Do Kid Drug Educational Programs Make Drug Use More Likely?

[00:00:00]In 1983, First Lady Nancy Reagan visited Longfellow Elementary School in Oakland, California when a schoolgirl asked her about what to do if she was offered drugs. The First Lady responded, "Just say no." This trip was not the first foray by Mrs. Reagan to raise awareness regarding the dangers of drug use.

[00:00:17]However, this interaction was picked up by the press and resulted in an advertising campaign in her husband's war on drugs. Nancy Reagan spent her time in public life raising funds for wounded and returning Vietnam veterans as First Lady of California. She also pushed for funding for missing soldiers and soldiers believed to be still held as prisoners of war and was critical in creating the foster grandparents program. And through it all, she traveled over 250,000 miles visiting schools, rehabilitation centers, and other nations attempting to warn children of the dangers of drug use. To some extent, this caring and dedication made programs that sprung up around her challenging to criticize even if they accomplished nothing of any value. In this political environment, DARE, Drug Abuse Resistance Education, was born a year later when the LAPD and the Los Angeles School District decided to take on drug use on the demand side rather than the supply side. The leadership of the LAPD drove the project to bring it to fruition, and a congressional committee responsible for funding DARE cited earlier studies showing it was helpful in order to justify the cost.

[00:01:15]Further, the committee's report found that fifth and sixth grade children often had a more sophisticated understanding of drugs than their teachers did. It also found that since police officers had to deal with the effects of drugs every day, they would be more effective in teaching the curriculum and deterring students. For those outside the United States who weren't put through the program, the DARE program took place over 17 weeks promising a reduction in vandalism, violence, and drug use. Each week, a police officer provides 45 minutes to an hour of training to students in grades five through nine. The program also suggested that teachers integrate the material into components of their regular curriculum, as well as included methods to help students improve their self-esteem, learn to resist unwanted offers, and improve their assertiveness in general. It also gave them real information about various substances and their impact on the body. A controversial side issue with the program is it also encourages kids to report any drug use they observe in school or in their home to the D.A.R.E.

[00:02:04]officers. In any events, the program is identical across the United States. The goal is that each student will see the same information the same way to hopefully have the same outcome everywhere. However, as you might expect, students' environments, income, and local cultures are quite different across the United States. The authors of the program hoped that such differences would not matter, but let's just say that it really does, a lot. As for funding for the program, the initial law required the Secretary of Education to set aside $15 million from the Drug Free Schools and Communities Act to support the Drug Abuse Resistance Education Act.

[00:02:37]Two Republican members of the House, Bill Goodling and Tom Petri, wrote a short dissent to the committee's findings concerning the program stating, "We join our colleagues in offering both encouragement and support to the Drug Abuse Resistance Education Program, D.A.R.E., which has been widely used in many communities and has been a compelling force in encouraging youth to resist the of drug use. Though I we fully support the use of D.A.R.E., we do have a concern regarding the mechanism contained in H.R. 5064 to provide financial support to D.A.R.E. H.R. 5064 would provide a reservation off the top of the Drug Free Schools and Communities Act appropriation for grants to local education agencies to establish D.A.R.E.

[00:03:13]programs. We do not believe that it is prudent to reserve funds for such a specific type of program when many effective drug abuse education curricula have been developed. Further, such a reservation will limit the funds available to local education officials to use at their discretion in determining which programs will best serve the particular needs of the youth in their communities. As for Goodling, he had the background to know what he was talking about, a master's degree in English, and had been a teacher as well.

[00:03:38]Representative Goodling also had served on a local school board and as its president. He brought that experience with him to Congress. [music] But on this one, nobody really listens.

[00:03:47]Pointing out the major issue as alluded to, D.A.R.E. set aside money for its operation independent of its effectiveness, whereas other programs have to prove their effectiveness through data and peer review. The crux of the descent is that it is better to let those who know the children and situation in a community make those decisions rather than national legislators who may mean well but are often more motivated by needing to appear to be doing something useful whether what they do is actually useful or not. Inevitably with all of this, soon after the passage of the law, researchers began asking the question, "What does DARE do?" That is whether it was actually effective at any of its goals. Of course, one of the challenges in the sciences, especially in the social sciences, is called the replication crisis. Even in the best of circumstances, it can be difficult to get research on a single topic to agree when the underlying population is quite different or diverse. In its simplest form, the replication crisis happens when someone performs research and finds that something works, then someone else looks and it doesn't work. Part of the issue is that it takes a lot of money and work across a large sample to be sure one way or the other. [music] As for DARE and its effectiveness, the initial work after it was approved into law was not promising. Ironically, some of the first research found that it not only wasn't reducing drug use, but it actually increased certain types of substance abuse. Funnily enough, the effect of finding that educating people on what they should not do producing the opposite result happens more than one might expect. The results have come up in a variety of fields. For example, some of the research on financial education has found that mandatory financial education and bankruptcy can actually increase the probability of future insolvency rather than decrease it. In short, while people with our knowledge of personal finance can make foolish choices that fail, people with education and more know-how on finance can engage in genuinely sophisticated and more spectacular failures. Lastly, one thing the research on DARE shows is that it does a very good job of providing information about drugs. From here, the next round of research found that DARE did not work in its original area, California. But in this round, it also didn't seem to increase the rate of abuse, at least. So, to sum up, there were now three sets of studies surrounding the DARE program. The initial studies showed it worked. The next round showed evidence that it had the opposite of the intended effect, and the third round showed no impact at all.

[00:06:02]Although it may be possible to engage in methodological criticism with each of the studies, the overall state of the research at this point, let's just say, doesn't really make DARE look like a particularly worthwhile program, nor would the follow-ups, which we'll get into shortly. Now, going back to the purpose of DARE, reducing violence in schools, vandalism, and the rate of substance abuse, since that time, the nation has gone through school shooting after school shooting. The children that took DARE grew up to participate in the opioid crisis. Property crimes [music] did fall. The question is, how to sift out DARE's impact on the more extensive set of social questions driving each of these phenomena. DARE would still be worthwhile if it reduced the level enough despite all the other problems.

[00:06:45]Of course, if a different program cut substance abuse by 20% while DARE reduced it by five, DARE's money should probably go to the other program. As you might expect, both of these questions have since been well studied. The first meta-analysis studied both of these in 1994. They concluded that DARE had a small effect on tobacco use, but no impact on alcohol or other drug use.

[00:07:05]When it was compared to another program that was studied, it was found to be comparatively ineffective. Subsequent local studies found that either there was a small gain from using DARE or that there was a small amount of harm. Later meta-analysis concluded that DARE produced no short-term impact on substance abuse. A large-scale study of New Jersey schools looked at the original claims related to vandalism, violence, and substance use. It found no effect of DARE on the outcomes. Students that participated in DARE were equally likely to engage in violence, commit vandalism, or abuse substances. From all this, in 2001, the Surgeon General classified DARE in its list of programs that were ineffective. Hopefully, the Surgeon General also created a list of programs that have been shown to work well. One thing to remember about substance abuse is that they are often used initially to numb pain. That pain may be physical or psychological.

[00:07:51]Children in pain, like adults in pain, do not want to be in that situation.

[00:07:54]Further, children typically have fewer resources and less maturity than adults to cope with pain. Of course, there is another factor to consider when looking at such programs' effectiveness, the role supply and demand play in the problem. If schools are successful in reducing the demand for illegal drugs, then suppliers would cut their prices to bring up the quantity demanded to at least near its old level. For example, when the South Beach dieted America, the demand for spinach skyrocketed. It takes an entire season to change the amount of spinach planted in the ground, so the prices [music] shot through the roof. At least in part, the diet was choked off because the cost of the healthy foods in the diet became too expensive for most people, while the prices of unhealthy foods dropped. Similarly, if schools are successful in changing attitudes about drugs, and thus students and later their adult selves not partaking as much, it is in the interest of suppliers to adjust the cost so that any market losses will be minimal. Needless to say, the school attempting to change transient attitudes is up against pretty powerful forces. But in the end, the supplier of substances is at the end of a long chain of events that began with [music] pain. To attack demand is to attack pain-causing issues. For example, during the Vietnam War, the military estimated that 40% of all infantrymen were addicted to heroin. The enemy was indistinguishable from civilians. Combat was often by ambush. There's another war where soldiers watched their friends die and were sometimes wounded themselves.

[00:09:15]Heroin dulls the pain of life in a war zone. When the soldiers returned to America, the level of addiction fell to the background level normal throughout society. The pain was gone. The use mostly went away outside of the national norm. The same phenomenon has been seen repeatedly by looking at wage levels and unemployment. It has been found to be no different for children. Prevent or remove pain and substances do not enter the picture to the same degree. Further, a child busy with activities and friends is less likely to get involved in such negative activities. Unsurprisingly from this, programs that center around pain removal and more productive activities often have been shown to do what D.A.R.E. does not. On this note, and important to the overall discussion, is that the Surgeon General's office found many things that worked well at preventing drug abuse among kids. One of the most straightforward and longest-lasting interventions may seem unrelated to drug use, and that's prenatal and infancy visits by nurses, which have been shown to be effective in both white and African-American communities, as well as in both rural [music] and urban settings. With this, a 15-year follow-up on low-income teenage mothers found a 79% reduction in reports of child abuse and neglect. They found a 44% decline in maternal behavioral problems, and a 9% reduction in maternal arrests. A side benefit of all of this from the perspective of the goals of D.A.R.E., they found a 56% reduction in alcohol consumption versus those that did not have visiting nurses. It was also determined that the effects were diminished for those children with more than 28 incidents of child abuse.

[00:10:37]Another model for the first and second graders is the Seattle Social Development Project. This program is designed to help early grade school children with problems of aggression, antisocial behavior, externalizing behavior, and self-destructive behaviors. Participants have lower levels of alcohol and delinquency initiation, greater attachment and commitment to school, and less involvement with antisocial peers.

[00:10:56]Follow-up on students that were 18 years old found significant reductions in violent acts and heavy alcohol use.

[00:11:02]Teens who had received a full intervention were also less likely to be sexually active, had multiple partners, or have gotten someone pregnant or become pregnant themselves. Moving on from there, the LifeSkills Training Program run by Cornell reduces alcohol, marijuana, and tobacco use by an average of 50 to 75%. Long-term follow-up after 6 years shows the program reduces multiple drug use by 66% and pack-a-day smoking by 25%. It also reduces inhalants, narcotics, and hallucinogenic use, as well. The Surgeon General also studied programs for children in trouble. Functional family therapy was found to significantly reduce the percentage of children in the juvenile justice system that re-offended. One study found that 60% re-offended compared to with 93% who did not receive it. Another study found that only 11% re-offended versus 67% that did not receive the therapy.

[00:11:48]Perhaps unsurprisingly, another study found that the programs most likely to be implemented were not the best programs in terms of outcomes, but the best programs in terms of marketing. In a democracy, there is a strong preference for the familiar as well as things that seem like they would more directly help rather than programs like nursing visits that indirectly get the results sought. [music] There is also, very sadly, sometimes a strong resistance to science. On top of this, a law once passed is very difficult to remove as Congressman William Goodling and Tom Petri observed, despite its ineffectiveness, especially compared to other programs with similar goals, DARE has an infrastructure in the US Department of Justice. It has regional training centers. Its funds are also used to buy police equipment. In addition, a couple of generations of students have gone through the program and remember it now that they are parents perhaps without being aware that the program itself [music] didn't accomplish its goals. As for alternate proven programs like the nurse visits, visiting nurses are also less politically palatable to a wide swath of the American public. They want the substances and the abuse to go away, but they don't necessarily want to pay for infants or mothers' health care. They are opposed to money going to others that they seemingly, at least on the surface, see nothing from directly despite the proven benefit to society as a whole, not unlike free public education. In the latter case, ostensibly, if you have no kids, free public education for all children is the government spending your tax dollars on something you don't use or seemingly benefit from directly. But when factoring in the massive benefit to society as a whole to have the entire populace educated, not to mention ancillary benefits like a productive place to stash the kids while parents work, few have a problem with this. In a nutshell, everyone lives in a society, so it's nice to make it nice. But in the end, the difference between perception and reality makes it difficult for legislators to move away from funded programs that do not work to get funds for proven programs. Further, the US Department of Education does not use a system of testing to determine what programs to fund, and so it is that empirically proven programs can lose out to programs shown not to work, but that are perhaps better from a marketing standpoint. In the end, D.A.R.E. is not the only program in widespread use that has been shown to fail in accomplishing its goals. It is just the best-known anti-drug program. The irony is that if Nancy Reagan could see the results side by side, she would likely be out there advocating for the programs that work, and perhaps making headway towards this given its political pressure that is needed to make the needed changes. A person that flies 250,000 mi visiting children, rehabilitation centers, and hospitals doesn't want all that work to be for nothing. Nancy Reagan, in addition to being an actress, was also a nursing assistant. She is the same type of person that might have advocated for nurses to go home to home checking on mothers and babies. In the end, good working programs do exist to execute the goals of D.A.R.E. It's simply the the most widely known program meant to accomplish this. D.A.R.E.

[00:14:42]isn't one of them.