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."
