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A critique of a particular method of prevention or intervention with reference to alcohol
Drug and alcohol abuse is a major concern for governments in most Western countries. Each year significant amounts of funds are designated to try and tackle the problems that alcohol abuse causes. In Britain we are constantly reminded of our so called binge drinking culture and the damaging effect this is having on our society. Between 1993 and 2005, mortality rates from alcohol related diseases increased by 99% among males and 67% amongst females. Figures from the Prime Minister’s Strategy Unit show that the financial cost to the country of alcohol misuse is somewhere in the region of £20 billion a year (2004). None of this has been aided by longer opening times, alcohol being more readily available from a variety of sources and for much cheaper than it has ever been before. The UK government is aiming to devolve responsibility for dealing with alcohol related problems to a local level. In a recent white paper entitled Our Health, Our Care, Our Say (2006), there is a clear expectation that local agencies have to work in partnership to tackle the problems caused by alcohol misuse. This means that there is more pressure on local stakeholders such as schools to take on the responsibility of introducing programs to prevent alcohol abuse.
This essay will attempt to provide a critique of schools-based intervention programs. It is widely accepted that schools-based intervention programs can lead to a better understanding of substances such as alcohol and can therefore result in better attitudes when it comes to the use of those particular substances. Studies have also shown that well designed programs can lead to reduced usage of alcohol in the long term as well. This essay will provide a rather broad look at schools-based programs and provide a more general critique rather than focussing in one on particular program. It is hoped that by doing this, it will be possible to utilize more of the academic research that exists and provide a more complete picture of the successes and the problems that these particular programs encounter. Because there is such a wealth of academic research in this area, this essay will be broken into 3 separate parts. The first will provide a meta-analyses where different types of programs are compared against each other. The second part of this essay will look very briefly at which mediators or characteristics of the programs are leading to a reduction in alcohol use. The final part of the analysis will look at studies that compare different programs and determine which are the most successful programs. It is important to note that this study will not be location specific because of the wealth of research there is into other countries. The essay will end with a conclusion that will use all the research gathered to form a critique of schools-based intervention programs.
Perhaps the most useful meta-analyses comes from Tobler et al (2000) who looked at 144 separate studies involving 207 schools-based programs. They found that the most effective way of reducing substance use was by employing interactive methods which encouraged the participants to exchange ideas and learn refusal skills. Cuijpers (2002) states that, “receiving feedback and constructive criticism in a no threatening atmosphere enables students to practice newly acquired refusal skills” (p. 1012). The least successful programs according to Tobler et al (2000) were those that used non-interactive methods such as those that looked at the knowledge of the harm alcohol can do. The interactive programs used methods based on social influence. Donaldson et al (2002) state that this is, “enhancing an adolescent’s ability to resist passive social pressure”. (p. 291). These particular programs were found to be more effective and superior to programs utilizing non-interactive methods. However, Tobler et al (2000) are not able to identify what specific components of the interactive programs are most successful at limiting substance use.
Another useful meta-analyses was conducted by White and Pitts (1998). Although they looked at far fewer studies than Tobler et al (2000), they still came up with some interesting findings. They found that the effectiveness of such programs could be improved if there were additional components that weren’t necessarily school related such as a mass media campaign or booster sessions. They go on to argue that another factor that can affect schools-based intervention programs is the intensity of the program. They found that the most effective programs had 10 or more sessions.
A final meta-analyses comes from Rooney and Murray (1996). They came to many of the same conclusions as White and Pitts (1998) such as the intensity of the program. They also found that combining lots of different components could have a significant impact on the success of program. For example, the use of booster sessions and using trained teachers side by side with same-age peer leaders. Programs that did this were more likely to have success in limiting alcohol use amongst those young people participating.
It would now be useful to look at the particular characteristics, or mediators, of these programs. As Cuijpers (2002) states it is important to know, “whether drug use is reduced by the intervention, whether the mediating variables are influenced by the intervention, and whether the mediating variables do have a mediating role in the reduction of substance use” (p. 1016). It is possible to identify several key mediators across many of the studies conducted in schools-based intervention programs. Wyn et al (2000) argue that key mediators are based around social influence factors such as those aimed at the acceptability of the use of alcohol, knowledge about how prevalent the misuse of alcohol is and how peers would perceive the use of alcohol. This essay will now focus on three mediators and look at how effective they are in schools-based intervention programs. These mediators will be booster sessions, peer versus adult led programs and the use of community involvement in addition to schools-based intervention programs.
Booster sessions are those sessions taken on after the initial program has ended. There seems to be little conclusion in the research if booster sessions are an effective addition to intervention programs. Botvin et al (1983) and Dijkstra et al (1999) argue that they are where as Shope et al (1992) state that they have no effect at all. However, it should be noted that those in agreement state that these booster sessions are only effective if they are peer led rather than teacher led. One has to take into account other mediating factors when considering booster sessions as an effective method of intervention.
Cuipers (2002) argues that peer led sessions are more likely to be effective versus adult or teacher led sessions. In her study of the existing research she finds that peer led programs are more effective in the short-term but that after a year the difference in effectiveness between peer and adult led programs is negligible. She goes on to argue that the, “research suggests that the effectiveness of a prevention program is determined by several characteristics of the programs. The leader may constitute one of those characteristics” (p. 1018).
Community involvement is a very interesting area of study and one that has been widely covered. In the past few years there has been a realisation that for any form of social change there has to be involvement from more than one source. There is also a realisation that individual communities know how to best deal with their own problems. This is why the UK government has devolved so much to a local level, from the creation of Primary Care Trusts to dealing with the problems that alcohol abuse causes, there is an understanding that communities know best how to tackle their problems. The methods used can vary considerable from community to community but they may include media campaigns, community task forces and parental intervention (Holder, 2004). It might be helpful to look at one such example of a community led intervention program in the UK.
The Broad Street Business Improvement District (BID) in Birmingham is one such example of a community led intervention program. This program was initiated in 2005 as a response to anti-social problems caused by the large number of bars and clubs on Broad Street and also the disproportionately high number of alcohol related deaths in the region (Rao and Kemm, 2006). This partnership is made up of many local agencies such as property owners/developers, business representatives, the city council, the police, the leisure forum, and the city centre neighbourhood forum. The BID have undertaken several projects which according to their annual report included, “(a) street wardens (b) additional street cleansing (c) floral dressing (d) marketing programme (e) communication and public relations (f) safer business area (g) lighting and gateway features (h) a business led partnership”. The results from this community led intervention have been largely positive. Crime has dropped in the Broad Street area by almost 60% between June 2005 and May 2006. A survey conducted in 2006 found that 78% of respondents felt that safety was good and 27% felt that it was safer than 2005.
Although the Broad Street BID doesn’t completely relate to schools-based programs, it would be fair to assume that schools in the area will be benefiting from this improvement. Any sort of community involvement creates a greater sense of responsibility and even though this particular scheme is not directly targeting young people, it is surely having an impact on schools-based intervention programs.
This essay has provided a broad look at schools-based intervention programs as a method of prevention of alcohol abuse. There is no doubt that this is an important role that schools play. However, some programs can be ineffective and have little or no impact. This essay has highlighted some of the characteristics of programs that are most likely to succeed. They should use interactive delivery methods, they should be based on the social influence model, they should be supported by the wider community and they should use peer leaders in conjunction with trained teachers.
It is clear that in the UK we need to be doing more in our schools. The school is an important battleground when it comes to preventing alcohol and drug based abuse in the future. However, government figures would suggest that not enough is being done or if it is being done, it is being done in the wrong way. What this essay has hopefully demonstrated as well is that we shouldn’t just leave it to the schools to run these programs. Families and the wider community should also share some of the responsibility. All agencies involved need to be working in a co-ordinated fashion to try and support the work that the schools are doing.
Although this critique has been rather broad in scope and not specifically related to the UK, it was felt that in order to give a more complete picture of the problems and opportunities encountered by schools-based programs it was best to utilize as much of the research as possible. As has been hopefully demonstrated, the schools-based approach does present with numerous problems, especially if done in the wrong way. However, with the right mix of components, these programs can have a lasting impact on children and young people and their attitudes to alcohol use. Perhaps it should be left to individual communities to decide what mix works best for them. The governments role should be supporting that through funding, training and providing additional components such as a media campaign.
Bibliography and References:
Botvin, G. J., Renick, N. L., & Baker, E. (1983). The effects of scheduling format and booster sessions on a broad spectrum psychosocial approach to smoking prevention. Journal of Behavioural Medicine, 6, pp. 359–379.
Broad Street BID, A brighter, safer, cleaner, the story so far, Annual Report, 05-06
Cuijpers, P. (2002). Effective ingredients of school-based drug prevention programs: A systematic review, Addictive Behaviours, 27, pp. 1009-1023.
Dijkstra, M., Mesters, I., De Vries, H., van Breukelen, G., & Parcel, G. S. (1999). Effectiveness of a social influence approach and boosters to smoking prevention. Health Education Research, 14, pp. 791–802.
Holder, H.D. (2004). Community action from an international perspective. In R. Muller and H. Klingemann (Eds.) From Science to Action? 100 Years Later, Alcohol Policies Revisited, pp. 101-112. Dordrecht, Netherlands: Kluwer Academic.
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Wynn, S., Schulenberg, J., Maggs, J. L., & Zucker, R. A. (2000). Preventing alcohol misuse: the impact of refusal skills and norms. Psychology of Addictive Behaviors, 14, pp. 36–47.
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