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Chapter 2: Foundations of Substance Abuse Prevention Curricula

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Introduction
Users of the Curriculum Builder and accompanying Handbook most likely already possess skills and experiences that can help them build and deliver effective substance abuse prevention curricula. In Chapter 2, a variety of factors are discussed that can help maximize the likelihood that prevention efforts will have their desired impact. More specifically, this chapter will:
  • Define substance abuse prevention.

  • Describe where substance abuse prevention activities can occur.

  • Describe the difference between school-based substance abuse prevention programs and school-based substance abuse prevention curricula.

  • Discuss research findings that can be used to guide the selection of substance abuse prevention curricula for use in a classroom setting.

  • Explain the importance of interactive activities as part of a successful substance abuse prevention curriculum.


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"Every American child will face a conscious choice whether to smoke, drink or use [other] drugs before they graduate from high school. What each chooses will be related to a host of factors, including parental and family engagement, religious and moral values, genetics, learning disabilities and psychological factors. Schools have a unique opportunity to affect two of the critical factors: availability of drugs and students' perception of risk in using them" (CASA, 2001).

Defining Prevention

  • Many of those working with youth already possess valuable skills and experiences that can be applied to prevention efforts.

  • A thorough understanding of the concept of prevention can maximize the likelihood that prevention efforts will have their desired impact.

  • Prevention efforts are activities aimed at various audiences, with the ultimate goal of preventing, postponing, or reducing substance abuse and its negative outcomes.

  • Types of prevention:

    • Universal programs: designed to reach the general population

    • Indicated programs: designed to reach those who have already begun to experiment with drugs or exhibit early danger signs

      • Controversy exists over the issue of harm reduction/responsible use:

        • Activities or programs might seem to give tacit approval to undesirable behaviors.

        • Schools and other institutions may be opposed to harm reduction or responsible-use messages.

        • Prevention practitioners should be aware of their institutions' stance on this issue.

    • Selective programs: designed to reach youth at high risk for drug use.


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Foundations for Prevention

  • Prevention efforts should be guided by sound theory and findings from relevant research.

  • Theories are useful in planning prevention programs because they:

    • Clarify the nature of targeted health behaviors.

    • Explain potential processes for changing behavior.

    • Explain the effects of external influences on behavior.

    • Help identify the most suitable targets for programs, methods for accomplishing change, and outcomes amenable to evaluation.

  • The ecological approach:

    • Recognizes that individuals are influenced by a multitude of factors.

    • Includes interventions aimed at various levels of potential influence.

      • Intrapersonal

        • Individual characteristics that influence behavior, such as knowledge, attitudes, and beliefs

      • Interpersonal

        • Social networks (family, peers, roommates, friends) that provide social identity, support, and role definition

      • Institutional

        • Rules, regulations, policies, and informal structures that may constrain undesirable behaviors or promote recommended behaviors

      • Community

        • Social networks and norms, which may exist formally or informally among individuals or among groups and organizations

        • Public policy

        • Laws and regulations at the local, State, and Federal levels

  • Most classroom-based prevention programs in use today are based on theoretical models aimed at individual or interpersonal change:

Level Theory Focus
Intrapersonal (individual) Stages of Change Model Individuals' readiness to change or attempt to change toward healthy behaviors
Health Belief Model Individuals' perceptions of the threat of a health problem and the appraisal of recommended behaviors) for preventing or managing the problem
Interpersonal Consumer Information Model Process by which consumer acquire and use information in their decisionmaking
Social Learning Theory Behavior is explained via a three-way, dynamic reciprocal theory, in which personal factors, environmental influences, and behavior continually interact


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Where Should Communitywide Prevention Occur?

  • Community-based programs:

    • Schools

    • Universities

    • Daycare centers

    • Businesses

    • Treatment centers

  • School-based programs, as components of broad-based community prevention efforts, are able to:

    • Reach a majority of school-aged children and adolescents

    • Take advantage of the learning environment

    • Use the teaching skills of the staff

    • Use resources available in the school/classroom

    • Provide opportunities to reach subpopulations at risk for substance abuse

    • Many substance abuse prevention activities address the following National Health Education Standards for Students:

      • Students will comprehend concepts related to health promotion and disease prevention.

      • Students will demonstrate the ability to access valid health information and health-promoting products and services.

      • Students will demonstrate the ability to practice health-enhancing behaviors and reduce health risks.

      • Students will analyze the influence of culture, media, technology and other factors on health.

      • Students will demonstrate the ability to use interpersonal communication skills to enhance health.

      • Students will demonstrate the ability to use goal-setting and decision-making skills to enhance health.

      • Students will demonstrate the ability to advocate for personal, family, and community health.

  • Classroom-Based Prevention: Prevention Curricula vs. Prevention Programs

    • The Curriculum Builder is designed to help those working in classrooms and similar community settings select appropriate, research-based activities with which they can build classroom-based prevention curricula that best meet the needs of their particular groups of students.

    • Curricular prevention is defined as prevention activities or lesson plans used in a classroom setting.

    • Extracurricular prevention is defined as prevention activities used outside the classroom and include school policies, parental components, and school connectedness.

    • School-based prevention programs include both curricular and extracurricular activities.

  • Who Should Receive School-Based Substance Abuse Prevention Programming, and When Should It Start?

    • All youth should be targeted.

    • Preschool or kindergarten is not too early.

    • Prevention should be an ongoing effort.

    • Students should not be oversaturated with information.


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Elements of an Effective School-Based Prevention Curriculum

  • Most schools do not use effective curricula or delivery methods.

  • An effective curriculum includes the following critical elements:

    • Enhances "protective factors" and moves toward reversing or reducing known "risk factors"

    • Targets all forms of substance abuse

    • Elementary school: targets social-emotional learning

    • Middle school: focuses on academic and social competence

    • Includes skills to:

      • Resist drugs when offered
      • Strengthen personal commitment against substance use
      • Increase social competency

    • Employs interactive methods

    • Includes a parents' or caregivers' component

    • Is administered long-term over the school career, with repeat interventions

    • Is adaptable to the specific substance abuse problems in the local community

    • Is age-specific, developmentally appropriate, and culturally sensitive

    • Is cost-effective

  • Critical content areas:

    • Normative education: helps students realize that use of alcohol, tobacco, and other drugs is not the norm

    • Social skills: help youth develop ease in handling social situations

    • Social influences: help youth recognize and resist external pressure (e.g., advertising, role models, peer attitudes) to use alcohol, tobacco, and other drugs

    • Perceived harm: helps youth understand the risks and short- and long-term consequences of alcohol, tobacco, and other drug use

    • Protective factors: supporting and encouraging the development of positive aspects of life—such as helping, caring, goal setting—challenging youth to live up to their potential and facilitating constructive affiliations with peers

    • Refusal skills: teaching youth ways to refuse alcohol, tobacco, and other drugs effectively and still maintain friendships

  • What does not work:

    • Scare tactics

    • Teaching only the adverse consequences of substance use

    • Self-esteem building

    • Values clarification

    • Large assemblies

    • Didactic presentation of material


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Elements of Successful Program Delivery

  • A successful leader:

    • Engages students in active learning

    • Establishes trust

    • Establishes high expectations

    • Practices open and supportive communication

    • Creates a positive atmosphere of caring and helping

    • Prepares for the role

    • Is willing to support and work on broader community prevention efforts

    • Understands the serious consequences of substance use during the teen years, particularly for younger adolescents

    • Examines personal substance use patterns to identify biases that might be conveyed to students

  • Interactive activities

    • Definitions of interactive activities:

      • Exercises that actively involve youth in the learning process

      • Instructional techniques that involve youth in activities and allow them to reflect on their performance of those activities

      • Endeavors requiring active involvement—youth engaged in higher-order thinking tasks such as analysis, synthesis, and evaluation

    • Evidence to support use of interactive activities:

      • Interactive activities show more positive results than didactic methodologies in communicating prevention messages to a wide cross-section of children and adolescents.

      • Role plays, simulations, Socratic questioning, brainstorming, small-group activities, cooperative learning, class discussions, and service-learning projects have a favorable influence on the attitudes and achievement levels of youth.

      • Programs relying solely on the provision of information may result in a greater likelihood of drug experimentation.

    • Advantages of interactive activities:

      • Interactive activities lend themselves to addressing the critical content areas of substance abuse prevention:

        • Refusal skills — practiced in the classroom through role plays in the context of realistic settings where alcohol, tobacco, or other drugs may be used

        • Videos and multimedia software — set in real-world environments to provide models of appropriate behavior and stimulate discussion

        • Visual-based instruction — to provide a helpful focal point for other interactive techniques

        • In-class writing across disciplines — to involve children and adolescents in activities and allow them to reflect on their performance of those activities

      • Learning theories/styles:

        • Youth present a vast array of intelligences and learning preferences.

        • Interactive activities are more likely than didactic methods to engage a variety of learning styles.

        • The Curriculum Builder uses the four major modalities of learning to categorize classroom-based activities: visual, auditory, tactile/kinesthetic, and kinesthetic.

      • Social skills:

        • Interactive activities can improve learning and help develop social skills proven effective in drug use prevention.

    • Types of interactive activities:

      • Problem solving

      • Cooperative learning

      • Group discussion

      • Fishbowl discussions

      • Role plays/simulations

      • Games:

        • Competitive
        • Cooperative

      • Debates

      • Oral reports/presentations

      • Demonstrations

    • Elements of interactive activities:

      • Lesson plan

        • Example: Divide youth into five groups and ask them to create antidrug posters to present to the class.

      • Educational product (video, magazine, puzzle, etc.)

        • Example: An interactive CD on refusal skills that youth can use alone on a computer.

      • Lesson plan plus educational product

        • Example: A video on teenage smoking accompanied by a leader's guide that illustrates how to conduct a group discussion based on the video.

      • Lesson plan plus supplemental, noneducational materials (such as magazines or music CDs)

        • Example: An analysis of magazine advertisements for tobacco and alcohol chosen by the youth.

      • Lesson plan plus educational product plus supplemental; no educational materials

        • Example: After viewing a video analyzing advertisements, students bring in magazine advertisements and perform their own analyses.


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Conclusions

  • Substance abuse prevention should be targeted to influence people, institutions, and community and societal norms.

  • Classroom-based prevention curricula are an important part of school- and community-based prevention programs.

  • School- and community-based prevention curricula aimed at children and adolescents should be tailored to the specific characteristics of the target audiences.

  • Substance abuse prevention programs must include five basic content areas: normative education, protective factors, social skills, perceived harm, and refusal skills.

  • Interactive activities can and should be used across all prevention content areas in order to achieve optimal learning by participants.


Previous Chapter: Chapter 1 Next Chapter: Chapter 3
  Handbook Preface
Chapter 1: The Nature and Extent of Substance Abuse in the U.S.
Chapter 2: Foundations of Substance Abuse Prevention Curricula
Chapter 3: Needs Assessment and Curriculum Development
Chapter 4
Chapter 5
Chapter 6
Chapter 7: Curriculum Implementation
Practical Points


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