Summary of the Article
Tobler et al. performed a meta-analysis of 144 published studies to assess the effectiveness of school-based drug prevention programs, sometimes referred to as Drug Awareness Resistance Education (DARE). Hundreds of studies evaluating the effectiveness of DARE programs have resulted in differing conclusions as regards whether the programs work as well as their effectiveness. Differences regarding the sample sizes, the design of the experiments, content of the programs, pedagogy, variables used to measure success and implementation thoroughness all have an effect on the conclusions made regarding the effectiveness of school-based drug prevention programs. In order to derive valid conclusions regarding the effectiveness of DARE programs, Tobler et al. (2000) synthesized the results of the available studies, taking into consideration the differences.
The studies analyzed in this meta-analysis comprised of published and unpublished reports obtained from private and/or public sponsorships at national, state, and local levels for the period between 1990 and 1998. In the selected 144 studies, 207 eligible school-based drug prevention programs were analyzed. Out of the 140 selected studies, 100 studies contained single programs, whereas the remaining 44 contained at least two types of programs. Tobler et al. (2000) classified the DARE programs into non-interactive and interactive programs depending on a combination of the delivery method and program content. The weighted categorical together with the weighted regression methods were used to establish the attributes of the programs that are likely to effectively prevent, delay, or reduce drug use. Other attributes taken into consideration included the program size, target drug, the level of drug use, intensity, attrition, and the type of control used.
The meta-analysis found out that the program size and type were significant predictors of the effectiveness of school-based drug prevention programs. Tobler et al. (2000) also found out that non-interactive lecture-oriented DARE programs that emphasize affective development or drug knowledge have small effect. The findings of the meta-analysis showed that interactive DARE programs that emphasize the development of interpersonal skills have significantly greater impacts; however, these impacts reduce with an increase in the program size, this means that large-scale implementations of interactive programs are likely to produce small effects.
Assessing the Effectiveness of the DARE Program
The findings from the meta-analysis point out different situations and program attributes that determine its effectiveness in achieving its goals. According to the meta-analysis by Tobler et al. (2000), the size and type of the programs were found to be vital program attributes that determine the effectiveness of the DARE program with regard to the objectives of delaying, preventing, and reducing drug use. With regard to program type, school-based drug prevention programs can be categorized into two: interactive and non-interactive programs. When comparing the sample size versus the type of the program (basing on the delivery method), Tobler et al. (2000) reported that irrespective of the quality of the research design or the sample size, interactive programs had significantly higher effectiveness when compared to non-interactive programs. In addition, even when non-interactive programs are implemented in small scales, they are minimally effective. Overall, with respect to the delivery method of the school-based drug prevention programs, non-interactive prevention programs that are lecture-oriented and place emphasis on affective development or drug knowledge are less effective when compared to interactive prevention programs that place emphasis on the development of interpersonal skills. With regard to the size of the programs, it is evident from the meta-analysis that an increase in the size of the program reduces the effectiveness of the school-based drug prevention programs. From these findings, it can be concluded that a DARE program that is interactive and implemented in small scale is more effective, whereas non-interactive programs implemented in large-scale are the least effective in reducing, preventing, and delaying drug use.
Besides, the delivery method and the size of the program are other factors that could determine the effectiveness of DARE programs including the targeted drug type, leaders of the program, intensity of the program, grade, special populations and levels of drug use; however, it is important to note that in all these situations, the interactive delivery method is more effective when compared to the non-interactive delivery method. For instance, with respect to the targeted drug regardless of the delivery method (interactive or non-interactive), prevention programs targeting alcohol are less effective when compared to prevention programs targeting tobacco usage. However, when delivery method is factored in interactive prevention programs targeting specifically tobacco and substance abuse in general, they are significantly more effective when compared to their non-interactive counterparts. Regarding the intensity, high intensity programs (31-55 hours) are the most effective, those that are followed by medium intensity (11-30 hours) and low intensity (less than 10 hours) are the least effective. When the type of program is factored in, then interactive high intensity programs are the most effective while non-interactive low-intensity programs are the least effective. With respect to Grade, without taking into consideration the type of program, junior high school programs and elementary programs are equally effective; however, interactive junior high school programs are more effective when compared to their non-interactive counterparts.
Overall, from the findings of the meta-analysis, it can be concluded that interactive prevention programs targeting tobacco led by medical or health professionals and implemented in high intensity are the most effective, whereas non-interactive programs targeting alcohol use led by teachers and implemented in low intensity are the least effective. It is imperative to note that the effectiveness of interactive programs decreases with an increase in size, whereas interactive programs are not affected by size. In a few thousand students, the effectiveness of interactive and non-interactive prevention programs is the same.
The Greatest Obstacle in Making DARE Effective
As Tobler et al. (2000) explained, the marginal effectiveness associated to DARE-type programs can be linked to their “limited number of refusal skills to their primary emphasis on personal competence”. Other program types need the youth to have a moral commitment not to use drugs and make a rational choice between using and not using drugs. Other program types such as values, decisions, attitudes are mostly based on affective development and emphasize drug knowledge; rather than putting an emphasis on the development of interpersonal skills. From this observation, it can be inferred that the greatest obstacle to implementing effective DARE-type programs involves the lack of appropriate choice of the program content as well as the delivery method. The differences in effectiveness of non-interactive programs, DARE included, can be attributed to program content; therefore, improving the outcomes associated with DARE-type programs requires an improvement of the content of the program. Perhaps, incorporating the interactive delivery method together with appropriate content can help improve the outcomes of DARE-type programs in preventing, reducing, or delaying drug use.
Recommendations to Make DARE Program Successful
As pointed out in the meta-analysis, the effectiveness of school-based drug prevention programs depends on a number of factors including the delivery method, program content, program size, leaders of the program, program intensity, and the targeted drug type. Basing on these factors, recommendations can be made on how to implement a successful DARE program. The first recommendation relates to changing the delivery method in DARE program to be more interactive rather than non-interactive; this draws on the premise that interactive prevention programs are more effective than non-interactive prevention programs. In this regard, DARE-type programs should be structured in a manner that it places emphasis on the development of interpersonal skills and be based on psychosocial principles. For DARE type programs to be effective, they should be based on the principles of social learning theory. Practical applications of this could include positive reinforcements from their peers, immediate feedback, rehearsals, and role plays. It is simply stated that improving the outcomes of the DARE-type programs requires transforming the program from a non-interactive to interactive, which can also be achieved by changing the program content. DARE-type programs are mostly lecture oriented and place emphasis on drug knowledge; this content should be changed to enable DARE-type programs to emphasize youth developing their interpersonal skills, interpersonal refusal skills, decision-making skills, goal setting, communication and coping skills.
Another recommendation to improve the DARE program relates to the program size, leaders of the program, and program intensity. In order to improve the outcomes, medical/health professionals must lead the program. This program should be implemented in small scales, and in high-intensity (31-55 hours); these have been affirmed to increase the effectiveness of school-based prevention programs. Currently, DARE programs are school-wide with police officers acting and teachers as program leaders, which are contrary to the attributes of an effective school-based prevention program (Cuijpers, 2002). In addition, DARE programs are not tailored to target a specific drug; rather, they target drug abuse as a whole. In order to tweak the program, changing the leaders of the program to health professionals and ensuring that the program is implemented in small scales will be a priority.
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