With schools and localities battered by budget cuts, getting good value for all instructional programs has taken on increasing importance.  What does this mean for drug prevention?  Ultimately, the argument for drug prevention programs rest on their ability to reduce use of alcohol and other drugs and, in so doing, to capture the benefits of improved attention in the classroom and less risky behavior outside the classroom.   Schools can best ensure that their students get these benefits by using programs with proven results and implementing them with fidelity.

Project ALERT does the job on both counts.  It has solid drug prevention results and it provides experience-based training and technical assistance designed to help teachers get the most of the materials for their students.  RAND’s two multi-site evaluations of ALERT, one on the West Coast and one in the Midwest, have received the highest rankings possible on the National Registry for Evidence-Based Prevention Programs; BEST’s technical assistance strategies and materials win very high marks as well. 

But what makes Project ALERT stand out from other programs with positive outcomes that also offer implementation assistance?  Why should teachers and schools continue to implement it in these difficult times?   We think there are several reasons.  Some derive from RAND’s studies of the program’s effectiveness; some derive from the depth and breadth of BEST’s support system for effective implementation. 

ALERT helps both high- and low-risk youth

Let’s look first at who ALERT helps. A major criticism of drug prevention is that it only helps   the kids who need it least, those who are least likely to become regular drug users.  In an unusual move for prevention research, RAND directly addressed this criticism in its evaluations of ALERT.  Both studies showed that Project ALERT helps both high and low risk kids—those who need it most because they have already shown a propensity to drug use and those who are less risk-prone because they have not tried different substances by the time they enter grade 7.

 

That’s a big plus.  If we can help high-risk youth avoid making the transition to more regular use, we may also help them avoid getting in trouble because of other risky behaviors that are highly correlated with drug use.  These include, for example, driving after drinking (or drug use), having unprotected sex, getting into fights, shoplifting and multiple other actions linked with impulsive or impaired decision-making.  Those benefits are important for the lower risk kids as well, but their timetable for engaging in risky behavior is likely to lag behind that for their more risk-prone peers.  With documented results for kids at different levels of risk, Project ALERT countered the argument that drug prevention works only for low-risk youth and showed that it helps kids drawn from across the spectrum of prior drug use experience.  And, of course, it also helps all kids considered together.

 

ALERT works in diverse communities and schools

Another criticism of drug prevention is that it works only for middle class youth from homogeneous white communities.  RAND countered that argument as well.  Its West Coast evaluation of Project ALERT, which included 30 urban, suburban and rural schools with varying socioeconomic profiles, worked across all these environments.  And, when RAND compared high and low minority schools, we found that the program worked equally well in both groups. In fact, where there were differences across the two groups, the results favored the high minority schools.  The second RAND study, which included 55 midwestern schools from urban, small town and rural communities, extended ALERT’s results to the country’s heartland and to small towns and very rural areas.

 

ALERT curbs multiple risky behaviors and has long-term effects into young adulthood

A third criticism of drug prevention is that it is not cost-effective, targeting a single risk behavior and only helping youth during adolescence.  RAND’s research has addressed that argument in several ways.   The West Coast and Midwestern studies showed that the program curbs multiple forms of drug use--from alcohol and marijuana use, which can lead to accidents and other negative consequences in the near future, to cigarette use, which has extremely deleterious health effects in the long-term (cites 1 and 2).  Finding results for all three substances means that the potential benefits from ALERT extend from reducing the likelihood of lung cancer, alcoholism and heart attacks to reducing the likelihood of more immediate alcohol-and- marijuana related problems such as poor school performance and vehicular accidents.  Helping vulnerable adolescents avoid consequences that could affect their lives over many years is a plus that all parents understand.

 

In addition, we now know that Project ALERT has effects that last into young adulthood and curbs other risky behavior besides drug use.  RAND found that 21 year olds who had ALERT during middle school are less likely to engage in risky sexual behavior that is linked with HIV and unwanted pregnancy (cite 3).  Furthermore, these effects, which occurred many years after receiving the program lessons, are partly attributable to program-induced reductions in alcohol and drug misuse at ages 19 and 21.  The bottom line, therefore, is twofold:        1. ALERT’s positive outcomes for drugs extend into the young adult years and include mitigating the consequences of misuse; and  2. ALERT curbs multiple risky behaviors that can harm the health and future of young people.  The message for schools is that using ALERT in the classroom ensures good value and is cost-effective:  the program yields both immediate and long-term benefits and it affects multiple risky behaviors.

 

ALERT offers experience-based training and technical assistance

Nevertheless, achieving these benefits also requires effective implementation.  This is where the curriculum, training and technical assistance offered by The BEST Foundation is invaluable.  As teachers who have used Project ALERT often attest, the materials are easy to use, the videos and posters capture students’ attention and the rationale underlying the program is clear.  That’s because hundreds of teachers and their students actually contributed to the curriculum—providing implementation tips, ideas about how to introduce and wrap up different activities, comments on video “treatments” and posters, and classroom management advice.  These ideas are written into the curriculum that BEST disseminates today.  Similar teacher input has informed the workshop and web-site training, as well as the regular updating and refreshing of the posters, videos and drug information.

 

ALERT’s evaluations led to curriculum improvements and better information about program delivery

Taking into account the lessons learned from research, teachers and students are notable hallmarks of Project ALERT.  After the West Coast evaluation of the program, RAND developed lessons aimed at improving the program’s effects on alcohol use, as well as its impact on the early high-risk smokers who initially responded negatively to the program.  The next evaluation showed that the program helped these early smokers reduce cigarette use and curbed alcohol misuse, important gains in student benefit (cite 2). Two other evaluations confirmed our belief that the program should be given to all students in a particular cohort, not just some of them (cite 4), and that it has better results when delivered to 7th graders, as opposed to 6th graders (cite 5).

 

The BEST Foundation continues to learn from teachers and to help teachers learn from each other through a variety of technical assistance strategies that go far beyond the basics of providing teacher-friendly curriculum materials and training. Newsletters provide updated information about drugs; the opportunity to find out how others have handled difficult problems in the classroom; and in-depth examples of how different districts, schools and teachers have implemented ALERT.  Direct help-lines provide immediate answers to teacher questions.  And, new this year are Project ALERT social networks on Facebook and YouTube.

 

ALERT’S dedicated and skilled teachers make it unique

All of these strategies are designed to help teachers do what they do best—inject enthusiasm, dedication and skill into making Project ALERT come alive with their particular students in their particular classrooms.  Because, in the final analysis, Project ALERT is only as good as the teachers who deliver it to their students.  It is the motivation and skill of its teachers, all of whom have participated in training and many of whom provide help and assistance to others, that make this program really unique.

 

CITES:

Ellickson, Phyllis L., and Robert M. Bell, "Drug Prevention In Junior High:  A Multi-Site Longitudinal Test," Science, 247, 1299-1305, 1990; also RAND, R-3919-CHF, March 1990.

 

Ellickson, Phyllis L., Daniel F. McCaffrey, Bonnie Ghosh-Dastidar, and Douglas L. Longshore, “New Inroads in Preventing Adolescent Drug Use:  Results from a Large-Scale Trial of Project ALERT in Middle Schools,” American Journal of Public Health, 93(11), 1830-1836, 2003, also RAND RP-1088, 2003.

 

Ellickson, Phyllis L., Daniel F. McCaffrey, and David J. Klein, "Long-term Effects of Drug Prevention on Risky Sexual Behavior among Young Adults”, Journal of Adolescent Health, 45 (2), 111-117, 2009 (Epub, 5/09).

 

St. Pierre, Tena L., D. Wayne Osgood, Claudia C. Mincemoyer, D. Lynne Kaltreider, and Tina J.

Kauh, “Results of an Independent Evaluation of Project ALERT Delivered in Schools by Cooperative Extension”, Prevention Science, 6 (4), 305-317, 2005.

 

Ringwalt, Christopher L., Heddy KovachClark, Sean Hanley, Stephen Shamblen, and Robert L. Flewelling, “Project ALERT: A Cluster Randomized Trial”, Archives of Pediatric Adolescent Medicine,  163 (7), 625-632,2009.

Joseph A. Califano’s new book, “How to Raise a Drug-Free Kid,” is a comprehensive volume featuring state-of-the-art prevention research complemented by data, anecdotes, and practical strategies.

Mr. Califano is founder and chairman of The National Center on Addiction and Substance Abuse (CASA) at Columbia University, a premier think tank that studies the effects of substance abuse on people and society.  As U.S. Secretary of Health, Education, and Welfare in the late-1970s, he launched the nation’s anti-smoking campaign, and has been a passionate supporter of prevention and early intervention efforts.  Mr. Califano is a father of five and grandfather of eight.

 

Califano’s latest book isn’t a pocket reference: it measures more than 3/4 of an inch thick, with narrow margins, smallish fonts, a seven page Table of Contents, plus 30 glossary pages. The dense but rich 270 page resource could be intimidating to a parent.

 

This prevention primer would be ideal for professionals or as a college level text, and should be required reading for every credentialing syllabus related to prevention or treatment.

 

The 14 chapters are organized into three sections: Prevent It, Recognize It, Confront It.  Each section includes conversational narrative, cartoons, and quotes from prevention experts and parents; each chapter closes with bulleted Parent Tips. For busy parents, the Parent Tips would be sufficient to get started.  In case of emergency, skip directly to signs of drug use, starting on page 217.

 

Chapter 1 sets the agenda, explaining The Nine Facets of Parental Engagement.

 

“The better you are at listening, the likelier your child is to open up to you and to listen to you,” says Califano, explaining strategies for parents who want rapport and open dialogue with their children.

 

“Did you do drugs?” is a question parents dread, and Chapter 2 includes specific ideas for preparing an answer.  Gently inquire why the question is being asked, be as truthful as you can, and focus on negative aspects of your experience. Explain that today there is greater knowledge of drug dangers, and lead into a conversation about how drugs can affect a person’s future.

 

In Chapter 6 and 7, Califano thoroughly lays out when and how children are at risk for drug use, including times of day, emotional states, and family circumstances such as illness or divorce. The book particularly emphasizes the importance of adult supervision for youth, including verifying where they are and who is in charge. He says to call other parents to see if they will be home, and ask if alcohol will be available at the gathering.  The issue is safety, not trust.

 

Media influences surround us all, including music, Internet, movies, advertising, television, and more.  Chapter 11 calls tobacco and alcohol advertising a money-winning formula: “Get ‘em hooked young and they’ll be hooked for life.”  Using specific examples in songs and movies, parents are warned that youth need to be better equipped to understand and resist negative or harmful ideas that can make alcohol, tobacco or other drugs seem glamorous and inviting.

 

An entire chapter discusses school environments, mostly in negative terms. In Chapter 12, Califano cites research reporting that eight out of ten high school students say there are drugs in their schools. Then the book quotes students in focus groups who say “the other 20 percent [who say there are no drugs in their schools] must be lying.” (See page 176.)

 

In this chapter, any school where drugs are used, kept or sold is termed a “drug-infected school,” a rather inflammatory choice of words.  As it is strongly implied that all schools are drug-infected, this may be deliberately provocative, trying to spur parents to become engaged in their local school. But the reality is, schools have earned excellent safety records.

 

According to the 2008-9 PRIDE drug survey (122,000 students), 9.4 percent of high school youth reported that they bought or sold drugs at school, while 17.1 percent reported they bought or sold drugs when not at school. While 22 percent of youth reported they usually drink alcohol at home, only 3.2 percent reported they usually drink alcohol at school; 7.8 percent usually smoke marijuana at home, while only 2.9 percent usually smoke marijuana at school. Schools should be applauded for their efforts, sometimes in spite of parental resistance.

 

However, Califano is right on the mark when discussing the impact of so-called zero tolerance drug policies in school. Expelling students for a single infraction such as possession or being under the influence, can easily boomerang into a code of silence, where staff members and students won’t speak up because they are concerned about draconian punishment. Policies that emphasize counseling and treatment command more support and enforcement, because they are perceived as helpful.

 

Chapter 14 describes signs of drug use. This chapter should be required reading for every parent in America. Along with early signs of substance use, parents can find concrete steps to follow if s/he suspects a problem.

 

“You are more likely to detect the early signs of use if you are engaged in your child’s life, know your child’s world, and have established a foundation of communication that will allow you to discuss any issues that arise,” notes Califano. Classic, sound advice.

 

Califano and The National Center on Addiction and Substance Abuse have put together a timely, invaluable resource that will be read, highlighted, bookmarked, and re-read.

Want to rev up the meter on how much your students learn in Project ALERT? Here are several simple strategies.

 

When I’m giving a training session on Project ALERT, I suggest that at the beginning of each class teachers share with students their proximal goal for the lesson—which some educators refer to as a learning target. In Core Lesson One, for example, the goal is to explore the reasons why young people make a decision about whether or not to smoke. Stating the goal engages students in sharing responsibility for achieving it. According to research, this results in an increased retention rate of more than twenty-five percent. It’s such a simply strategy, but highly effective.

 

I’ve also learned that planting visual images in students’ minds helps them understand consequences. If you compare experiencing the nicotine high of smoking to running on a treadmill, students will have a visual image of forever running in place, trying harder and harder to get to that nicotine high. This is the time to remind them that the younger people are when they start to smoke, the more quickly they become addicted—while the longer you wait to try your first cigarette, the more likely you are to never start.

 

Sometimes we finish a Project ALERT lesson with a few minutes to spare. Don’t waste this opportunity to keep students involved with the subject matter and reinforce what they’ve been learning. You can create a game like Pictionary to help teach facts about alcohol or other drugs by using facts in place of pictures. When you’ve got those few minutes, pull out the game and review one or two facts. It helps keep students on task and also extends their learning.

 

These small bites of time are also ideal for sharing new information about topics covered in class. I keep a file of articles that appear in the news to reinforce what we’re discussing in the classroom. The Project ALERT website also has the latest information and statistics, so check it frequently.

 

New research is coming out all the time. For example, we now know that the marijuana commonly available today is so powerful that smoking one joint a day is equal to smoking five cigarettes. For a long time we thought that marijuana caused only dependency and that it was nicotine in cigarettes that caused addiction. But new research shows that marijuana causes both addiction and dependency.

 

Here’s another interesting finding. Most young people are compassionate toward animals, and they’ll be surprised by new research showing that second-hand smoke harms pets. An estimated 50,000 Americans die annually from the effects of second hand smoke, but in addition, dogs living in smoking households have a 60 percent greater likelihood of getting lung cancer. They’re also at risk of developing nasal cancer, while cats in smoking households are three times more likely than other cats to get cancer.

 

Involving students in achieving a class goal, using visuals, playing your special Pictionary, and sharing the latest findings about drugs may seem like simple classroom strategies, but you’ll find they make your course even more interesting—and unforgettable.

Young people are using drugs. And when students think everyone is doing it, using tobacco, marijuana, alcohol or inhalants... they may feel more pressure to use them too.

When students overestimate the number of their peers who are involved in drug use, they are less likely to perceive social support for refusing offers to use drugs. Actually, most youth don't use drugs.

As a Project ALERT teacher, you strive to make this point with your students in Lesson 4, Activity 3 — The Prevalence of Use Activity. To make your point with credibility, you need to be aware of current statistics.

The 2009 National Institute on Drug Abuse (NIDA) Monitoring the Future Study reports the following national usage patterns for eighth graders:

 

• 6.5% smoked cigarettes in the last month

• 6.5% used marijuana in the last month

• 14.9% used alcohol in the last month

 

Yes, the numbers are high. But nationally, most young people don't use drugs!

The complete Monitoring the Future Study can be found at: www.monitoringthefuture.org

1.     Stay updated on current teen use data. 

Each year new statistics on teen drug and alcohol use are reported via the University of Michigan’s Monitoring the Future study, where over 50,000 nationally representative 8^th, 10^th, and 12^th graders are surveyed.  Some significant changes have occurred with regards to prevalence of e-cigarettes and attitudes about marijuana over the last few years so it’s best to use current data when presenting these numbers in lessons. 

2.     “Class up” your classroom with printable posters.