PREVENTION TAKES A DIFFERENT TACK

Stopping is hard. It's easier not to start. But policy makers and educators
are in a quandary over drug prevention: They don't want to condone drug
use, but the "Just Say No" message isn't necessarily persuasive to a
generation of kids whose parents, teachers, and elected leaders have used
drugs and, in some cases, still use them. Techno-savvy teens use the
Internet to find what they consider to be accurate information about the
effects of drugs. They'll tout Web sites such as erowid.org or
dancesafe.org as their sources for information on drugs-not the classroom
or The Talk with Mom or Dad.

The "Just Say No" campaign "has almost a backwards impact," says Andrew, a
21-year-old software engineer in Seattle who started smoking marijuana six
years ago. "A lot of kids are smoking pot at school. You see this
commercial talking about how weed is a drug, and then you see this
commercial with the egg hitting the frying pan and saying, 'This your brain
on drugs.' And then you see grown adults, and they're fine."

So Andrew did his own research. "Heroin is pretty bad for you, but Ecstasy
doesn't seem that bad, and marijuana isn't that bad," he says. "As far as
what I heard in school and what I read on Web sites from the government,
[all drugs] should be the same. But they're not."

Andrew has a point, concedes Alan Leshner, the director of the National
Institute on Drug Abuse. In fact, the federal government's message may be
shifting from "Just Say No" to "Just Say When." Despite efforts to dissuade
them, some young people will try drugs no matter what, he says, so America
needs a second line of defense. He proposes new questions to ask: "How do
we stop them after they start it? How do we prevent their escalation?"

This approach is similar to prevention efforts aimed at drinking and sex,
where the messages have evolved into "Drink Responsibly" and "Practice Safe
Sex," rather than exhortations to never engage in these activities. The
difficulty in fashioning a message on drug use is that alcohol and sex are
legal-at least for adults-and drugs aren't.

The two most popular forms of prevention have been drug education in
schools and public service announcements. This year, the federal government
will spend $2.1 billion on prevention programs, plus $340 million on
prevention research. The prevention efforts are facing more scrutiny than
ever. The 18- year-old D.A.R.E. (Drug Abuse Resistance Education) program,
stung by studies saying it doesn't work, began a total remake this year to
focus on older students and make it more interactive. And last year, the
government's media campaign was evaluated for the first time.

The effectiveness of the major federal anti-drug media campaigns is a
subject of ongoing debate. When the first anti-drug advertisements appeared
in the late 1980s, drug usage fell, but then it rose again. Some critics
maintain that drug use was declining before the ads started. The ad
campaign was expanded in 1998, and teen drug use seemed to decline. But new
evidence indicates that teenagers' drug use might be creeping back up, with
some surveys showing a rise in that age group's use of marijuana and heroin.

Early verdicts on the most recent media campaign are mixed, said Bob
Hornik, who is a professor at the University of Pennsylvania's Annenberg
School for Communication and is overseeing the evaluation. So far, he has
found that children recognize the ads but don't necessarily change their
minds because of them.

A 1996 study by Drug Strategies, a nonprofit research group, found that a
few drug education programs seemed to be effective. One of the most
promising was Life Skills Training, which was used in 150 schools in New
York and New Jersey. The program consisted of about 15 sessions for
seventh-graders and included follow-up sessions with eighth- and
ninth-graders. Research showed that high school seniors who had taken part
in the program were only 60 percent as likely to use drugs as their peers
who hadn't. Meanwhile, the D.A.R.E. program, which research shows has
little impact on teen drug use, was running in 75 percent of America's
school districts. Taught by police officers, D.A.R.E. is used primarily in
elementary schools with little follow-up in later grades. D.A.R.E. gets
about 20 percent of its funding from the federal government.

According to Richard Clayton, a public health professor at the University
of Kentucky and author of the first study critical of D.A.R.E., drug
education efforts haven't been very effective because researchers and
policy makers fail to ask why children and young adults begin using drugs.
"We need to know what causes drug use," he said. "The fact of the matter
is, we don't know as much as we think we know. We're making parents feel
really good, but that's not the goal of prevention."

In the past few years, more schools have turned to programs such as Life
Skills. The Education Department in 1998 adopted "Principles of
Effectiveness" that require that all drug programs it funds, including
D.A.R.E., have research to back up their claims. Perhaps the biggest gap in
drug prevention efforts is their failure to reach young adults, who are the
biggest users. Colleges target binge drinking, but not drug use.

Among children, prevention programs are rarely carried through from
elementary school to high school. And some experts say that peer group
members and former drug users are better able to deliver persuasive
anti-drug messages than teachers or police officers. Programs might also be
more effective, some experts suggest, if they targeted the children who are
most at risk-those who are disruptive or are having problems at home.

But education is just one element of prevention, noted Herbert Kleber, who
was deputy director for demand reduction at the Office of National Drug
Control Policy during the Administration of George H.W. Bush. "Education is
not prevention," he said. "Education is the cure only to the extent that
ignorance is the disease. For most adolescents, ignorance is not the
disease. They have some idea that drugs can be addicting, they can kill
you, and they can ruin your life." But they think "it can't happen to
them," Kleber says, because they believe they're invincible.

In an attempt to broaden its prevention efforts, the Office of Drug Control
Policy is targeting parents in half of its ads. And to influence how drugs
are portrayed in mass culture, it has revamped its outreach efforts to
Hollywood by recruiting celebrities for its public service announcements,
and by inviting screenwriters to participate in drug information
roundtables where they can hear from drug-use experts and former drug users
about the impact of drugs. Police officers and government officials are
deliberately excluded.

"This is the real stuff," said Don Maple, a policy analyst with the drug
control office. "Instead of trying to persuade them, it's, 'Let them
experience it themselves.' We step out of the way. These folks are invited.
They don't have to come."

Maple says this approach works better than trying to persuade Hollywood to
adopt the government's perspective, as was done in the past. When a
producer for the television series Boston Public came to one roundtable,
the topic was Ecstasy. The producer heard from a number of teens who were
living in halfway houses after abusing Ecstasy. When Boston Public's
episode featuring Ecstasy ran, Maple was thrilled. "We thought it was
great," he said. "We thought they handled the issue very accurately."

Still, prevention will always have its limits. Take the case of "James,"
whose caretaker made him spend much of his first five years sitting quietly
under a table. Later, when James came home from school, his stepfather
routinely beat him. At 14, after his girlfriend broke up with him, James
ran away. He had never used alcohol or drugs for fear of ruining his
football skills, but once he'd left home, he dropped out of school, despite
the pleadings of his coach, and began selling crack. Now 28, he's a veteran
user of marijuana, crack, and PCP. James has been in and out of jail and
treatment centers. He has scars on his right wrist from a suicide attempt.
He's back in treatment now.

Could anything have prevented his free fall? James himself is unsure.

"I don't know. I know there was something that could have stopped it a lot
of times," he says, before pausing and looking at the floor for several
seconds. "I think maybe, if I'd have just listened. If I'd have just
listened, and believed what people were telling me a long time ago." He
shakes his head. "I don't know why I was so hard-headed."