Monday, December 24, 2012

D.A.R.E. To Take A New Direction – Alan Breaud

Drug abuse in the United States continues to be an issue that is being inappropriately addressed.  According to the National Institute on Drug Abuse, the most recent statistics show that close to 22.6 million Americans abused a psychotherapeutic medication or used an illicit drug in 2010 (1).  It is also pointed out, unfortunately, that this drug usage typically begins when people are in their teenage years (under 18 years old) and hits its peak in their late teen years or early twenties (1).  Given that the most prevalent use of these drugs is highest among this particular age group, it would seem logical to develop effective drug resistance programs that target pre-teens.
            One method of addressing this issue has become popular over the past few decades in the form of the D.A.R.E. program.  This program seeks to educate kids on the harmful effects of illegal drugs, tobacco, and abuse of prescription drugs and alcohol.  D.A.R.E., or Drug Abuse Resistance Education, began in 1983 as a result of a collaborative effort between the Los Angeles Unified School District and the Los Angeles Police Department (2).  It is a program that is highly endorsed by law enforcement nationwide, in addition to the U.S. Department of Justice, the Department of Defense and the Department of State (3)(4).  However, the program comes with a heavy cost.  Ten years after its inception in 1983, it was reported that the cost of the program, as a whole, across the country was around $750 million by 1993 (2).  
D.A.R.E. is a school-based education system with a curriculum taught almost entirely by police officers   Their mission, according to the official website, “is to provide children with the information and skills they need to live drug-and-violence free lives” (3).  They delve a little more into this by explaining how important it is to “equip kids with the tools that will enable them to avoid negative influence” and instead focus on their individual talents and gifts (3)
            While this seems to be excellent intervention geared toward keeping kids off of drugs, research in the field of health communication tends to point to a different conclusion.  Many researchers have found that the D.A.R.E. program is hardly effective at all, despite the overwhelming support it receives from law enforcement nationwide (2).  Results looking at the short-term effects of the program show that the D.A.R.E program had no effect on illegal drug use, alcohol abuse, or even selling and dealing drugs (2).  Long-term studies echo these same results.  A longitudinal study of the program’s effectiveness reported limited success of the program and determined that the curriculum’s effects decay significantly over time (6) .  In the American Journal of Public Health, Drs. Steven West and Keri O’Neal of the Virginia Commonwealth University state very blatantly that “Project D.A.R.E. is ineffective” (7).    
            Because drug abuse is climbing among teenagers and young adults alike, the D.A.R.E. program needs to be completely revamped in order to provide an effective and lasting message that reaches its estimated 300,000 classrooms (3), possibly even by removing the classroom element altogether.  In its current format, the program is almost like an intellectual exercise.  The D.A.R.E. officers are instructed to provide a strict curriculum that includes in-class exercises and homework (4).
The purpose of this paper is to look at several problems in the design of the D.A.R.E. program that are undermining its effectiveness.  First, the framing used by D.A.R.E. will be analyzed, followed by the issues of contributing to misperceptions of social norms and creating psychological reactance that can potentially be causing prevention efforts to backfire.  Then, the paper will look at a new intervention effort and how it will address these problems in order to have a much more effective campaign.

Critique #1 - Improper Framing of the Issue
            One key issue that plagues the D.A.R.E. program is its improper framing of the issues the campaign is trying to address.  Framing refers to the way in which a message is “packaged” (5).  It is more than just a way of arguing a point.  It employs images, symbols, catch phrases, and a strong core position that complements the key core value the communicator is wishing to get across (5).  The key goal of framing, from a health perspective, is to provide a message that encourages one type of behavior over another (8).  In a health context, messages are typically framed to present gains or losses (8).  However, gain frames have been seen to be much more effective in preventative behavior (8)
            The problem with the D.A.R.E. campaign is that it appeals to the core value of health and make use of loss frames.  They simply relate the risk factors associated with different products and trust that kids and adolescents are going to make the right choice, given that information.  This same idea, for example, is used to try and get people to stop drinking soda.  Everyone knows from his or her doctor or the news that sodas are bad for you because they contain too much sugar and provide empty calories.  However, soda remains widely available because people still like to drink it.  Vending machines are ubiquitous, and soda can be purchased at practically any restaurant and convenience store.  Appealing to the core value of health is just not enough to prevent people from drinking soda.     
The messages coming from D.A.R.E. are always ones of how dangerous various illicit substances are for one’s body.  For example, on the drug information section of their website, all the drug information comes with a “dangers and effects” section that relate the negative consequences of use (3).  While this information is important, it is simply presenting the negatives associated with use, while giving no information on the benefits of non-use.  As Jeffery Hicks points out, youth already know the dangers associated with drugs, alcohol, tobacco, etc. (9).  They want to be left to their own faculties to make a decision for themselves. 
Positive frames, or information presented in a positive light, have a more substantial impact on preventive health behavior (10) compared to negative frames.  For example, a message of self-esteem that was packaged in a positive way has been shown to increase intentions to exercise more often.  When information is given in a positive manner, this gives individuals a more risk averse option and gain-oriented choice (11).  Therefore, while the D.A.R.E. campaign is interested in preventative behavior, they are using the incorrect tone of frames to achieve that goal.    

Critique #2 - Kids Will Try What Their Friends Are Trying
            One of the key problems at the heart of the D.A.R.E. program is that it is conveying a message that illegal drug usage is highly prevalent throughout the school system.  The instruction in the curriculum informs students what to say when offered drugs from their peers and how to avoid negative peer pressure.  Consequently, this turns the issue into a scenario of not if children will be offered illegal drugs, but when it will happen.  This type of language leads to the idea that drugs are much more common than they may actually be.  In fact, several papers have looked at how teenagers and young adults are significantly overestimating the amount of substance abuse that their peers are engaging in.  One study out of Addictive Behaviors journal looked at how college students often overestimate their peers’ drinking habits by as much as 76% (12), a trend that was also seen in middle school and high school students (13).  These inaccurate perceptions can also be extended to tobacco and illicit drug use.  Researchers found that on 100 college campuses, perceived drug and tobacco use was highly exaggerated compared to actual self-reported use (14).  
Unfortunately, since D.A.R.E. is continuously relating a message that drugs are a highly prevalent problem within the school system and social setting, their curriculum may be inadvertently creating a problem that causes more drug use rather than preventing it.  Research out of the School of Public Health at the University of Michigan found that peer usage of alcohol and drugs is positively associated with individual usage of these substances (12).  Studies looking into social norms have shown repeatedly that even perceived prevalence of substance use is an excellent predictor of an individual’s likelihood of experimenting or using that same substance (16) (17).  Likewise, researchers out of the University of Washington, Seattle found that perceptions of friends’ use and descriptive norms regarding marijuana were “most strongly associated with marijuana use” (18).  Therefore, direct exposure is not needed to have a substantial influence.    
            So, beyond seeing friends or peers using marijuana or alcohol, even the perception that a large number of members in a school or social network are using illicit substances can lead to individual usage. Unfortunately, as previously seen, overestimation of drug and substance use is quite substantial.  Therefore, if kids have a skewed idea of the actual amount of drug use their peers are engaging in, then statistically they are going to be more likely to try these substances.  A look into the D.A.R.E. resources and curriculum shows that this skewed idea is exactly what is being relayed to kids and their parents.  According to the D.A.R.E. program’s own website, among other messages, they say “fifty percent of young people have used an illegal drug by the time they leave high school” and there are “over 50 factors that might put someone at risk for drug use” (19).  In terms of alcohol, they claim that 90% of kids graduating from high school have experimented with alcohol (19).  If these kids that are exposed to the D.A.R.E. program are seeing these statistics, they are receiving the message that the prevalence of drug and alcohol use is incredibly high, causing these substances to be perceived as a social norm.  And, as stated earlier, social norms are one of the best predictors of drug and alcohol consumption.   

Critique #3 – There is Possible Reaction to Threats to Freedom
            The D.A.R.E. program curriculum teaches kids skills to avoid the peer pressure of using drugs, alcohol, and even the dangers of involvement in gangs.  According to Jack Brehm, continuously telling an individual not to engage in a particular behavior only encourages that individual to attach a greater importance to that given behavior (20).  When a free behavior, such as the ability to use drugs or smoke tobacco, is taken away or threatened, especially in a situation where an outsider eliminates the choice instead of the individual, then that behavior instead becomes more desirable (20).  The elimination of a perceived freedom creates a state of “psychological reactance,” a psychological state where an individual seeks to re-establish the eliminated freedom (20).  A police officer standing in front of a classroom full of children or young adults who is reiterating the idea over and over again not to engage in marijuana or alcohol use may actually be giving that behavior a greater value in his or her audiences’ minds.  Taking away the freedom to make that choice to engage in the behavior of using a drug or drinking alcohol, for example, can contribute to an individual wanting to, as Dr. Brehms’ theory contests, re-establish the ability to make that choice.    
Research in the Journal for Social Psychology indicates that this psychological reactance tends to be greater in younger subjects compared to older ones (21).  The authors of this theory even noticed this phenomenon in children as young as two years old (22).  The rationale is that the younger population tends to view more situations and behaviors as freedom-threatening (21).  Additionally, these young people also tend to question more, including adult authority (23).  This is problematic for the D.A.R.E. campaign, given that it is taught in a classroom atmosphere by a police officer in uniform to young children.  These officers are trained to teach children how to completely avoid drugs and alcohol.  Additionally, as part of the program, D.A.R.E. highly encourages parents to get involved by setting “no-use” rules regarding alcohol and tobacco and set strict rules regarding their children’s social activities (19).  Unfortunately, research regarding reactance theory would indicate that emphasizing a message of not engaging in a particular behavior to a young audience could actually be counter-productive to the D.A.R.E. mission. 

New Intervention - The D.A.R.E. 75 program: A New Start Tackling One Issue          
In order to address the issues surrounding the effectiveness of the D.A.R.E. campaign, I would propose a new strategy that involves focusing not so much on the individual harms and direct consequences of drugs, alcohol, etc., but rather a design that includes individual as well as group-level factors that appeal to the emotional side of the individual and tries to create a social change rather than an individual one.  This type of approach should be modeled after the Florida “Truth” campaign, which has seen success in getting youth in that state to quit smoking (9).  “Truth” was an anti-tobacco marketing campaign that resulted from a tobacco industry settlement and began in 1998 (9).  The Truth campaign was successfully able to re-frame tobacco use as an issue of the tobacco industry putting limits on kids’ freedom and independence (9).  According to Jeffery Hicks, youth already knew the harmful effects of tobacco.  What youth wanted is to be left to make their own decision after being given the facts (9). 
These implications can be translated to D.A.R.E. in a new, re-vamped media campaign called the D.A.R.E. 75 campaign that re-frames the use of illicit substances as putting restrictions on freedom, as opposed to providing more freedom.  The “75” is a response to a National Survey on Drug Use and Health report that found 25% of kids aged 12 to 20 years old reported drinking alcohol in 2011 (24).  The 75 focuses on the 75% of kids not using alcohol, which can hopefully begin to create a social norm that alcohol prevalence is not what many may think it is.
            This new approach would tailor the D.A.R.E. campaign to look at the use of alcohol only, as opposed to taking up a cause against a variety of harmful substances or behaviors such as drugs, gang violence, tobacco or any other issues.  This would allow D.A.R.E. to focus all their energy on effectively reducing the number of youth who currently use or are thinking about using alcohol in the future.  Part of the Truth campaign success is their ability to focus all their energy simply on reducing tobacco use prevalence in youth (9).  Their interests were not spread out across an array of different causes.       
            Comparable to the Truth campaign, this new approach would be a mass advertising campaign that depicts the alcoholic beverage industry as one that thrives and makes enormous profits off of youth continuing to buy their product.  It would make use of TV slots, billboards, and social media.  This message is intended to relate the idea that alcohol beverage companies are in the business of increasing profit margins.  They thrive on the ability to make a profit off of their customers.  For example, a billboard could be used that shows money going from a young teenager’s pocket to the pockets of well-dressed executives sitting around a conference room with a big “Budweiser” or “Miller-Lite” plaque above their head, indicating they work at that respective company.   
            This approach can address all three issues previously laid out.  It changes the whole issue of alcohol use as not one about how alcohol has detrimental effects on the growing brain, or showing alcohol-related fatalities, but about how the alcohol-producing companies are strictly in the business of providing an alluring product that will undoubtedly bring in a large profit margin.  Thus, the main frame coming across to the youth audience has completely changed to one of empowerment of their individual freedom, while hopefully creating some psychological reactance against the alcohol companies instead of the communicator of the health message.

Defense of Intervention #1 - A Change in Frame
The new campaign would shift the core value of health that D.A.R.E. traditionally uses to the core value of freedom.  As previously seen, the frame is the way information is packaged to convey an underlining meaning of what the message is all about (5).  In the new approach, the core value is taking a dramatic shift from one of health to one of individual freedom (from the alcoholic beverage industry).  As Dr. Siegel points out, the tobacco industry has been really effective in creating a message to the public that has a frame that appeals to individual freedom, an intuitively American core value (5).  This new approach takes that core value over to the D.A.R.E. 75 campaign so they can craft their own message around it, as seen in the Truth campaign.  This new campaign can make use of images depicting rich executives and how they may see youth as just another customer, not a friend or someone they have any invested interest in beyond making money.  In addition, a series of catch phrases, such as “pocket to pocket” or “my good time is not worth giving them my dime,” can be used to support the frame of individual autonomy from the alcohol companies. 
            The key, then, is to provide an emotional appeal to youth so they will refuse to submit to peer pressure and so they will turn away from the harmful effects of alcohol at such a young age.  Kids know they are not supposed to use alcohol.  They have all the information about it, but again, they want to be left to their own faculties as to whether or not to make decisions based on that information (9). Here, the goal of the frame is to tap into youth’s desire to have control, a gain-frame that potentially can appeal more to them and be more effective (8).  Kids are constantly being told what to and what not to do and this is providing that ability to make their own choice, even if the message is making an attempt to sway that decision.            

Defense of Intervention #2 - It’s not as Popular As You Might Think
            The name of the new campaign would be entitled the D.A.R.E. 75 campaign.  Again, this is a play on the statistic that in 2011 it is estimated that 25% of adolescents were using alcohol (24).  As shown previously, social norms can play a significant role in predicting whether or not an individual will choose to adopt a behavior.  In fact, one study looking at college students found social norms to be the biggest predictor of alcohol use (16).  For some reason, young people have a very skewed idea of the actual drinking habits of their friends and peers (17).  Dr. H. Wesley Perkins of Hobart and William Smith Colleges points out how misperceptions can have a strong influence on an individual to drink heavily (12).  He goes on to explain how showing actual drinking rates and numbers are likely to lessen misperceptions help those abstaining from drinking or engaging in healthy drinking habits feel better about their decision (12). 
            Therefore, the key idea in the name is to turn around the misperception of actual drinking rates.  If social norms are a significant predictor of use, then this should be the first key issue to address in the new program.  Kids at a young age are always eager to fit in somewhere.  If the prevailing belief is that all the kids in school are experimenting with alcohol, then research has shown that this belief is very likely to encourage an individual who is contemplating using alcohol.  With this in mind, D.A.R.E. 75 seeks to relate the fact to youth that 75% of adolescents are not using alcohol.  This will hopefully, as Dr. Perkins points out, help those in that tricky youth decision whether to drink or not, feel more at ease in choosing the route of not to drink.

Defense of Intervention #3 - Providing Freedom to Make Their Own Decisions
Driving home the message of the dangers of an illicit substance and telling children not to do something counter-intuitively can create an allure of that substance through psychological reactance (9).  For example, telling a child not to watch a certain range of channels on a television can create an enormous amount of curiosity that can drive that child to see exactly what is on those channels that the adults do not want him or her to see.  This approach of explicitly telling kids exactly what they can and cannot do puts restriction on their freedom.  And as previously found, Hammock and Brehm show that reactance leads to an attempt to re-establish that eliminated freedom (20).  Therefore, a campaign that seeks to show the use of illicit substances putting limits on freedom, as opposed to providing more freedom, should greatly reduce the amount of reactance from the message. 
    According to Jefferey Hicks, what’s important in a message is the tone of what you are trying to get across.  Youth do not want to be preached to with a series of “do’s” and “do nots” (9).  As one could see, a police officer in uniform standing in front of a classroom or auditorium full of young people could easily give off that paternalistic and preaching tone.  Hicks found that youth were using tobacco as a tool of rebellion because they were continuously being told not to do it (9).  The Truth campaign was successfully able to use that tool of rebellion against the big tobacco industry.  The D.A.R.E. campaign needs to show a message that relates drugs, alcohol, or tobacco to be substances that limit their freedom in life.   
            In addition to creating a better tone for the overall messages related by D.A.R.E., Paul Silvia points out that similarity is a good tool to “deflect” reactance (25).  He found through a series of experiments that similarity can have multiple effects that increase effectiveness of the communication of a message, including reducing the negative force towards reactance and increasing positive force by increasing the likeability of the communicator (25).
            This all relates back to D.A.R.E.’s use of a police officer to provide information to young people.  Police officers are people who represent law and authority.  They have very little in common with a classroom full of kids.  Therefore, kids see this situation as an authority figure telling them what not to do.  The communicator needs to be youth providing information to youth.  These communicators also need to be people that youth can relate to and who are going through the same set of social situations and life decisions.  This can immediately provide a more similar communicator that can be more relatable to youth.  Using young people to provide the message of standing up against the alcohol companies has the potential to significantly deflect any reactance to the message.          

Conclusion - A New Step Forward
            The D.A.R.E. 75 campaign can be a significant improvement upon the existing D.A.R.E. model.  While the current program does an excellent job at providing information on a variety of different substances and behaviors, that is simply all it may be doing.  Because of programs such as D.A.R.E, young people are very aware of the dangers of drugs or alcohol, but have not given them the right push to act accordingly.  The D.A.R.E. 75 campaign addresses these issues that have been potential barriers to effectively communicating with the younger generation.  It is a definite improvement and step in the right direction for the D.A.R.E. program.    


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