“Active ingredients” are the key elements of evidence-based programs. Without the active ingredients, the program may not deliver the same results in the real world as it did in the lab. But it’s not always easy to pick out which components are the essential ones.

In fact, there are two ways researchers can identify active ingredients, a Spanish team says. The first is meta-analyses that look at previous evaluations. The second way is to design an experiment where participants receive different components of a particular program.

The researchers use both methods to examine the essential ingredients in what works to prevent and reduce substance misuse among adolescents. And they come to the interesting conclusion that two components – problem-solving training and social skills training – may combine to produce the skills that help reduce teens’ substance use. Together, these active ingredients deliver a bigger impact than either alone.

Meta-analysis
Psychologist Jose Espada, of Spain’s Miguel Hernandez University, and his colleagues first looked to the results of previous meta-analyses of school drug prevention programs. The team found that effective school-based prevention programs share three key components. First, effective programs build skills in decision-making and peer resistance. Second, they are taught interactively, as opposed to lecture-based programs. And third, they emphasize the social influences that promote use and how to resist those influences.

These findings are promising and highlight possibilities for further testing – such as the experiment carried out by the Spanish team.

Experimental manipulation of intervention components
Espada’s team tested the findings of the meta-analysis in a quasi-experimental evaluation of a program called Saluda, the core components of which are problem-solving skills and social skills training.

Saluda aims to delay the age at which adolescents use drugs and alcohol. The program comprises 10 sessions that are delivered using a variety of methods including the provision of instructions, modeling, role-play, constructive feedback, positive reinforcement and homework assignments.

The study involved nearly 350 adolescents attending schools in the Murcia region of Spain. Individual classrooms were assigned to one of four conditions. The first received the full Saluda program; the second group received only the social skills training component of the program; the third group received only the problem-solving skills training component; and the fourth group were assigned to a wait-list control group.

The researchers explain the content of the two components. First, the social skills training component “teaches students skills related to active listening, how to initiate, maintain and conclude conversations, ways to express opinions and positive feelings, and skills related to defending one’s personal rights, such as saying ‘no’ and coping with peer pressure.”

Second, the problem-solving skills component “teaches students to understand and appreciate the advantages of non-consumption and the disadvantages of drug abuse in order to make healthy personal decisions. This is achieved by first applying problem solving methods to everyday situations and then specifically to substance use scenarios.”

Searching for the “active ingredients”
And what did the experiment uncover? The findings revealed that all three of the intervention conditions were more effective than the wait-list control – but with no significant differences in substance use among the full program and the single-component programs.

Does this mean that either the problem-solving skills or the social skills training could be used equally well in isolation? Not necessarily. Although there were no significant differences among intervention groups in alcohol use or drug use intentions, there were differences in skill formation.

Interestingly, students’ problem-solving skills following receipt of the full program were better than those who only got the problem-solving training. According to Espada and colleagues, this suggests a synergistic effect between problem-solving and social skills training. They write that “the relationships between problem-solving training and social skills training are more than additive, such that a deficit in one of these two areas can have effects on the other.” When it comes to skills, then, both components may be “active ingredients.”

This research contributes to the evidence base on what works for substance abuse prevention, but there are caveats. This is a quasi-experimental study and the classrooms were not randomly assigned to the four conditions. Although the researchers report that there were no pre-test differences across the conditions, there could be unmeasured differences that affect the results of the study.

Reference:
Espada, J.P., Griffin, K.W., Pereira, J.R., Orgiles, M., Garcia-Fernandez, J.M. (2011). Component analysis of a school-based substance use prevention program in Spain: Contributions of problem solving and social skills training content, Prevention Science. DOI 10.1007/s11121-011-0249-y.