School-based drug prevention programs: a review of what works

Australian and New Zealand Journal of Criminology, August, 2008 by David W. Soole, Lorraine Mazerolle, Sacha Rombouts

This article examines the effectiveness of school-based drug prevention programs in preventing illicit drug use. Our article reports the results of a systematic review of the evaluation literature to answer three fundamental questions: (I) do school-based drug prevention programs reduce rates of illicit drug use? (2) what features are characteristic of effective programs? and (3) do these effective program characteristics differ from those identified as effective in reviews of school-based drug prevention of licit substance use (such as alcohol and tobacco)? Using systematic review and mere-analytic techniques, we identify the characteristics of school-based drug prevention programs that have a significant and beneficial impact on ameliorating illicit substance use (i.e., narcotics) among young people. Successful intervention programs typically involve high levels of interactivity, time-intensity, and universal approaches that are delivered in the middle school years. These program characteristics aligned with many of the effective program elements found in previous reviews exploring the impact of school-based drug prevention on licit drug use. Contrary to these past reviews, however, our analysis suggests that the inclusion of booster sessions and multifaceted drug prevention programs have little impact on preventing illicit drug use among school-aged children. Limitations of the current review and policy implications are discussed.

Keywords: drug prevention, meta-analysis, illicit drug use

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Schools are a popular starting point for the delivery of many social education and prevention efforts, addressing a variety of social phenomena such as drug use, crime and delinquency, teenage sexual activity and pregnancy, and various health issues such as nutrition, exercise, and sexually transmitted disease (Botvin & Griffin, 2003). School-based drug prevention (SBDP) programs are especially popular, with evidence suggesting their benefits to be twice that of costs (Caulkins, Pacula, Paddock, & Chiesa, 2002). Schools are thus an appropriate and convenient 'platform' from which to launch drug prevention efforts. Schools have the ability to reach large numbers of school-aged children, and programs delivered during school hours are relatively easy to implement compared to other types of noninstitutionally-based programs (such as family or community-based programs). Petrosino (2003) laments, however, that the large number of highly variable school-based programs creates confusion among policymakers as to which strategies to implement.

A plethora of studies have assessed the effectiveness of SBDP efforts, most of which focus on the impact of these programs on reducing or preventing licit drug use' (Allott, Paxton, & Leonard, 1999; Belcher & Shinitzky, 1998; Black, Tobler, & Sciacca, 1998; Botvin & Griffin, 2003, 2004; Coggans, Cheyne, & McKellar, 2003; Cuijpers, 2002; Dusenbury, Mathea, & Lake, 1997; Ennett, Tobler, Ringwalt, & Flewelling, 1994; Flay, 2000; Gottfredson & Wilson, 2003; McBride, 2003; Midford, 2000; Skara & Sussman, 2003; Tobler et al., 2000). The focus in the literature on licit drug consumption, such as alcohol and tobacco, makes intuitive sense given that most SBDP programs are implemented at a developmental stage when illicit drug use rates among adolescents are low.

We know, however, that illicit substance use among school-aged children is a major and growing concern. In 2004, 28.5% of Australian adolescents aged 12 to 17 years had used an illicit drug during their life. More than one in five 12- to 17-year-olds reported having tried marijuana (23.2%), 3.7% reported having tried amphetamines, 3.4% ecstasy, 1.0% cocaine, and 0.5% opiates (Australian Institute of Health and Welfare [AIHW], 2005). In the United States (US) 36.8% of 8th through 12th graders reported having used an illicit substance during their lifetime (Johnston, O'Malley, Bachman, & Schulenberg, 2005). To our knowledge there have been just two systematic reviews that have examined the impact of SBDP programs on illicit drug outcomes (Tobler, Lessard, Marshall, Ochshorn, & Roona, 1999; White & Pitts, 1998). Our research extends the body of literature around SBDP in two ways: first, we update these two past systematic reviews by accessing studies conducted after the late 1990s to assess the effectiveness of SBDP programs in reducing or preventing illicit substance use. Second, we compare and contrast our results with reviews of licit drug use outcomes.

Our article addresses three fundamental research questions: (1) do school-based drug prevention programs reduce rates of illicit drug use? (2) what features are characteristic of effective programs? and (3) are these effective program characteristics similar to those identified as effective in reviews of school-based drug prevention of licit substance use? To answer these research questions our approach proceeds in three stages: first, we identify the key elements of program success found in past reviews of SBDP programs that target licit drug use. Second, we update the two past reviews of SBDP that report results pertaining to illicit drug use outcomes using systematic and meta-analytic approaches to synthesise relevant recent literature. We then compare and contrast the elements that we find to be components of successful SBDP programs that target illicit drug use with the successful elements found in the majority of the literature on the impact of SBDP programs on licit drug use outcomes. We conclude our article with a discussion of the policy implications of our research findings.