A Psycho-social Critique of the Drug Abuse Resistance Education Program (DARE) and Suggestions for Alternative Interventions - Su ma
Introduction:
The need to wage the “war on drugs” and solve the drug problem has been a recurrent theme and social commentary for much of the past two decades. When President Bush announced the government’s formal initiatives in waging a “war on drugs” in 1989, public concern over the drug problem was at its all-time high. The heightened public concern was in part due to the rise in the popularity of casual cocaine use among the middle and upper class, and the invention of crack cocaine, a smokable, more potent form of cocaine, used primarily by poorer, drug addicted people. (1) Before long, cocaine became the main export of Colombia, and a major product of Bolivia and Peru. Crack became so prevalent that by 1990 it cost only 35 cents to import and manufacture a vial (a common quantity) of it. (2) The dramatic increase in popularity of cocaine was a crude awakening of the potential dangerous ramifications of drug use and started an era of political and social battle against illegal drug use in America.
In response to the increase of national drug use, a plethora of legislations and interventional programs were developed to curb the rising popularity of drugs. In spite of numerous legislations such as the Anti-Drug abuse Act of 1988 and drug education programs such as the Drug Abuse Resistance Education programs (DARE) set forth by the Bush administration to educate and combat drug use, America’s “war on drugs” has been largely unsuccessful. Today an estimated 6 percent of the household population (12.8 million Americans) aged twelve and older used illegal drugs within the past thirty days. More than a third of Americans twelve or older have tried illegal drugs at some point in their lives. Ninety percent of those who have used illegal drugs used Marijuana or Hashish. Approximately a third used cocaine or took a type of prescription type drug for non-therapeutic purposes. About a fifth used LSD. (3) These statistics suggest a recent shift in preferred drug use from cocaine in the 80s to cannibinols such as Marijuana and Hashish, but fails to indicate any significant decrease in drug abuse and drugs remain as prevalent today as they were 20 years ago. This paper specifically examines the failures of a hugely popular government funded drug education program- the Drug Abuse Resistance Education program (DARE) and proposes three new interventions that would address these flaws. The basis of the critique is supported fundamentally by social and behavioral principles and theories.
Underlying Assumption of Rational Behavior in DARE:
DARE is an anti-drug education program that began in 1983 in Los Angeles, under Chief of Police Daryl Gates, that seeks to help children and teens “say no” to drugs through interactive lessons, role playing, dialogues between police officers and students in a class room setting. (4) Because of the program’s focus on training students to associate drug use with negative outcomes and resistance of peer pressure-a major relevant construct of social acceptability, it is an intervention program designed loosely based on the theory of reasoned action (TRA). Central to the TRA theory are three general constructs: behavioral intention (BI), out come expectancy (E), and subjective norm (SN). TRA suggests that a person's behavioral intention depends on the person's expectancy of the outcome associated with the behavior and subjective norms (BI = E + SN). If a person intends to do a behavior then it is likely that the person will do it. Furthermore a person's intentions are themselves guided by two things: the person's attitude towards the behavior and the subjective norm or social acceptability. (5) Although unlike the older models such as the Health Belief Model which primarily emphasizes factual information as the most important factor in shaping individual decisions, TRA is still fundamentally an individual-level model that assumes rationality decision making processes and does not encompass spontaneous behaviors.
This assumption forms the cornerstone for DARE’s entire curriculum. The first five of the ten lessons in the current DARE curriculum inundate students with facts about the overwhelming prevalence of drug use in our society and the frightening negative health and social consequences associated with drug use. The goal of the remaining five lessons is to equip students with the necessary tools and skills to not defer to peer pressures through the application of DARE’s decision making model. (6) The basic premise of the DARE program is that if police officers educate children and teens about the health and social consequences of drug use, and indoctrinate them with a method of resisting drugs, then they will not experiment or engage in drug use. This basic assumption of rationality in decision making especially regarding drug use is inappropriate and untrue. As illustrated by numerous examples presented in the book Blink by Malcolm Gladwell, contrary to popular belief that people’s decisions are rational; people make irrational decisions on a daily basis. It is doubtful that a highly impressionable population such as children and teens would be emotionally and mentally capable of making rational and logical decisions regarding complicated behaviors such as drug use under the often emotionally charged circumstances involving friends and peers.
In addition, DARE claims to provide students with the essential tools to make the right decisions with regard to drug use, but it is essentially flawed for the same reason in that it is underlined by rationality. The acclaimed necessary tools are basically encompassed in the DARE decision making model which consists of four steps (Define, Assess, Respond, Evaluate). (7) These four sequential steps not only are rigid in their reasoning but assume logical thinking every step of the way. In real life settings, a decision making model becomes irrelevant and unrealistic for students to apply.
DARE’s Choice of Framing:
DARE was created based on the contention that the present generation had already surrendered to drug dependency and that the country's future lay with the readiness of its children to resist involvement. By admitting to the defeat that students have already surrendered to drug use, DARE inadvertently frames drug use as the norm rendering it a normative adolescent behavior in America. This conveys feeling of loss of control over drug use. The hopeless sentiment is reflected in the curriculum’s emphasis on resistance of peer pressure, in particular the songs taught to young students. One of the songs titled “Just Say No” opens with the line “Too bad, so sad Drugs are everywhere. It just isn't fair. The lives they have taken.”(7) Another DARE song sings “Don’t want to fall into the trap. Don’t want to be somebody’s sap. I’m better than that. I’ll go to the mat to prove I can be drug free!”(9) These songs lyrics are reprehensive of the overall tone of the DARE approach to drug intervention. Children and teens are bombarded with messages by DARE police officers that all their friends and peers are already using drugs, but they should rise above the influence even if that implies going against the crowd. Framing drug use as the norm is demoralizing because by overly stressing and exaggerating the extent of drug use among youth, DARE is passively accepting drug use as common practice. Instead of imbuing the targeted audience with hopeful and inspirational messages, it forces students to accept drugs as inevitable aspect of the reality.
Superficial Approach to Drug Intervention:
Although DARE with its emphasis on peer pressure recognizes environmental factors as determinants of behavior, its approach to preventing drug use is almost entirely based on reducing the affects of peer pressure. Such an approach to solving the drug problem is superficial and overly simplistic. In order for the interventions to be effective, DARE needs to be more analytical in its assessment of the causes of drug use. The interventions should be redirected toward addressing the fundamental predictors of drug use instead of trying to limit the influence of peer pressure. Recent research in health behaviors has identified a number of social and emotional factors associated with substance abuse. Some of the most important predictors are history of abuse, violence within the family, depression and stress. (10) The DARE interventions are ineffective because the approach is overly simplistic and fail to address the key underlying risk factors of drug use among adolescents.
Moreover, the DARE program is designed with the inherent assumption that knowledge and behaviors are linked in a causal chain. The program’s heavy emphasis on negative factual information highlights this widely accepted belief that by instilling negative attitudes in adolescents, they will be respond aversively to drug use. This proves to be inadequate. Research in social psychology has shown conclusively that creating effective persuasive interventions is more complex than merely providing negative factual information. First, there are more attitudes that are relevant to the demand and use of drugs than one's attitude toward the drug itself. For example, among the attitudes relevant to the demand for drugs are attitudes toward: (a) oneself (e.g., low self-esteem may contribute to drug use), (b) authority figures (e.g., parents, government offi¬cials, and teachers who advise against drug use), (c) peers (e.g., friends and peers who may encourage or discourage drug use). (11) Although the program aims to help students cope with peer pressure, the rationale for non-conformity is still based on negative factual information.
Heavy Emphasis on Drug Resistance and Poor Choice of Messenger Lead to Forbidden Fruit Effect:
As any parent will attest, the need for independence and the desire for unique, autonomous identity are the hallmark characteristics of adolescents. Self-determined adolescents, many of whom are defiant and rebellious especially of authorities are likely to perceive external controlling forces as threats to their own autonomy. (12) Psychological reactance theory was formulated by Brehm in 1996 to specifically address the human needs for independence, freedom and control (three greatest factors concerning adolescence) provides an especially useful framework for understanding the failures of DARE. According to Brehm, psychological reactance is an emotional response in direct contradiction to the rules that threaten or attempt to eliminate certain behavioral freedoms. It can occur in situations when a person is heavily pressured or forced to accept a view or attitude towards a certain behavior. (13) Results from past studies have shown that DARE is an ineffective drug intervention and in some cases counterproductive. (14) Psychological reactance is likely to account for the negative results found in the studies for two main reasons. The intense focus on the negative consequences of drug use may result in the forbidden fruit effect and the choice of police officers (an authoritative figure) as agents for delivering the anti-drug messages may exacerbate the problem and produce emotional reactance against the program messages. Behaviors in defiance of the program may lead to drug experimentation which probably would not have occurred in the absence of psychological and emotional reactance.
Conclusion:
Although DARE recognizes the importance of environmental factors as determinants of behaviors, it still fails as an effective drug intervention because of four key factors. First, it is inherently flawed in its program design because the curriculum fails to include topics related to some of the most important underlying predictors for drug use. Second, the choice of framing drug use as the norm is discouraging. By emphasizing on its prevalence which implies hopeless acceptance of drug use as common practice, DARE does not engender positive feelings such as hope, control and empowerment in students. Third, DARE assumes rational behavior with regard to drug use and consequently the tools and skills which DARE attempt to equip the students with (decision making model) are irrelevant and unrealistic under real life situations because people’s decisions have been proven to be irrational. Finally, heavy stress on negative drug facts and poor choice of authoritative figures as messengers may result in defiance which may ultimately lead to counterproductive results
Interventions
In this paper, I propose three different interventions that could help to address the aforementioned flaws of the DARE program. One intervention is at the group level which adopts a group-level model as the basis for the intervention. The group-level intervention aims to improve effectiveness in preventing drug use by addressing DARE’s deficiencies in the framing of drug use and the incorrect assumption of rationality in decisions making processes. The second and third interventions are at the community and individual levels respectively. The community-level intervention aims to reduce the impact of the underlying social causes contributing to drug use while the individual-level intervention addresses the forbidden fruit effect.
Intervention 1: Use of Social Expectations Model in Group-Level Intervention
In order for an intervention to be effective in guiding the individual towards making the desired decision, it has to be compatible with the individual’s own decision making process. In particular, it has to assume irrationality in complex decision processes such as decisions in regard to drug use. In addition, spontaneity in decision making should also be embraced as a possibility. Although the social learning theory may be considered as a framework for designing an intervention, it is still limited to effects only at the individual level. Therefore, an alternative group-level model should serve as a more effective framework for two reasons. First, it affects behaviors at a much broader group- level, and precisely because of its capacity to affect group-level behaviors, it is an especially suitable model to use to change behaviors in young adolescents – a population that is highly susceptible to norms and behaviors of others. Second, group-level models specifically model irrational behaviors and are designed to exploit the irrationality in decision making processes.
The social expectations model is a classic group-level model which is based on the social expectations theory. The social expectations theory posits that people’s behaviors are dictated and influenced by the normative behavior in the person’s environment and when something becomes normative it becomes not only permissible but in some senses obligatory. Thus, people tend to adopt social norms and to tailor their behavior to meet the expectations entailed by the norms. (15) Because the social expectations model predicts group behavior based on the prevailing norm, it has the potential to change behaviors through manipulation of social norms.
With this in mind, the new intervention should focus on changing normative behavior. One powerful way to change the norm is to change people’s perception of the normative values. As discussed in the critique section, one of the major flaws of the DARE program lies in its framing of drug use as the prevailing normative behavior among adolescents. Therefore, the new intervention should aim to change students’ impression of the normative behavior through reframing in such a way that deemphasizes the prevalence of drug use among their peers and redirects the emphasis on those who do not use drugs. One approach would be to establish a national drug free student association website that functions as a tool establishing communication and connection among students who are drug free. The short term goal of the drug free association should be aimed at building a strong sense of pride and identity associated with being drug free instead of sending punitive anti-drug messages to the public. To achieve the short term goal, marketing strategies such as branding will be applied through wide distribution and use of drug free bumper stickers and other commercial merchandises. Ultimately, the long term objective of the intervention is to modify adolescents’ attitudes and behaviors towards drug use by resetting the norm regarding drug use from general deference to overt public disapproval.
Intervention 2: A Community-Level Approach
As discussed in the critique section, one of the major reasons DARE is ineffective as a drug intervention program is due in part to a superficial understanding about the causes of drug use. The more important predicators (history of abuse, family violence, depression and stress) have been completely disregarded by DARE. In order for the new intervention to be effective, it must address these risk factors. The strong associations between feelings of stress, depressive symptoms with substance abuse have important implications for designing health interventions. Stress and depressive symptoms are likely to have resulted from negative life experience and therefore intervention efforts should be directed at reducing or eliminating the effects of negative life experience.
In addition to asking the standard questions about smoking or alcohol use, health care providers should also elicit information regarding significant negative life events such as parents divorce, being bullied at school or poor academic performance. Once the nature of the negative life experience has been identified by the health care provider, appropriate outreach programs and counseling must be made available to the adolescent. To ensure adequate support for the adolescents who are struggling with significant negative emotional and psychological effects from the negative life experience, support should be delivered at every level within the community. This entails a huge demand for qualified professionals such as psychologists, counselors, support group coordinators and public health program implementers. All these professionals should be working together to promote positive emotions and feelings of well being in struggling adolescents. Thus the aim of the new intervention is building a strong community support system. For example, psychologists and counselors could function as outlets for adolescents to talk about their problems and also make suggestions that could potentially promote positive thinking. At the same time, support groups or programs could be implemented both in school and at the community level.
In addition, there needs to be general increased awareness among educators and primary health care providers of the possible link between adolescent substance use and history of abuse. One way to raise the awareness is by incorporating relevant information from adolescent research as part of the education and medical school curriculum. The ultimate goal is to establish a common practice at schools and health care settings; if a student is screened positive for drug abuse, there will be efforts from all levels of the community directed towards identifying possible history of family abuse or violence and vice versa. The idea is that by catching the problems early on, interventions may be more effectively at preventing or stopping drug use.
Intervention 3: Use of the Social Learning Theory in Individual-Level Intervention
Impressionability in children and adolescents has been well researched. Cigarette and alcohol companies actively exploit that in the promotion of their products both in the media and print. (16) Similar tactics can be adopted and used in designing public health interventions to modify adolescent attitudes and behavior in regard to substance abuse. Because children and adolescents are highly susceptible to modeling after behaviors of others due to their impressionable nature, social learning theory provides the pertinent groundwork for designing the new intervention.
Social learning theory emphasizes the importance of observing and modeling the behaviors, attitudes, and emotional reactions of others. Thus, the environment is the predominant determinant of behavior. Social learning theory encompasses three major components: 1) Reinforcements (the experience and results from doing a behavior can provide feedback for the behavior), 2) Observation or modeling (people model after the behavior which they observe, 3) Self-efficacy (the ability of the observer to complete and model after the observed behavior). (17) The new intervention will address all three components. The key element of effective application of the social learning theory lies in the choice of role models. The objective of the new intervention should be fostering and supporting modeling of healthy behaviors by creating role models to whom students can relate or be inspired to model after. Suitable role models could be other students who are similar in most aspects to the target population but have made the decision to not use drugs. Other potential role models might be ex-drug users who have made comebacks or just became tired of using drugs. The point is that by choosing role models who are easily perceived as non-threatening, genuine and inspiring, students are more likely to adopt similar attitudes and behaviors.
As discussed in the previous section, one of the flaws of the DARE program is the potential to provoke psychological reactance in the target population, the new intervention will completely eliminate the problem since in principle it’s not based on scare tactics and the role models are specifically chosen to relate to students in a non-coercive, non-threatening way.
In addition to choosing positive, encouraging role models, the new intervention should also boost students’ perception of their own ability to resist drug use thus increasing their sense of self-efficacy. One way to do this is to implement informal discussion groups after or during school in which the role models share with students their own experiences dealing with peer pressure, or resisting drug involvement. Finally, students who decide to model after the role models will most likely experience positive feedbacks from drug abstinence since it is highly associated with better academic performance and overall sense of well-being, thus reinforcing modeling behaviors. (18)
References:
1. Krane L. “How to Win the War on Drugs”, Fortune, 12 March 1990, 75.
2. National Criminal Justice Reference Service. American’s drug abuse profile. US Department of Justice.
3. Treaster, Joseph B. "Police in New York Shift Drug Battle Away From Streets," New York Times, 3 August 1992. A1.
4. A Different Look at Dare. What is DARE? A brief history and description of the DARE program.
5. Ajzen, I., Fishbein, M. Understanding attitudes and predicting social behavior. Englewood Cliffs, NJ: Prentice-Hall. 1980
6. The Official DARE Website.
7. DARE Curriculum Power point.
8. The DARE Song. “Just Say No.”
9. You Tube. The DARE Song. “I Will Dare.”
10. Simantov, E., Schoen, C., Klein, J. Health-Compromising Behaviors: Why Do adolescents Smoke or Drink?, Adolesc Med. 2000; 154: 1025 – 1033
11. Baker, Sara M., Petty, Richard E., Gleicher, Faith. Persuasion Theory and Drug Abuse Prevention, Health Communication, Vol. 3, 1991
12. Miller, Claude H., Burgoon, Michael, Grandpre, Joseph R. and Alvaro, Eusebio, M. Identifying Principal Risk Factors for the Initiation of Adolescent Smoking Behaviors: Significance of Psychologlical Reactance, Health Communication, 19: 3, 241-252
13. Brehm, S. S., & Brehm, J. W. (1981). Psychological Reactance: A Theory of Freedom and Control. Academic Press.
14. Steven L. West, Keri K. O’Neal, Project D.A.R.E. Outcome Effectiveness Revisited, American Journal of Public Health, 94: 6, 1027-1029
15. HIV/AIDS. Communication Initiative Site.
16. Tye JB, Warner KE, Glantz SA. Tobacco advertising and consumption: evidence of a causal relationship. J Public Health Policy. 1987 Winter; 8(4): 492–508.
17. Bandura, A. Social Learning Theory. New York: General Learning Press. 1977
18. Hazelden Foundation. Substance Abuse Linked to Poor Academic Performance, Memory Loss Among Teens. 2009
The need to wage the “war on drugs” and solve the drug problem has been a recurrent theme and social commentary for much of the past two decades. When President Bush announced the government’s formal initiatives in waging a “war on drugs” in 1989, public concern over the drug problem was at its all-time high. The heightened public concern was in part due to the rise in the popularity of casual cocaine use among the middle and upper class, and the invention of crack cocaine, a smokable, more potent form of cocaine, used primarily by poorer, drug addicted people. (1) Before long, cocaine became the main export of Colombia, and a major product of Bolivia and Peru. Crack became so prevalent that by 1990 it cost only 35 cents to import and manufacture a vial (a common quantity) of it. (2) The dramatic increase in popularity of cocaine was a crude awakening of the potential dangerous ramifications of drug use and started an era of political and social battle against illegal drug use in America.
In response to the increase of national drug use, a plethora of legislations and interventional programs were developed to curb the rising popularity of drugs. In spite of numerous legislations such as the Anti-Drug abuse Act of 1988 and drug education programs such as the Drug Abuse Resistance Education programs (DARE) set forth by the Bush administration to educate and combat drug use, America’s “war on drugs” has been largely unsuccessful. Today an estimated 6 percent of the household population (12.8 million Americans) aged twelve and older used illegal drugs within the past thirty days. More than a third of Americans twelve or older have tried illegal drugs at some point in their lives. Ninety percent of those who have used illegal drugs used Marijuana or Hashish. Approximately a third used cocaine or took a type of prescription type drug for non-therapeutic purposes. About a fifth used LSD. (3) These statistics suggest a recent shift in preferred drug use from cocaine in the 80s to cannibinols such as Marijuana and Hashish, but fails to indicate any significant decrease in drug abuse and drugs remain as prevalent today as they were 20 years ago. This paper specifically examines the failures of a hugely popular government funded drug education program- the Drug Abuse Resistance Education program (DARE) and proposes three new interventions that would address these flaws. The basis of the critique is supported fundamentally by social and behavioral principles and theories.
Underlying Assumption of Rational Behavior in DARE:
DARE is an anti-drug education program that began in 1983 in Los Angeles, under Chief of Police Daryl Gates, that seeks to help children and teens “say no” to drugs through interactive lessons, role playing, dialogues between police officers and students in a class room setting. (4) Because of the program’s focus on training students to associate drug use with negative outcomes and resistance of peer pressure-a major relevant construct of social acceptability, it is an intervention program designed loosely based on the theory of reasoned action (TRA). Central to the TRA theory are three general constructs: behavioral intention (BI), out come expectancy (E), and subjective norm (SN). TRA suggests that a person's behavioral intention depends on the person's expectancy of the outcome associated with the behavior and subjective norms (BI = E + SN). If a person intends to do a behavior then it is likely that the person will do it. Furthermore a person's intentions are themselves guided by two things: the person's attitude towards the behavior and the subjective norm or social acceptability. (5) Although unlike the older models such as the Health Belief Model which primarily emphasizes factual information as the most important factor in shaping individual decisions, TRA is still fundamentally an individual-level model that assumes rationality decision making processes and does not encompass spontaneous behaviors.
This assumption forms the cornerstone for DARE’s entire curriculum. The first five of the ten lessons in the current DARE curriculum inundate students with facts about the overwhelming prevalence of drug use in our society and the frightening negative health and social consequences associated with drug use. The goal of the remaining five lessons is to equip students with the necessary tools and skills to not defer to peer pressures through the application of DARE’s decision making model. (6) The basic premise of the DARE program is that if police officers educate children and teens about the health and social consequences of drug use, and indoctrinate them with a method of resisting drugs, then they will not experiment or engage in drug use. This basic assumption of rationality in decision making especially regarding drug use is inappropriate and untrue. As illustrated by numerous examples presented in the book Blink by Malcolm Gladwell, contrary to popular belief that people’s decisions are rational; people make irrational decisions on a daily basis. It is doubtful that a highly impressionable population such as children and teens would be emotionally and mentally capable of making rational and logical decisions regarding complicated behaviors such as drug use under the often emotionally charged circumstances involving friends and peers.
In addition, DARE claims to provide students with the essential tools to make the right decisions with regard to drug use, but it is essentially flawed for the same reason in that it is underlined by rationality. The acclaimed necessary tools are basically encompassed in the DARE decision making model which consists of four steps (Define, Assess, Respond, Evaluate). (7) These four sequential steps not only are rigid in their reasoning but assume logical thinking every step of the way. In real life settings, a decision making model becomes irrelevant and unrealistic for students to apply.
DARE’s Choice of Framing:
DARE was created based on the contention that the present generation had already surrendered to drug dependency and that the country's future lay with the readiness of its children to resist involvement. By admitting to the defeat that students have already surrendered to drug use, DARE inadvertently frames drug use as the norm rendering it a normative adolescent behavior in America. This conveys feeling of loss of control over drug use. The hopeless sentiment is reflected in the curriculum’s emphasis on resistance of peer pressure, in particular the songs taught to young students. One of the songs titled “Just Say No” opens with the line “Too bad, so sad Drugs are everywhere. It just isn't fair. The lives they have taken.”(7) Another DARE song sings “Don’t want to fall into the trap. Don’t want to be somebody’s sap. I’m better than that. I’ll go to the mat to prove I can be drug free!”(9) These songs lyrics are reprehensive of the overall tone of the DARE approach to drug intervention. Children and teens are bombarded with messages by DARE police officers that all their friends and peers are already using drugs, but they should rise above the influence even if that implies going against the crowd. Framing drug use as the norm is demoralizing because by overly stressing and exaggerating the extent of drug use among youth, DARE is passively accepting drug use as common practice. Instead of imbuing the targeted audience with hopeful and inspirational messages, it forces students to accept drugs as inevitable aspect of the reality.
Superficial Approach to Drug Intervention:
Although DARE with its emphasis on peer pressure recognizes environmental factors as determinants of behavior, its approach to preventing drug use is almost entirely based on reducing the affects of peer pressure. Such an approach to solving the drug problem is superficial and overly simplistic. In order for the interventions to be effective, DARE needs to be more analytical in its assessment of the causes of drug use. The interventions should be redirected toward addressing the fundamental predictors of drug use instead of trying to limit the influence of peer pressure. Recent research in health behaviors has identified a number of social and emotional factors associated with substance abuse. Some of the most important predictors are history of abuse, violence within the family, depression and stress. (10) The DARE interventions are ineffective because the approach is overly simplistic and fail to address the key underlying risk factors of drug use among adolescents.
Moreover, the DARE program is designed with the inherent assumption that knowledge and behaviors are linked in a causal chain. The program’s heavy emphasis on negative factual information highlights this widely accepted belief that by instilling negative attitudes in adolescents, they will be respond aversively to drug use. This proves to be inadequate. Research in social psychology has shown conclusively that creating effective persuasive interventions is more complex than merely providing negative factual information. First, there are more attitudes that are relevant to the demand and use of drugs than one's attitude toward the drug itself. For example, among the attitudes relevant to the demand for drugs are attitudes toward: (a) oneself (e.g., low self-esteem may contribute to drug use), (b) authority figures (e.g., parents, government offi¬cials, and teachers who advise against drug use), (c) peers (e.g., friends and peers who may encourage or discourage drug use). (11) Although the program aims to help students cope with peer pressure, the rationale for non-conformity is still based on negative factual information.
Heavy Emphasis on Drug Resistance and Poor Choice of Messenger Lead to Forbidden Fruit Effect:
As any parent will attest, the need for independence and the desire for unique, autonomous identity are the hallmark characteristics of adolescents. Self-determined adolescents, many of whom are defiant and rebellious especially of authorities are likely to perceive external controlling forces as threats to their own autonomy. (12) Psychological reactance theory was formulated by Brehm in 1996 to specifically address the human needs for independence, freedom and control (three greatest factors concerning adolescence) provides an especially useful framework for understanding the failures of DARE. According to Brehm, psychological reactance is an emotional response in direct contradiction to the rules that threaten or attempt to eliminate certain behavioral freedoms. It can occur in situations when a person is heavily pressured or forced to accept a view or attitude towards a certain behavior. (13) Results from past studies have shown that DARE is an ineffective drug intervention and in some cases counterproductive. (14) Psychological reactance is likely to account for the negative results found in the studies for two main reasons. The intense focus on the negative consequences of drug use may result in the forbidden fruit effect and the choice of police officers (an authoritative figure) as agents for delivering the anti-drug messages may exacerbate the problem and produce emotional reactance against the program messages. Behaviors in defiance of the program may lead to drug experimentation which probably would not have occurred in the absence of psychological and emotional reactance.
Conclusion:
Although DARE recognizes the importance of environmental factors as determinants of behaviors, it still fails as an effective drug intervention because of four key factors. First, it is inherently flawed in its program design because the curriculum fails to include topics related to some of the most important underlying predictors for drug use. Second, the choice of framing drug use as the norm is discouraging. By emphasizing on its prevalence which implies hopeless acceptance of drug use as common practice, DARE does not engender positive feelings such as hope, control and empowerment in students. Third, DARE assumes rational behavior with regard to drug use and consequently the tools and skills which DARE attempt to equip the students with (decision making model) are irrelevant and unrealistic under real life situations because people’s decisions have been proven to be irrational. Finally, heavy stress on negative drug facts and poor choice of authoritative figures as messengers may result in defiance which may ultimately lead to counterproductive results
Interventions
In this paper, I propose three different interventions that could help to address the aforementioned flaws of the DARE program. One intervention is at the group level which adopts a group-level model as the basis for the intervention. The group-level intervention aims to improve effectiveness in preventing drug use by addressing DARE’s deficiencies in the framing of drug use and the incorrect assumption of rationality in decisions making processes. The second and third interventions are at the community and individual levels respectively. The community-level intervention aims to reduce the impact of the underlying social causes contributing to drug use while the individual-level intervention addresses the forbidden fruit effect.
Intervention 1: Use of Social Expectations Model in Group-Level Intervention
In order for an intervention to be effective in guiding the individual towards making the desired decision, it has to be compatible with the individual’s own decision making process. In particular, it has to assume irrationality in complex decision processes such as decisions in regard to drug use. In addition, spontaneity in decision making should also be embraced as a possibility. Although the social learning theory may be considered as a framework for designing an intervention, it is still limited to effects only at the individual level. Therefore, an alternative group-level model should serve as a more effective framework for two reasons. First, it affects behaviors at a much broader group- level, and precisely because of its capacity to affect group-level behaviors, it is an especially suitable model to use to change behaviors in young adolescents – a population that is highly susceptible to norms and behaviors of others. Second, group-level models specifically model irrational behaviors and are designed to exploit the irrationality in decision making processes.
The social expectations model is a classic group-level model which is based on the social expectations theory. The social expectations theory posits that people’s behaviors are dictated and influenced by the normative behavior in the person’s environment and when something becomes normative it becomes not only permissible but in some senses obligatory. Thus, people tend to adopt social norms and to tailor their behavior to meet the expectations entailed by the norms. (15) Because the social expectations model predicts group behavior based on the prevailing norm, it has the potential to change behaviors through manipulation of social norms.
With this in mind, the new intervention should focus on changing normative behavior. One powerful way to change the norm is to change people’s perception of the normative values. As discussed in the critique section, one of the major flaws of the DARE program lies in its framing of drug use as the prevailing normative behavior among adolescents. Therefore, the new intervention should aim to change students’ impression of the normative behavior through reframing in such a way that deemphasizes the prevalence of drug use among their peers and redirects the emphasis on those who do not use drugs. One approach would be to establish a national drug free student association website that functions as a tool establishing communication and connection among students who are drug free. The short term goal of the drug free association should be aimed at building a strong sense of pride and identity associated with being drug free instead of sending punitive anti-drug messages to the public. To achieve the short term goal, marketing strategies such as branding will be applied through wide distribution and use of drug free bumper stickers and other commercial merchandises. Ultimately, the long term objective of the intervention is to modify adolescents’ attitudes and behaviors towards drug use by resetting the norm regarding drug use from general deference to overt public disapproval.
Intervention 2: A Community-Level Approach
As discussed in the critique section, one of the major reasons DARE is ineffective as a drug intervention program is due in part to a superficial understanding about the causes of drug use. The more important predicators (history of abuse, family violence, depression and stress) have been completely disregarded by DARE. In order for the new intervention to be effective, it must address these risk factors. The strong associations between feelings of stress, depressive symptoms with substance abuse have important implications for designing health interventions. Stress and depressive symptoms are likely to have resulted from negative life experience and therefore intervention efforts should be directed at reducing or eliminating the effects of negative life experience.
In addition to asking the standard questions about smoking or alcohol use, health care providers should also elicit information regarding significant negative life events such as parents divorce, being bullied at school or poor academic performance. Once the nature of the negative life experience has been identified by the health care provider, appropriate outreach programs and counseling must be made available to the adolescent. To ensure adequate support for the adolescents who are struggling with significant negative emotional and psychological effects from the negative life experience, support should be delivered at every level within the community. This entails a huge demand for qualified professionals such as psychologists, counselors, support group coordinators and public health program implementers. All these professionals should be working together to promote positive emotions and feelings of well being in struggling adolescents. Thus the aim of the new intervention is building a strong community support system. For example, psychologists and counselors could function as outlets for adolescents to talk about their problems and also make suggestions that could potentially promote positive thinking. At the same time, support groups or programs could be implemented both in school and at the community level.
In addition, there needs to be general increased awareness among educators and primary health care providers of the possible link between adolescent substance use and history of abuse. One way to raise the awareness is by incorporating relevant information from adolescent research as part of the education and medical school curriculum. The ultimate goal is to establish a common practice at schools and health care settings; if a student is screened positive for drug abuse, there will be efforts from all levels of the community directed towards identifying possible history of family abuse or violence and vice versa. The idea is that by catching the problems early on, interventions may be more effectively at preventing or stopping drug use.
Intervention 3: Use of the Social Learning Theory in Individual-Level Intervention
Impressionability in children and adolescents has been well researched. Cigarette and alcohol companies actively exploit that in the promotion of their products both in the media and print. (16) Similar tactics can be adopted and used in designing public health interventions to modify adolescent attitudes and behavior in regard to substance abuse. Because children and adolescents are highly susceptible to modeling after behaviors of others due to their impressionable nature, social learning theory provides the pertinent groundwork for designing the new intervention.
Social learning theory emphasizes the importance of observing and modeling the behaviors, attitudes, and emotional reactions of others. Thus, the environment is the predominant determinant of behavior. Social learning theory encompasses three major components: 1) Reinforcements (the experience and results from doing a behavior can provide feedback for the behavior), 2) Observation or modeling (people model after the behavior which they observe, 3) Self-efficacy (the ability of the observer to complete and model after the observed behavior). (17) The new intervention will address all three components. The key element of effective application of the social learning theory lies in the choice of role models. The objective of the new intervention should be fostering and supporting modeling of healthy behaviors by creating role models to whom students can relate or be inspired to model after. Suitable role models could be other students who are similar in most aspects to the target population but have made the decision to not use drugs. Other potential role models might be ex-drug users who have made comebacks or just became tired of using drugs. The point is that by choosing role models who are easily perceived as non-threatening, genuine and inspiring, students are more likely to adopt similar attitudes and behaviors.
As discussed in the previous section, one of the flaws of the DARE program is the potential to provoke psychological reactance in the target population, the new intervention will completely eliminate the problem since in principle it’s not based on scare tactics and the role models are specifically chosen to relate to students in a non-coercive, non-threatening way.
In addition to choosing positive, encouraging role models, the new intervention should also boost students’ perception of their own ability to resist drug use thus increasing their sense of self-efficacy. One way to do this is to implement informal discussion groups after or during school in which the role models share with students their own experiences dealing with peer pressure, or resisting drug involvement. Finally, students who decide to model after the role models will most likely experience positive feedbacks from drug abstinence since it is highly associated with better academic performance and overall sense of well-being, thus reinforcing modeling behaviors. (18)
References:
1. Krane L. “How to Win the War on Drugs”, Fortune, 12 March 1990, 75.
2. National Criminal Justice Reference Service. American’s drug abuse profile. US Department of Justice.
3. Treaster, Joseph B. "Police in New York Shift Drug Battle Away From Streets," New York Times, 3 August 1992. A1.
4. A Different Look at Dare. What is DARE? A brief history and description of the DARE program.
5. Ajzen, I., Fishbein, M. Understanding attitudes and predicting social behavior. Englewood Cliffs, NJ: Prentice-Hall. 1980
6. The Official DARE Website.
7. DARE Curriculum Power point.
8. The DARE Song. “Just Say No.”
9. You Tube. The DARE Song. “I Will Dare.”
10. Simantov, E., Schoen, C., Klein, J. Health-Compromising Behaviors: Why Do adolescents Smoke or Drink?, Adolesc Med. 2000; 154: 1025 – 1033
11. Baker, Sara M., Petty, Richard E., Gleicher, Faith. Persuasion Theory and Drug Abuse Prevention, Health Communication, Vol. 3, 1991
12. Miller, Claude H., Burgoon, Michael, Grandpre, Joseph R. and Alvaro, Eusebio, M. Identifying Principal Risk Factors for the Initiation of Adolescent Smoking Behaviors: Significance of Psychologlical Reactance, Health Communication, 19: 3, 241-252
13. Brehm, S. S., & Brehm, J. W. (1981). Psychological Reactance: A Theory of Freedom and Control. Academic Press.
14. Steven L. West, Keri K. O’Neal, Project D.A.R.E. Outcome Effectiveness Revisited, American Journal of Public Health, 94: 6, 1027-1029
15. HIV/AIDS. Communication Initiative Site.
16. Tye JB, Warner KE, Glantz SA. Tobacco advertising and consumption: evidence of a causal relationship. J Public Health Policy. 1987 Winter; 8(4): 492–508.
17. Bandura, A. Social Learning Theory. New York: General Learning Press. 1977
18. Hazelden Foundation. Substance Abuse Linked to Poor Academic Performance, Memory Loss Among Teens. 2009
Labels: Adolescent Health, Drug Use, Red
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