"DRUG EDUCATION: THE TRIUMPH OF BAD SCIENCE

Dare And Programs Like It Don't Stop Kids From Using Drugs.

But There's Too Much At Stake To Replace Them

IN FEBRUARY, THE HEAD OF DRUG ABUSE Resistance Education - used in
seventy-five percent of U.S. school districts and fifty-five countries
worldwide - made the extraordinary admission that the program has not
been effective. Nonetheless, the Robert Wood Johnson Foundation gave
DARE a $13.7 million grant to bring the curriculum up to date and to
scientifically evaluate its usefulness. The foundation reasoned that it
would be easier to change DARE than to bring another program to its
level of penetration. And so, in September, DARE will launch its new and
improved program with great fanfare in six cities, including New York
and Los Angeles. In March 2002, administrators will implement it
worldwide.

The DARE-makeover announcement is being interpreted by some as a signal
that science is coming to the rescue at last in the politically
sensitive field of drug education. Zili Sloboda, the former director of
the Division of Epidemiology and Prevention Research at the National
Institute on Drug Abuse, was chosen to oversee the evaluation of the
renovated program. She says that DARE "will do everything it can to
update its programs and to make them evidence-based."

But many social scientists are unimpressed: They argue that
drug-prevention education must be the only category in their field where
failure - such as DARE's - is used as an occasion to continue and even
expand a program.

IN FACT, THE PROBLEM GOES WAY beyond DARE. In interviews with more than
a dozen experts, a picture emerges of a dysfunctional and highly
politicized drug-education environment in which even the "research-based
programs" now favored by the federal government don't stand up to
scientific scrutiny. In fact, many say, despite all the "scientific"
claims to the contrary, drug-prevention education - at least the
abstinence-based model that reigns in America's schools - is just as
likely to have no effect or to make kids curious as it is to persuade
them not to use drugs.

Here's why the current models are flawed: Drug-education researchers
generally evaluate their own programs, and, with few exceptions, they
tend to parse out their data so programs seem more successful than they
actually are. Scientists call it "over-advocating." Positive results in
limited situations are exaggerated, and instances of increased drug use
are obscured or suppressed. Such practices should never survive the
process of peer review, critics say, but they do.

The federal government plays a major role. Key agencies set unrealistic
guidelines that ensure failure, and they continue to nurture programs
despite bountiful evidence that they don't work. What's worse, drug
education is big business. Fueled by a perpetual sense of crisis,
schools and communities pour scarce resources into prevention programs.
Each year, the federal government spends upward of $2 billion on
drug-prevention education, and states and localities contribute more,
according to data extrapolated by Joel Brown, director of the Center for
Educational Research and Development, in Berkeley, California. Estimates
on total expenditures range as high as $5 billion annually. Researchers
who evaluate their own programs stand to profit only when they can
report success. And these same researchers are often asked to sit on
exclusive government panels, deciding which programs will be recommended
for sale to the nation's schools.

DARE MAY BE "THE ONLY GAME in town," as Sloboda puts it, but that hasn't
kept other researchers from developing programs to fight for a share of
the market. These competitors have been buoyed by DARE's
public-relations woes and by a 1998 law limiting Department of Education
drug-prevention funds to programs that at least minimally demonstrate
"the promise of success" in reducing teen drug use.

Only one of the programs deemed exemplary by all three major agencies -
the Department of Education, NIDA and the Center for Substance Abuse
Prevention - is commercially available nationwide. That program is
called Life Skills Training. While LST is not nearly as big as DARE, the
program is currently in about 3,000 schools, and an estimated 800,000
students have gone through it to date, according to a spokesman.

LST has never been evaluated independently; two studies are going on
now, with the results expected this summer. But the program's creator,
Gilbert Botvin, a professor of psychology and public health at Cornell
University, claims that the program reduces tobacco, alcohol and
marijuana use in young people by up to an incredible seventy-five
percent. He has published more than a dozen articles in leading
journals, including the Journal of the American Medical Association,
saying as much. These would be remarkable outcomes indeed, enough to
warrant implementing LST in every school in the country, if it weren't
for one thing: They are probably not true.

As LST has risen in prominence, other researchers have begun analyzing
Botvin's published articles, and many have discerned a common pattern.
"Botvin gets positive effects but only in a very small subsample," says
Dennis Gorman, an expert in prevention and evaluation methodology at the
Texas A&M University System Health Center.

As an example, Gorman showed in the 1998 article "The Irrelevance of
Evidence in the Development of School-based Drug-Prevention Policy,
1986-1996," in Evaluation Review, that Botvin emphasizes specific data
from students who were exposed to at least sixty percent of the
program's curriculum. Gorman states that the students Botvin ends up
focusing on are likely to be those who were most motivated and least
inclined to be involved with drugs in the first place. Botvin responds
that breaking down the data from only the high-implementation group
tells you most about the usefulness of a program. (This is a practice
that the National Academy of Sciences called "misleading" in a report
that condemned the quality of current prevention research.)

Others have gone beyond Gorman in criticizing Botvin's methods. In an
article in the April issue of Journal of Drug Education, Joel Brown
found that when students received fifty-nine percent or less of Life
Skills Training, their drug use was actually higher than that of
students who didn't go through LST at all. Botvin categorically denies
any negative results: "The fact of the matter is, we present more data
than any of these other researchers."

Another person who takes issue with Botvin's claims is Stephanie Tortu,
an associate professor of public health at Tulane University in New
Orleans. In 1984, she was project manager on one of LST's first major
studies - an investigation of the effectiveness of the program in
fifty-six schools across New York state.

She says that when Botvin presented her with the draft of the study's
results, she was shocked to discover that crucial data on the students'
alcohol use had been left out. Tortu and the other researchers had found
that students who went through LST were more likely to drink alcohol
than students who weren't exposed to the program, but this information
was nowhere to be found in the report.

She and several colleagues on the project, including Barbara Bettes, a
data analyst, sent Botvin a memo documenting their concern and asking
that an investigation of the alcohol findings be made their highest
priority.

"He was the principal investigator," Tortu says. "When he saw that
alcohol use was up in his prevention group, he should have been trying
to figure out why. I felt he was required ethically to call attention to
it and investigate it."

Shortly afterward, Tortu says, Botvin denied her a standard raise, a
message she interpreted as punishment for sticking her neck out. Soon
after that, Botvin informed her that there was no longer enough money to
keep her on the project.

"To be straightforward and candid," says Botvin, "we've produced the
strongest effects for tobacco, and also strong effects for marijuana,
but the alcohol effects in some studies have been inconsistent." And he
maintains that the data at issue in the staff memo was just preliminary.
Bettes counters that Botvin felt comfortable using the same set of data
to announce positive effects on tobacco and marijuana.

In the end, the report delivered to New York state did not indicate that
alcohol use had increased among students who went through the program.
Joel Moskowitz, director of the Center for Family and Community Health
at UC-Berkeley, notes that "unfortunately, Botvin is not the only
researcher to engage in such practices of overstating positive program
effects or neglecting to report negative program effects and limitations
of the research."

Tortu maintains that, ultimately, Botvin has a conflict of interest in
both evaluating and profiting from LST, but Botvin says that he has
fully disclosed the fact that he receives royalties from sales of the
program. Furthermore, he says, the evidence confirming LST's success is
superior. "In my view, the quality of the science in the Life Skills
Training research is higher than for any other prevention program that
I'm aware of in America," he says.

That may not be far from true, but it's also not saying a whole lot.
Botvin has been careful to distance LST from DARE and other programs
that have been found to be ineffective. He calls LST a "comprehensive"
approach to drug education.

"Life Skills Training deals with a broad array of skills that we think
kids need to navigate their way through the dangerous minefield of
adolescence," Botvin says. "Skills that will help them be more
successful as adolescents and help them to avoid high-risk behaviors,
including pressures to drink, smoke or use drugs."

These skills include how to make conversation with strangers and
politely end a conversation when it could lead to offers of drugs. "It
goes beyond `Just Say No' to identifying unreasonable requests and
reacting to those requests in an appropriate way," Botvin says.

But critics of LST, who include top DARE officials, say the difference
is not so great as Botvin likes to make out. "DARE has `Eight Ways to
Say No,' LST has `Nine Ways to Say No,' says DARE spokesman Ralph
Lochridge. "A lot of these programs look, talk and walk like DARE."

DESPITE RECENT CRITICAL attention, LST has emerged as the leading
contender to DARE. Major news organizations have hyped it, and Botvin
even seems to see DARE's ongoing troubles as an opportunity. After the
recent DARE announcement, he wrote a letter to the New York Times and
also encouraged me to paint LST as a David to DARE's Goliath. "Why wait
two, three or five years to find out whether or not [the new DARE]
works," Botvin asks, "when we already have prevention programs available
today that have been extensively researched and for which there is
strong scientific evidence of effectiveness?" Even Sloboda, now in
DARE's camp, is quick to list LST as an exemplar of "highly effective
prevention programs in use today."

LST may be ready for its close-up, but has the program gotten an easy
ride from scholarly journals and the government agencies that endorse
it? Some researchers think so.

"If I had been asked to review these studies, I would not have
recommended publication," says Richard Clayton, director of the Center
for Prevention Research at the University of Kentucky. "Some people have
a vested interest in saying that our current drug prevention strategies
work. They're looking for a poster child for prevention to take
attention away from DARE, and they've chosen LST. But that doesn't mean
it works."

LST AND DARE ARE ONLY TWO of the many programs drawing criticism from
those in the prevention-research community who have grown disgusted with
the field.

Prevention science, they say, is a niche that tends to attract those
more concerned with waging the War on Drugs in America's classrooms than
with performing careful science. Evidence is ignored or used so
selectively that it becomes irrelevant. When studies turn up negative or
neutral results, prevention boosters employ a variety of deceptions,
according to critics.

One tactic is to continually change the measurements for success. Rather
than looking for changes in drug behavior, researchers might look for
changes in reported attitudes toward drugs. If attitudes haven't changed
much, they can always test how much kids know about the dangers of
drugs. DARE, for example, has continued to claim success because kids
who go through the program tend to have a better attitude toward the
police - as if the goal of the program was to raise awareness for law
enforcement rather than to keep kids off drugs.

Another common trick is to revise the program. Since any longitudinal
evaluation requires, by definition, years to compile, researchers can
always deflect criticism by saying the program has evolved since the
evaluation began.

As with other aspects of the War on Drugs, hawkish prevention makes for
good politics, and the truth be damned. The Center for Substance Abuse
Prevention has developed a set of talking points for advocates to
present. The title? "Winning the Numbers Game: How to Keep Saying
`Prevention Works' When the Numbers Say Something Else."

This dissing of science is part of what makes independent researchers
conclude that the whole enterprise of drug prevention is run through
with politics and ideological arthritis. Since it's a small area of
study, they say, the same group of scientists is continually chosen to
sit on the panels that recommend programs to schools and to review
articles for publication, a practice that encourages mutual
back-scratching rather than critical investigation. (One prominent
figure calls it a "research mafia.") It's a closed feedback loop that
works in favor of those researchers whose programs fit the narrow
guidelines defined by the federal government. They get the big grants,
so they publish the most research and are consequently chosen to
peer-review the research of others.

The federal guidelines in question are found in the 1994 Safe and Drug
Free Schools and Communities Act, which codified zero-tolerance drug
policy as a "no-use" education strategy. The philosophy of no-use is
similar to abstinence-based sex education: Kids learn that they have a
choice between keeping their bodies pure or ... not. This is a "choice"
that few kids will fail to see as rigged.

While it may seem appropriate that schools play that role, no-use
programs, from DARE on down, have never been shown to help keep kids off
drugs. Even the General Accounting Office, which evaluates how
effectively federal money is being spent, reported, "There is no
evidence that the no use approach is more successful than alternative
approaches, or even successful in its own right."

Federal policymakers have chosen to ignore the GAO's recommendation that
they broaden the search for effective prevention strategies. So today,
schools and researchers who want federal funding must demonstrate that
their programs teach abstinence as the only option.

NOT ALL RESEARCHERS HAVE GONE along with the policy. Joel Brown, for
one, wants to study an alternative program based on "resilience
education," the subject and title of his recent book. Brown says
resiliency is a general scientific concept that focuses on young
people's ability to adapt and thrive in the face of educational
challenges. Applying the idea to drug education is natural, he says.

"Over the course of their lives, kids will inevitably face a variety of
decisions about drugs, including legal drugs and alcohol when they are
of the right age," Brown says. Rather than starting with the idea that
kids don't have the capacity to make wise decisions if they're dealt
with honestly, a resiliency approach would allow educators to deal
credibly with students on the issue of drugs. In this way, Brown says,
teachers can help kids become skilled decision makers rather than merely
telling them which decision is the right one.

Brown says a resilience-based program would not condone youth drug use.
However, he says, it's critical to provide honest, accurate and complete
drug information while focusing on health and safety. Marsha Rosenbaum,
director of the San Francisco office of the Lindesmith Center-Drug
Policy Foundation, says that this approach is exactly what America's
schools need.

"What's missing from `drug education' is education," says Rosenbaum.
"For the kids who don't say no, where can they go for honest, realistic
information about drugs in a life-or-death situation?" she asks. "They
sure can't go to the so-called educator in a no-use prevention program."

Realistically, educators must recognize that some kids will do drugs no
matter what they're told, Rosenbaum says. And that means adults have the
responsibility to provide information that can help save lives. She
offers the example of Ecstasy, whose most common health risk comes from
dehydration when people take it and go dancing. Some deaths have
occurred when kids either fail to drink water or drink so much that they
literally drown.

But such useful information is rarely taught in America's schools.
Federal policy and the overall zeitgeist of the War on Drugs make it too
difficult to implement and study programs based on resiliency or its
less comprehensive cousin, harm reduction, Rosenbaum says.

If education is missing from drug education, then reality is what's
missing from federal policy. In addition to prescribing no-use messages,
the Safe and Drug Free Schools Act also set as a goal "that by the year
2000, all schools in America will be free of drugs and violence." It was
unsuccessful in more ways than one. By chasing unrealistic goals, the
policy has endangered the most at risk students and failed to properly
educate anyone.