Drug Abuse

THE INTERNATIONAL JOURNAL OF DRUG POLICY, VOL 7, NO 3,1996

DRUG EDUCATION: POLITICS< PROPAGANDA AND CENSORSHIP

This is a version of an article previously published in Druglink, March/April 1996. We are grateful to them for permission to publish it here.

Julian Cohen, JDC Training and Consultancy, Hadfield, UK

There is a long history of well meaning, but ill advised, drug education programmes that have attempted to stop young people using drugs. They have failed miserably. In the past, many drug education programmes have been more in the realm of propaganda than education. CaYnpaigns, anti-drug crusades, simplistic messages and sloganeering have been prominent. Dangers of drug use have often been exaggerated in an attempt to put young people off drugs, what one commentator has called 'prophylactic lies' (Trebach, 1987). Young people have often found, through their own experiences of drug use and what friends tell them, that they have been lied to and have thus mistrusted adult sources of drug information. At a time when more young people are using a range of drugs it is important to pursue approaches to drug education that are based on firm educational principles and take full account of research evidence and evaluation studies of drug education. Developing effective and realistic drug education programmes in schools, the wider community and through the media involves learningfrom past misukes.

APPROACHES TO DRUG EDUCATION

Most past drug education programmes have tried to dissuade young people from using drugs. This is called primary prevention and has been attempted using a number of different approaches. In rough chronological order these have been:

1 . the shock/ scare approach as exemplified in hard hitting anti-drug videos, talks by ex-junkies or some government TV and billboard campaigns that focus on the horrors of drug use;

2. the information approach where young people are given the 'facts' about drugs (and especially the dangers) on the assumption that if they knew the 'facts' they would not use drugs;

3. the attitudes/values approach whereby the attempt is made to promote a 'drug free lifestyle', ' personal responsibility' and 'strong moral beliefs' to avoid drugs;

4. the refusal skills approach where young people are seen as easy prey to peer pressure and in need of developing the skills to 'Say No To Drugs';

5. the decision making skills approach that assumes young people lack the generic skills to make rational choices and that if they had these skills they would not use drugs;

6. the alternative highs approach whereby the attempt is made to replace the excitement of drug use with other forms of risk taking such as pot holing, climbing and abseiling on the assumption that young people will then not need to take drugs;

7. the self-esteem approach where the focus is on the individual rather than drugs per se and it is assumed that young people of high self-esteem will not use drugs.

The British Government's current strategy 'Tackling Drugs Together'is mainly based on primay prevention with its aim of 'Helping young people to resist drugs' ( 1995).

WHAT IMPACT DOES DRUG EDUCATION REALLY HAVE?

Many teachers, parents and politicians believe that drug education will deter young people from using drugs. However, evaluations of all kinds of drug education programmes in this country and all over the developed world show that drug education does not prevent young people using drugs.

Dorn and Murji's exhaustive review of evaluation studies reached this conclusion and suggested that the best that can be expected of drug education is to restrain post-initiation escalation of use and reduce drug related harm (Dom and Murji, 1992).Cogganset al. 0 99 1) conducted the largest and most comprehensive evaluation of school drug education ever carried out in the UK. It also concluded that drug e6ucation does not stop drug use but could play a role in harin reduction.

DARE and Life Education have recently made claims that their programmes prevent drug use but evaluations of both programmes have concluded that this is not the case (Ennett et al., 1994; Hawthorne et al., 1995).

Some people argue that drug education may increase drug use because it will put ideas into the heads of innocent children who would otherwise not think about drugs. This is unlikely because even young children are already aware of drugs and also because the behavioural impact is clearly limited. Research conducted by a team at Southampton University, and replicated in many localities, has demonstrated that even young children think and know about drugs to an extent that parents and teachers find surprising (Williams et al., 1989a, 1989b). In no other area of education, apart from sex education, would people regard ignorance as a virtue. Education is about 'putting ideas into children's heads' and introducing new information and concepts for use, now and in the future. To be effective, drug education has to prepare young people for the future and enable them to understand and help others, even if they never use drugs themselves.

However, some evaluations do demonstrate that shock/scare approaches may glamorise and legitimise drug use amongst some young people. This means that the most anti-drug forms of drug education may bc worse than having no drug education at all.

At a macro level, recent years have seen many more young people exposed to primary prevention school programmes and media campaigns at the very same time as the number using illicit drugs has escalated (Parker et al., 1995).

The research evidence shows that appropriate drug education can increase drug knowledge, develop decision making skills and make young people more discerning about what they actually do. This does not mean they will not use either legal or illegal drugs. In other words, drug education can play a role in reducing drug related harm rather than preventingdrug use perse.

FLAWED ASSUMPTIONS

These approaches have not stopped young people using drugs mainly because they are based on flawed assumptions about why young people use drugs in the first place (Cohen, 1993; Davies and Coggans, 1991 -) Kay, 1994; Plant and Plant, 1992). Pleasure is never considered as a reason for drug use and neither is young people's curiosity and need to experiment, to take risks and define their own boundaries. In fact, we approve of activities that are encouraged to prevent young people getting into drug use, such as outdoorpursuits, which can be extremely dangerous and annually result in many deaths and injuries.

The assumption that overt peer pressure is a significant factor is neither proven nor reliable, as drugs are more likely to be pulled from friends and family than pushed from unscrupulous strangers (Coggans and Mckellar, 1994).The assumption that high selfesteem and possession of all the facts are protection against drug use is also not borne out by reality (Schroeder et al., 1993).

All of the traditional approaches stand accused of double standards in the way they deal with legal drug use, especially alcohol use, compared with illegal and socially unacceptable drugs.

Above all proponents of primary prevention ignore the available research evidence about why young people use drugs and evaluation studies of the impact of drug education programmes. In recent years increasing numbers of practitioners have advocated a harm reduction approach to drug education. This involves education about, rather than against, drugs on the understanding that drug educati,Dn will not stop drug use, but that accurate information and development of appropriate skills will enable children and young people to be more discerning about their own, and other people's drug use.

EDUCATION NOT PROPAGANDA

In deciding what the aims of drug education should be it helps to distinguish between specific educational aims and health related behaviours. Too often in the past practitioners have fallen into the trap of thinking the aim of drug education should be to prevent all drug use. They then find that this aim cannot be achieved and are disappointed with the outcomes of the programme.

Drug education should be based on the three broad educational aims that underpin the teaching of other subjects:

1. to increase young people's knowledge and understanding of drugs, drug use and related issues;

2. to explore a range of opinions and attitudes towards drug use and enable young people to arrive at their own, informed views;

3. to develop a range of skills relating to drug use and enable young people to make their own, informed decisions about drugs.

Knowledge of drugs needs to be based on informationthat is accurate and acknowledges both the benefits and risks of drug use. Attitudes towards drug use vary greatly and there is no one 'correct' view of drug use that raises complicated issues which need to be debated and explored from different angles. Encouraging young people to make their 'own, informed decisions' means just that, and does not mean telling young people what decisions they should be making. It is about young people's drug use here and now, but should also be about their futures, helping others and understanding the role of drugs in society.

Most drug education is not based on the educational principles that underlie the teaching of other subjects. Primary prevention programmes tend to skew and censor information, give a narrow view of drug use and tell young people what they should think and do. This is propaganda, not education. It often results in young people not being able to talk openly and honestly and saying what they think their teachers or parents want to hear rather than whatthey reallybelieve. The gulf between adults and young people widens, open dialogue lessens and the notion that drug use is a deviant activity is reinforced. If young people have problems or concerns about drugs they become less likely to approach adults for support. Primary prevention programmes can cause harm and may themselves exacerbate drug problems amongst young people.

In terms of health and behavioural aims, evaluations of drug education programmes indicate that the main aim should be to reduce drug related harm rather than prevent drug use per se. The key issue is not whether young people use certain drugs or not but what happens to them if they do choose to use drugs. The clearest success stories in recent years have been the reduction in needle sharing amongst injectors and the decrease in ecstasy related deaths through overheating and dehydration. Unfortunately, no evaluations of school-based harm reduction drug education programmes have yet been carried out. This is not through want of trying. A number of practitioners have sought funding for such an evaluation but the powers that be have been less than interested.

WHO SHOULD TEACH SCHOOL EDUCATION?

Many individuals and organisations are eager to get into schools to tell young people the'real facts'about drugs. This includes police officers, ex-addicts, certain drug agencies, theatre companies and the DARE programme. School drug education should be lead by normal classroom teachers. The use of outsiders tends to sensationalise the drugs issue and reinforce the idea that teachers cannot talk about drugs. Many outsiders use discredited 'shock/ scare' approaches, exaggerate dangers and do not relate their input to the situation of the young people they are addressing. Most are propagandists, some are evangelists. Few are educationalists. They usually perform a'one off', come and go and do not know the young people they are talking to. Teachers know their pupils and are available to them on an ongoing basis to follow up work and issues.

You do not need to be a 'walking encyclopaedia' on drugs to successfully teach drug education. Some drug knowledge helps but many drug education resources have activities that contain accurate drug information for teachers to use and training courses are available for teachers. Too much drug knowledge may even be a hindrance in that it can skew the drug education programme to an information approach, which omits attitude exploration and skill development. Drug education is probably more about people than drugs themselves. Unlike outsiders, teachers are trained and skilled in tinderstanding young people, stru cturing4e arni rig and using a variety of teaching methods. Outsiders may occasionally usefully supplement a teacherled programme but their input needs to be carefully planned and integrated.

POLITICS, PROPAGANDA AND CENSORSHIP

I have argued that the underlying assumptions on which primary prevention is based are flawed, that evaluation studies show it to be ineffective and that it is more about propaganda than education. Many proponents of primary prevention are either ignorant about the research evidence or appear to know about it yet ignore it for political reasons. Below are a few examples of the way the'powers that be'either ignore or censor the evidence.

The Dorn and Murji (1992) survey of evaluation studies cited above is probably the most comprehensive so far carried out. It was commissioned by the Home Office before setting up the Drug Prevention Initiative (DPI) projects. Its conclusions were ignored and the DPI projects were mainly given a remit to pursue primary prevention objectives. The Coggans et al. (1991) study cited above was funded by the Scottish Education Department, but on seeing the conclusions it reached they decided not to publish it; this task was left to ISDD.

The Department for Education (DFE) recently launched a drug education initiative with the slogan 'Drug Proof'. Such slogans may be politically popular but they are clearly unrealistic and doomed to failure. The DFE has also run a series of regional conferences at which the work of DARE and Life Education was actively endorsed, speaker presentations were censored and harm reduction approaches were deliberately excluded. It has censored 'politically unacceptable'aspects of the SCAA guidance on drug education for schools ( 1995) against the advice of the expert consultants and advisory group they employed on the task. This included changing the words'drug use' to 'drug abuse' and omitting references to the benefits ofdrug use, understanding the role ofdrugs in society, history of drug use, social and cultural uses of drugs, why young people use drugs and challenging stereotypes and myths. It has also deliberately omitted some best selling drug education resources from the listings in its 'Digest Of Drug Education Resources for Schools' because they took a harm reduction approach even though the introduction to the digest stresses that none of the resources included are'recommended or endorsed' (1995).

Ignore it or censor it seems to be the order of the day when it comes to making information and research evidence available to teachers and other drug education practitioners. This very much mirrors the practice of much past drug education in schools and that through the media whereby the information given to young people is also doctored. Dishonesty should have no place in education.

THE CHANGING LANDSCAPE

Over the years I have found that some 'officials' and people who hold the major purse strings in the drug education world will talk about the ineffectiveness of primary prevention (strictly 'off the record'), but are scared to publicly speak out against it or actively endorse a harm reduction approach for school drug education. Others have decided that what we now need are even more primary prevention programmes than ever. One or two have been brave enough to fund the produc, tion of harm reduction drug education materials and training programmes.

Practitioners on the ground have increasingly recognised the need for a harm reduction approach. Sales of harm reduction drug education materials to schools and youth services have mushroomed. For example, harm reduction materials from Healthwise, ISDD and Lifeline have become widely and enthusiastically used in many schools. Many teachers, youth workers, police officers and others have positively responded to training and development programmes based on a harm reduction principles. Many parents have found that the'Don't Dc, Drugs' message merely prevents open discussion wirh their children and does nothing to ensure their safety. Harm reduction approaches are being found to be more meaningful to, and more effective with, young people. Practitioners are finding that a harm reduction approach allows more honesty and is refreshingly educational compared with the propaganda of primary prevention.

Many drug workers and drug edi~cation specialists have been a bit coy about harmreduction when it is applied to young people and drug education programmes. Will open support for harm reduction mean we loose our funding to the latest razzmatazz primary prevention jamboree? The situation is changing on the ground and it is about time more of us came out of the closet, to use the available evidence and take up the challenge.

According to Michael Gossop (1982) in his book Living With Drugs:

There is an urgent need to reassess what drug education can realistically be expected to achieve. It is vital that everyone realises that it cannot eliminate drug taking. What it could do, is to reduce the amount of harm that people suffer as a result of their drug taking.

He wrote this almost 15 years ago. If we do not take this advice, it is young people who will be the losers.

REFERENCES

CoggansN, Shewan D, HendersonM, DaviesJB (199 1). National Evaluation of DrugEducation in Scotland, London: ISDD.

Coggans N, Mckellar S (1994). Drug use amongst peers: peer pressure or peer preference? Drugs Education, Prevention and Policy I (I).

Cohen J (1993). Achieving a reduction in drug-retated harm through education. In Heather N, Wodak A, Nadelmann E, O'Hare P (Eds) Psychoactive Drugs and Harm Reduction: From Faith to Science. London: Whurr.

Davies J, Coggans N (199 1 ). The Facts About Adolescent Drug Abuse. London: Cassell.

Department for Education (1995). Drug Prevention and Schools, Circular 4/95.

Dorn N, Muri i K (1992). DrugPrevention: A Reviewof the English Language Literature. London: ISDD.

Ennett S, Tobter N, Ringwalt C, Flewelling R (1994). How effective is drug abuse resistance education? Americanjournal of Public Health 84(9).

Gossop M (1982). Livingwith Drugs. Aldershot: Ashgate.

Hawthorne G, Garrard.j, Dunt D (1995). Does Life education's drug education programme have a public health benefit? Addiction90:205-215.

Kay J (1994). Don't wait till it's too late. International Journal of Drug Policy 5 (3).

ParkerH, MeashamF, AldridgeJ (1995). DrugFutures: Changing Patterns of Drug use Amongst English Youth. London: ISDD.

Plant M, Plant M (1992). Risk Takers: Alcohol, Drugs, Sex and Youth. London: Routledge.

SCAA (1995). Department For Education Drug Education: Curriculum Guidance for Schools, May.

Tackling Drugs Together A Strategy for England and Wales 1995-1998 (1995). London: HMSO

Trebach A (198 7). The Great Drugs War and Radical Proposals that can make America Safe Again. New York: MacMillan

Williams T, Whetton N, Moon A (1989a). Health for Life 1, Walton on Thames: Nelson.

Williams T, Whetton N, Moon A (1989b). Health for Life 2, Walton on Thames: Nelson.

Schroeder DS, Laflinard MT, Weis DL (1993). Is there a relationship between self-esteem and drug use? Methodological and statistical limitations of the research. Journal of Drug Issues 23 (4): 644-5.

Julian Cohen, 15 Church Road, Hadfield, Hyde, Cheshire, SKI 4 8AD, England