Who needs drugs when you can binge on life skills?

In some countries it’s the drink. In others it’s the drugs. In Spain spring has become the season of the Botellon (the “Big Bottle”), even of the macrobottelon, when young people meet in the open and binge-drink away the night of the vernal equinox. In the US, in Denver at least, it’s time to worry about the damage drink, drugs and both together are doing to young people the world over.

None of it is new, of course. Youth and excess go together and “substance” problems of one kind and another thread their way through history. Wormwood, peyote, tobacco, gin, amphetamine… take your pick.

Richard Nixon, who developed a habit for declaring wars on phenomena, announced a presidential “War on Drugs” in 1971. Over the decades since, billions of dollars have been spent trying to reduce consumption by young people – usually with little to show at the end.

Prevention science has not been immune to these failures. Many programs show neutral or even negative effects. Notably ineffectual have been those relying on "affective education": just tell young people about drink and drugs and about all the terrible things that will happen – never mind the reasons why children start experimenting in the first place, or the fact – old as time and narcotics – that adolescents kick against the traces by doing the opposite of whatever their elders tell them.

Drug and alcohol prevention or reduction remains at the heart of many interventions designed for young people. Recent years have seen them proliferate in the US particularly, reflecting what national surveys suggest has been a 30 per cent increase in use and abuse over the last decade. Similar trends have been identified by epidemiological studies all across the developed world.

If so much money has been spent, why are things getting so much worse? Well actually, despite the perceived wisdom, the last few years have seen a slight decrease in substance abuse among young people. The causes of the improvement are contested, however, with the Office of National Drug Control Policy applauding its own High Intensity Drug Trafficking Program and associated media campaigns, while critics suggest that the abuse of legal prescription drugs has become the fashion.

So what measurable impact are intervention approaches for children having? Many show neutral or even negative effects. These are typically the programs just mentioned that rely on “affective education”. But one of the Blueprints model programs discussed yesterday, Life Skills Training [1] (LST) has tried a different approach – and with startling results.

The man behind LST, Gilbert Botvin from the Institute for Prevention Research at Cornell University Medical College [2], argues that there is no single pathway to drug or alcohol use. Most program developers would shy away from terms like “multiple pathways”, “dynamic” and “complex combinations of various factors” but not him.

Children start using drugs for one or more of a wide variety of reasons, he argues. To have any impact, you need to acknowledge and take account of them all – peer pressure for example, media influences, or existing substance use in the family – and factors particular to the individual child, such as low self-esteem, anxiety or a need for stimulation.

LST tries to do all this using a school-based curriculum delivered by trained teachers to all children between the ages of eight and 14. Fifteen sessions are taught in the course of a year, each lasting about 45 minutes. Teachers make use of instruction manuals, video and interactive tools. Booster sessions are offered in the second and third years.

The program consists of three components relating to certain “critical domains” associated with drug use.

Firstly, it teaches drug resistance skills to enable children to question media and peer portrayals of drug culture and to equip them with the skills to resist social pressure.

Secondly, it teaches personal self-management skills in sessions where children examine their self-image and its effects on their behavior. They are encouraged to set personal goals and to monitor their own progress, also to recognize how their decisions may be influenced by others. They analyze problem situations and consider different ways of dealing with them. They get help with stress and anxiety and are encouraged to approach challenges positively.

Thirdly, LST teaches general social skills including overcoming shyness, communicating effectively and initiating conversations, all on the principle that they should not need to react aggressively or over-passively when faced with tough decisions.

Rigorous evaluation has found compelling evidence of the program’s effectiveness. Over a dozen experimental studies, mostly using random allocation methods, and a number of long-term follow-ups, indicate reductions of between 50 and 75 per cent in drug, smoking and alcohol use. Low cost (after training, an average of about $7 per child over three years) and huge benefits make an impressive cocktail.

• For more about Gilbert Botvin’s work, see To tackle violence – first kill two birds with one stone [3]; for more about the untidy theoretical landscape of substance abuse research see Untangling program design the Tanglewood way [4].

References
Botvin G J, Griffin K W, Paul E, Macaulay A P (2003) “Preventing Tobacco and Alcohol Use Among Elementary School Students Through Life Skills Training”. Journal of Child and Adolescent Substance Abuse, 12 (4) pp1-17.
Griffin K W, Botvin G J, Nichols T R, and Doyle M M ( 2003). “Effectiveness of a universal drug abuse prevention approach for youth at high risk for substance use initiation”. Preventive Medicine, 36, pp1-7
Botvin G J, Griffin K W, Diaz T, and Ifill-Williams M ( 2001). “Preventing binge drinking during early adolescence: One- and two-year follow-up of a school-based preventive intervention”. Psychology of Addictive Behaviors, 15, pp360-365.