Challenging Dogma - Fall 2009

Wednesday, December 16, 2009

Just Say No to DARE: A Critique and Re-creation of the Drug Abuse Resistance Education Program – Michael Kalfin

I. Introduction
Drug use among youth is a serious concern of parents, school districts, communities, and politicians across the United States. Youth drug, alcohol and tobacco use is a stark reality across the nation that cannot be denied, ignored, or overlooked (8). For decades, researchers, educators, politicians, and parents have debated over the most effective ways to prevent drug and alcohol abuse among youth. According to a 2008 study by the National Institute on Drug Abuse, marijuana use within the past year was reported by 10.9 percent of 8th-graders, 23.9 percent of 10th-graders, and 32.4 percent of 12th-graders (17). Also in 2008, 15.4 percent of 12th-graders reported using a prescription drug non-medically within the past year (17). The prevalence of alcohol use among high school students also poses a negative increased cost and burden on society. Alcohol use among 10th graders was 52.5 percent and 65.5 percent among 12th graders in 2008 (4). Although overall youth drug abuse patterns continue to gradually decline, the statistics remain high enough to attract international attention (4).

II. Critique of the D.A.R.E. Program
Arguably the most famous non-profit organization brand, logo and slogan in youth drug abuse prevention in the United States is “D.A.R.E.” Developed in 1983 by the Los Angeles Police Department and the Los Angeles Unified School District, the D.A.R.E. (Drug Abuse Resistance Education) America program has been the most popular school-based substance abuse program in the nation (5). D.A.R.E. is a collaborative effort by law enforcement officers, educators, students, parents and communities to provide classroom-based education to prevent or reduce drug abuse and violence among children and youth (8). The programs primary mission is to provide children with the information and skills they need to live drug-and-violence-free lives (8). The DARE program is used in nearly 80 percent of the school districts in the United States, in 54 other countries around the world, and is taught to approximately 36,000,000 students each year (10). In April of 2003, the estimated cost of the DARE program ranged from $1 to $1.3 billion annually (9). The DARE kindergarten-12th grade curricula focus upon the abuse of gateways drugs such as alcohol, marijuana, tobacco and inhalants (8). The program offers a preventative strategy to enhance protective factors, especially bonding to family, community and school (8). The basic DARE program consists of a series of lectures delivered to schoolchildren by police officers over a 10-week period (14). With the DARE campaign reaching so many youth and spending so much money, it is important to determine if the program is effective in reducing alcohol and drug abuse patterns among school-aged children.
Over the past 25 years, since DARE’s founding, numerous articles, researchers, educators, politicians and parents have discredited the campaign. Some individuals have not only labeled it as ineffective but as counterproductive, claiming it has actually increased drug and alcohol use among our nation’s youth (14). In the study, “Project DARE: No Effects at 10-Year Follow-Up,” which was published in the Journal of Consulting and Clinical Psychology, 20-year-olds who had DARE classes at age 10 were no less likely to have smoked marijuana or cigarettes, drunk alcohol, used illicit drugs, or caved in to peer pressure than students who had never been exposed to DARE (20). Even worse, in a study conducted at the University of Illinois, researchers found that some high school seniors who had been previously exposed to DARE were more likely to use drugs than their non-DARE peers (20). Although there are several plausible critiques of the DARE campaign, this paper will focus on three specifically. First, the DARE program is based on the outdated and traditional health belief models. Second, the program fails to consider environmental and social factors influencing youth behavior. Lastly, DARE continues to focus on negative health outcomes rather than core values.
According to David J. Hanson, Ph.D., Professor Emeritus of Sociology of the State University of New York, DARE is based on out-dated theories of learning and human behavior and presents a view of substance use inconsistent with what most students see in their own environment (14). The health belief model stipulates that an individual’s health-related behavior depends on the person's perception of four critical areas: the severity of a potential outcome, the person's susceptibility to that outcome, benefits of taking a preventive action, and the barriers to taking that action (12, 23). In essence, the model is stating that in order for an individual to change their behavior the perceived benefits, which is comprised of perceived severity and susceptibility, must outweigh the perceived barriers (23). Unfortunately for the DARE campaign, many youth do not view the severity and susceptibility of drugs and alcohol to be high. On average, marijuana today is far more intoxicating than 30 years ago (8). According to the Drug Abuse Quarterly Potency Monitoring Project Report, THC levels in analyzed illicit cannabis samples have grown from 1.37 percent in 1978 to 8.49 percent in 2008, an increase of more than 500 percent (9). Yet, in contrast, students’ perceived harmfulness and disapproval of marijuana and inhalant use softened among 8th-graders in this same year (17). In addition, among 12th graders, perceived risk of harm associated with LSD continues to decrease (17). Despite years of advanced health education and awareness on the harmful effects of drugs, these statistics represent the growing majority of youth who do not perceive the use of illegal substances as harmful. According to a study conducted by Hazelden's Center for Youth and Families, only 6 percent of youth considered alcohol and drugs a serious problem (18). On the other hand, the barriers to drugs and alcohol among youth are relatively low. In 2008, 22 percent of all students in grades 9 through 12 reported someone had offered, sold, or given them an illegal drug on school property and almost 84 percent of those high school seniors reported they could obtain drugs fairly easily or very easily (4). The health belief model suggests that individuals rationally weigh the costs versus the benefits. Since youth do not perceive the severity of drugs and alcohol as all that harmful and they do perceive the barriers to obtaining drugs and alcohol as relatively low, the health belief model would suggest that school-aged children would be more inclined to experiment with drugs and alcohol.
DARE also assumes that behavior is both rational and planned. Rational behavior is defined as the notion that people make decisions based on the desire to obtain the best possible outcome or greatest level of satisfaction (11). After all the education students receive from the DARE program on the negative aspects of drugs and alcohol, one would expect a rational individual to abstain from drug use due to the various negative health effects. However, according to data from the University of Michigan Monitoring the Future Study, almost 43 percent of high school seniors reported having ever used marijuana (4). Similarly, according to data from the 2007 National Household Survey on Drug Use and Health, 114 million Americans age 12 or older (46 percent of the population) reported illicit drug use at least once in their lifetime (4). The DARE program fails to explain the dynamic part of an individual’s behavior. It fails to take into account that human behavior can be spontaneous. Youth in particular live vibrant, energetic lifestyles filled with peer pressure, stresses, and irrational decisions. Again, in a Hazelden's Center for Youth and Families study, only 20 percent of the youth surveyed said that they plan activities that revolve around alcohol or drugs (18). When compared to the previous statistics on the percent of youth that actually engage in drug and alcohol use it is clear that most youth behavior surrounding drugs, alcohol and tobacco use is not planned.
In more than 30 studies conducted across the United States, although results have varied, there has been no tangible evidence that the DARE program deters drug use by the time participants enter high school or college (5). In some studies even negative results have been shown for both short- and long-term outcomes (5). A study conducted in Houston, Texas actually showed a 29 percent increase in drug use among students participating in DARE (10). In addition, a study conducted by the Research Triangle Institute, which was hired by the United States Justice Department, analyzed 9,500 students and concluded that DARE “had a limited to essentially non-existent” effect on drug use (6). In 2003, the General Accounting Office of the US Government found “no significant differences in illicit drug use between students who received DARE and students who did not” and gave the program a failing grade (9, 24).
Another reason why the DARE program is a failure is the fact that the program fails to consider environmental and outside social factors influencing youth behavior. Family factors have a major influence in youth drug patterns. Family history of criminality or anti-social behavior, alcoholism in parents or other siblings, inconsistent parental direction or discipline, and parental drug use or parental attitudes approving drug use are all risk factors for teenage drug use (21). Despite these specific risk factors the DARE program had little connection to parents and siblings. The majority of the DARE curriculum is focused in the classroom with the absence of family. Peer pressure is an example of a social factor contributing to youth drug use. Children whose friends (and/or siblings) smoke, drink or use other drugs are much more likely to do so than those whose peers do not (21). While DARE’s mission is to promote self-esteem and skills necessary to recognize subtle peer pressure, the lectures are conducted by a police officer instead of through peer engagement. According to the study, “Project DARE: No Effects at 10-Year Follow-Up,” individuals who were exposed to DARE in the sixth grade had lower levels of self-esteem 10 years later (20). DARE also ignores the fact that students learning abilities, interests, and achievements vary. Children who are poor academic achievers, easily bored by schoolwork, feel “at odds,” and demonstrate antisocial behavior are more likely to begin using drugs early (21). The program fails to separate children into more appropriate groups linking students based on interests, achievements, social skills, and/or learning disabilities.
Lastly, DARE focuses on health outcomes rather than core values. During the 10 lessons, students are taught the negative effects of drugs and skills needed to recognize and resist the subtle and overt pressures that cause them to experiment with these drugs. Health becomes the main focus and essentially the “selling” point in attempting to prevent youth from using drugs. The promise from police officers is that you will lead a healthier life if you avoid using drugs, alcohol and tobacco products. Advertising theory explains that the basic core values must support the entire communication or pitch (23). Core values such as family, tradition, youth, attractiveness, sex, and acceptance are proven to have a greater influence in changing behavior than focusing on health (23). Organizations such as the Family Council on Drug Awareness found that DARE creates what they call the “Forbidden Fruit syndrome” by both glamorizing and demonizing drugs at the same time (7). Students are aware that the program exaggerates the health consequences and therefore mistrust the entire DARE campaign and message (7). The program fails to take a realistic look at each separate drug and instead lumps all the consequences together (7). Michael Hecht, professor of communication at Penn State, said "effective resistance strategies go beyond repeating simplistic slogans at kids (16).” One reason for the failure of DARE is that it uses police officers to deliver anti-drug messages in schools. As Hecht notes, "there is no evidence that police officers are effective in this role (16)." Among high school aged students police officers are often viewed as the opposition. DARE prides itself as being universally viewed as an internationally recognized model of community policing which aims to humanize the police so that young people can start to relate to officers (8). Many critics of DARE have argued that the program has failed to effectively accomplished this.
Several school boards and administrators, politicians, and parents have called for the removal of the DARE campaign in their neighborhoods and to eliminate funding being provided to the organization. In 2001, according to the Office of National Drug Control Policy (ONDCP), 41 million dollars in federal support was provided to the DARE program (22). Salt Lake City Mayor Rocky Anderson has been one major critic of the program. Going as far as to call DARE, "a fraud upon the people of America," Anderson cut funds for DARE from the city budget, which had previously funded DARE to the tune of $289,000 annually since 1987 (1). After a 19 year run, Suffolk County, home to 1.4 million residents on eastern Long Island, has become yet another community to drop the DARE program (24). Also, in July 2009, the Columbia, Missouri school district announced that they will be dropping the dare program after 20 years (2). Currently the U.S. Department of Education prohibits schools from spending federal money on DARE because it found the program ineffective in reducing alcohol and drug use (15). Although the DARE program has survived constant backlash for nearly 3 decades, many people believe that it is inexcusable to continue using the ineffective program when other proven, successful alternatives are readily available.

III. Re-creation of the D.A.R.E. Program
Public health campaigns and interventions may not always be the simplest to design, create, test and implement. However, there are several effective improvements or alternatives to the DARE program. A program can be made more effective by using multidisciplinary techniques including sometimes keeping parts of the original program that might already be deemed successful. As proven in the previous section with several compelling journal articles, statistics, and industry research, the DARE campaign is not effective at reducing youth drug, alcohol and tobacco use. However, there remain practical opportunities to build upon the program to create a new and effective campaign supported by research already conducted in the field of youth drug prevention and proven to be successful public health campaigns already in place in this area.
The new intervention would continue to take place in the school environment with one major substitute that youth will now converse with each other on the issues of drug, alcohol and tobacco use instead of being lectured to by a police officer. The open forum dialogues will be mediated by a professional instructor; however, that individual will only serve as a resource or support instead of leading the conversation. The new campaign will create a new brand, slogan, and logo that youth can relate and belong too. The campaign will reenergize youth and instill a sense of ownership, control over mind and body, increased self-esteem, and self-efficacy. Most importantly the new campaign will steer away from the outdated health belief models that use negative health outcomes and scare tactics about drugs, alcohol and tobacco to change behavior and will instead focus on core values attractive to youth. Several parts of the new intervention are listed below in detail with evidence in defense that the new program will be more effective than the original DARE campaign.
The DARE program can be reformulated to better incorporate ideas from two alternative and more modern social science theories, advertising theory and social norms marketing. Advertising theory uses marketing techniques in order to change individual behavior (23). The theory consists of a basic element called the promise. In holding the advertisement together, it is understood that the larger the promise, the more effective the advertisement (23). Support in the form of examples, stories, images, symbols, metaphors, and music is what backs up the promise (23). In addition advertising theory uses core values in order to alter behavior instead of traditional health belief models, which use health to alter an individual’s behavior (23). Social norms marketing is based on the central concept of social norms theory - that much of people's behavior is influenced by their perceptions of what is "normal" or "typical. (19)" It is based on applying social marketing techniques to social norms theory (19). Developed in 2001, social norms theory is an innovative health promotion technique that has only begun to be understood and used to its full potential (19). These theories are founded on the group level as opposed to the individual level. The theories also understand that behavior is not always planned, static, and rational. The idea behind these theories is that behavior can be spontaneous and involve environmental and social factors that affect behavior. According to Dr David Hanson, social norms marketing technique has repeatedly proven effective in reducing the use and abuse of alcohol among young people (14). It's based on the fact that the vast majority of young people greatly exaggerate in their minds the quantity and frequency of drinking among their peers. Therefore, they tend to drink -- or drink more -- than they would otherwise, in an effort to "fit in. (13)" Using these theories the new campaign would aim to use core values such as youth, sex, attractiveness, athleticism, freedom, etc. to change youth behavior and attitude towards drug use.
Youth often severely misperceive the typical behaviors or attitudes of their peers. For example, if people believe that the majority of their peers smoke, then they are more likely to smoke (19). The new campaign would aim to illustrate to youth that there is a misperception in the number of their peers that engage in drug use. To accomplish this goal, the DARE program would refocus their efforts to encourage dialogue between students, creating an environment where school-aged children feel comfortable speaking up about not using drugs. Along with the criticism of many other public health campaigns, DARE is too preachy (20). Opening up dialogue between peers hinges on discussion groups rather than lectures. The most effective school based substance abuse prevention programs are ones that group youths into smaller "schools-within-schools" to create smaller units, more supportive interactions, or greater flexibility in instruction (5). The new campaign will attempt to get rid of the notion that drug abuse patterns are widespread among youth and make kids realize that everyone their age does not do drugs after all (20). Studies have shown that when a practical survey of the student body is conducted and the unexpected results widely promoted, student illegal drug use drops dramatically as students discover the truth that not as many students use drugs as they had originally thought (14). The campaign would in effect reverse the stigma in place that the “cool” and popular kids take drugs, drink alcohol and smoke cigarettes. In contrast, DARE would make it cool to become a part of the majority of students that do not take drugs, drink alcohol or smoke cigarettes. Beginning a dialogue among youth might even be easier than expected. In a survey, conducted by the Hazelden's Center for Youth and Families, when asked hypothetically about their comfort level in talking with friends about drinking or drug use, more than three-fourths (77 percent) of the teens said they felt very or somewhat confident and comfortable discussing the topic (18). Along with open peer dialogue, parental engagement will be just as important in the new campaign. A new study by Columbia University’s Center of Addiction and Substance Abuse reports that parents are the key to kids avoiding drugs (25). In 2001, the Chicago Tribune reported that children who live with attentive parents stand a better chance of never using drugs than do those with 'hands-off' parents" according to the center's sixth annual report on attitudes of US teens on drug use, peer pressure and parental involvement (25).
Another critical component to an effective public health intervention is the idea of branding. Branding is defined as a distinguishing name and/or symbol intended to identify a product (3). Branding aims to establish a significant and differentiated presence in the market that attracts and retains loyal customers (3). Just as important is an effective slogan. Marketing theory uses branding and slogans all the time to create and package a product that fulfills the needs and wants of the intended audience (23). Although DARE has created a brand, it has often been the source of parodies, jokes and mockery. Online clothing companies are selling t-shirt that read, “DARE… to keep cops of donuts” and “D.A.R.E. – Drugs Are Really Expensive.” DARE has in effect created a negative brand for itself. Creating a new brand and slogan would help to eliminate the old ridicule associated with DARE. A cool new brand, slogan, and logo would be created to obtain students attention. A complete overhaul of the website would also immediately take place. The outdated and lifeless current DARE website would be replaced with cool images, music, stories, and colors. The website would sell apparel that appeals to youth instead of the original DARE t-shirts and teddy bears. Hats, t-shirts, and tote bags, with interesting, exciting, and colorful graphics would be distributed and sold. The goal would be to make the new campaign a revolution that students would regret not being a part of, similar to that of the truth and 84 campaigns.
In addition the new brand, the new campaign would rid itself of police officers delivering the message. New celebrity endorsements and commercials would be aired with popular, youthful, and exciting icons that will better relate to school-aged children. As Michael Hecht describes, “it is clear from a large body of research that students are more receptive when their peers are involved with delivering the message (16)."According to Dr. Denise C. Gottfredson, a Professor at the University of Maryland Department of Criminal Justice and Criminology, anti-substance-abuse messages are much more effective coming from a peer (5). In one extremely effective campaign “Keepin it REAL” high school students produced video narratives that show how youth have made good decisions and dealt with offers of drugs in their own lives. These videos are shown to middle school students, who then discuss the content (16).

IV. Conclusion
Since its creation in 1983 the DARE campaign has been the focus of both national and international criticism. While DARE has spent billions of dollars and reached millions of students, it remains an ineffective public health intervention. It proves to be inefficient at promoting healthier lifestyles among youth to be free from drugs, alcohol and tobacco use. DARE is built on traditional health belief models that fail to consider environmental and social factors contributing to alternative behaviors. With several modifications, including new student led discussion groups, a new brand, and a model centered on core values instead of health, the new proposed intervention will greatly reduce the number of children engaging in drug, alcohol and tobacco use.

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25. Zeese, Kevin, Mike Gray, Melvin Allen, and Doug McVay. Common Sense for Drug Policy: Drug Abuse Resistance Education (DARE). Lancaster, PA, 2009.



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