JUST SAY NO AGAIN

The Old Failures of New and Improved Anti-Drug Education

I'm at the February 2001 Teens at the Table conference, a feel-good event
sponsored by a coalition of Los Angeles youth organizations and high
schools. It's designed to boost self-esteem and teach teenagers how to make
smart decisions. In one of the sessions, a group of students is about to
learn how easy it is to stay off drugs. It doesn't require anything as lame
as red ribbons or "Just Say No" chants. It just takes knowing what
constitutes a healthy decision -- one that is all your own -- coupled with
a little real-life practice.

The kids test their skills with a role-playing skit. The scenario: Two
girls are walking home from a party late at night when a car full of boys
pulls up to offer them a ride. "The boys have been drinking and smoking,"
the script reads. "Trouble is imminent."

Here is where the teenagers are supposed to call on their newfound decision
making skills in choosing whether to get into the car. They're asked to
think about their options, weigh the consequences, and decide what to do
based on what would be best for them -- no judgments, no right or wrong,
none of that thoughtless Just Say No stuff from the 1980s and early '90s.
Today's drug prevention lessons, scientifically crafted and tested, are
supposed to be all about teaching teenagers how to make choices, not
telling them what to do; respecting their autonomy, not treating them like
ventriloquist's dummies.

So the teenagers choose. If they don't get into the car, they walk home and
everything is fine. But if they do...

Boys: Hop in girls!

(Eventually the boys get out of hand and come on to the girls.)

Girls: Stop it!

Boys: Come on, it will be fun!

Girls: No!

(Car accident.)

The teachers say there's a choice here, but these kids aren't stupid. They
can stay out of the car and live, or get in the car and die. So...just say no.

Dare to Keep Your Kids off DARE

That three-word mantra "Just Say No" became a national punch line for a
reason: It didn't keep kids away from drugs. Drug use among teenagers
dropped steadily from the early 1980s until 1992, mirroring a decline in
drug use among adults. But this downward trend began before the anti-drug
curricula developed in the 1980s, exemplified by Drug Abuse Resistance
Education (DARE), could have had any impact. The drop was detected in
surveys of students who had never heard of DARE or Just Say No. And by the
early 1990s, when students who were exposed to DARE and similar programs in
grade school and middle school reached their late teens, drug use among
teenagers was going up again. In the 2002 Monitoring the Future Study, 53
percent of high school seniors said they had used illegal drugs, compared
to 41 percent in 1992. Past-month use rose from 14 percent to 25 percent
during the same period.

Meanwhile, the leading model for drug education in the United States has
been DARE, which brings police officers into elementary and middle school
classrooms to warn kids away from drugs. DARE claims to teach kids how to
resist peer pressure and say no to drugs through skits, cartoons, and
hypothetical situations. Founded by Los Angeles Police Chief Daryl Gates in
1983 and organized as a nonprofit corporation (DARE America) in 1987, DARE
is still used in around three-quarters of the nation's school districts. At
the annual DARE Officers Association Dinner a few years ago, Bill Clinton's
drug czar, Barry McCaffrey, declared that "DARE knows what needs to be done
to reduce drug use among children, and you are doing it -- successfully."
But as McCaffrey should have known, the effectiveness of DARE has never
been demonstrated, a fact DARE America itself implicitly conceded when it
announced, half a year after the drug czar's praise, that it was revamping
its program.

During the last decade DARE has been widely criticized as unproven and
unsophisticated. In one of the most damning studies, published in 1999, a
team of researchers at the University of Kentucky found that 10 years after
receiving the anti-drug lessons, former DARE students were no different
from non-DARE students in terms of drug use, drug attitudes, or
self-esteem. "This report adds to the accumulating literature on DARE's
lack of efficacy in preventing or reducing substance use," the researchers
noted. In a 2003 report, the General Accounting Office reviewed six
long-term evaluations of DARE and concluded that there were "no significant
differences in illicit drug use between students who received DARE...and
students who did not." The surgeon general, the National Academy of
Sciences, and the U.S. Department of Education also have declared DARE
ineffective.

Determined not to repeat past mistakes and prodded by a federal government
that lately has been demanding accountability in education, teachers today
are turning to prevention programs backed by "scientifically based" claims
of effectiveness. In 1998 the Department of Education, concerned that money
was being wasted on a mishmash of ineffective programs, decided to fund
only those proven by "scientifically based research" to reduce or prevent
drug use. Testimonials and we-think-it's-working assurances like those
cited by DARE would no longer pass muster. Every prevention program now
needed hard numbers, objective experiments, and independently reviewed
conclusions based on long-term follow-ups to prove they worked.

In 2000 the Department of Education convened an expert panel that judged
nine prevention programs "exemplary" for their proven effectiveness and 33
others "promising." Comprised mostly of educators and health professionals,
the panel gave the "exemplary" or "promising" nod only to programs backed
by at least one scientific evaluation of effectiveness (DARE did not make
the cut). Schools using programs that were not on the list would risk
losing their slice of the Department of Education's $635 million drug
prevention budget. In 2001 President George W. Bush included the
"scientifically based research" criterion for drug education in his No
Child Left Behind Act, signing into law what had previously been only
administrative practice.

But the officially endorsed alternatives to DARE aren't necessarily better.
Once you remove the shiny packaging and discard the "new and improved"
labels, you'll find a product that's disappointingly familiar. The main
thing that has changed is the rhetoric. Instead of "Just Say No," you'll
hear, "Use your refusal skills." The new programs encourage teachers to go
beyond telling kids that drug use is bad. Instead, they tell teenagers to
"use your decision making skills" to make "healthy life choices." Since
drugs aren't healthy, the choice is obvious: Just say no.

The persistence of this theme is no accident. Prevention programs can get
the federal government's stamp of approval only if they deliver "a clear
and consistent message that the illegal use of drugs" is "wrong and
harmful." But this abstinence-only message leaves teenagers ill-equipped to
avoid drug-related hazards if they do decide to experiment.

After examining some of the new anti-drug curricula and watching a sampling
of them in action, I strongly doubt these programs are winning many hearts
and minds.

The Class Struggle Against Drugs

In September 2001, I join a class of middle schoolers in the upscale Los
Angeles suburb of Palos Verdes Estates as they run through a series of
hypothetical scenarios ostensibly designed to put their decision making
skills to work. The program, called Skills for Adolescence, is used in
about 10 percent of the nation's 92,000 K-12 schools. The curriculum, which
the Department of Education deems "promising," "teaches the social
competency skills young adolescents need for positive development,"
according to program literature.

Clustered into small groups, each student fingers a wallet-size blue card.
The card -- titled "Will it lead to trouble?" -- lists the five questions
adolescents should ask themselves when confronted with a difficult choice.
It's laminated, presumably so teenagers can keep it in their back pockets
and whip it out whenever they're faced with a tough decision and need a
quick reminder about how to make one.

If the answer to any of these questions is yes, the students are supposed
to say no: "Is it against the law, rules, or the teachings of my religion?
Is it harmful to me or to others? Would it disappoint my family or other
important adults? Is it wrong to do? Would I be hurt or upset if someone
did this to me?"

The questions clearly are designed to elicit a complete rejection of drug
use. Is it against the law? Yes, drugs are against the law. Therefore, you
must reject them. Is it harmful? Yes, they can be harmful. Reject them.
Would it disappoint my family or other adults? Yes, reject. There's no way
to make any other decision. "If the only decision that's the right decision
is the decision to say no, you've effectively cut off the discussion
again," observes Marsha Rosenbaum, director of the West Coast office of the
Drug Policy Alliance and author of Safety First: A Reality-Based Approach
to Teens, Drugs, and Drug Education.

Another program praised by the Department of Education is Project ALERT,
which it calls "exemplary." A series of anti-drug and anti-tobacco lessons
used in about a fifth of the nation's 15,000 school districts, Project
ALERT boasts that it "helps students build skills that will last a
lifetime," including "how to identify the sources of pressure to use
substances," "how to match specific resistance techniques with social
pressures," "how to counter pro-drug arguments," and "how to say 'no'
several different ways."

Eliminate the psychobabble, and Project ALERT's message is almost
indistinguishable from that of the 1980s anti-drug programs that teachers
now roundly scorn: Peer pressure is bad. Drugs are bad. Just say no.

In a room plastered with posters titled "Pressures" and "Ways to Say No," I
join a class of Los Angeles middle schoolers in November 2002 as it breaks
into small groups to plod through an anti-drug lesson from Project ALERT.
The adolescents have just finished watching a video about smoking
cigarettes featuring former teenaged smokers who say things like, "Life is
too short. I'm not eager to die."

Each of the four groups is assigned a different question to answer: How can
you help people quit? What's good about quitting? How do people quit? What
gets people to quit?

There is little discussion. The kids know what the teacher expects. How can
you help people quit? Tell them smoking is dumb. Don't hang out with them
anymore.

When asked if she knows anyone who smokes, one girl nods.

Do you think any of this helps?

"No," she says without hesitation.

Why not?

The girl barely lifts her eyes from the paper, where she is decorating the
"Smoking is dumb" and "Don't hang out with them anymore" list with bright
red hearts. She shrugs. "Some people just don't care," she says.

The students are asked why they think kids use drugs.

They respond in unison, "Peer pressure" -- the answer they know is
expected. When asked to explain what this means, the students conjure up
images of older kids hassling younger ones. "Sometimes they're your
friends, but sometimes they're crazy people that come up and ask if you
want some," one boy says, drawing on concepts that prevailed during the
Just Say No era but have little basis in real life.

One boy defines peer pressure as other students "trying to force you,
trying to convince you to do it." When asked if he's ever experienced peer
pressure, he shakes his head. He's waiting for a group of sinister
strangers to thrust drugs in his face. Drug education apparently has not
helped him realize that peer pressure is far subtler, like wearing the same
clothes as your friends or sharing inside jokes. And the teachers, by
continuing to portray peer pressure as a palpable evil, fail to protect
their students from anything.

Everything Old Is New Again

Today's anti-drug programs claim to have replaced all the scare tactics of
years past with good, solid information about the physiological effects of
drug use. But these programs, which are based on the same flawed
"scientific" information that adults have been using for years to keep kids
off drugs, are a lot like anti-alcohol propaganda from the late 19th and
early 20th centuries.

Back in the late 1800s, health lessons endorsed by the Woman's Christian
Temperance Union (WCTU) and its Department of Scientific Instruction
portrayed alcohol as a wicked poison that created an uncontrollable
appetite for more: "Many persons who at first take only a little beer,
cider, or wine, form a great desire for them....The appetite for alcoholic
liquors usually grows rapidly, and men who use but little at first often
become drunkards in a short time." This selection comes from The House I
Live In, a schoolbook written in 1887 and heartily endorsed by the WCTU.

A century later, another popular textbook offers a similar perspective on
drug use. This passage comes from Making Life Choices (1999), lauded by
teachers for its scientific content: "Attachment to the drug becomes almost
like a great love relationship with another person. The only sure way to
escape drug addiction is never to experiment with taking the drugs that
produce it."

In the popular classroom video Marijuana Updates, produced in 1997,
teenagers and Leo Hayden, a former college football player turned drug
counselor, describe how pot ruined their lives. They say the drug made them
feel invincible, tired, hungry, and numb. Soon they were slacking off in
school, shirking responsibilities, and turning to harder drugs for a better
high. Their testimonials, which suggest that pot turns people into useless
zombies eager to snort cocaine and shoot heroin, draw on two major themes
in anti-marijuana propaganda: "amotivational syndrome" and the "gateway
effect."

A century ago, kids heard the same warnings about tobacco, another target
of the so-called temperance movement. Our Bodies and How We Live (1904)
warned that "the mind of the habitual user of tobacco is apt to lose its
capacity for study or successful effort." According to the 1924 Primer of
Hygiene, a smoker "forgets the importance of the work he has to do, and
idles away his time instead of going earnestly to work to finish his task."
The Essentials of Health (1892) worried that cigarettes would lead to
harder stuff: "It is to be feared that if our young men continue the use of
cigarettes we shall soon see, as a legitimate result, a large number of
adults addicted to the opium habit."

The scientific studies allegedly proving the effectiveness of the new drug
education programs aren't much more impressive than the tired rhetoric.
Consider Life Skills Training, a fast-growing program that reaches about 2
percent of the nation's 47 million schoolchildren and tops the list of
"exemplary" programs. Generally touted as the future of drug education,
Life Skills Training purports to cut tobacco, alcohol, and marijuana use by
up to 75 percent; to reduce the use of multiple drugs by two-thirds; and to
decrease the use of inhalants, narcotics, and hallucinogens. These claims
aren't based on testimonials or case studies about 12-year-old Johnny
turning his life around after a few Life Skills Training lessons. The
program's supporters cite actual scientific studies, reported in journals
published by the American Medical Association and American Psychological
Association.

But the lead scientist on those evaluations, Cornell University
epidemiologist Gilbert Botvin, is the creator of Life Skills Training and
the one profiting from its success. Botvin also sits on the expert panel
that deemed his prevention program "exemplary." He is not the only program
developer sitting on the expert panel; two other panelists have
participated in rating prevention programs they helped develop. All of
their programs have received "exemplary" marks.

Such conflicts of interest aren't proof that the conclusions are flawed.
But independent researchers such as Joel Brown at the Center for
Educational Research and Development in Berkeley have found problems with
the Life Skills Training studies. Brown charges that the evaluations often
focused only on positive outcomes and omitted results indicating that
teenagers who went through the prevention program were more likely to use
drugs or alcohol than their peers.

You Gotta Believe

In a 2001 analysis published by the Journal of Drug Education, Brown noted
that a six-year evaluation of Life Skills Training reported data only from
students who had completed 60 percent or more of the curriculum, just
two-thirds of the original 2,455-student sample. The students left out were
the ones who missed many of the anti-drug lessons -- probably students who
skipped class a lot or were less motivated. Such students, other research
suggests, would be especially prone to drug use. Carving them out of the
picture inflated the program's apparent effectiveness, Brown's study shows.

Brown also found that when students completed anything less than 60 percent
of the Life Skills Training curriculum, even 59 percent, their drug use was
no lower, and in many cases higher, than that of students who did not
participate in any lessons at all. Since the researchers don't give a good
reason for using 60 percent as the cutoff point (only saying it was "a
reasonably complete version of the intervention"), it seems they simply
chose the point at which the outcomes turned positive.

Furthermore, Brown says, real students in real classrooms are unlikely ever
to see 60 percent of the curriculum, because most teachers simply pick out
lessons and squeeze them in whenever possible. The Life Skills Training
research reinforces this caveat: Even under pristine conditions, with
teachers getting constant training and monitoring, one-third of the
students failed to reach the 60 percent mark. And those kids, Brown's
research shows, were more likely to use drugs than the students who did not
participate at all.

The National Academy of Sciences found similar gaps in drug education
research in its 2001 report Informing America's Policy on Illegal Drugs:
What We Don't Know Keeps Hurting Us. Too many studies omit negative
results, exclude students from the original sample, and inflate statistical
evidence, the report concluded. But because the federal government only
requires a prevention study to demonstrate a single positive outcome,
programs backed by weak evidence stay in business.

Another problem with many of the new "science-based" prevention programs is
that they continue to rely on statistics measuring student attitudes toward
drugs. Project ALERT celebrates outcomes such as these: "Anti-drug beliefs
were significantly enhanced," among them "intentions not to use within the
next six months," "beliefs that one can successfully resist pro-drug
pressures," and "beliefs that drug use is harmful and has negative
consequences." But whether a student intends to abstain or believes he can
resist drugs does not tell us whether he actually will do so.

DARE officials likewise tried to counter bad publicity by falling back on
beliefs, trumpeting that 97 percent of teachers rated DARE as good to
excellent, 93 percent of parents believed DARE teaches children to avoid
drugs, and 86 percent of school principals believed students would be less
likely to use drugs after DARE. With only beliefs to cite, DARE was left
off the federal government's list of "exemplary" and "promising" prevention
curricula in 2000. Many schools have dropped it from their anti-drug
lineups or scaled it back to the point of irrelevance, a fact that DARE
officials concede while refusing to release numbers on the decline.

Desperate to retain its dominance in the prevention market, DARE has
embarked on a dramatic retooling of its lessons to keep up with the current
emphasis on scientific research, decision-making skills, and resistance
techniques. The Robert Wood Johnson Foundation has given DARE a $13.7
million grant to create a new middle school curriculum, which teachers
began testing last fall. DARE officials said the new curriculum was
drastically different.

"It's not just say no, it's not Nancy Reagan," says Charlie Parsons,
executive director of DARE America. "We're teaching kids how to say no."

It remains to be seen how this revamped DARE curriculum is going to be any
different from the old one -- or, for that matter, how any of the new
prevention programs are different from the old DARE. Many of the DARE
tactics now scorned by educators are quite similar to those used in the
new, supposedly revised programs. Project ALERT and Life Skills Training
have "Ways to Say No" almost identical to the ones taught in DARE.

Drug Education as if Reality Matters

What all of these programs continue to ignore is the most crucial piece in
the drug prevention puzzle -- the kids, and their stubbornly independent
reactions to propaganda. They aren't fooled by "decision making" skills or
"healthy choices." They know what the teachers expect: Just say no.

"They make you feel as bad as they can if you do it," says one Los Angeles
teenager. Still, he says, "almost every person I know has tried marijuana.
Even good people."

At Mira Costa High School in Manhattan Beach, California, a 10th-grade
summer health teacher, Guy Gardner, recognizes his difficult position.
About one in four Manhattan Beach students are "current" (past-month)
marijuana users, according to the district's own studies, which puts them
near the national average. "A lot of them know more than I do," Gardner
confesses. Yet he plays the game, rattling off a list of warnings --
cocaine will rot out your nose, marijuana could kill you, there's no such
thing as recreational drug use -- even as most of his students know how
unlikely or just plain wrong it all is.

In one lesson, Gardner asks students to name the first thing that comes to
their minds when they hear the word drugs. "Don't give me answers I want to
hear, give me your answers," he urges.

A couple of kids call out: Crime. Death. Stupid. Something that alters your
mind and screws up your body.

But a few offer another point of view.

"I think it's bad, but people have the choice to do it, and if they do it,
it's their problem," says one boy.

"If you really want to do it, you're going to do it," says another, even
going so far as to advocate legalizing drugs. "We'd be so much more chill
in the nation."

That may be, but saying so is untenable in the abstinence-only world of
drug education. Gardner pulls back the debate. You can't legalize drugs, he
tells the students, because they're harmful. "The ultimate message" of
legalization, he says, "is it's OK to do drugs." And that, he implies, just
isn't true.

In the end, meaningful drug education reform probably won't come from
educators. It will have to come from those who have far more at stake when
it comes to drug use by teenagers: their parents. They are the ones who see
their kids stumble home with bloodshot eyes, who can't fall asleep when
their kids are partying the night away, who know their kids are
experimenting with drugs and want, above all, for them to be safe.

That's why drug experts such as Safety First author Marsha Rosenbaum are
calling for a truly new approach to drug education, one that abandons the
abstinence-only message and gives kids the unbiased, factual information
they need to stay safe, even if they choose to experiment. Such information
could include now-forbidden advice on real but avoidable hazards such as
driving under the influence, having sex when you're high, mixing alcohol
with other depressants, and overheating while using Ecstasy.

One possible model is Mothers Against Drunk Driving (MADD), which
recognized that if it couldn't stop young people from drinking, it could at
least stop them from getting behind the wheel while intoxicated. MADD's
efforts, which made designated driver a household term, seem to have
worked: Since 1982, according to the National Highway Traffic Safety
Administration, the number of teenagers killed in drunk driving accidents
has plunged 57 percent. MADD thus helped prove that we can make drug use
safer without eliminating it entirely.

"There are kids who are not going to use drugs for religious reasons,
because they're athletes, because they're focused on school, because they
don't like the way they feel," Rosenbaum notes. "These kids don't need a
program to tell them no. They're already not using. But for the kids who
are amenable to the experience, it doesn't matter how many DARE programs
they sit through; they're going to do it anyway....If we can't prevent drug
use, what we can prevent is drug abuse and drug problems. But we have to
get real."