There’s an interesting looking paper in the Journal of Substance Use, I’ve only got access to the abstract, which argues that:
The persistent failure to differentiate use from abuse where currently illicit drugs are concerned undermines effective primary prevention of the addictive disorders we are really concerned with. Typical programmes have ignored this reality, which helps explain the failure of most drug education. Adolescents soon recognize the inaccuracies and exaggerations, which undermines the credibility of drug education and limits its effectiveness.
Without having read the whole article I’m clearly at a disadvantage, but I want to use the thesis as a jumping off point for a discussion of some of the complexities that drug education needs to grapple with.
My experience is that you can have quite sophisticated discussions about drugs from a relatively early age. My sons, for example, are both interested in (by which I mean obsessed with) professional wrestling and have wanted to talk through why the wrestlers might use steroids, the sort of side effects they might experience, and the difference between steroids being used as a medicine and as a drug of abuse.
Just one puff…
As the paper suggests we know that just using the worst possible outcomes of drug use can damage the credibility of the information we provide in drug education. And we also know that a fear based appeal to sustaining non-drug use has the potential for boomeranging.
But does that mean we don’t address the potential for harm?
It isn’t just about addiction
It seems to me that it is important that drug education doesn’t focus (at least primarily) on the problems of addiction and problematic use caused by drugs and alcohol.
Partly because those issues can seem very distant to young people, and perhaps bringing it back to situations that are closer to their lived experience of the peer group would be more effective.
For example, we know that getting drunk before the age of 13 is associated with other risk factors at the age of 15, including smoking and cannabis use. It seems clear that delaying the age at which young people start to smoke even a little means they are more likely to give up earlier. We also know that for boys drinking 8 or more units in a week at the age of 16 are less likely to get a degree. But there are indications that the harms associated with drinking are not something that deters teenage drinking.
Nevertheless, those harms can be real.
Drug prevention without talking about drugs?
There’s a case to be made that there’s not much point in talking about the harms of drugs and alcohol at all. Two of the interventions that we’ve been very interested in (because of their strong evidence base for reducing harmful outcomes), Preventure and the Good Behaviour Game, don’t include any mention of drugs at all. The Preventure programme uses a Cognitive Behaviour Therapy approach to help young people understand triggers to risky behaviours in particular personality types. And the Good Behaviour Game is an effective way to socialise disruptive children into primary school, thus providing them with a long-term protective factor in their lives.
And the life-skills programmes we’ve looked at focus more on developing social and cognitive skills and health values than discussing the harms of particular drugs.
So whilst I think that an emphasis on problematic use and the harms caused may not be as helpful as instinct would suggest I would be loathed to give the impression that use is risk free, particularly for children and young people.