them (22). The student’s clubs will be labeled in an effort to foster the group identity. For example, a football club in the town of Fairview might be labeled as Fairview’s Freestyle Fifth Grade Footballers. It will be expected that other clubs will identify the clubs by their given labels. Also, for competitions, presentations or other club activities group members will be expected to wear their club’s t-shirt that is adorned with their group label. The clothing will help the student to connect with their label.

Predictably irrational behavior involves ownership of a behavior (23). The Freestyle program with labeling students as drug free athletes or drug free painters is helping them own this behavior. Involving students at an age that they are able to partake in recreation activities builds the behavior over time and will help student to feel as if they own the behavior. Also, the use of t-shirts for club activities is another way to build ownership of the label by giving students a tangible object (23). With ownership comes a strong aversion to loss (23). The goal of the Freestyle program is to ingrain the behavior as a non-drug user in order to decrease drug use from occurring later in life.
D.A.R.E. understood that people have little self control, but taught lessons on resistance behavior that were found to be ineffective for stopping drug use (3-8). Contracts have been found to be effective methods to help individuals accomplish goals (24). Contracts will be done at both individual and group level. This will be used in the Freestyle program for individual contracts starting in the third grade (when students can sign their own name) to state their goals for enrolling in the program at the beginning of every school year. The group contracts will set goals for accomplishment by the entire group. For example, the art club could have a goal of getting a collaborative mural entered into the state art show. Upon completion of the school year it will be evaluated how many students and clubs have met their goals and these along with a drug use survey will be used as the assessment tool for the Freestyle program. This outcome measurement system is in contrast to the D.A.R.E. scale which measured regurgitation of facts.

III b. Freestyle utilizes Marketing Theory
The D.A.R.E. program was set up using the public health paradigm for marketing, but the Freestyle program follows the marketing theory paradigm. Using the marketing theory paradigm a benefit being sought must be provided by the program (10). This benefit must be found through comprehensive research of the market and the public health intervention can then be repackaged, reframed and reposition in order to offer the benefit that is sought (10). The Freestyle program uses the research done by the Centers for Disease Control for prevention of smoking initiation and uses the five identified core values: freedom, independence, rebellion, control and identity and sells these values as the product of the program (10). These core values are then used to develop the lessons and goals of the program.

The overall promise of the Freestyle program is freedom from addiction to drugs. The brand of the program includes the word “free” in order to position itself as promoting freedom first and foremost and then the fact that it is freedom from addiction second (13). Freedom has a much more positive connotation than the “no” or “don’t” promise that D.A.R.E. put forth. Individuals are more responsive to a positive promise (11).

Lessons based on core values will include independence; independence from media manipulation through the portrayal of alcohol, cigarettes and illegal drugs in print, movies, websites and other media forms. The independence lesson will build off the work that the D.A.R.E. program had successfully executed for the urban schools and will be tweaked to fit into a rural setting. The rebellion lessons will build on the independence lessons, as well as the work already done by the Truth campaign. The rebellion lessons will teach students to rebel against drug dealers, cigarette and alcohol companies that have manipulated the students with misrepresentations of their products and have tried to get them addicted (10, 12). Control, which will be another lesson, will focus on the control the student has over the way other people see themselves and the club they belong to. Students can control if their club is seen as non-drug users or as phonies who are not really true to the premise of the club. The final lesson will revolve around identity. The identity lesson ties into having students label themselves as non-drug users. The identity lessons emphasize that individuals who are the best at their club activity are those who abstain from drug use. Also, the identity of the club as the best club is dependent on the amount of individuals who remain non-drug users.

As seen in D.A.R.E. a carefully crafted message can be ineffective because of who is delivering the message. In D.A.R.E. the message was viewed as ineffective because of reactance theory and the use of a police officer to deliver the message. Freestyle was set up understanding that less reactance occurs when the individual delivering the message shares a great deal of sameness with the audience (14). This is one of the main reasons that the adult who is the leader of the club is the individual who is doing the school based lessons. This adult has already built in the same interests and values in the views of the students and they will be more receptive to the message because of it (14).

Freestyle is not built upon the male treatment model, like D.A.R.E. is. Freestyle was developed based on overlapping principles shared by both genders, the core values of independence, freedom, rebellion and control. These values are gender neutral. A main goal of the Freestyle program was to not separate genders. This is because separation would create too little interaction between genders and the student will experience peer group situations in which both genders are present and need to be capable of handling these situations.

III c. Freestyle is a group level program
It has been shown that drug use moves through a social network (20). The Freestyle program teaches kids in their preexisting social networks; their sports teams, theater groups or other activity grouping. These social groups are most likely to contain their friends. Friends have a significant influence on thoughts and behavior because they are within an individual’s network (25). Teaching students anti-drug behaviors while they are in their social network will help to introduce the behavior at one time to the entire group (25). Behaviors move from the center of the social network out to the perimeter of the networks (25). In order to identify from year to year the center of the networks each club will vote for two captains. The captains can then be monitored for behaviors for the entire group. Once the captains buy into an idea or piece of the program the rest of the group will follow. The captains are also a good resource of feedback for the coach or director who can check in to make sure that they are still on the same page with students as far as interests and influencing factors. For example, the coach of the baseball club maybe able to find out who the current favorite baseball player is and use stories about this player as support for the lessons that are given.

The Freestyle program will take into account the environment in which the program is taking place, unlike D.A.R.E.. With Freestyle there will be a minimum of three versions: urban schools, suburban schools and rural schools. Each will take into account the different communities in these environments and the language and content in some of the lessons will be changed. For example, for urban schools it was shown that students have a greater variety of drugs that they experiment with and have higher rates of cocaine, marijuana and methamphetamine use (18). Students in the rural schools have higher uses of tobacco in the form of cigarettes, chew, and cigars and binge drinking (18). The type of drug that will be part of each the lesson will be different depending on regional drug use. Examples and stories used for support in rural towns would be different from those in the suburban and urban areas. For example, discussion about situations in apartment complexes might be relevant to urban students, but would not have the same effect on rural students living in houses and therefore would not be included in the rural program.

IV. Conclusion
After 26 years of the D.A.R.E. program, it is clear that in its original form the goal of drug abuse resistance education was achieved, but this education did not correlate to decreased drug use. D.A.R.E.’s failures were results of setting the program up to assume that children would behave rationally, violating marketing theory, and focusing on the individual level. The Freestyle program takes the school based anti-drug intervention a couple of steps further by assuming irrational behavior, utilizing marketing theory, and implementing a group level program. The Freestyle program uses the natural social networks that are formed when students join clubs and teams and uses them to diffuse anti-drug behaviors and ideas. The Freestyle program still has its limitations, but is step in the right direction for school based anti-drug programs.


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