Drug Abuse Resistance Education (D.A.R.E.): An evaluation of program efficacy based on social science theory and available alternatives--Ashley Thomas
Introduction: The Drug Abuse Resistance Education (D.A.R.E.) Program
I remember when
he first came into our classroom. He was very tall, neatly dressed, and very
austere (I didn’t know that word at the time, but it perfectly encapsulates his
demeanor). Then again, as a fifth-grader, everyone is very tall, anyone in
uniform always appears neatly dressed, and all adults are austere. He quietly
sat in the back of the room until our teacher, Mrs. English, introduced him.
Despite how vivid all of his physical characteristics and mannerisms still are,
I cannot remember his name, so for our purposes, we’ll refer to him as Officer
Joe. Officer Joe was a trained officer of the Drug Abuse Resistance Education
(D.A.R.E.) in-school program, and our classroom was his “beat” for the next few
weeks.
Developed in
1983, D.A.R.E. is an in-school curriculum that addresses pressures placed on
youth regarding drug use and violence (1). It has since expanded from
its original home of Los Angeles to around 80% of United States school
districts and 43 countries worldwide (1). Intrinsic to the program,
making it unique among other in-school drug resistance education programs, is
the incorporation of local law-enforcement personnel (2). Over a series of 16 weekly
lessons, the officer charged with educating the students introduces facts about
drug use (both underage and otherwise) and violence, while giving the students
tools and strategies to employ later on should they be confronted with a,
“…high-risk, low-gain choice…” (3)(4). At the program’s
culmination, lesson 17, participating students will reflect upon what they have
learned and what they hope to carry with them going forward.
The D.A.R.E.
program was borne out of Nancy Reagan’s directive to children to, “Just say
no!” to drugs and alcohol (5). Despite its current
ubiquity, the D.A.R.E. program has been the target of many analyses and
criticisms decrying its efficacy. In some cases, it achieves no measurable
effect, certainly not enough to warrant the resources necessary for its
implementation. While the program has, admirably, evolved significantly in
response to these evidence based evaluations, understanding past failed
strategies will be integral to creating new, more effective curricula.
In context, as of
2010 (most recently available data), drug and alcohol usage rates among teens
and young adults climbed compared to past years. Among youth aged 12-17, the
rate of illicit drug use was about 10% and about 7% reported currently using
marijuana. The data is much starker when looking at alcohol: 29% of those
surveyed reported being current users. Within this category, 25% of those aged
12-17 reported current use, and nearly 50% of those aged 18-20 reported current
use in the past month (6). As was demonstrated not only
by multiple meta-analyses, but also by the persistence of drug and alcohol use
among minors, D.A.R.E. fails to resonate with the students for whom the program
is tailored. This failure comes at high cost to the school, the state, and the
federal government (7)(8).
This analysis
will take a hard look at three specific aspects of the program model and
question the social sciences theories from which those elements were derived.
The model of the program is predicated on the assumption that, regardless of
the situation or background of the student, he or she will be able to reason
through a decision relating to drugs, alcohol, or violence. Many of the
weaknesses of the earliest iterations of the program were a result of this
intense focus on individual linear reasoned behavior. New curricula and lessons
still fail to consider the environment in which the student is raised and the
modeling that impacts their ultimate choice. Compounding this issue is the
fundamental flaw of the program in addressing the normalizing of risky behavior
in youth. While “peer pressure” is a focus of the program model, its
interpretation within the model is dated and often not applicable to real-world
circumstances. Finally, the program assumes that by injecting the students with
a bolstered sense of self-esteem, environmental and situational influences will
no longer be relevant. Unfortunately, youth and their social situations are
much more complex than that.
I.
Criticism of
the D.A.R.E. model
A. Critique 1: What works for one should work
for all
In its earliest
versions, D.A.R.E. targeted fifth- and sixth-grade students. The goal was to
intervene as early as possible to equip students as quickly as possible for any
challenges they may face regarding drug or alcohol use, or violence. Even
though the program was created for an extremely racially and socioeconomically
diverse student population (9), the program takes a homogenous
approach to all students, regardless of background.
Simply due to the
sheer volume of students exposed to this program regularly, it is unrealistic
to assume that all students receive the program in the same way. Based on the
social learning theory, some behaviors have likely already been modeled and
normalized in the home. While these are not the behaviors targeted by the
program, the efficacy of the program is questionable if the students already
have a mental construct of the impact of drugs and violence in the home. This
mental construct can be healthy or dangerous, but the structure of the D.A.R.E.
program does not account for either. The implicit conclusion that follows from
the D.A.R.E. model is that any drug or alcohol use should be absolutely
avoided. These rigid social norms will conflict with the modeling to which the
student has already been exposed, and the desired effect of imparting a
zero-tolerance mentality on the student is not just diluted, but also
eventually lost (given the brief nature of the program).
In 2001, the
National Highway Traffic Safety Administration (NHTSA) released a comprehensive
set of “How To” guides around the topic of underage drinking prevention. In it,
they mentioned that there are a number of risk factors that are reliable
indicators of a student’s likelihood to abuse alcohol underage. These include
the following: parental drug use, family structure and function problems, lack
of commitment to school, anti-social behavior, and biological predisposition (10). With these in mind, the
student who can most benefit from the message given by D.A.R.E. is least likely
to engage with the program because she is not in school, nor would it be her
first (or most formative) encounter with drug and alcohol use. Because of the
program’s structure, however, these differential risks within the student
population are masked and unattended. Even if family or friends have not
exposed students to any sort of drug culture, they certainly encounter print,
media, or Internet advertisements, and each student to varying degrees. Admittedly,
singling out students who are at greater risk is not a favorable alternative,
but the D.A.R.E. model presumes a homogeneity among students that does not, in
fact, exist. If it did, the model would be singularly effective in any setting
with any permutation of student representation, including those who’d already
tried drugs or alcohol prior to participating in the program.
D.A.R.E.’s
disregard for social and environmental pressures is indicative of its baseline
belief in the capacity of the individual student to reasonably make a decision
regardless of the situational constraints or past experiences. This stringent
adherence to the individual level social science model (particularly the Theory
of Planned Behavior) is effective in perpetuating the mission of the program
but does not successfully equip students and youth with the tools necessary to
confront complex situations involving friends and social pressures to conform.
B. Critique 2: Fitting in is of no concern
In focusing so
heavily on the individual agency of the student, the D.A.R.E. model does not
effectively confront the realities of tenuous social situations, especially
those encountered in groups. D.A.R.E. struggles to address peer pressure, but
it does so in ways that neglect the very basic principles of herd behavior and
social organization theory. Students are taught strategies and methods to,
“Just say no!” but those strategies do not take into account the pressure of
group behavior and perceived social roles.
The D.A.R.E
curriculum prescribes very vague and general steps towards confronting peer
pressure. In their model, they help students to identify characteristics of
positive and healthy friendships and encourage them to build social and support
networks buttressed by these relationships (3). The difficulty, however, is
translating these skills to new environments with new and different potential
friends and navigating potentially risky situations while in these novel
surroundings.
The herd
mentality theory asserts that individual choice is heavily, often
imperceptibly, impacted by perceptions of behavior within the same peer group.
In this scenario, a young underage student, most likely in high school or early
college, attends a party where alcohol is being consumed. She leaves for the
party armed with her fifth-grade D.A.R.E. training, but upon encountering a
group of like individuals who are drinking, she is more likely to forget
Officer Joe and instead join her peers. Thaler and Sunstein document behavioral
changes like this not only in underage drinking, but in eating habits, voting
patterns, and tax compliance (11). They point out that the
notion of “acceptable” or “normal” behavior may, in fact, be based on false
information, but the reality is that the group will behave in accordance with
the prevailing assumptions. In this case, the prevailing assumption is, when
you attend a party, you drink alcohol. What is at play here is an intense
desire to conform. If the long-term consequences, however grave or benign, are
not frighteningly obvious, conformity to immediate group behavior is inevitable
and well documented. This is an insidious form of peer pressure for which the
D.A.R.E. model does not account. Its earlier models were actually chastised for
hyperbolizing the ever-present threat of drugs and alcohol, counter-intuitively
normalizing a behavior that they were trying to stop.
Behaving in
accordance with the peer group is not to say that all agency has been stripped
from the individual. On the contrary, according to social organization theory,
there is an implicit understanding within a group that each individual has a
role to play and rules to play by to maintain the order of the social structure
(12). As our student example from
above is likely the newest member to the social hierarchy, her desire to conform
is driven by deeply held socialization that differentiation is the enemy of
assimilation. Coupled with her understanding of the rules, as they are manifest
by the other, more senior, members of the group, she adheres to the norms
established prior to her introduction. If she doesn’t, she runs the risk of
being ostracized simply because other members of the group will no longer be
able to play by the same set of rules in approaching her as they would if
approaching anyone else.
D.A.R.E.
scratches the surface of the pressure encountered by young adults on daily
basis when confronted with risky decisions. It does not, however, incorporate
the pressures of making decisions, as a new actor, within the confines of a
group with either limited knowledge or well-earned knowledge. In that scenario,
the actor is faced with the seemingly more important decision to either fit in
or get out, despite her level self-confidence prior to entering the party.
C. Critique 3: Self-efficacy will save us all,
or at least the children
D.A.R.E.
proponents vehemently believe in the Theory of Planned Behavior. The current
model is built around the notion that improving a student’s sense of
self-efficacy will ultimately empower the student to make the best decision in
a high-risk situation, regardless of surroundings. If this is true, then all of
the weaknesses noted above are immaterial because the more confident the
student is, the less external social and environmental constructs and group
behavior will matter. The fatal flaw of this model, however, is the assumption
that an agent will always behave rationally.
A hallmark and
critical success of the D.A.R.E. model is the focus on the self-esteem of the
students. Noted in the same NHTSA guidelines, two additional warning signs for
early drug and alcohol abuse are: low self-esteem and shy temperament at a
young age (10). This programmatic strength
is, unfortunately, only a proximal result of the model: the students reported
feeling a bolstered sense of self only immediately after the program’s
conclusion (2). If this is a method to
counter the impact of the externalities of environment and group behavior, it
is ineffective.
This focus
appears to be the model’s participation in the transition from the Theory of
Reasoned Action (TRA) to the Theory of Planned Behavior (TRB). Past studies
have tried to show that the TRB is a somewhat reliable predictor in the
underage use of alcohol, as long as the most compelling factors (e.g. attitude
toward alcohol, subjective norms, and prerequisite intention to use) align
correctly (13). The researchers firmly
asserted that as long as a young adult intended
to use alcohol, and all of the other social and personal factors were met, he
or she would, indeed use alcohol. Perhaps, then, if the students were taught to
no longer intend to use alcohol, the
risk would be eliminated.
Unfortunately,
what the TRB does not take into account are changes to those critical factors
that influence intention, while assuming a strictly linear movement from
assessment to intent to action (14). Does this theory hold in the
context of our party example from earlier? Does the new student have the time
and opportunity to weigh her parents’ opinions, her siblings’ opinions, and her
friends’ opinions in a moment after she is asked whether or not she would like
a drink? Likely not. D.A.R.E.’s vision to empower the participating students to
take greater stock in themselves and have faith in their own self-worth is
absolutely essential for healthy development. However, as a means of addressing
the rather amorphous concept of “self-efficacy” in an effort to impact a nice,
but unrealistic, decision-making model, it is idealistic and poses no real
lasting beneficial effect for the students.
II.
Proposed
Improvement: Every 15 Minutes and Mariah’s Challenge
As vividly as I
remember Officer Joe, I remember a day in May when I was in eighth grade. I had
just come home from school and I noticed a newspaper article with my older
brother’s photo. The headline read, “High School Junior Dies in Tragic Drunk Driving
Accident.” The article talked about all of his achievements, how bereaved our
family was, and what a shame it was to have lost him that way. I was confused.
While I was reading the article, my brother came bounding in to the kitchen and
grabbed a snack from the refrigerator. It was safe to say I had no idea what
was going on. I came to find out that my brother was part of the Every 15
Minutes program at his high school.
Every 15 Minutes
was developed around the statistic that every fifteen minutes, someone was
killed in a drunk driving accident. While this statistic is now dated, and
drunken driving fatalities have decreased by more than 50%, underage drinking
and driving is still a reality. The CDC reported that in 2011, nearly one
million high school aged youth drank and decided to drive (15). Clearly there is still a
disconnect in the message being communicated by anti-drug programs and the
actual behavior of teens and young adults.
The D.A.R.E.
program, in an effort to be comprehensive, attempts to educate students on the
dangers of multiple drugs and violent acts. Because the program is limited to
16 lessons, the practitioners cannot delve deeply into specifics about a given
drug. These recommendations will focus on adolescent drinking and risky
behavior associated with the decision to drink. Here we will critically look at
two interventions that successfully use social science models to strengthen and
brand community of non-alcohol users: Every 15 Minutes and the Mariah
Challenge. An effective intervention targeting underage drinking and risky
behavior will combine the key elements of both of these programs and will reach
more students and resonate more deeply.
A. Response to Critique 1: Creation of a new
community through shared experience
The
Every 15 Minutes campaign is a multi-faceted program incorporating various
media to bring the reality of drunk driving directly to a student population
through simulation. Students from the school will be selected to participate in
a mock car collision, where some will play the victims (both injured and dead)
and others will play the perpetrators. The simulated accident will take place
on the school grounds, and the car (often a car that was actually involved in a
drunk driving accident) will remain on the campus for a specified period of
time. Those who have “died” will have obituaries written for them, and the
school will hold a memorial assembly in those students’ honors. Parents will be
notified of the students’ “deaths” and both students and parents will
participate in a letter-writing exercise expressing their feelings surrounding
the incident. After the “accident” and prior to the memorial assembly, students
involved in the “accident” will be taken off campus to participate in a one
evening retreat led by local law enforcement officers and counselors, while
their classmates are instructed to reflect on the accident witnessed.
Individual schools can choose to incorporate or subtract specific elements from
the experience, but overall, the program is the same across schools (16).
The
brilliance of this intervention lies in its novelty. No matter what the
background or former experiences are of the students participating, the entire
community together witnesses and works through a tragic accident. This
group-level intervention incorporates multiple members of the community, and
serves as a unifying event within the school populations’ collective history.
If the school chooses to adopt this same intervention annually, the tragedy is
not lost on those who have previously experienced it as different students are
selected to participate each year. In contrast to the D.A.R.E.
one-size-fits-all model, Every 15 Minutes simulates a difficult and tragic
event around which an entire community rallies, effectively and lastingly
reaching more students than the D.A.R.E. model structurally could.
Emotional
and resonant in nature, Every 15 minutes also capitalizes on one recognized
strength for addressing underage drinking through school programming:
interaction (17). In this intervention, the
students are the very center of the appeal and those who are targeted are the
students as well. This dramatization exemplifies the central piece of the
communications theory, as the victims of this simulation are those with whom
fellow students can identify the most. While the simulation initially is not
positive in nature, the reintroduction of the students back into the school
population brings a sense of relief. After forcing the students to confront the
realities of losing a classmate either to arrest, injury, or death by reckless
decision making, that relief is much more profound and persistent over time.
B. Response to Critique 2: Branding a
community of non-users
A sense of relief
is a feeling that Leo McCarthy has been trying to regain for the last five
years. In 2007, his 14-year-old daughter was struck and killed by an underage
drunk driver. While giving his daughter’s eulogy, McCarthy made a commitment to
provide scholarships to high school students who pledged not to drink until
they are 21, not to get into a car with someone who’d been drinking, and to
give back to their communities. The pledge can be taken and signed online and
as long as a student has not been convicted of any underage possession related
offenses, the student is eligible to receive at $1,000 scholarship upon
graduation (18).
Mariah’s Challenge
is a grass-roots organization that is built on the fifth premise of alternative
social science models, and creates a sense of premature ownership in the
students who decide to take the pledge. By incentivizing students with the a
potential scholarship, McCarthy is forcing the students to commit to a behavior
based on an anticipated, but not guaranteed, pay-off without having to buy into
the principles or dogmas that would otherwise lead to the desired behavior
change. As the students get closer to graduation, the likelihood of winning the
$1,000 scholarship is greater and greater and, based on the theories of
ownership, the students are more likely to adhere to the pledge regardless of
external pressures.
The intriguing
facet about this intervention is that it also builds a branded community. In
the way that the popular Livestrong campaign has merchandise and identifiable
imagery, Mariah’s Challenge has a very recognizable logo and associated pink
merchandise that is quickly and easily linked to the cause. In creating this
brand, McCarthy has also created a community of inclusion for the students who
choose to pledge. Regardless of where those students go, or with whom they
interact, they will always be a part of Mariah’s Challenge. With that brand comes
the promise of responsibility. Being armed with that is much more potent in the
face of making difficult choices than being taught strategies to deal with
one-on-one peer pressure, as the D.A.R.E. model would advocate. A member of
this Challenge community will always be a member as long as he or she follows
through on his or her pledge. Because it is reinforced in a comfortable setting
at first, it is something that can transcend the pressure introduced by novel
surroundings, new individuals, or a changed culture of acceptance.
C. Response to Critique 3: Changing social
norms
Both the Every 15
Minutes intervention and the Mariah Challenge are working to change the social
norms surrounding underage drinking and driving by approaching the community
most affected. It was not until recently that the D.A.R.E. program expanded to
include high schools. By the time the graduates of the early D.A.R.E.
elementary programs reached high school, the value of the program, if any
gained at all, diminished. One could thus surmise that any lessons learned were
either forgotten or drowned out by other social pressures, personal
experiences, or environmental stressors.
By the time early
graduates of the D.A.R.E. program reach high school, they are no longer in
control of the social norms surrounding drinking culture. They are subject to
them. Interventions like Every 15 Minutes and Mariah’s Challenge are forcing
high school students to question two assumptions: that it is permissible to
drink underage and that driving after drinking is not a serious offense. Every
15 Minutes combines the gruesome reality of drunk driving accidents with the
profound emotional impact of losing a loved one to such a horrific incident. It
makes tangible the otherwise easily written off threat that drinking and
driving poses. Mariah’s Challenge, borne out of such a tragedy, mobilizes a
community of committed students to take ownership of their futures. In doing
so, they will first change their behaviors, later change their attitudes, and
even further down the line, impact others to do the same. These collective
changes serve to impact the culture of drinking in the high school environment
by changing the subjective norms on the group level.
Changing the
subjective norms, particularly those of immediate peers, surrounding the
decision or intention to drink while underage would render the Theory of
Planned Behavior moot. At the point where norms are changed, the issue of
self-efficacy is no longer relevant. Three independent studies evaluating
effective strategies for mitigating underage alcohol consumption have all
recommended that a concerted effort be placed on changing the societal and
community norms surrounding drinking (19)(17)(10). D.A.R.E.’s insistence on the
use of individually focused social science models, particularly the TPB, just
speaks to its own inability to adapt and evolve in time with the populations
they are most trying to impact.
III.
Conclusion
The United States
Surgeon General has issued a comprehensive, multi-tiered plan to address the
persistent problem of underage drinking (20). She, a newly appointed
official, taking such a bold step towards combating this issue is indication
enough that current programming has not been working. One of the most
ineffective of all of these currently existing is the Drug Abuse Resistance
Education program. It is built using individually focused social science
theories and fails to take into consideration the pressures of group behaviors
and environmental pressures into its model, and the only group suffering are
those for whom it was initially intended.
In its wake,
other interventions have arisen to address D.A.R.E.’s shortcomings. Programs
like Every 15 Minutes and Mariah’s Challenge have built communities around
shared experiences and have branded young students as ambassadors of
responsibility, imbuing them with a sense of purpose that transcends peer and
social pressures. A program with the brand power and sense of ownership of
Mariah’s Challenge coupled with the powerful community building effect of Every
15 Minutes could elicit significant change among high school students and young
adults. These programs are specialized to target very specific drug related
behaviors, compared to D.A.R.E.’s comprehensive, all-encompassing approach, and
create a profound and lasting impression on those who participate, adults and
students alike.
CNN recently
reported on a young woman who lost her father and older brother to a drunk
driver in one evening. She has since become an advocate against the behavior
and has told her story to multiple audiences. What she’s realized is that her
story is much more powerful than any numbers or fact sheets, and she has committed
to continue telling her story as long as it proves beneficial to anyone
somewhere (21). I don’t remember Officer
Joe’s real name, but I do remember my brother’s “obituary” and I won’t forget
Mariah’s story
IV.
References
1.
D.A.R.E.
[Internet]. The Official D.A.R.E. Web Site: Drug Abuse Resistance Education.
Available from: http://www.dare.com/home/default.asp
2. Ennett,
Susan T., Rosenbaum, Dennis P., Flewelling, Robert L., Bieler, Gayle S.,
Ringwalt, Christopher L., Bailey, Susan L. Long-Term Evaluation of Drug Abuse
Resistance Education. Addictive Behaviors. 1994;19(2):113–25.
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for D.A.R.E. School Curriculum [Internet]. 2012. Available from:
http://www.dare.org/officers/Curriculum/Storyf98c.asp?N=Curriculum&M=10&S=12
4. Rosenbaum,
Dennis. Program Profile: Drug Abuse Resistance Education (DARE) [Internet].
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Christopher, Greene, Jody M., Ennett, Susan T., Iachan, Ronaldo, Clayton,
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III, Edward M. The Economic Costs of D.A.R.E. Institute of Industrial
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theories
11. Thaler,
Richard H., Sunstein, Cass R. Chapter 3: Following the Herd. Nudge: Improving
Decisions About Health, Wealth, and Happiness. New Haven, CT: Yale University
Press; 2008. page 53–71.
12. DeFleur,
Melvin L., Ball-Rokeach, Sandra J. Chapter 8: Socialization and Theories of
Indirect Influence. Theories of Mass Communication (5th edition). White Plains,
NY: Longman, Inc.; 1989. page 202–27.
13. Marcoux,
B.C., Shope, J.T. Application of the Theory of Planned Behavior to adolescent
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14. Edberg,
Mark. Chapter 4: Individual Health Behavior Theories. Essentials of Health
Behavior: Social and Behavioral Theory in Public Health. Washington, D.C.:
Jones and Bartlett Publishers; 2007. page 191–205.
15. CDC
Vital Signs - Teen Drinking and Driving [Internet]. [cited 2012 Dec 13].
Available from: http://www.cdc.gov/vitalsigns/TeenDrinkingAndDriving/index.html
16. Every
15 Minutes - Someone dies from an Alcohol Related Collision [Internet]. [cited
2012 Dec 14]. Available from: http://www.every15minutes.com/aboutus/
17. Komro,
Kelli A., Toomey, Traci L. Strategies to Prevent Underage Drinking. NIAAA
Spectrum [Internet]. Available from: http://pubs.niaaa.nih.gov/publications/arh26-1/5-14.htm
18. Grieving
father offers teens money not to drink [Internet]. CNN. [cited 2012 Dec 14].
Available from:
http://www.cnn.com/2012/06/14/us/cnnheroes-mccarthy-alcohol-challenge/index.html
19. Holder,
Harold D. Community Prevention of Young Adult Drinking and Associated Problems.
NIAAA Spectrum.
20. General
S. Surgeon General’s Call to Action to Prevent and Reduce Underage Drinking
[Internet]. [cited 2012 Dec 14]. Available from:
http://www.surgeongeneral.gov/library/calls/underagedrinking/programs.html
21. What
sways teens not to drink, drive? Stories, not stats [Internet]. CNN. [cited
2012 Dec 13]. Available from:
http://www.cnn.com/2012/10/10/us/cnnheroes-underage-drunken-driving/index.html
Labels: Adolescent Health, Drug Abuse, Yellow
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