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Editor's Note: Dr. Gene Tinelli, a board member of ReconsiDer: Forum on Drug Policy, and a board certified addictions psychiatrist, wrote the following report on the nationwide drug education program, DARE, which is federally funded. Dr. Tinelli shows that, when held up against the U.S. Department of Education''s new Principles of Effectiveness, DARE does not measure up as an effective program. Readers wishing to have their local school systems reevaluate the effectiveness of their DARE program, or wishing to replace the DARE program with a more effective one, should share this paper with their local school superintendent or school board. Dr. Tinelli's full professional biography is provided at the end of this report.

Gene Tinelli By Gene Tinelli, M.D., P.h.D.
Fall, 1997

The U. S. Department of Education has proposed new Principles of Effectiveness that would govern recipients' use of fiscal year 1998 and future years' funds received under Title IV-State and local programs of the Elementary and Secondary Education Act -the Safe and Drug-Free Schools and Communities Act (SDFSCA) State Grants program ("Safe and Drug-Free Schools Program", Federal Register, 62 (136), 38072-38073, July 16, 1997). To be funded, recipients shall:

1. Base their programs on a thorough assessment of objective data about the drug and violence problems in the schools and communities served.
2. Design their activities to meet their measurable goals and objectives for drug and violence prevention.
3. Design and implement their activities based on research or evaluation that provides evidence that the strategies used prevent or reduce drug use, violence, or disruptive behavior among youth.
4. Evaluate their programs periodically to assess their progress toward achieving their goals and objectives, and use their evaluation results to refine, improve, and strengthen their program, and to refine their goals and objectives as appropriate.

Funding for local programs will require that grant recipients "implement programs that have demonstrated that they can be effective in preventing or reducing drug use." The Department of Education "believes that the implementation of research-based approaches will significantly enhance the effectiveness of programs supported with SDFSCA funds. Grantees are encouraged to review the breadth of available research and evaluation literature in selecting effective strategies most responsive to their needs. and to replicate these strategies in a manner consistent with their original design." Given the proposed mandate, how does the DARE program fare?

Recent studies of DAREıs effectiveness:

In September 1994, the Research Triangle Institute in North Carolina completed a project sponsored by the National Institute of Justice which analyzed eight of the top studies of DARE. The researchers concluded that the program had only a short-term effect on reducing drug use, and that several other interaction-based drug education programs were more effective in preventing drug use (Susan Ennett, Nancy Tobler, Christopher Ringwalt, Robert Flewelling, "How Effective is Drug Abuse Education? A Meta-Analysis of Project DARE Outcome Evaluations," American Journal of Public Health, September 1994).

In 1996, University of Kentucky researcher Richard Clayton published a five-year evaluation of the effectiveness of DARE. Using data from 31 elementary schools, Clayton found that any results from DARE were short-term. There are "limited effects of the program upon drug use, greater efficacy with respect to attitudes, social skills and knowledge, but a general tendency for curriculum effects to decay over time." Bill Alden, deputy director of DARE America, has responded to such criticism by saying, "There's a natural erosion that takes place" and that the program cannot "inoculate children for life" (Richard Clayton. Anna Cattarello, Bryan Johnstone, "The Effectiveness of Drug Abuse Resistance Education (Project DARE): 5-Year Follow-up Results." Preventive Medicine,, 1, 307, 1996; Robert Greene, "Drug Education not saving kids, U.S. report admits," Charlotte Observer, February; 5, 1997, p. 4A).

In February 1997, the Research Triangle Institute completed a four-year study sponsored by the Department of Education. The study, which tracked 10,000 fifth and sixth graders from 1991 to 1995, found programs other than DARE to be more successful in preventing drug use and promoting anti-drug attitudes among students. The report recommends that DARE increase emphasis on role-playing and decrease emphasis on self-esteem and establishing negative attitudes toward drugs (E. Suyapa Silvia and Judy Thorne, "School Based Drug Prevention Programs: A Longitudinal Study in Selected School Districts," Research Triangle Institute (Chapel Hill, NC), February 1997).

A study published in March 1997 found the drug-prevention scheme in California schools to be unsuccessful in reaching students. The Drug, Alcohol, and Tobacco Education programs (DATE) primarily consisted of the DARE program plus Red Ribbon Weeks, Life Skills, etc. The research, which combined by quantitative and qualitative methods, included in-depth interviews with 400 educators, administrators, parents, and counselors, included in-depth interviews with 40 focus groups, and included surveys to over 5000 randomly-selected students, grades 7-12. This study showed that nearly 70% of the students felt that the program had little or no effect on them and children and adolescents wanted more complete information and an identifiable referent relationship with educators (Joel Brown, Marian D'Emidio-Caston, and John Pollard, "Students and Substances: Social Power in Drug Education," Educational Evaluation and Policy analysis, 19, 65-92, Spring 1997). The researchers stated "None of us advocate programs which advocate adolescent substance use. However, at its essence, today"s drug education imparts values to children that run counter to those found in a well-informed, free, open society. By almost any examination, the evidence suggests that the cultural values we find in our California Prevention programs - the values of indoctrination, censorship, punishment, stigmatization, and exclusion - do not contribute to a successful, healthy democracy."

In Syracuse, the ineffectiveness of our DARE program was shown by the most recent survey conducted by the City County Drug and Alcohol Abuse Commission, which documented the rise in drug use by children and adolescents of central New York.

The U. S. General Accounting Office (GAO) recently examined school-based, drug prevention programs ("Drug Control: Observations on Elements of the Federal Drug Control Strategy", GAO/GGD-97-42, B-275944, United States General Accounting Office, March 14, 1997). The GAO identified five types of approaches: information dissemination, affective education, alternative approaches to drugs, psychosocial, and comprehensive. Of the five, two, the psychosocial and comprehensive, seem to work with school-aged youth. The psychosocial approaches are programs that emphasize problem-solving and decision-making skills. The comprehensive approaches involve the use of the family, the school. and several other institutions to achieve a multi-operational approach to prevention. They cited five psychosocial and five comprehensive drug programs that have shown promise for reducing drug use and risk factors and for enhancing protective factors among school-aged youth.

Psychosocial approaches:

1. Life Skills Training Program showed 44% fewer intervention participants that completed at least 60% of the program reported use of three drugs over a specified period of time, as compared to control group participants.
2. Project ALERT showed significantly fewer students in experimental intervention groups anticipated using marijuana and believed marijuana and cigarette use could bring immediate and negative social consequences and result in drug dependence.
3. Generic Skills Intervention showed drinking frequency, amount of alcohol consumed, and intention to drink beer/wine were lower in the experimental groups and these groups used drug-refusal skills more often than controls.
4. Adolescent Alcohol Prevention Trial, which demonstrated that the increase in initial use of marijuana for intervention participants was 65% less than that of a comparison control group at one year follow-up and 23% less than control group participants for alcohol.
5. Interpersonal Relations Program showed significantly decreased drug use, fewer problems with family and friends, fewer school disciplinary actions, lower dropout rate, and higher grade point average than controls.

Comprehensive approaches:

1. Seattle Social Development Project showed the group receiving intervention demonstrated significantly greater school commitment and attachment, fewer school problem behaviors, less alcohol use, less violent behavior, and fewer sexual partners compared to controls.
2. Midwestern Prevention Project - also known as Project Star or I-Star, showed a 20-40% net reduction in the use of two drugs by school-aged youth over a three year period.
3. Safe Haven Program (a cultural version of the Strengthening Families Program, SFP) showed parents in both the high and low substance abuse groups reported significant decreases in drug use for themselves and their families and children in the high substance abuse group showed significant reductions in school problems, aggression, delinquency, and hyperactivity.
4. Adolescent Transitions Program (ATP) showed mothers in parent and teen groups reported significantly less family conflict than controls and significant reductions in adolescent problem behavior. However, teen focus intervention had a negative effect.
5. Project Northland showed lower tendency to use alcohol, marijuana and cigarettes and significantly more likely to report being able to resist alcohol at a party of dance.

The most obvious point of the GAO report is what they do not say. The GAO report on promising programs completely omits any reference to the DARE program.

The Seattle experience is instructive. In the seventies, in response to both the anti-alcohol and wellness movements, Seattle launched a "Hereıs Looking at You" (HLAY) program, a comprehensive alcohol education program. The HLAY program spanned K through 12, with fifteen sessions each class year, and covered drug resistance through self-esteem training. On final evaluation, this school-based, well-intentioned model program made no significant difference in drug use. The researchers stated: "Although the HLAY curriculum was solidly based in comtemproary ideas about alcohol education, it must be concluded that the benefits from curriculum exposure were very small . . . much less than expected . . . longitudinal data showed little evidence of cumulative or long-term effects of curriculum exposure . . . on subsequent drinking or other problem behaviors."

They concluded: ". . . it may be that such a school program must be integrated with a comprehensive and coordinated community-wide prevention effort involving schools, parents, peers, media, churches, civic clubs, local government and other important institutions . . . it may be that no society can reasonably expect to single out certain drugs or certain age groups for proscriptive or restrictive policies, while at the same time condoning (or even encouraging) the consumption of alcohol and other drugs in the rest of the population." (R. H. Hopkins, A. L. Mauss, K. A. Kearney, R. A. Weisheit, "Comprehensive Evaluation of a Model Alcohol Educational Curriculum", Journal of Studies on Alcohol, 49, 38-51, 1988)

Though Seattle then adopted the DARE program, it did not limit itself to DARE. The Seattle Social Development Project began in 1981 to test strategies for reducing childhood risk factors for adolescent drug abuse and delinquency. First and seventh graders were taught how to refuse drug offers and build friendships with non-drug using peers. Parents and teachers learned how to strengthen bonding to family and school and encourage childrenıs positive behaviors and keep them actively engaged in learning. Its results are: more positive attachment to family and school; boys less aggressive and girls less self-destructive; fewer suspensions and expulsions among low-achieving students; less drug-use initiation; less delinquency; better score on standardized achievement tests (Daniel Goleman, Emotional Intelligence, 1995, Appendix F). This year, Seattle scrapped its DARE program (with the enthusiastic support of the Seattle Chief of Police).

At this point in time we have a popular and expensive ($750 million/year) DARE program that research shows doesnıt lower youth drug use. Among the notable quotations from researchers: "Itıs well established that DARE doesn't work", Gilbert Botvin - Cornell Medical Center ; "Research shows that, no, DARE hasn't been effective in reducing drug use", William Modzeleski, Top Drug education official at the Department of Education; "I think the program should be entirely scrapped and redeveloped anew.", Dr. William Hansen, who helped design the original DARE program. We have promising programs that may work - but with certain cautions and caveats.

1. We must be open to the possibility that directly targeting drugs in school substance abuse prevention programs may not only be ineffective but may be harmful for many youth.

a. Working with K through 8 students in targeted drug programs provides a safe haven for those students who want and need support to remain abstinent but is statistically balanced by those youth whose curiosity about drugs (i.e., "just say yes") is stimulated by drug discussions that are not age appropriate.
b. Teaching fifth and sixth graders (e.g., the DARE approach) to "just say no" can encourage early rebellion toward parents rather than increasing latency age bonding.
c. DARE proponents argue that the reason the research shows their program to be ineffective is that it is only in the fifth and sixth grade level and that DARE would work if its principles were extended through high school. However, adapting drug resistance education from the K through 8 level to the adolescent, junior and senior high school level not only doesnıt work, it is counterproductive. Both the Adolescent Transition Program and the far more extensive evaluation of the California DATE (Drug, Alcohol, Tobacco Education) program show that an entirely new approach is needed for this group. Adolescents challenge and reject traditional approaches and want honesty rather than indoctrination. The result of traditional programs is increased alienation and increased drug use. This should not be surprising as one of the missions of adolescence is to challenge family and social norms and experiment in establishing new peer bonds and norms.
d. The developing tragedy of a HIV outbreak in a western New York high school also highlights how difficult prevention is in the teen population.

A Chautauqua county health coordinator stated: "Weıre dealing with a teen population . . . in their minds, nothingıs going to happen to them." A mother whose son died in 1995 after receiving a HIV tainted blood transfusion, claimed the school districts in Chautauqua County told her to tone down her lectures to students. She said "They tell me to tell my personal story without mentioning sex or condoms . . . I can talk about my son and the blood supply but really nothing further . . . itıs like theyıre burying their heads in the sand" ("HIV Outbreak Shows Safe Sex Message Not Always Heard By Teens", Post-Standard, Oct. 30. 1997, A3). The teen population is difficult enough to reach. To eliminate the harm-reduction component of either sex or drug education condemns our youth to a much higher morbidity and mortality than necessary.

2. The most promising K through 8 programs use teachers who aim to enhance social competence, increase the skills of emotional intelligence, involve families, target at risk groups and obliquely target drug use. The net effect of these psychosocial and comprehensive programs is to produce a healthier, more resilient child and this is apparently what has an effect in lowering drug use.

3. Programs directed at adolescents must use an integrated, harm reduction model that:

a. provides them with factual information about drugs.
b. helps them examine their own attitudes about drugs and drug users.
c. helps them understand people who experience a drug problem and foster a caring attitude.
d. helps them avoid the harmful consequences of drug use by explaining secondary prevention strategies.
e. raises awareness of the legal, health, and social implications of their own drug sue.
f. helps them to understand the role of drug use in past and present societies and cultures.

Providing this type of program requires a confluent education whose goals are to one, facilitate harm reduction through student awareness and responsibility by fostering trust, care and a sense of membership and two, facilitate awareness and responsibility through integration of youth thoughts, feelings and actions, within themselves, relative to groups and various social contexts. Accomplishing this requires:

a. the educator being a facilitator in addition to a knowledge imparter.
b. without advocating substance use, providing caring, knowledgeable educators.
c. emphasize promoting wellbeing through resilience, not through identification and isolation.
d. providing time to talk and someone to listen.
e. provide small groups to confidentially, openly, and honestly discuss their values.
f. make available contact with people who experience similar problems or who do not have problems.
g. provide help for those who need it.

The final edition of the largest evaluation of the DARE program has concluded that the DARE program does not reduce drug use, and, in at least category of marijuana, the DARE graduates smoked more frequently than the controls. The report concluded: "The DARE program's limited effect on adolescent drug use contrasts with the program's popularity and prevalence. An important implication is that DARE could be taking the place of other, more beneficial drug education programs that kids could be receiving." ("How Effective is DARE", American Journal of Public Health, Sept 1994, p 1399).

In an era of diminished resources and increased surveillance of school programs' effectiveness, the Department of Educationıs Principles of Effectiveness monitoring should be applied to our local DARE program. If it is found wanting, we should be searching for other programs that may be more effective in accomplishing their goals.

ABOUT THE AUTHOR: Dr. Gene Tinelli is a former U. S. Navy psychiatrist and current assistant professor of psychiatry and behavioral science at the State University of New York Health Science Center at Syracuse, New York. He is a board certified psychiatrist with added qualifications in addiction psychiatry and is on the staff of the Chemical Dependency Clinic of the Veterans Affairs Medical Center in Syracuse. In addition to his medical training, he holds a PhD in biochemistry. He may be reached by e-mail at: genet43@dreamscape.com


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