|Prevention of Drug Abuse through Education and Information: An Interdiscplinary Responsibility Within the Context of Human Development (EC - UNESCO, 1994, 26 p.)|
|CHAPTER IV - THROUGH WHAT MEASURES?|
Even if drug taking is essentially a personal question, use takes place within a socio-cultural context and is linked to a whole series of societal events. This would suggest that when devising measures and formulating preventive programmes, understanding and analyzing personal motivations will not suffice; it is also essential to study and understand the influence exerted on individuals by their environment.
A preventive education programme is thus addressed both
a) to the individual, aimed at increasing involvement in the goals of the community and his or her possibilities for, inter alia, self control and self determination, through a series of complementary and concerted activities directed towards maximizing possibilities of intellectual, affective, psychological and physical autonomy the individual;
to the community (13) aimed at increasing possibilities of social control by groups if its members. In this case, measures proposed are based on a varied range of methods supported by networks of primary and secondary socialization at formal or non-formal levels intended to engender individual and collective behavioral change through societal controls. Such measures aim at improving the living conditions of the whole community and thus promoting human development.
(13) The notion of community is not taken to mean a geographical entity or uniform policy, but refers to neighbours, inhabitants of a village, town or city, who are concerned with the quality of life of their collectivity
To this end, different networks and levels of socialization, ie. the family, the school, the community, and society as a whole, must be integrated within active and participatory pedagogy.
The strategy is one of establishing links between school and life, life outside school and leisure activities, through inter generation communication and by making each individual aware of his or her responsibilities, penetrating social interfaces from schooldays up to entry into the world of work. Whence the importance of curbing any inhibition of informal social controls by placing too much weight on formal control (for example, it must be remembered that all young people in every region of the world do not necessarily go to school). It is essential that this strategy takes account of the social fabric, its wealth and its potential, enhancing the value of cultural roots of individuals and social groups and their initiatives. Articulating the more or less spontaneous responses of the institutions of civil society with those of a more or less formal nature established by the State, and enriched by those coming from institutions specialized in this domain, is a key to the success of these programmes.
As UNESCO reminds us «Specialists of this problem should not stand alone in the fight against drug abuse, but increasingly be supported by the active involvement of different sectors of society and social partners, by the political will of Governments, through coherent national drugs policies and assisted by .specialized institutions» (14)
(14) Drugs: Demand Reduction, op. cit. p 1.
Joining efforts at local, national and international levels, producing convergent synergies, the mutual enrichment of different cultures, is not only a response to this issue, but also a duty when faced with breakdowns in the fabric of society. To listen, to reflect together, to understand, to analyze and set in place collective responses by mobilizing the widest possible partnership is necessary and urgent. Awareness of individual and collective responsibilities should be stimulated to recreate the solidarity which once existed within different population groups by increasing their capacities to defend themselves and to resist pressures to take drugs as a solution to difficult problems and in order to cope with situations arising out of the crises of our modern world.
Notwithstanding, " in the domain of the consumption of drugs and the consequent dependencies this can cause, there is no exact way to form a link between them and the different levels of explanation. Therefore, it is not possible to disparage an uniform process in response to a causal logic. One could argue here that the important issue is neither the quality nor validity of an aetiologic theory, but is rather the practical success of the preventive action. In other words, a theoretical knowledge on the causes of drug use is not a guarantee for the efficiency of prevention. In fact, it is only when a theory and functional hypothesis have been successfully combined that the necessary conditions for an effective prevention, are joined " (15)and, in this way a contribution could be made to the promotion of human development.
(15) "Le probl de la drogue (en particulier en Suisse) consid dans son aspect social et prntif". Lausanne University, 1990, pi. 178
The sole aim of theoretical and conceptual contributions is to improve understanding of the mechanisms at play in different situations. However, these contributions are preventive tools, not a sine qua non of success. Notwithstanding, if these contributions are lacking, then the preventive intervention could become nothing more than a moralizing enterprise and, in this respect, some consideration should be given to the danger inherent in insufficiently planned production of preventive materials, for example, audio-visual aids, posters, etc., generally designed simply to appease the collective conscience.
To increase the effectiveness of preventive education, we also need a methodology, through the analysis of situations, choice of priorities, definition of objectives, definition of methods, planning and evaluating action, reformulating the latter in accordance with results.
To obviate any moralistic concerns in preventive education, the choice of techniques is also very important and should be the outcome of a precise analysis of situations (socio-cultural context) and adapted techniques. To this end, the following list of techniques, albeit not exhaustive, can be used in various preventive education programmes. (16)
(16) The following points were drafted making use of the work commissioned by the Swiss Federal Office of Health: "Le probl de la drogue (en particulier en Suisse) consid dans son aspect social et prntif" op. cit.
Some studies centre around the effects on information on drugs (cat Berberian et al.; Pickens). Findings concord that even short-term programmes have an effect on the level of knowledge of pupils. If results from the cognitive point of view are generally positive, those concerning attitudes tend to be contradictory. Whilst a first set of studies concludes that there is no effect on attitudes, a second set describes a transformation of attitudes in favour of drugs, a third bringing to light a modification of attitudes towards their rejection.
That most reports conclude that programmes for the prevention of drug abuse, if well-designed, increase knowledge in this domain is not surprising from both theoretical and practical points of view. Studies indicate that knowledge which has no links with affectivity and behaviour is easiest to change. On the other hand, the hypothesis whereby more precise knowledge about drugs would be likely to greatly decrease future consumption has rarely been confirmed. Despite the diversity of approaches in prevention of drug abuse, as well as the methodology and findings of evaluation studies, it can be affirmed that there is no consistent relationship either between knowledge and attitudes, or between attitudes and behaviour. The simple dissemination of objective knowledge is not therefore sufficient to modify attitudes and behaviour. This does not, however, mean that the transmission of information is not a prerequisite for promoting rational choice. Some studies indicate that the desire for new and exciting experiences is an important motive in drug taking. From this it can easily be deduced, on the one hand, that better knowledge increases the probability of drug taking by awakening curiosity in the substance and, on the other, that an objective presentation of facts might lead to some unjustified fears about drugs being eliminated. Various studies observe that the prevention of drug abuse can have a boomerang effect on attitudes with respect to drugs and their use.
The classical work of Stuart is certainly the best known and most frequently cited. In his research, Stuart establishes that, in comparison with a control group, a test group has more knowledge about the effects of drugs, but that in this group the use of alcohol, of marijuana and of LSD increased, as did the purchase of drugs, whilst fears in respect of drugs diminished. The programme for the test group comprised six teaching units taught once a week. The content of the programme included transmission of knowledge regarding the physiology and the pharmacology of drug use, as well as a presentation of the legal, social and psychological consequences of use. Moreover, the programme demonstrated differences not only in content (only " hard " drugs, only " soft " drugs, the two types together), but also in respect of the person transmitting the knowledge (teacher, or teacher and pupil). Stuart finds no significant differences according to the content or style of intervention. Similarly, he brings no significant relationship to light between knowledge and fear of drugs. These findings can be considered as an indication of the fact that links between increased knowledge, reduction of fear and increased use of a drug respond to mechanisms which are more complex than is usually admitted.
If this was the only study to bring to light such results, it would be simple to question the findings and consider it as an experimental artefact. Whereas, several other studies also tend to show that, under certain circumstances, concrete effects of persuasive prevention can be inconsistent with the desired effects (cf. Polich et al; Pickens). Gonzales in two studies, however indicated that the " knowledge - attitude - behaviour " model can serve as a basis for prevention of alcohol abuse, on condition that the target audience is exposed over a long period of time to persuasive information and is actively involved in educational programmes. This point of view is confirmed by Evans et al., as regards the prevention of addiction to smoking. These authors observe a two-fold behavioral response to a programme for prevention of smoking. During a first stage, consumption of cigarettes increases, but decreases on the long-term. Blum, et al. and Williams et al., also observe that the short term negative effects of information programmes can be compensated for by positive long-term effects.
Even if information programmes can arouse youthful curiosity about drugs (available data on this subject is not completely unanimous), this would not justify ceasing to inform young people about drugs. That would be to hide from them the possibly serious consequences of drugs, whereas they are often exposed to partial or inadequate information from informal sources. The findings discussed above should, rather, be seen in a different light; to transmit information on drugs without at the same time teaching some abilities and skills as to how to resist temptation is a questionable prevention strategy. To proceed in the opposite direction and provide information based on the acquisition of technical competence, is to promote human development.
The idea that mass media can exert an influence on consumption of drugs is based on two hypotheses:
1. Increased knowledge leads to transformation of attitudes, which leads to behavioural change;
2. Recourse to mass media is, in itself, an efficient means by which to influence the " knowledge - attitudes - behaviour " chain.
It goes without saying that the expected effect of mass media will only occur insofar as these hypotheses prove true. From the empirical point of view, few elements exist to back them up. Generally speaking, even in the case of carefully prepared campaigns involving considerable resources, for example in advertising, it is rarely possible to prove a measurable influence on behaviour of one or another action. On the other hand, we are constantly surprised by the unwanted and undesirable effects of mass media, such as the influence of television programmes on violent behaviour (Wallak). Leibert and Schwarzenberg, in particular, brought to light the paradoxical fact that mass media was more effective in achieving the undesired than the desired effects. In his pioneering work, Klapper had already demonstrated that mass media play a part in strengthening rather than modifying behaviour and Mendelsohn later concluded that a mountain of scientific evidence demonstrates that conversion occurs rarely and only under the most complex of psychological and communication circumstances.
In the sphere of illicit drugs there are, however, few evaluation studies on the effects of mass media. Kinder had already concluded as early as 1975 that data on the effects of mass media (on alcohol and drug consumption) were largely anecdotal and speculative.
Similarly, Goodstadt writing much later revealed himself to be very sceptical about the efficiency of mass media for the prevention of drug abuse.
The only field where it has been possible to be more or less convincing about the effects of mass media on behaviour is that of the availability of legal drugs, for example, the " Stanford Heart Disease Program ", which was also taken up in part in Northern Europe and in Switzerland (Farquhar et al; Gutzwiller et al). Within the framework of this programme, Stern and his colleagues were able to demonstrate a clear change in eating habits of the population. In this case, the authors combined in their evaluation the use of mass media with an intensive offer of personalized advice, which, of course, limited the validity of the findings of this study. Meter et al highlighted the positive results obtained by the combined use of mass media and personal counselling. It would thus seem that the influence of the media strengthens the effect of other persuasive techniques. Sussman, (quoted by Goodstadt), thus observed that the effect of a programme for the prevention of drug abuse at school is greater when children watch television advertising against drugs with their parents over the same period.
In an early study, Blane is certainly correct when he affirms that attempts to influence consumption of licit drugs through the mass media have not had much success. Robinson at a later date observes, on the other hand, that campaigns against smoking have had a positive effect and Rogers raises similar arguments in respect of contraceptive campaigns. Warner estimates the effects of anti-smoking campaigns by means of a regressive model predicting what the consumption of cigarettes would have been if the anti-smoking campaign had not taken place. He clearly demonstrates that anti-tobacco messages disseminated between 1968 and 1970 resulted in a significant decrease in cigarette smoking. Warner also shows that the relative increase in price of cigarettes between 1964 and 1972 was also a contributory factor. In this respect, it should be stressed that anti-smoking publicity probably played an important role in political decisions to increase taxes on cigarettes. Warner indicated that whilst scattered actions, for example, the publication of the Surgeon General's Report have only a fleeting effect on behaviour, it would seem that anti-smoking publicity of several years duration has a substantial cumulative effect. Without these campaigns, consumption per inhabitant would probably have been higher by 20 to 30 % Warner's findings reveal the important fact that when measuring the effects of media actions to prevent drug consumption it is perhaps inadequate to only consider individual attitudes and behaviour. At that level, in effect, there are few direct effects. More notice should be taken of the possible changes at the level of social clusters when evaluating the effectiveness of media campaigns.
Repeating preventive messages conveyed by the mass media within " local prevention activities " at the level of small daily social interaction of individuals is an effective method of preventing drug abuse.
A basic principle of information transmission is that the person receiving the information always deciphers it in accordance with who is transmitting it. Many studies have shown that the credibility and the charisma of the transmitting source is an essential quality from the point of view of the receiver. The more credible a source of information - in other words, the greater the competence and credibility attributed to the transmitter by the receiver - the greater the appeal of this source to the receiver. The more impartial the transmitter, the greater the chance of the message producing the desired effect. Generally speaking, young people do not accord great credibility to adults, nor do they always consider them to be impartial. For this reason, young people would appear to be better than adults at transmitting drug abuse prevention messages to their peers.
Using peers as advisers, educators and tutors is not a new concept in pedagogy. In drug abuse prevention - smoking in particular - adolescents have frequently and effectively contributed as educators and communicators (Klepp et al). When peers become agents of drug abuse prevention they serve as influential models by parading their non-consumption. Moreover, in so doing they make it clear that taking drugs is not the norm for young people (nor for other social groups), but on the contrary deviant behaviour. Peers working as educators strengthen the idea of social responsibility and the value of health, transmitting social skills which enable their peers to modify their behaviour in order to resist social pressure which might push them to experiment with drugs.
There is some controversy about using fear as a tool of disuasion. If it is clear that fear should ensue from the genuine negative consequences of drug abuse, it should not, however, be only a by-product of society's imagination reflecting other social concerns Many programmes for the prevention of alcoholism and drug abuse, as well as much informal information transmitted by adults on this subject, are, however, based on fear. In an experimental study, Fritzen and Mazer compare one group of pupils having been confronted with particularly frightening messages about alcohol with another group exposed to more moderate messages. There was evidence of increased fear in the first group immediately afterwards, but only amongst those pupils who were already more frightened than their peers. The authors observe no difference in attitude as regards the consumption of alcohol, either between the two groups, or between the more frightened and the less frightened pupils. A study carried out at the request of the " Haut Comit'Etudes et d'Informations sur l'Alcoolisme " in Paris (1976) draws, inter alia, the following conclusions:
"1" Traumatic " messages accompanied by frightening images are more effective than " non-traumatic " messages in the respect that they provoke more coherent, resistant attitudes, more often followed by action being taken. But, it must not be concluded that " non-traumatic " messages have no effect at all.
2. A certain time lapse can be seen between the development of opinions and that of behaviour. In fact, three months after the diffusion of a message, attitudes and awareness tend to revert to where they started from, most probably because they have been subjected to the influence of the environment and influenced yet again by traditional preconceived opinions regarding alcohol ".
A study by the London Institute for the Study of Drug Dependence compares the effects produced by different forms of lesson, i.e. a lesson on drugs taught in the same way as any other lesson by a teacher; a medical film on bad trips; a biographical " shock " film about a drug addict who dies at the end; and a film on pharmacological aspects of drugs. The study shows that, in the short term, the effects on groups of pupils differed according to the material used. The greatest immediate effect was provoked by the projection of the shock film, pupils affirming their intention never to take drugs. During a test carried out two months later it was, however, observed that most differences between the groups had vanished. To all intents and purposes, messages based on fear only lead to short-term attitudinal change. In a basic study, Smart and Feyer made a pertinent observation in this respect: the effect of fear techniques will depend upon how much is known about the drug in question; the better known the drug, the less influence fear techniques will have on the intention to take the drug.
In their classical studies, Jannis and McGuire, using different arguments, have attempted to demonstrate that there is no linear relationship between fear and understanding a message, but that this relationship can be represented by an inverted U-bend. Consulting literature on this subject, Sutton later notes, however, that empirical research does not bring to light any clear-cut non-linear relationship between fear and understanding a message; increased fear is consistently associated with increased understanding of the message. In their general study, Sternhal and Craig also drew the conclusion that fear tactics are efficient, but only insofar as they are accompanied by concrete behavioral guidelines deemed effective by the receivers, (cad also Farquhar et. al) and where the transmitter is judged to be totally credible.
In conclusion, over and above the transmission of the message, it is upon the credibility and the quality of the relationship existing between transmitter and receiver that the success of this prevention strategy will depend, it being understood that the prevention of drug abuse implies, of necessity, the use of mechanisms of dissuasion based on fear as a normal element of human adaptation and evolution. However, if fear is used as a mechanism of disuasion, then the information must be honest and reflect reality. In other words, fear should be used to present the incontrovertible consequences of drug abuse and certainly not to manipulate the receiver of the message.
All teaching and learning processes are situated somewhere between the two poles of the affective and the cognitive. Knowing that the two aspects are difficult to separate, however, the teacher might be more oriented towards one or the other pole. The affective deals with feelings or emotional aspects of life and learning. How children perceive what they would like to learn and how they experience it during the learning process falls within the province of the affective. Cognition, on the other hand, concerns mental activity during the acquisition of skills or knowledge in respect of a given phenomenon. Affective education has long been a concern in pedagogy. For Rousseau, Pestalozzi and Frl, affective development was the major objective of education. However, even if the affective aspect of education is mentioned in most school philosophy, there can be little argument that education in school falls essentially within the framework of Cartesian logic. The task of the school is, first and foremost, to inculcate in children the abilities required by other sectors of society (economy, administration, etc.), and the school thus places more emphasis on education to generate autonomous individuals. Schoolchildren are evaluated primarily on their performance; the way in which performance is endorsed determines, on the one hand, the social esteem in which the children will be held in school and, on the other, acts as a passport into the working world (cf Brusten and Hurrelmann)
Affective education aims at exerting a positive influence on emotional development and, in this way, to promote one of the main dimensions of human development: affectivity. This means promoting self-esteem, personal capacities and the ability to relate to others. Transmission of cognitive content also takes place in an affective context. The feelings which animate someone necessarily influence his or her faculty of reasoning; even so, this is not generally consciously taken into account in the teaching-learning process. Affective education is based on the hypothesis that aptitudes falling within the affective domain are likely to be taught and learned through conscious or unconscious means.
Recent models of affective education are mainly based on the work of Piaget, Kohlbert and Erikson, but also on that of the representatives of the " humanistic psychology " (Rogers, Maslow, Perls). The Anglo-Saxon community, in particular, has developed an operational model of affective education, with an approach based on the notion that an awareness of values and personal needs, and of their role in the decision-making process fosters responsible behaviour. Particular attention is paid to behaviour linked to the consumption of psychoactive substances (clarification of values).
Few evaluations have been made of the effectiveness of the clarification of values method and transmission of other elements in decision-making. Gerbasi observes that schoolchildren having followed such a programme take less drugs than their peers in a control group. Goodstadt and Sheppard at a later date compare the effects of three programmes, the first acting essentially at the cognitive level and the two others at the affective level. A thorough evaluation of these three programmes has shown that only the cognitive programme improved the knowledge of the test group in relation to those in the control group. This was true not only for the verification test taken immediately after the programme, but also for the one given six months later. None of these programmes had any verifiable effect on attitudes towards alcohol and six months later, it turned out that the group participating in the clarification of values programme consumed more alcohol than the two other experimental groups. It is also interesting to observe that the pupils in the test group preferred the cognitive information programme comprising very few affective elements which had been proposed to the two other groups. This can probably be explained by the fact that both the form and the content of the traditional programme corresponded best to the expectations of pupils. For this reason, it is important to phase in new educational methods, in order to progressively modify pupils' expectations and give them time to adapt to new pedagogical methods.
The above reservations about the validity of evaluations relate to both cognitive and affective education programmes. Some studies have evaluated such programmes, but the empirical data they contain on the effectiveness of affective education in respect of alcohol and drugs is not very optimistic. A basic study made by Goodstadt reviews many methodological problems posed in evaluating such programmes, concluding that a strictly scientific evaluation allows no room for an assessment of the effectiveness of this type of prevention of drug abuse. In their general study, Kinder et al, draw the conclusion that, if the present or future abuse of drugs is applied as an evaluation criterion, programmes for the prevention of drug abuse, whatever they are, all appear to be wholly ineffective. Similarly, Berberian et al and Blum are pessimistic about the possibility of effectively preventing drug addiction through education. This does not seem to have been contradicted since and similar conclusions are also to be found in subsequent studies by Hansen, M Grant and Goodstadt.
Notwithstanding, it is worthwhile mentioning two studies made by Schaps and his colleagues whose conclusions differ somewhat. In the first study, the authors analyze 35 drug prevention programmes and measure their effects on drug taking. Of these programmes, 14 transmit information about drugs; the others form part of the " new generation ", that is, they stress the affective approach, peer education, or a multidimensional approach. The evaluation shows quite clearly that the new methods of prevention produce more positive effects - and above all less negative effects - than traditional programmes. Which does not, however, prevent the authors from issuing a warning against drawing hasty conclusions. They indicate, in effect, that the methods of evaluation applied in several of these studies do not correspond to rigorous scientific criteria. The authors, nonetheless, consider that results indicate that some of these new methods of prevention of drug abuse might have desired, positive effects which traditional methods have never achieved. They add that this potential should be further tested in depth.
In a second study, Schaps et al, review 127 evaluations of drug abuse prevention programmes, 7 of which present negative results. Of these 127 evaluations, few are without important methodological gaps, and only 8 are considered exemplary by Schaps and his colleagues, both from the standpoint of the method of evaluation, and from that of the intensity of the programme. These 8 studies globally bring to light rather positive results, i.e. a satisfactory correlation between desired effects and actual effects.
The final objective of preventive education is to ensure that selective choices are made for each particular circumstance. Measures which will be adapted to each context have to be chosen from a range of levels of intervention, a variety of theoretical approaches and between different techniques. In so doing, education for the prevention of drug abuse is an effective contribution to human development by including more qualitative variables in its construction