Evidence-based programmes in schools: are they a realistic solution for drug and alcohol prevention?

On 26 March, Mentor will be hosting a seminar: ‘What works’ in supporting young people’s development – making evidence useful for schools and practitioners. Mentor is very supportive of the use of evidence-based programmes, but to say that their use in the UK for drug and alcohol prevention has been limited is an understatement.

There are different types of evidence (see the presentation below) but some of the strongest comes from randomised controlled trials (RCTs). Allocating randomly between the intervention and control groups makes it more likely that any improvement is due to the intervention and not some other factor. Continue reading

Thinking prevention and public health

Prezi w title

Mentor’s core purpose is the protection of young people from drug and alcohol harms. These harms may be to health – the immediate impacts seen in A&E departments on a Saturday night, or the long-term damage that can be caused by alcohol, tobacco and other drugs.  But there are also indirect harms. Drinking at a young age is linked, especially for girls, to having sex earlier, with a higher risk of unprotected or regretted sex. There are higher levels of drinking and use of other drugs among young people who drop out of education, and very high levels among young offenders.

So what do we know about cause and effect, and what does this mean for prevention?

Continue reading

Tobacco: a gateway drug?

I wanted to find a nice statistic for the overlap between cigarette smokers and cannabis smokers, so I had a look at one of the tables in Smoking Drinking and Drug Use 2011. Which was interesting. The headline statistic is that among 15 year olds surveyed in 2011, of those who had smoked tobacco in the past week, half reported drug use in the past month. This compares with 4% of ‘non-smokers’ (during the past week). ‘Risk-taking behaviours’ tend not to be in isolation, and it’s unsurprising that tobacco smokers would be more likely to smoke cannabis as well (other illegal and illicit drugs are less common among young people) but this is a very stark figure.

Table showing breakdown for smoked / not smoked

Smoked Not smoked
Alcohol, not drugs 25% 19%
Drugs, not alcohol 13% 2.4%
Both alcohol and drugs 38% 2.4%
Neither 25% 76%
Total taken drugs 50% 5%
Total drank alcohol 63% 21%

Table showing breakdown for drank in past week / not drank

Alcohol Not alcohol
Smoked, not drugs 14% 6%
Drugs, not smoked 7% 3%
Both smoked and drugs 21% 3%
Neither 57% 89%
Total taken drugs 29% 6%
Total smoked tobacco 36% 8%

Finally the original figures (table 5.4 of Smoking, Drinking & Drug Use)

Smoked only 4%
Drank alcohol only 16%
Took drugs only 2%
Smoked and drank alcohol 4%
Smoked and took drugs 2%
Drank alcohol and took drugs 2%
Smoked, drank alcohol and took drugs 6%
None of these 64%

In search of feasible fidelity

In the University of York publication “Better Evidence-based Education: Evidence-based policy and practice”, David Andrews looks at the process required for evidence programmes to be adopted by schools. Commitment to fidelity is vital, so educators must assess whether this will be feasible for the intervention they are considering.

He urges educators thinking about adopting evidence-based approaches to weigh the costs and benefits for themselves. In particular he stresses that benefits need to be “practically significant” as well as “statistically significant”.

His list of the costs and benefits to be assessed includes the following:

Direct costs

  • How much do the materials cost, and do they duplicate other materials that need to be purchased?
  • How much does the training and ongoing support cost?
  • How much time will it require?
  • Will there be a need for additional personnel?

Indirect costs

  • How much teaching time will be required from personnel and pupils?
  • How much time will be expended in gaining teacher and staff support?
  • How much prep time should teachers expect outside the classroom? Are there hidden costs?
  • How much political capital will be expended in changing to a new approach?

Direct benefits

  • What are the academic gains expected?
  • What non-academic gains are expected, for example attendance, discipline, parent engagement or reduced academic disruptions?
  • Are there direct savings of teaching time?

Indirect benefits

  • What are the expected improvements in staff climate and morale?
  • What are the expected benefits in retaining teachers and staff?
  • What are the expected benefits from the general skill development of teachers?

He also states “Sustaining the adoption can be more difficult than choosing and getting started.” While it is important not to judge an intervention prematurely, and to allow sufficient time to gain results, if ‘early wins’ can be identified, these are crucial to maintaining teachers’ enthusiasm, and helping sustain the programme.

Another consideration for Mentor is that if schools are failing to adopt evidence-based interventions which have a direct impact on pupil learning and achievement , for example reading ability, there will be an additional challenge in getting them to adopt programmes where the main benefit (e.g. reduced alcohol consumption) is perceived to lie outside schools’ ‘core business’.

The European School Project on Alcohol and Other Drugs

The findings of the 2011 ESPAD survey of 15-16 year olds has just been published, covering  36 countries . Unfortunately, since only six schools in the UK completed the survey, the authors warn that it is not possible to draw firm conclusions about trends among the UK’s young people. However, comparing the data to 2007, as in the graph below, shows that 2011’s results are not dramatically different: our teenagers are drinking more than the European average, smoking less, and are slightly more likely to use cannabis.

UK data and average across all countries for 2011 and 2007

I also noticed a graph which shows the link between poly drug use (‘drugs’ including alcohol and tobacco) and getting into trouble of one form or another:

Parental monitoring and prevention: what makes a difference

The recently published Understanding Society research found that for 15 year-olds, staying out late is associated with risky behaviours in particular, going to pubs, drinking alcohol and ever using cannabis.

This reinforces one of the standard recommendations to parents, worried about whether their child may start to drink or take drugs, to ensure they know where their child is when they go out and who they are with.

Research generally supports the idea that ‘parental monitoring’ is important, but does it offer any further help to parents?

This paper looks at four different ways of thinking about ‘parental monitoring’ which may affect the amount of knowledge parents have about their son or daughter’s activities, friends, feelings or opinions:

  •  parental monitoring behaviour;
  •  parental psychological control
  • parent-adolescent relationship quality; and
  • parent-adolescent communication.

The authors point out that although monitoring is generally a positive, protective action, some related behaviours can be negative, for example, ‘parental psychological control’ describes behaviour which is intrusive, manipulative, and disrespectful.

‘Parent-adolescent relationship quality’ describes the extent to which the relationship is loving responsive, and involved. Researchers most often define relationship quality as adolescents’ perceptions of their parents as involved, accepting, and emotionally and physically available. One of the criticisms is that studies have not focused enough on parents’ own perspectives.

Other theories of relationships may help us understand parental monitoring and their children’s reactions. For example, Strachman and Gable (2006) describe two types of commitment: approach and avoidance. Approach commitment has as its goal the desire to maintain the relationship and see it grow. Avoidance commitment has as its goal the desire to prevent relationship damage. Young people may be torn between a desire to build the relationship with their parents by sharing information (approach) and the fear that information disclosed could damage the relationship (avoidance).

’Parent-adolescent communication’ relates closely to the other ideas: it is part of parental monitoring behaviour (communicating expectations, asking questions); it can be psychologically intrusive or controlling; and it can both reflect and influence relationship quality.

Asking isn’t enough

Research by Stattin and Kerr (2000) found that what parents knew about their children’s movements was dependent almost exclusively on how much their kids chose to share with them, rather than how much the parents asked or the boundaries they set.

In contrast, Soenens et al. (2006) found that parents’ behaviour (e.g. asking) did have a direct impact on what they knew, however it also worked indirectly, affecting the amount of information that young people chose to disclose to their parents. Where parents acquired more knowledge about their children’s whereabouts and activities, this was associated with a lower probability of adolescent problem outcomes.

Other research, not directly on parental monitoring, but on patterns of communication, may be relevant. For example, one particularly damaging pattern of marital conflict is demand/withdraw, which involves one person nagging or criticizing while the other person avoids the topic. Research on parent-adolescent communication found that this pattern of conflict (on any subject, not just alcohol or drugs) was associated with low self-esteem and high alcohol and drug use for both adolescents and parents (Caughlin and Malis, 2004).