Youth, drugs and resilience education

Is there room for resilience? A scoping review and critique of substance use literature and its utilization of the concept of resilience

Research in the area of illicit substance use remains preoccupied with describing and analyzing the risks of people who use drugs (PWUD), however more recently there has been a drive to use a strengths-based or resilience approach as an alternative to investigating drug use. This leads us to ask: what can be known about PWUD from the point of view of resilience? The objective of this scoping review is to analyze how the concept of resilience is defined, operationalized, and applied in substance use research. Popular health, social science, psychology, and inter-disciplinary databases namely: SCOPUS, PUBMED, PsycINFO, and Sociological Abstracts were searched. Studies were selected if they used the concept of resilience and if substance use was a key variable under investigation. A total of 77 studies were identified which provided a definition of resilience, or attempted to operationalize (e.g., via scales) the concept of resilience in some manner. Data were charted and sorted using key terms and fundamental aspects of resilience. The majority of studies focus on youth and their resistance to, or engagement in, substance use. There is also a small but growing area of research that examines recovery from substance addiction as a form of resilience. Very few studies were found that thoroughly investigated resilience among PWUD. Consistently throughout the literature drug use is presented as a 'risk factor' jeopardizing one's ability to be resilient, or drug use is seen as a 'maladaptive coping strategy', purporting one's lack of resilience. Currently, substance use research provides a substantial amount of information about the internal strengths that can assist in resisting future drug use; however there is less information about the external resources that play a role, especially for adults. Though popular, outcome-based conceptualizations of resilience are often static, concealing the potential for developing resilience over time or as conditions change. Studies of resilience among PWUD predominantly concentrate on health-related behaviours, recovery-related factors or predefined harm reduction strategies. Indeed, overall, current conceptualizations of resilience are too narrow to recognize all the potential manifestations of resilience practices in the daily lives of individuals who actively use drugs.

Systematic review of universal school-based 'resilience' interventions targeting adolescent tobacco, alcohol or illicit substance use: A meta-analysis

Universal school-based interventions that address adolescent 'resilience' may represent a means of reducing adolescent substance use, however previous systematic reviews have not examined the effectiveness of such an intervention approach. A systematic review was undertaken to 1) assess whether universal school-based 'resilience' interventions are effective in reducing the prevalence of tobacco, alcohol or illicit substance use by adolescents, and 2) describe such effectiveness per intervention characteristic subgroups. Eligible studies were peer-reviewed reports (1994-2015) of randomised controlled trials including participants aged 5-18years that reported adolescent tobacco, alcohol or illicit substance use, and implemented a universal school-based 'resilience' intervention (i.e. those addressing both individual (e.g. self-esteem) and environmental (e.g. school connectedness) protective factors of resilience). Trial effects for binary outcomes were synthesised via meta-analyses and effect sizes reported as odds ratios. Subgroup (by intervention type, prevention approach, setting, intervention duration, follow-up length) and sensitivity analyses (excluding studies at high risk of bias) were conducted. Nineteen eligible studies were identified from 16,619 records (tobacco: n=15, alcohol: n=17, illicit: n=11). An overall intervention effect was found for binary measures of illicit substance use (n=10; OR: 0.78, 95%CI: 0.6-0.93, p=0.007,Tau²=0.0, I²=0%), but not tobacco or alcohol use. A similar result was found when studies assessed as high risk of bias were excluded. Overall intervention effects were evident for illicit substance use within multiple intervention characteristic subgroups, but not tobacco and alcohol. Such results support the implementation of universal school-based interventions that address 'resilience' protective factors to reduce adolescent illicit substance use, however suggest alternate approaches are required for tobacco and alcohol use. PROSPERO registration: CRD42014004906.

School-based programmes that seem to work

H. Pape: School-based programmes that seem to work: Useful research on substance use prevention or suspicious stories of success?

School-based prevention programmes targeted at adolescent substance use rarely seem to have the desired effects on behaviour. It is true that some outcome studies do conclude that such programmes have been successful, but they are relatively few and far between. Even so, one may ask whether the body of published research in this field may originate from unrealistic optimism due to publication bias and underreporting of no or counterproductive effects. Thus, anecdotal evidence suggests that the literature is biased in favour of studies with positive findings. Moreover, nearly all these studies have been carried out by programme developers, and it is well known that researchers with vested interests are more likely to bring “good news” than independent researchers. Indeed, rather than approaching the field with critical reflection, some evaluators have intended to prove that school-based prevention works and have conducted their research accordingly. Examples of questionable analytical approaches and selective reporting of positive ifindings are consequently not hard to find. The external validity of evaluation studies with favourable outcomes is also often questionable because they almost exclusively have assessed the effects of programmes delivered under optimal rather than real-life conditions. In conclusion, the empirical “evidence” in favour of school-based substance use prevention programmes is generally weak and does not allow recommendation of widespread dissemination of any specific programme.

Implementing the Rock Challenge

This paper presents the qualitative process findings from an evaluation of a school-based performing arts programme, ‘Rock Challenge’. Rock Challenge aims to promote healthy life styles ‘by building resilience amongst young people involved’. The research aimed to capture the experiences and perceptions of young people’s involvement in the programme, particularly in relation to the concept of the ‘drug-free high’, support offered throughout the programme and participants’ response to Rock Challenge as a drug-prevention initiative. Findings from the study suggest young people felt very positive about their involvement and, in particular, valued the skills and experiences associated with organising a performance, team-working, developing confidence, friendship, fun and excitement. The excitement felt during dance rehearsals and the live performance was associated with the concept of a ‘drug-free high’, feeling good in the absence of drugs and alcohol, and was seen as a key benefit of the programme. While support from teachers and families was perceived as high, difficulties were identified in the recruitment of males and students vulnerable to substance misuse and recommendations are made for improvement. The health promotion opportunities for school nurses and other public health practitioners and personal, social and health education co-ordinators are highlighted.

Community-Based Prevention Programs in the War on Drugs: Findings from the “Fighting Back” Demonstration

Illegal drug use remains one of the United States' most serious health problems, and the “War on Drugs” continues without an end in sight. Antidrug programs, which offer the potential to reduce substance abuse problems, are a component of efforts to deal with the problem, but they operate absent adequate scientific analysis. Although policy has shifted from a focus on supply control to one that includes prevention and treatment, research and theory lag behind program implementation. Thus, for example, community-based programs designed to change norms and systems of substance use have been widely promoted despite the lack of data to support their use. The present paper summarizes findings from an evaluation of a large national demonstration program, “Fighting Back.” Results of the evaluation of broad-based community initiatives in a dozen communities show that the programs failed to reduce rates of substance use and associated harms. These findings, along with other evidence, place reliance on community-based programs at odds with public rhetoric. To deal more effectively with substance abuse, there is a need to move from “grading” programs to understanding why and how interventions function.

An evaluation of the 4-H Health Rocks program: implications for program improvement

The National 4-H Council developed the Health Rocks substance abuse educational program to prevent youth from engaging in risky behaviors. The program was presented in 2010 to more than 8,000 middle school youth in Georgia. A post-then-pre evaluation was conducted with youth who completed 10 hours of instruction to determine if changes in youth knowledge, beliefs/attitudes, skills, and behavioral intentions occurred during the course of the program. This study sought to measure the impact of the program and critically evaluate the questionnaire used. The data revealed statistically significant increases in knowledge, beliefs/attitudes, skills, and behavioral intentions of participating youth. Suggestions for improvement of the questionnaire included utilizing questions that are more specific to the curriculum and adding questions to measure the influence of peer pressure.

Dissonance-Based Interventions for Substance Using Alternative High-School Youth

This article describes an innovative new intervention tailored to older youth who are already abusing drugs, but who are not diagnostically ready for treatment. The basic tenet of this intervention is to utilize adolescents engaged in drug use as "experts" in the prevention curriculum adaptation activity. This activity then serves as a mechanism for their dissonance-based change. This process is designed to intervene with drug abusing youth prior to their development of substance dependence. The community-based design grew from a United States federally funded NIDA project (National Institute of Drug Abuse Mentored Research Scientist Award) which found that the youth who conduct program adaptations were effectively engaged, animatedly discussing the payoffs and downsides of drug and alcohol abuse. It is maintained through this research that dissonance between their role of "Preventionist" and their own substance abuse behaviors lead to shifts in attitudes and behaviors. Dissonance-based interventions (DBIs) have been successfully utilized for positive behavioral change with a variety of disorders, but have not yet been implemented with substance abusing youth. Findings of pilot research are shared along with implications for future research and interventions.

Additive and subtractive resilience strategies as enablers of biographical reinvention: a qualitative study of ex-smokers and never-smokers

The notion of developing resilience is becoming increasingly important as a way of responding to the social determinants of poor health, particularly in disadvantaged groups. It is hypothesized that resilient individuals and communities are able to 'bounce back' from the adversities they face. This paper explores the processes involved in building resilience as an outcome in relation to both quitting smoking and never smoking. The study involved 93 qualitative, oral-history interviews with participants from population groups with high and enduring smoking rates in Adelaide, Australia, and was essentially interested in how some people in these groups managed to quit or never start smoking in the face of adversities, in comparison to a group of smokers. Our key findings relate to what we call additive and subtractive resilience strategies, which focus on the practices, roles and activities that individuals either 'took on' or 'left behind' in order to quit smoking or remain abstinent. The theoretical lenses we use to understand these resilience strategies relate to biographical reinforcement and biographical reinvention, which situate the resilience strategies in a broader 'project of the self', often in relation to attempting to develop 'healthy bodies' and 'healthy biographies'.

Family and personal protective factors moderate the effects of adversity and negative disposition on smoking among Chinese adolescents

Tobacco use among Chinese adolescents is increasing at approximately 80,000 new smokers per day. Assessing the causes for initiating tobacco use in China will be important in developing effective interventions and policies to stem rising prevalence rates. This study tested predictors of Resilience Theory in a sample of 602 Chinese adolescents. Results revealed that prior adversity, measured through school and family-related events, was significantly associated with increased smoking in females. Family factors (i.e., family cohesion, family adaptability, parental monitoring) and one personal factor (i.e., academic score) were associated with lower odds for smoking due to prior adversity and negative disposition.

The Making of Evidence-based Practice: The Case of Project ALERT

Evidence-based practice has been enthusiastically embraced within the field of drug prevention during the past decade. Project ALERT, a school-based universal prevention program, is among the most widely advocated evidence-based interventions. We examined the results of three large-scale evaluations of Project ALERT, and concluded that assessment of data from the total samples shows that the program has little effect on drug use. Despite this, Project ALERT is included on evidence-based drug prevention lists because the criteria for inclusion are extremely weak. We discuss the implications of this for drug prevention evaluation research and the creation of evidence-based practice lists.

Resilience and risk competence in schools: theory/knowledge and international application in project rebound

Despite a 50-year interdisciplinary and longitudinal research legacy--showing that nearly 80% of young people considered most "at risk" thrive by midlife-only recently have practitioners/researchers engaged in the explicit, prospective facilitation of "resilience" in educational settings. Here, theory/knowledge distinguishing and extending risk and resilience from its risk-based social history to resilience's normative occurrence leads to the first known international and prospective application of resilience in school-based drug education, Project REBOUND [resilience-bound]. It will be implemented as a controlled pilot study, first in Germany, then expand to the United States, as well as other parts of Europe. With evaluation occurring throughout, the goal is to enhance the quality of drug decisions among young people, as well as support their overall competence-based learning and development throughout school. With limitations and underlying psychological mechanisms discussed, it is concluded Project REBOUND offers promising potential for supporting positive drug decisions as well as youth learning and development.

Artikel

H. Pape: School-based interventions that seem to work: Useful research on substance use prevention or suspicious stories of success?

School-based prevention programmes targeted at adolescent substance use rarely seem to have the desired effects on behaviour. It is true that some outcome studies do conclude that such programmes have been successful, but they are relatively few and far between. Even so, one may ask whether the body of published research in this field may originate from unrealistic optimism due to publication bias and underreporting of no or counterproductive effects. Thus, anecdotal evidence suggests that the literature is biased in favour of studies with positive findings. Moreover, nearly all these studies have been carried out by programme developers, and it is well known that researchers with vested interests are more likely to bring “good news” than independent researchers. Indeed, rather than approaching the field with critical refelction, some evaluators have intended to prove that school-based prevention works and have conducted their research accordingly. Examples of questionable analytical approaches and selective reporting of positive findings are consequently not hard to find. The external validity of evaluation studies with favourable outcomes is also often questionable because they almost exclusively have assessed the effects of programmes delivered under optimal rather than real-life conditions. In conclusion, the empirical “evidence” in favour of school-based substance use prevention programmes is generally weak and does not allow recommendation of widespread dissemination of any specific programme.

The social construction of "evidence-based'' drug prevention programs: a reanalysis of data from the Drug Abuse Resistance Education (DARE) program

This study explores the possibility that any drug prevention program might be considered ;;evidence-based'' given the use of data analysis procedures that optimize the chance of producing statistically significant results by reanalyzing data from a Drug Abuse Resistance Education (DARE) program evaluation. The analysis produced a number of statistically significant differences between the DARE and control conditions on alcohol and marijuana use measures. Many of these differences occurred at cutoff points on the assessment scales for which post hoc meaningful labels were created. Our results are compared to those from evaluations of programs that appear on evidence-based drug prevention lists.

Reducing adolescent use of harmful legal products: intermediate effects of a community prevention intervention

PURPOSE

Preliminary results are presented from a feasibility study of a comprehensive community prevention intervention to reduce the use of inhalants and other harmful legal products (HLPs) among adolescents in three Alaskan frontier communities conducted in 2004-2007. The legal products used to get high include over-the-counter drugs, prescription drugs, and common household products. Community mobilization, environmental and school-based strategies were implemented to reduce access, enhance knowledge of risks, and improve assertiveness and refusal skills.

METHODS

Pre- and post-intervention survey data were collected from 5-7th grade students from schools in three communities using standardized instruments to assess knowledge, assertiveness, refusal skills, perceived availability, and intent to use. The intervention consisted of community mobilization and environmental strategies to reduce access to HLPs in the home, at school, and through retail establishments. In addition, the ThinkSmart curriculum was implemented in classrooms among 5th grade students to increase the knowledge of harmful effects of HLPs and improve the refusal skills. Data were analyzed using hierarchical linear models that enable corrections for correlated measurement error.

RESULTS

Significant increases in knowledge of harms related to HLP use and decreases in perceived availability of HLP products were observed. The environmental strategies were particularly effective in reducing the perceived availability of HLPs among 6th and 7th graders.

DISCUSSION

Although limited by the absence of randomized control groups in this preliminary study design, the results of this study provide encouragement to pursue mixed strategies for the reduction of HLP use among young people in Alaskan frontier communities.

A case study of publication bias in an influential series of reviews of drug education

There has been remarkably little demonstration of the deleterious impact of publication bias within addiction science or indeed in wider healthcare policy and practice. An account is provided here of how publication bias was identified in relation to a series of drug education reviews which have been very influential on subsequent research, policy and practice. Later data analyses unpublished by the same review team demonstrated earlier findings to be unreliable. These later findings were not published. The policy context in which evidence on drug education in schools is produced is considered and the need for unbiased evidence is emphasised. A broadened conception of publication bias is proposed which takes account of the environment in which publication decision-making occurs. It is suggested that this is particularly necessary for subjects with such direct policy relevance as the effectiveness of drug education in schools.

Conflict of interest in the evaluation and dissemination of "model" school-based drug and violence prevention programs

Conflict of interest refers to a set of conditions in which professional judgment concerning the validity of research might be influenced by a secondary competing interest. The competing interest that has received most attention in the literature addressing the prevalence and effects of such conflicts on the practice of empirical research has been that of financial relationships between investigators and research sponsors. The potential for conflicts of interest to arise in the evaluation of drug prevention programs was raised by Moskowitz in this journal in 1993, but to date there has been no attempt made to estimate the scope of this problem. The present study addressed this issue using a sample of "model" school-based drug and violence prevention interventions by first, identifying the types or relationships that exist between program developers and program distributors, and, second, by assessing how many of the evaluations of these programs published in peer-reviewed journals had been conducted by the developers of the programs compared to independent evaluation teams. The data presented indicate that there are relatively few published evaluations that do not involve program developers and that there are few instances in which there is complete separation between the program developer and program distributor. Using the open systems model of the Institute of Medicine Committee on Research Integrity as a framework, it is argued that the culture and norms of the program developer and those of the program evaluator are fundamentally distinct and therefore failure to separate these roles produces high potential for conflict of interest to arise.

Resilience in children of substance users: in their own words

Understanding what children of alcoholics and other substance users experience has dominated the scientific literature and popular press for the past several decades. To date, the empirical studies have relied primarily on quantitative data to understand the individual and environmental factors associated with the lives, the developmental trajectories, and the growth of children of alcoholics and other substance users. Many of these studies focus on their risks, and very few of them focus on their strengths. Additionally, very few studies have used qualitative techniques to collect data. While quantitative studies have given us great insight, perhaps we could learn a great deal more if we employed data collection methods which would actually provide us with the child's perception of their strengths, or resilience, and what they think it takes to grow into happy, healthy adults. For this reason, this study presents data from the interviews of 50 children of substance users who present their views on resilience.

Interviewer as instrument: accounting for human factors in evaluation research

This methodological study examines an original data collection model designed to incorporate human factors and enhance data richness in qualitative and evaluation research. Evidence supporting this model is drawn from in-depth youth and adult interviews in one of the largest policy/program evaluations undertaken in the United States, the Drug, Alcohol, and Tobacco Education evaluation (77 districts, 118 schools). When applying the explicit observation technique (EOT)--the strategic and nonjudgmental disclosure of nonverbal human factor cues by the interviewer to the respondent during interview--data revealed the observation disclosure pattern. Here, respondents linked perceptions with policy or program implementation or effectiveness evidence. Although more research is needed, it is concluded that the EOT yields richer data when compared with traditional semistructured interviews and, thus, holds promise to enhance qualitative and evaluation research methods. Validity and reliability as well as qualitative and evaluation research considerations are discussed.

Does measurement dependence explain the effects of the Life Skills Training program on smoking outcomes?

BACKGROUND

The Life Skills Training (LST) program is the most prominent school-based smoking prevention program in terms of its consistency in being named on lists of best practices. This study assessed whether the results pertaining to cigarette smoking reported in evaluations of the LST program are measurement dependent.

METHODS

Seventeen reports published between 1980 and 2003 that included at least one outcome measure pertaining to cigarette smoking were identified. Data pertaining to the cigarette smoking measures used in the analysis and whether the results showed a statistically significant difference between experimental and control groups at follow-up were extracted from the reports.

RESULTS

Fourteen different outcome measures were used across 17 reports. Only three pairs of reports presented the same set of outcomes. Recent reports showed the most consistent set of findings in support of the LST program, but there was little consistency in the outcome measures used in these analyses.

CONCLUSIONS

The use of so many smoking outcomes in the LST program evaluations raises concern as to whether the positive program effects reported are measurement dependent.

Implementing The Rock Challenge: teacher perspectives on a performing arts programme

The Rock Challenge is a school‐based performing arts programme that that aims to promote healthy lifestyles amongst secondary school students. This paper reports on teacher perspectives on the implementation of The Rock Challenge in nine English schools. This study highlights how performing arts programmes, such as The Rock Challenge, are unlikely to have a simple relationship between guidance and practice in spite of their being popular and sustainable.

Adolescent reactance and anti-smoking campaigns: a theoretical approach

Children between the ages of 9 and 15 are a high-risk group for tobacco use. The Centers for Disease Control estimates that first use of cigarettes among adolescents has risen 30% over the past decade, and that more than 1.2 million people age < 18 became daily smokers in 1996 alone. Moreover, research indicating that awareness and liking of cigarette advertisements is higher among adolescents than adults underscores the need to devote more effort to understanding reactions to tobacco-related messages. Adding to this problem is the fact that the early gains of some successful anti-tobacco interventions disappear as adolescents age. Drawing on the theory of psychological reactance, a number of hypotheses were tested that addressed the impact of pro- and anti-smoking messages on a variety of outcomes, including participants' intended behaviors, evaluation of message sources, and seeking of disconfirming information. All the messages were created and delivered to 4th-, 7th-, and 10th-grade students via personal computers. The pattern of results supports the theoretically derived hypotheses, indicating that grade level and message type had a significant impact on the processing of tobacco-related messages. Implications and suggestions for future tobacco prevention campaigns are discussed.

Principles that underpin effective school-based drug education

This study identifies the conceptual underpinnings of effective school-based drug education practice in light of contemporary research evidence and the practical experience of a broad range of drug education stakeholders. The research involved a review of the literature, a national survey of 210 Australian teachers and others involved in drug education, and structured interviews with 22 key Australian drug education policy stakeholders. The findings from this research have been distilled and presented as a list of 16 principles that underpin effective drug education. In broad terms, drug education should be evidence-based, developmentally appropriate, sequential, and contextual. Programs should be initiated before drug use commences. Strategies should be linked to goals and should incorporate harm minimization. Teaching should be interactive and use peer leaders. The role of the classroom teacher is central. Certain program content is important, as is social and resistance skills training. Community values, the social context of use, and the nature of drug harm have to be addressed. Coverage needs to be adequate and supported by follow-up. It is envisaged that these principles will provide all those involved in the drug education field with a set of up-to-date, research-based guidelines against which to reference decisions on program design, selection, implementation, and evaluation.