Our children and youth are our most precious gifts in life. It’s our job as parents and educators to keep our children safe by teaching Alcohol and Substance Abuse Prevention. We have learned that our children and youth of the world are inquisitive, that many will experiment with alcohol and drugs, and that they are not necessarily naive. Drug education in the past hasn’t worked for many people and it’s time to take a different approach.

Safety First is a realistic approach to Drug Education which entails knowledge, communication, listening on our part, honesty on their part as well as ours, and safety where drugs and alcohol are concerned. Telling our children and youth that drugs are ‘bad’ and ‘just never do them’ doesn’t work. It’s time to be ‘real’ with them and allow them to be ‘real’ with us.


I first thought about drug education over twenty years ago, while working on my Ph.D. dissertation about heroin addiction. One of my first interviews was with a “nice Jewish girl,” like myself, from an affluent suburb in a large metropolitan area. Genuinely intrigued by the different turns our lives had taken, I asked how she had ended up addicted to heroin and in jail. I will never forget what she told me:

“When I was in high school they had these so-called drug education classes. They told us if we used marijuana we would become addicted. They told us if we used heroin we would become addicted. Well, we all tried marijuana and found we did not become addicted. We figured the entire message must be b.s. So I tried heroin, used it again and again, got strung out, and here I am.”

For the next decade I dismissed drug education until my own daughter entered adolescence. Then I panicked. Like most parents, I wished “the drug thing” would magically disappear and my children would simply abstain from using all intoxicating substances. But as a drug abuse expert whose research was funded by the National Institute on Drug Abuse, as a resident of a large U.S. city, and as a parent in the 90s, I knew this wish to be a fantasy. A wide range of substances are cheap, potent, and readily available to adults and teenagers alike, with 90% of high school seniors reporting that marijuana is easy to obtain. Indeed, despite expenditures of more than $2.1 billion on “prevention” this year, government surveys indicate that many teenagers experiment with drugs.

The number of users has gone up and down since the government began collecting data in the mid-1970s, but persists. According to the most recent National Institute on Drug Abuse Household Survey, 21% of teenagers (aged 12-17) have experimented with an illegal substance at some point in their lives; 16% used within the year prior to the survey; and nearly 10% had used at least once a month.3 Drug use becomes more prevalent as teens get older. According to another government-sponsored study, the Monitoring the Future Survey, in 1998, 54% of high school seniors had experimented with drugs at some point in their lifetime; 41% had used an illegal drug during the past year; and one quarter had used drugs in the past month.

Most youthful drug use is experimental, and fortunately the vast majority get through adolescence unscathed. Still, I worry about those teenagers whose experimentation gets out of hand, who fall into abusive patterns with drugs and put themselves in harm’s way. Hasn’t this cohort of adolescents been exposed, since elementary school, to the most intensive and expensive anti-drug campaign in history? Haven’t they been told, again and again, in school-based programs such as Drug Abuse Resistance Education (D.A.R.E.), to “Just Say No”? Why aren’t they listening? What, if anything, can we do about it? How might we, as parents and teachers, be educating our teenagers more effectively? Is there anything we can be doing to further ensure their safety?

As a parent, I urgently wanted to know the answer to these questions, so I looked at drug education, its history, curricula, and evaluations. I talked with drug educators and parents, one-on-one and in groups. I gave lectures and solicited feedback. I visited schools. Best of all, I talked with teenagers, lots of them. The reader should know that I did not set out to criticize particular programs. On the contrary, I wanted to understand what might be missing from their content, and how we might accomplish the prevention of drug problems more productively. I wrote this pamphlet with other parents in mind, as well as teachers and school administrators. I know that they, like me, are interested first and foremost in the safety of our children.

An Overview of Drug Education in the United States

  Although often championed as a new form of weaponry in the War on Drugs, drug education in the United States was first conceived over a century ago by the Women’s Christian Temperance Union (WCTU), a leading organization of the anti-alcohol crusade. Early programs claimed to be based on scientific research. Standard textbooks, however, were filled with misinformation: alcohol would cause permanent damage to the liver, lungs, kidneys, heart and brain; and marijuana could drive users insane and cause homicidal rages. All drugs were portrayed as equally dangerous and addicting. Only total abstinence could save an individual from inevitable destruction.

Post-World War II drug education portrayed alcohol in a way more consistent with the beliefs and practices of most Americans, making distinctions between use and abuse, and characterizing the majority of users as moderate. Marijuana, however, continued to be described as causing crime and insanity, leaving its users exceedingly vulnerable to heroin addiction. The purpose of these programs was to frighten young people out of using illegal drugs, utilizing scare tactics reminiscent of the movie, Reefer Madness, a 1936 propaganda film now universally regarded as factually incorrect.

By the late 1960s and early 1970s, it was clear that exaggerations of danger had failed to prevent a generation of young people (the Baby Boomers) from experimenting with marijuana and other drugs. In response, there was an effort by some educators to take a different tack. Whereas abstinence continued to be promoted as the wisest choice, the idea was to give students all available information about drugs so they might use their education to make responsible decisions.

In the early 1980s, America’s new First Lady instituted “Just Say No” as official policy, with the simple goal of prevention of drug use.10 Anti-drug budgets climbed and “abstinence-only” school-based programs proliferated, with federal funding requiring a firm “zero-tolerance” stance.11 Materials construed as neutral were prohibited.12 These new programs were considered sophisticated because they utilized psycho-social innovations. Students were given information about the dangers of drugs as well as techniques for countering “peer pressure.” Mrs. Reagan instructed inner city children on how to say “no” to drugs, while “feel good” drug education programs gave them a heavy dose of self-esteem and self-control exercises to fill the alleged void that rendered them “at risk” to the lure of mind-altering drugs.13

Today’s drug education is extremely variable in content as well as quality and price. Classes are sometimes offered as early as kindergarten, and in later grades drug education is often taught in courses such as “family life,” or “health education.” First, a particular program is adopted by a school and then the school’s own teachers or outside “experts” teach the program’s curriculum. Some offer video presentations; others stickers, posters, and activity books. Some are designed to stand alone; others to be integrated into health or science curricula. Some hand out T-shirts and certificates when students complete the program; others have graduation ceremonies at which students are encouraged to take a pledge to remain drug-free. All programs provide information about the negative consequences of drug use and teach resistance/refusal skills. The majority teach students that most people do not use drugs, that abstinence is the societal norm, and that it is acceptable not to use drugs.

Does Drug Education “Work”?

  Increased governmental funding for “prevention” in the 1980s resulted in a plethora of “approved” drug-education programs, but it is very difficult to know which, if any, drug education programs really “work.” We do know that despite prevention education a majority of students experiment with drugs by the time they reach their senior year of high school. Somewhere there is a “disconnect.”

Of 49 programs reviewed in Making the Grade: A Guide to School Drug Prevention Programs only 10 had been subjected to rigorous evaluations. Of these, a handful of programs developed in university settings have shown favorable results in delaying or reducing some drug use. Yet they tend to be rather expensive, hence less available than those programs which are cheaper to administer, aggressively marketed, and of questionable value.

Some researchers question our ability to determine the effectiveness of drug education programs, because the evaluations themselves are too simplistic. They tend to measure student attitudes about drugs rather than drug use itself. Unfortunately, attitudes formed about drugs during childhood or early adolescence seem to have little bearing on later decisions, and high school students may rhetorically state reasons for avoiding drugs, yet use them anyway. Furthermore, such evaluations tend to report positive findings, while ignoring or even covering up those that show no effectiveness. In a comprehensive evaluation of several of the most popular programs, D. M. Gorman of Rutgers University’s Center of Alcohol Studies argues:

“The evidence presented. . .from both national surveys and program evaluations, shows that we have yet to develop successful techniques of school-based drug prevention. The claims made on behalf of this aspect of the nation’s drug control policy are largely unsupported by empirical data. Evidence is cited selectively to support the use of certain programs, and there is virtually no systematic testing of interventions developed in line with competing theoretical models of adolescent drug use.”

Education researcher Joel Brown and his colleagues conclude that flaws in the way programs are evaluated lead us to believe that drug education is effective although in reality it is an enormous taxpayer drain with precious few positive effects.

Perhaps no program has been evaluated more than D.A.R.E., which has been tested for its impact on drug use, both immediately after the program’s completion and several years later. A study tracking D.A.R.E. students over five years found that the program had “no long-term effects. . .in preventing or reducing adolescent drug use.” Another study, funded by the National Institute of Justice, found that “expectations concerning the effectiveness of any school-based curriculum, including D.A.R.E., in changing adolescent drug use behavior should not be overstated.” Based on a ten-year follow-up study conducted when D.A.R.E. graduates were twenty years old, a team of researchers led by Donald Lynam at the University of Kentucky concluded that D.A.R.E. created no lasting changes in the outcomes evaluated, including not only legal and illegal drug use, but self-esteem and peer pressure resistance. Other long-term studies have found little or no difference in drug use between D.A.R.E. graduates and non-graduates.

What do students themselves say? A common complaint about the D.A.R.E. program, according to researchers Wysong, Aniskiewicz and Wright, was from students who did not believe their opinions were taken into account:

“It’s like nobody cares what we think. . .The D.A.R.E. cops just wanted us to do what they told us and our teachers never talked about D.A.R.E. . . . It seems like a lot of adults and teachers can’t bring themselves down to talk to students. . . so you don’t care what they think either.”

As part of a large evaluation study of drug education in California conducted by Dr. Brown and his colleagues, students were asked to tell “in their own voices” how much their drug use had been influenced by the drug education they had received. Only 15% felt drug education had a “large effect” on their choice of whether to use drugs, and 45% said they were “not affected at all.” In conversations with students, Brown also obtained their views on the entire drug education experience. Many felt it was insulting to teach so-called “decision-making skills” when it seemed obvious that the only acceptable decision was to decline to use drugs. Brown believes this basic hypocrisy undermines drug education: “When young people recognize that they are being taught to follow directions, rather than to make decisions, they feel betrayed and resentful. As long as federal mandates force this charade, drug education programs and policies will continue to fail.”

Fundamental Problems with Drug Education

  The foundations of conventional school-based drug education are fundamentally flawed. Many programs are based on the conviction that any use of illegal drugs is inherently pathological, dangerous behavior, an indication that something is wrong. Some psychologists define drug use as deviant, aberrant behavior caused by a personality problem. Other explanations suggest a “proneness” on the part of some teenagers to problem behavior such as unconventionality (e.g., sagging pants and exposed bra straps) and willingness to take risks (e.g., driving too fast). Sociological explanations link youthful drug use to weak ties to family, religion and school, to “peer pressure,” and to membership in drug-using groups.

Alternative explanations, not based on the idea that experimentation with drugs is pathological, acknowledge the importance of culture. The American people and their children are perpetually bombarded with messages that encourage them to imbibe and medicate with a variety of substances. We routinely alter our states of consciousness through conventional means such as alcohol, tobacco, caffeine, and prescription drugs. Fifty-one percent of Americans use alcohol regularly, and nearly 1/3 have tried marijuana at some time in their lives. Even in the context of school, today’s teenagers have witnessed the Ritalinization of difficult-to-manage students. In today’s society, teenage drug use seems to mirror American proclivities. In this context, some psychologists argue, experimentation with mind-altering substances, legal or illegal, might instead be defined as normal, given the nature of our culture.

Another flaw in drug education is its assumption that drug use is the same as drug abuse. Some programs use the terms interchangeably; others utilize an exaggerated definition of use that in effect defines anything other than one-time experimentation and any use of illegal drugs as abuse. But teenagers know the difference. Most have observed their parents and other adults who use alcohol, itself a drug, without abusing it. Virtually all studies have found that the vast majority of students who try drugs do not become abusers. Programs that blur the distinctions between use and abuse are ineffective because students’ own experiences tell them the information presented to them is not believable.

The “gateway” theory, a mainstay in drug education, argues that the use of marijuana leads to the use of “harder” drugs such as cocaine and heroin. There is no evidence, however, that the use of one drug causes the use of another. For example, several researchers, as well as the federal government, have found that the vast majority of marijuana smokers do not progress to the use of more dangerous drugs. Based on the National Institute on Drug Abuse Household Survey, Professor Lynn Zimmer and Dr. John P. Morgan calculated that for every 100 people who have tried marijuana, only one is a current user of cocaine. Teenagers know from their own experience and observation that marijuana use does not inevitably, or even usually, lead to the use of harder drugs. In fact, the majority of teens who try marijuana do not even use marijuana itself on a regular basis. Therefore, when such information is given, students discount both the message and the messenger.

A common belief among many educators, policy makers, and parents is that if teenagers simply understood the dangers of drug experimentation they would abstain. In an effort to encourage abstinence, “risk” and “danger” messages are grossly exaggerated, and sometimes even completely false. Although the Reefer Madness messages have been replaced by assertions that we now have “scientific evidence” of the dangers of drugs, when studies are critically evaluated, few of the most common assertions (especially about marijuana) hold up.

Marijuana, the drug second only to alcohol in popularity among teens, has been routinely demonized in drug education today. Many “drug education” websites, including that of the Office of National Drug Control Policy, “Project Know,” include misinformation about marijuana’s potency, its relationship to cancer, memory, the immune system, personality alteration, addiction and sexual dysfunction. In their 1997 book, Marijuana Myths, Marijuana Facts: A Review of the Scientific Evidence, Professors Zimmer and Morgan examined the scientific evidence relevant to each of these alleged dangers. They found, in essentially every case, that the claims of marijuana’s dangerousness did not hold up. Over the years, the same conclusions have been reached by numerous official commissions, including the La Guardia Commission in 1944, the National Commission on Marijuana and Drug Abuse in 1972, the National Academy of Sciences in 1982, and, in 1999, the Institute of Medicine.

The consistent mischaracterization of marijuana may be the Achilles Heel of conventional approaches to drug education because these false messages are inconsistent with students’ actual observations and experience. As a result, teenagers lose confidence in what we, as parents and teachers, tell them. They are thus less likely to turn to us as credible sources of information. As one 17-year-old girl, an 11th-grader in Fort Worth, Texas, put it, “They told my little sister that you’d get addicted to marijuana the first time, and it’s not like that. You hear that, and then you do it, and you say, ‘Ah, they lied to me’.”

Ultimately the problem with delivering unbelievable messages, particularly about marijuana, is that students define the entire drug education exercise as a joke. But their dismissal of warnings should not be taken lightly. A frightening ramification of imparting misinformation to them is that teenagers, like the heroin addict I interviewed over two decades ago, will ignore our warnings completely and put themselves in real danger. She did not find the negative claims about marijuana credible, discounted the entire message, and tried heroin. Today’s increased purity and availability of “hard drugs,” coupled with teenagers’ refusal to heed warnings they don’t trust, have resulted in increased risk of fatal overdose such as those we’ve witnessed among the children of celebrities and in affluent communities like Plano, Texas.

Another problem with government-funded drug education programs is that they are mandated simply to prevent drug use. After admonitions and instructions to abstain, the lessons end. There is no information on how to reduce risks, avoid problems, or prevent abuse. Abstinence is seen as the sole measure of success and the only acceptable teaching option.

While the abstinence-only mandate is well-meaning, it is misguided. According to the government’s own General Accounting Office, the expectation that teenagers, at a time in their lives when they are most amenable to risk-taking, will be inoculated from experimentation with consciousness alteration, is unrealistic at best. In fact, more than half of all American teenagers have tried marijuana by the time they graduate from high school, and four out of five have used alcohol. The insistence on complete abstinence has meant the inevitable failure of programs that make this their primary goal.

The abstinence-only mandate leaves teachers and parents with nothing to say to the 50% of students who say “maybe” or “sometimes” or “yes,” the very teens we most need to reach. As seasoned drug education researchers Gilbert Botvin and Ken Resnicow note:

“As mandated by federal guidelines, most current substance-use prevention programs emphasize “zero tolerance” and abstinence. Although controversial, programs that include messages of responsible use, however, may be more credible, and ultimately, more effective. . . The primary goal of substance abuse prevention programs should, it could be argued, be the reduction of heavy use and abuse rather than limiting experimentation among individuals unlikely to become frequent users.”

Increasing numbers of educators are becoming frustrated by the abstinence-only mandate of federally funded drug education. While attending a local summit on teens and drugs, a county-funded drug educator pulled me aside and whispered that he would like to give his students (whom he knew smoked marijuana) information that might help them minimize its dangers (e.g., not to smoke and drive). But for him to admit that they might use it at all would violate the abstinence-only school policy dictated by federal funding regulations. He believed his hands were tied, and he could not really educate his students at all. This man was only one of dozens who have expressed such frustrations to me.

Safety First: A Reality-Based Alternative

  A safety-first strategy for drug education requires reality-based assumptions about drug use and drug education. Whether we like it or not, many teenagers will experiment with drugs. Some will use drugs more regularly. At the same time we stress abstinence, we should also provide a fallback strategy for risk reduction, providing students with information and resources so they do the least possible harm to themselves and those around them.

We must approach alcohol and other drugs as we approach other potentially dangerous substances and activities. For instance, instead of banning automobiles, which kill far more teenagers than drugs do, we enforce traffic laws, prohibit driving while intoxicated, and insist that drivers wear seat belts. Reality-based alcohol education provides a model, with Students Against Drunk Driving (SADD), “Alive at 25,” as well as many “designated driver” programs adopting a risk-reduction approach. Such “responsible use” messages are being introduced in alcohol education as an alternative to zero-tolerance.

The first assumption of safety-first drug education is that teenagers can make responsible decisions if given honest, science-based drug education. Few young people are interested in destroying their lives or their health. Many already know the pitfalls, having experimented with drugs before, during, and after receiving drug education, and/or having seen its consequences in their own families and communities.

The majority of teenagers do make wise decisions about drug use. According to the 1998 Household Survey, 90% of 12-17-year-olds refrained from regular use. In fact, studies conducted to discover the reasons why students quit using marijuana found they were motivated by health reasons and negative drug effects, which they themselves experienced. Thus, any form of drug education should respect and build upon teenagers’ abilities to reason and to learn from their own experiences.

A second assumption of a safety-first drug education program is that total abstinence may not be a realistic alternative for all teenagers. Drugs have always been, and are likely to remain, a part of American culture. To proclaim a “drug-free America by the year 2008” or some other arbitrary date is pure wishful thinking. Teenagers know this, and most parents and teachers know that they know it. Instead, a realistic perspective emphasizes safety and a reduction in drug problems rather than abstinence as the key measure of success of any program.

A third assumption of safety-first drug education is that the use of mind-altering substances does not necessarily constitute drug abuse. The majority of drug use (with the possible exception of nicotine, which is the most addictive of all substances) does not lead to addiction or abuse. Instead, 80-90 percent of users control their use of psychoactive substances.50 According to Professor Erich Goode, author of the best- selling text, Drugs in American Society: “The truth is, as measured by harm to the user, most illicit drug users, like most drinkers of alcohol, use their drug or drugs of choice wisely, non-abusively, in moderation; with most, use does not escalate to abuse or compulsive use.”

Students who, despite our strong admonitions to abstain, use marijuana, need to understand that there is a huge difference between use and abuse, between occasional and daily use. If they persist, students need to know that they can and must control their use by using moderation and limiting use. It is never appropriate to use marijuana at school, at work, while participating in sports, or while driving. As the late Harvard psychiatrist Dr. Norman Zinberg stressed, users must recognize the complex interaction between the drug they are ingesting, their own mind-set, and the setting in which they use substances, which combine to form the context of drug use.52 As with sexual activity and alcohol use, teenagers need to understand the importance of context in order to make wise decisions, control their use, and stay safe and healthy.

Some “How To’s” of Safety-First Drug Education

  Communication is key in safety-first drug education. We must keep the channels of communication open, find ways to keep the conversation going, and listen, listen, listen. If we become indignant and punitive, teenagers will stop talking to us. It’s that simple.

Safety-first drug education should be age-specific, and begin in middle-school, when teens are actually confronted with drugs. Courses should run continuously through high school, when most experimentation occurs, utilizing both student engagement and participation (which conventional drug education acknowledges as crucial) and reality- and science-based educational materials.

Almost any discussion of drugs captures the attention of students. Teenagers often know more than we (want to) think about drugs through experience, family, and the media. We must include them, incorporating their observations and experience in any drug education curriculum if we want it to be credible.53, 54 There must be no negative repercussions for their input and honesty.

Safety-first drug education affords us the opportunity to engage students in the broad study of how drugs affect the body and mind. Quality drug education may provide an introduction to physiology, including the psychopharmacology of drugs (how they work), as well as their health and psychological risks (and benefits). An exceptional text is Dr. Andrew Weil and Winifred Rosen’s From Chocolate to Morphine: Everything You Need to Know About Mind-Altering Drugs,55 which describes nearly every drug available to teenagers in a comprehensive but objective way. Finally, students should learn about the social context of drugs in America. Drug education courses provide an opportunity to teach history, sociology, anthropology, and political science.

Students must also understand the legal consequences of drug use in America. Because teens are underage, all drugs are illegal for them. With increasing methods of detection such as school drug testing and escalating “zero tolerance” efforts, drug education must acknowledge illegality as a risk factor in and of itself, extending well beyond the physical effects of drug use. There are real, lasting consequences of using drugs and being caught, including expulsion from school, denial of college loans, a criminal record, and lasting stigma.

On a positive note, a comprehensive, reality-based drug education curriculum may have the “side effect” of turning otherwise apathetic teenagers into students, as happened in my own family. My sister, who lives in a white middle-class suburb, phoned to tell me she had found a copy of Marijuana Myths, Marijuana Facts: A Review of the Scientific Evidence56 in her 17-year-old son’s room. “Are you surprised that he might have used marijuana?” I asked. “No,” she replied, “I’m surprised that he was reading!”

The goals of realistic drug education, as noted, focus on safety. With such an education, students will more deeply understand the concrete risks inherent in the use of drugs. But if we are to capture and retain students’ confidence, we must separate the real from the imagined dangers of substance use. Just as drugs can be dangerous, they can also provide users with psychological and medical benefits, which explains why use has persisted around the world since civilization began. Reality-based drug education will equip students with information they trust, the basis for making responsible decisions.

As the demand for reality-based drug education grows, programs are being developed in the United States and abroad. A listing of such programs can be found at the Lindesmith Center Website.

Summary

  Drug education has existed in America for over a century. It has utilized a variety of methods, from scare tactics to resistance techniques, in the effort to prevent young people from using drugs. Nonetheless, teenagers continue to experiment with a variety of substances. Despite the expansion of drug prevention programs, it is very difficult to know which, if any, “work” better than others. The assumptions that shape conventional programs render them problematic: that drug experimentation constitutes deviance; that drug use is the same as drug abuse; that marijuana constitutes the “gateway” to “harder” substances; that exaggeration of risks will deter experimentation.

The main reasons many students fail to take programs seriously, and continue to experiment with drugs, is that they have learned for themselves that America is hardly “drug-free”; there are vast differences between experimentation, abuse, and addiction; and the use of one drug does not inevitably lead to the use of others.
While youth abstinence is what we’d all prefer, this unrealistic goal means programs lack risk-reduction education for those 50% who do not “just say no.” We need a fallback strategy of safety first in order to prevent drug abuse and drug problems among teenagers.

Educational efforts should acknowledge teens’ ability to make reasoned decisions. Programs should differentiate between use and abuse, and stress the importance of moderation and context. Curricula should be age-specific, stress student participation and provide science-based, objective educational materials. In simple terms, it is our responsibility as parents and teachers to engage students and provide them with credible information so they can make responsible decisions, avoid drug abuse, and stay safe.

Postscript

  As the mother of a teenager, reality-based, safety-first drug education is not only academic, it is personal for me. Recently, two colleagues and I met with the editorial board of the San Francisco Chronicle. After a number of drug policy issues were discussed, one of the editors (whose son happened to play sports with mine) turned to me and asked, “What about the kids? What do you tell your own children about drugs?” I articulated my perspective, and he requested that I (as an expert on drug abuse, as well as a parent) express my ideas about drugs in an open letter to my teenage son, which was published on Labor Day, 1998

A Mother’s Advice About Drugs