The Evidence Behind Project ALERT

By some estimates, more than 2,000 drug prevention curricula are found in school classrooms and resource libraries, but only a handful have undergone the kind of thorough testing that Project ALERT has.

Project ALERT involves 11 lessons given over 11 weeks in seventh grade, then three booster lessons over three weeks in eighth grade are given to reinforce the lessons and solidify the outcomes. The frequency of the 45-minute lessons is intentional because one all-school assembly or a one-time lesson isn’t enough to instill self-efficacy and resistance. The program is delivered in middle school because that is when teenagers are making new friends and having new experiences.

Project ALERT to date has been the subject of five randomized controlled studies—the gold standard of intervention studies. This type of study compares the outcomes of two groups: 1) students who receive Project ALERT lessons and 2) students who receive their school’s typical anti-substance use programming. The comparisons reveal whether youths who receive Project ALERT (treatment group) fare better than youths who did not (control group).

The First Study Validated Project ALERT Before its Release

The Project ALERT curriculum was developed between 1984 and 1986 by RAND researchers and tested in 30 middle and junior high schools in California and Oregon. RAND researchers surveyed students about their drug use and drug-related attitudes before, during, and after the 2-year study and compared the results of the treatment and control groups.

Results

Reduced marijuana initiation by 30%
Prevented over 40% of experimental cigarette smokers from becoming regular smokers, but committed cigarette smokers were unaffected
Produced modest effects on alcohol use
Had positive effects on pro-cigarette and pro-marijuana beliefs

However, the first three effects disappeared by ninth grade. Some other effects persisted through 9th and 10th grade but disappeared by 12th grade. The results made it clear that the program was promising but some refinement was needed.

Publications

The Second Study Evaluated the Revised Project ALERT

Before releasing it to schools, RAND researchers added three more lessons in 7th grade aimed primarily at: 1) curbing alcohol misuse (such as binge drinking) rather than simply any drinking, 2) helping the more-confirmed smokers, 3) addressing inhalant use, and 4) involving parents. The revised curriculum was evaluated from 1997 to 1998 with more than 4,000 students in 55 middle schools in South Dakota. Three articles described the results. The third article looked at how the mechanisms targeted by Project ALERT—for example, resistance skills, positive and negative expectancies, beliefs about peers’ substance use—explained any preventive effects on actual cigarette and alcohol use at the end of 8th grade.

Initial Results

Generally replicated the results of the first study
Improved some outcomes, especially for higher-risk early smokers and drinkers
Improved alcohol misuse
Reduced negative consequences of substance use

Subsequent Results

Improved all outcomes related to cigarettes
Improved all but one outcome related to marijuana
Improved half of the alcohol outcomes
Improved students’ drug-resistant beliefs

Mechanism Results

The targeted mechanism explained the positive effects for cigarette use and intentions to smoke cigarettes
The targeted mechanism explained - although less consistently - the small to moderate effects on all areas of alcohol beliefs and self-efficacy

Publications

Third Study Tested ALERT Plus, a Revised Curriculum with Booster Lessons for 9th Graders

The findings from the first two randomized controlled trials of Project ALERT were promising, but researchers wanted to see stronger and lasting effects. They developed ALERT Plus for 9th graders, which was taught by teachers. Researchers used 45 middle schools in South Dakota from the second study to test whether adding 5 lessons in high school led to more robust and sustained effects, especially for high-risk students.

Results

At-risk girls who received Project ALERT Plus reported significantly lower rates of weekly alcohol use and weekly marijuana use, fewer alcohol consequences, and less high-risk alcohol use compared to at-risk girls in the control group.
Many of the targeted mechanisms, such as changing beliefs about drugs or resistance self-efficacy, explained some of the positive findings.
At-risk boys fared the same in the treatment and control groups.
At-risk youths who received Project ALERT only (for seventh and eighth graders) had similar substance use outcomes to at-risk youths in the control group. This meant that the previous effects did not persist through ninth grade.

Publication

School-based drug prevention among at-risk adolescents: Effects of ALERT Plus

A Fourth Study Tested Project ALERT When Taught by Outside Program Leaders Rather than Teachers

An independent research group based at Pennsylvania State University sought to test the effectiveness of Project ALERT when delivered by Cooperative Extension program leaders. Researchers used a sample of over 1,600 7th grade students from eight middle schools in Pennsylvania. Each school randomly assigned 7th grade classrooms to 1) Project ALERT facilitated by adult program leaders, 2) Project ALERT facilitated by adult program leaders plus teen assistants (local 10th through 12th graders), or 3) a control group that did not receive Project ALERT. Participants were assessed before and after the program in 7th grade, before and after the boosters in 8th grade, and again in 9th grade.

Results

Past-month cigarette, alcohol, or marijuana use were similar in all three groups
Characteristics of the outside providers and their teen leader assistants mattered. When the adults and teens were more sociable or comfortable with public speaking, students showed more positive outcomes than students in classrooms with adults and teen leaders who were low in these personal characteristics.

Publication

Results of an independent evaluation of Project ALERT delivered in schools by Cooperative Extension

The Most Recent Study Is Unclear on Whether Project ALERT Works Starting in Sixth Grade

Researchers at the Pacific Institute for Research and Evaluation set out to test if Project ALERT was effective starting in 6th grade, with booster lessons delivered in 7th grade. They randomized 34 schools within 21 school districts in 11 states to receive either Project ALERT taught by middle school teachers or the control condition. Almost 6,000 6th graders were in the study.

Results

Project ALERT participants were less likely than the control group to have consumed alcohol in the past 30 days, but the effect disappeared by 8th grade
No significant effects on past month use of cigarettes, marijuana, and inhalants, as well as lifetime use of all four substances

Publications

Conclusion

No drug prevention program is a magic bullet, but Project ALERT stands in a unique group of programs that has been rigorously tested in multi-year and multi-community studies. This can increase confidence among those interested in using the program that it can have the intended effects. Project ALERT has reported multiple successful outcomes across five randomized controlled trials of the program by working through targeted mechanisms to 1) delay the initiation of drug use during an at-risk time among vulnerable youth and 2) reduce use for high risk students who have already started using drugs. Specific facilitator characteristics may help to explain why some youth are positively engaged with the Project ALERT curriculum while others are not. However, the long-term effectiveness of Project ALERT is not yet well established, and it is not yet clear whether the program can be effective when delivered to youth younger than 7th graders. These areas warrant further research.