Waiho mä te tangata e mihi • Let someone else acknowledge your virtues 2003

EFFECTIVE DRUG EDUCATION

FOR YOUNG PEOPLE

AN OVERVIEW OF THELITERATURE REVIEW & ANALYSIS

As part of the Government’s Action Plan on Alcohol andIllicit Drugs, the former Ministry of Youth Affairs in 2003commissioned an international and national literature reviewon drug education for young people (12-24 years inclusive),families and communities. The purpose of the literaturereview was to identify and encourage evidence-based bestpractice for drug education.

This publication has been produced to providean overview of the literature review outcomesby reproducing the executive summary andthe recommendations.

The Ministry of Youth Development (MYD) stronglyrecommends that the full literature review is utilised toinform policy for, research on, and practice ofdrug education.

Allen & Clarke Policy and Regulatory Specialists Ltd producedthe literature review for the Ministry of Youth Affairs, andMYD has subsequently published it. The full report EffectiveDrug Education for Young People: A Literature Review andAnalysis is available on the MYD website www.myd.govt.nz

INTRODUCTION

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The Ministry of Youth Development is leading andcoordinating a review to identify and encourage bestpractice in alcohol and drug education. This project isbeing undertaken in consultation with the Ministries ofEducation, Health and Justice, and the Alcohol AdvisoryCouncil of New Zealand (ALAC). The purpose of theproject is to contribute to the following outcomes:

• Reduced alcohol and drug use, particularly by young people.

• Increased understanding about what constitutes effectivedrug education.

• Increased uptake of effective drug education by schoolsand communities.

• Increased understanding about drugs and their economicand social costs.

• Identification of gaps in service delivery and research.

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THE PROJECT

The project consists of three phases:

1. 2002/03: Information gathering and analysis

• Undertake a national/international literature reviewidentifying evidence-based best practice and keymessages for drug education for young people (in andout of schools), families and communities that not onlyraise awareness, but also result in sustainedbehaviour change.

2. 2003/04: Resource development

• Develop standards for effective drug education.• Develop guidelines for evaluation of drug education.• Develop criteria for purchasers of drug education to use

when deciding which programmes best meettheir needs.

3. 2004/05: Publish standards and guidelines anddevelop options for community pilots

• Publish guidelines, standards and criteria developedduring 2003/04.

• Develop options for pilots in selected communities todevelop and introduce appropriate key messages andinitiatives for their young people, families and the widercommunity.

This review is part of the first phase of the project:Information gathering and analysis. The terms ofreference for this review are:

To complete a national/international literature reviewand analysis identifying evidence-based best practiceand key messages for drug education for young people(in and out of schools), families and communities thatnot only raise awareness, but also result in sustainedbehaviour change.

Overview of findingsof the literature review

The literature on drug education shows the following:

• Young people’s drug use is shaped by social, culturaland economic contexts. These contexts are alsoimportant in developing effective education about drugsfor young people. Effective drug education requiresthe coordination of messages, and active support, byal l levels of government and community.

• Young people are more at risk of drug-related harm ifthey have poor relationships with their families,communities, school or peers. Improving theserelationships is one element in effective drug education.

• The development of young people’s strengths is likelyto reduce their chances of suffering drug-related harm.Development of strengths is one element in effectivedrug education.

• Drug education is most effective when it reflects theneeds and attitudes of young people, and when it isdelivered in an interactive manner. Young people shouldalso be involved in the development of drug educationprogrammes to ensure the programmes’ relevance.

• Information about young people’s drug use is essentialfor developing effective drug education programmes.Effective drug education sometimes involves theprovision of factual and relevant information about drugsand drug use.

These findings are generally consistent with the YouthDevelopment Strategy Aotearoa (Ministry of YouthAffairs 2002).

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EXECUTIVE SUMMARY

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Summary of key findingsof the literature review

Objectives of drug education

The overall objective of any drug education programmeshould be a net reduction of drug-related harm. Thismeans that a harm minimisation approach should beadopted for drug education. Harm minimisation caninclude a number of objectives, including abstinence orreduction in use. However, harm minimisation alsoemphasises realistic, evidence-based strategies, and thereis evidence that “drug education programmes having[the goal of abstinence] consistently fail to producebehavioural effects” (WHO 2002). While abstinenceshould be available as an option for young people, drugeducation programmes should have other harm mini-misation objectives as their focus.

Drug education programmes must be developed carefullyto ensure that they result in a net reduction of harm.Drug education strategies should, therefore, be based ona thorough assessment of the evidence about the likelyeffects of the strategy.

Particular harm reduction objectives for drug educationprogrammes should be realistic, achievable and measur-able. These objectives will vary depending on the natureof the programme, its setting and the needs of the groupundergoing intervention. Those who are participating inthe programme should be involved in developing its

objectives, and those objectives should reflect the needsof the target group, including the needs as the targetgroup perceives them.

Effectiveness of drug education

The term “effective” can be used to describe differentaspects of drug education programmes or their imple-mentation. A programme can be effective in one way,but ineffective in others. For example, a programme thatis effectively delivered in the classroom may not beeffective at producing any changes in behaviour amongthe programme participants. It is not possible to defineindicators of effectiveness for a drug education programmewithout first knowing its objectives.

Evaluation of drug education

The purpose of this report was not to evaluate NewZealand drug education programmes, but to identify bestpractice. However, in the course of the research, it wasnoted that there has been little reliable evaluation of drugeducation in New Zealand, and the report recommendsthat a framework for evaluation be developed to improvethe evaluation of New Zealand drug education programmes.

programmes to be subjected to outcome evaluations ofthe rigour necessary to establish their effectiveness atachieving sustained behaviour change.

Instead, this report recommends a three-tier frameworkfor evaluation. Best practice would be established fromoverseas and New Zealand research, including outcomeevaluations. Formative and process evaluations wouldallow New Zealand drug education programmes to becompared with best practice and developed or modifiedaccordingly. These programmes would then be imple-mented, and process evaluation would be used to monitorhow well the implementation was proceeding.

A subsequent stage of the MYD project is to developstandards for drug education based on current knowledgeabout best practice. Drug education programmes shouldbe evaluated according to whether they implement bestpractice.

| 5There are three main types of evaluation that are applicableto drug education:

• Formative evaluation, which is evaluation activitydirected at optimising a programme.

• Process evaluation, which describes and documentswhat happens in the context and course of a programmeto assist in understanding a programme and interpretingprogramme outcomes, and/or to allow others to replicatethe programme in the future.

• Outcome (and impact) evaluation, which assessesthe positive and negative results of a programme.

To know whether a drug education programme achievessustained effects, it is necessary to undertake an outcomeevaluation, which is usually highly complex and expensive.It is unrealistic to expect all New Zealand drug education

Proposed three-tier framework for evaluation of drug education

What is evaluated

Programme elements

Programme design

Programme implementation

Where evaluation takes place

In experimental test sites (formative,process and outcome evaluations)

During programme development, intest sites and through evaluation ofmaterials (formative, process andimpact evaluations)

Classrooms, communities and othersettings (process and impactevaluations)

What the evaluation shows

Whether elements of drug educationachieve changes in knowledge,attitudes or behaviour

Whether the programme is consistentwith best practice and likely to achieveharm minimisation

Whether the drug educationprogramme is being implementedproperly as designed

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| 7one drug causes use of another. These issues in youngpeople’s drug use require more research.

It is clear that drug use is not simply about an individual’srisk and protective factors, but is also determined by socialand environmental factors, such as how a drug is regardedand used in the community. In fact, many risk and pro-tective factors have social and environmental causes. Ifdrug education alters risk and protective factors at thelevel of the individual, it is likely that the social and environ-mental causes of drug use may continue to exert theirinfluence on the individual, and gradually erode anybeneficial effects of drug education. For drug educationto achieve lasting effects, it is important to have coordinateddrug education support in the community, societyand media.

Targeting populations

Targeted programmes are necessary for dealing withyoung people who are particularly at risk, who are notlikely to benefit from universal programmes (eg, becausethey have left school). There appears to be a special needfor programmes targeted at young people who havefinished school or have dropped out of school. Programmesshould also be targeted at young people who are subjectto a high degree of risk, including homeless young people,young offenders, those in special care or those with mentalillnesses. Population-wide programmes should beadaptable to account for differences between groupsparticipating in the programmes.

Cultural issues

For drug education programmes to work, they must beaccepted by and appropriate to their target communities.Therefore, it is important for drug education programmesto be developed in partnership with target communities,which include Maori, Pacific and Asian communities. Drugeducation programmes should recognise varying conceptsof health, family and community that are associated withdifferent target groups.

Causes of drug use – risk and protective factors

It is important to understand how drug education worksin order to design effective drug education programmes.Most research in this area focuses on risk and protectivefactors – it is believed that risk and protective factors aremeasures of a young person’s potential vulnerability orresistance to drug-related harm. For example, an importantrisk factor is early onset of drug use: the earlier youngpeople are exposed to drugs, the more likely that theywill experience later drug-related harm. However, thelinks between risk and protective factors and drug-relatedharm are complex and uncertain. Also, there is littleresearch into the way that drug education acts upon riskand protective factors.

There are also functional reasons for drug use beyond riskand protective factors. Some young people may usedrugs for functional purposes, such as to achieveexcitement or to relax. There are also developmentalpathways of drug use – patterns of progression from onedrug to the next -- though this does not mean that use of

There is more evidence and literature about drug educationin schools than there is about community-based or family-based drug education. It is possible to identify a numberof features of effective drug education in schools, andthere is growing international consensus about what thosefeatures are.

The evidence from international literature suggests thatthe following elements contribute to the success of drugeducation programmes in schools:

• relevance to the needs of young people, including theneeds as young people perceive them

• interactive and activity-oriented design• follow-up and ongoing education• provision of factual information• social influence approaches (factual information,

normative information and resistance skills training).

There is also some evidence for the importance of:

• training for those who deliver the programme• family-based components• consistency of the message throughout the school and

community.

One of the challenges facing school-based drug educationin New Zealand is the autonomy schools have been givenin their approach to drug issues. A drug education

8 | programme is likely to be less effective if it is provided ina school that has inconsistent policies on drug issues.

Another issue is how to support drug education in theclassroom with coordinated policies of governmentagencies, drug education providers and communities.

New Zealand best practice guidelines or standards shouldbe developed after consultation with stakeholders, andshould take into account local needs, attitudes and cultures.

Family-based drug education

Compared with school-based education, there is lessevidence about the effectiveness of family-based drugeducation, but the evidence is positive. Targeted family-based drug education programmes have been shown tobe effective in the short term. Although family-basedprogrammes may involve considerable resources, theyare an important strategy for reducing drug-related harmamong high-risk populations. There is also a small amountof evidence that school-based programmes involving familycomponents can be successful.

Programmes that involve parents and children togetherappear to be more effective than those that do not.Evaluations of family-based programmes in the UnitedStates show the importance of including componentsthat deal with parent-child communications and dynamics.

School-based drug education

Community-based projects are also promising, althoughthey involve the expenditure of considerable resourcesand require long-term support to be effective. New Zealandprojects are small, and are often based in very smallcommunities. Projects have had most success whenthey are based on cross-sectoral, collaborative action bygroups and agencies that have an existing interest inand responsibility for reducing drug-related harm.

Funding for a coordinator has been a key factor in successfulprojects and in sustaining community efforts over time.Community ownership has been identified as a key factorin success, and this is particularly important with Maoricommunities, with whom health promotion has been lesseffective than with the general population. Maori com-munities are, however, responsive to involvement in theirown projects based on Maori tikanga.

It is important that community action projects be sustainedover a reasonable period of time. Social change takestime, and short-term or pilot projects may be working butwill not allow for sufficient change to be captured inevaluations or local harm data. Recent community actionprojects have set realistic objectives related to communitycapacity building and activities affecting risk-and-protective

| 9factors that are known to influence drug use by youngpeople and drug-related harm.

Mass media and other interventions

A final means of providing drug education is through massmedia and product labelling. These strategies may havecumulative effects that are not captured by evaluationover short periods. Cumulative effects may contribute toslow change in the social cultures around tobacco, alcoholand other drugs that influence individual behaviour, andreinforce messages provided through community action,family-based or school-based education.

Industry sponsorship

There has been recent controversy over tobacco andalcohol industry sponsorship of drug education pro-grammes. To avoid such controversy in the future, and toidentify if/when such involvement may be appropriate, itis recommended that guidelines be prepared to provideguidance for drug education providers. There are interna-tional precedents for this in Canada and the United States.

Community-based drug education

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This section sets out recommendations, contained inthe literature review, for best practice for drug educationin New Zealand. The recommendations are groupedin the following headings:

• Best practice for drug education

° Harm minimisation

° Relevance to New Zealand communities

° Programme design

° Coordination

° Targeting

° School-based drug education

° Family-based drug education

° Community action on drugs

° Mass media and other strategies• Evaluation• Further research• Policy context• Further work

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" Drug education programmes in New Zealand shouldhave harm minimisation as their overall objective.

" The objectives of drug education programmes shouldbe realistic, achievable and measurable, and shouldlead to an overall reduction in drug-related harm.

" Decisions about which drug education strategies touse in any given situation should be based on anevidence-based assessment of the net harm reductionthat is likely to be brought about by the strategies inthat situation, having regard to the likely harms involvedin drug use, cultural issues, patterns of use, and thelikely effects of drug education interventions.

Best practice for drug education

Harm minimisation

RECOMMENDATIONS

Relevance to New Zealand communities

" Drug education programmes in New Zealand shouldtake into account the principles of the Treaty of Waitangi.

" The process of developing best practice guidelinesshould involve consultation with educators, programmeproviders, students, relevant community organisations,Maori and Pacific Island groups with expertise ineducation and drug education.

" Programmes should be established in consultationwith the programme participants to ensure that theirneeds are reflected in the programme objectives.

Programme design

" Best practice should include a requirement that theprogramme demonstrate a clear conceptual relationship,based on sound evidence, between the programmeas intended to be delivered, and the harm reductionoutcomes intended to be achieved.

" Standards should be developed for peer-led education,including ethical guidelines and training requirements.

" Drug education best practice guidelines for New Zealandshould take account of efficiency, effectiveness,programme coverage, cultural relevance or relevanceto the particular harms and risks faced by young peoplein New Zealand.

" Drug education programmes should be based on anholistic view of mental health, taking into accountspiritual and community well-being. A strengths-basedapproach to drug education is preferable to a deficit-based approach.

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Coordination

" There should be coordination of messages aboutdrugs and drug use throughout and across communities.This means that:

• Laws about drugs and drug use should be realistic,evidence-based and consistently and fairlyenforced, and consistent with the messagesbeing delivered through education.

• Messages in the media (including film, televisionand advertising) should be consistent with themessages delivered through education.

• Communities should be encouraged andsupported to work together to set examples thatare consistent with the messages deliveredthrough education.

• Families should be encouraged and supported tomodel behaviour consistent with the educationalmessages.

" Drug education programmes should contribute to theresiliency of communities, and an aspect of effectivedrug education is likely to be the strengthening of linksbetween communities and government institutions.

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Targeting

" Drug education should be provided to young peopleat an early stage in order to help prevent the earlyonset of drug use, which is a predictor of later drug abuse.

" Programmes should be targeted to meet the needsof particular groups. Some programmes should betargeted at young people who are subject to a highdegree of risk and those who are not in school. Thereis also a need for programmes to be targeted to differentcultures where there are linguistic, cultural or otherreasons why universal programmes might not be suitable.

" Solvents (and possibly other readily available drugsthat, despite their availability, are used by smallproportions of the population) should be excluded fromuniversal or general drug education programmes.Education about these drugs should be targeted tocurrent users.

School-based drug education

" Effective drug education in schools is likely to includethe following features:

• relevance to the needs of young people• interactive and activity-oriented design• peer-led education• follow-up and ongoing education• provision of factual information• social influence approaches.

Family-based drug education

" Family-based programmes should involve parentsand children together, and should include componentsthat deal with parent-child communications andfamily dynamics.

Community action on drugs

" Community action projects on drugs should:• involve cross-sectoral collaborative action by groups

and agencies that have an existing interest in andresponsibility for reducing drug-related harm

• be supported over long-term timeframes, includingprovision of a coordinator

• set realistic and measurable objectives.

" Communities should be given ownership of community-based drug education projects.

Mass media and other strategies

" Mass media campaigns are more likely to be effectivewhen provided in conjunction with a high-profile policypackage including enforcement and community action.

" Factual information about drug effects and healthand safety risks may be most effective when targetedto the groups to whom it is most relevant, and/or toindividuals who are at a stage of readiness for change.

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Evaluation

" Drug education programmes in New Zealand shouldbe evaluated according to whether they effectivelyimplement current best practice.

" A three-tier framework for evaluation of drug educationprogrammes should be developed.

" Evaluations should use a variety of methodologies(including formative, process and outcome evaluations)and data collection methods to ensure that there is noreliance on a single source of data.

" The following initiatives should be encouraged:• A greater emphasis on formative and process

evaluation against what is known about bestpractice for drug education.

• More use of formative evaluations duringprogramme design.

• Acknowledgement of the limitations of evaluationsthat have been undertaken to date.

| 17" A basic resource on evaluation should be developedto assist programme providers and purchasers in theirunderstanding of the implications and usesof evaluations.

" Indicators of programme effectiveness should measureaspects of harm minimisation, such as reductions inrisk-taking behaviour, as well as consumption of differentdrugs. Indicators should include appropriateness oracceptability of the programme (including culturalacceptability), but should also be designed to measurechanges in knowledge, attitudes and behaviour of theprogramme participants.

" Indicators should take account of cultural issues andshould be developed in consultation with the relevantcommunities.

" Indicators of programme effectiveness should beexplicitly related to the objectives of the programmeand reflect the programme logic (the steps by whichthe drug education intervention is believed to effectchange in the participants).

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Further research

" There should be ongoing research into current druguse trends to ensure that trends are identified earlyand programmes are developed or adapted toaddress them.

" There should be ongoing research into developmentalpathways of substance abuse, and the settings andexperiences that increase the risk of further drug useamong New Zealand young people to ensure thatpatterns of use in New Zealand are understood.

" There should be ongoing research into the ways inwhich drug education can act upon risk and protectivefactors to reduce the risk of drug-related harm.

" Further research is warranted into patterns of druguse among Asian young people, and also about attitudestowards drugs among all minority communities.

" There should be further research into the functionalreasons for drug use among young people in NewZealand.

" The results of the meta-analysis of 10 New Zealandcommunity action projects being undertaken by theSHORE Research Centre, Massey University, shouldbe taken into account in developing guidelines forcommunity-based drug education in New Zealand.

Policy context

" Greater coordination between school-based drugeducation and other drug-related measures isrequired,and school-based drug education needsadequate support.

" Strategies should be investigated for overcoming thechallenges for family-based programmes (cost ofimplementation, identification and targeting of high-risk families, and maximising participation rates).

" A review of industry involvement in drug educationin New Zealand is needed, with a view to developingguidelines similar to Health Canada’s Guidelines forEffective Collaboration.

Further work

The next stage of the MYD project will involve thedevelopment of three resources:

1. Standards or principles for effective drug education.

2. Guidelines for effective evaluation of drug education.

3. Criteria for purchasers of drug education to use whendeciding which programmes best meet their needs.

It is recommended that stakeholders be consulted inthe course of developing the standards, and that draftbest practice principles be circulated as part of theconsultation process.

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Disclaimer

This overview document is based on the report EffectiveDrug Education for Young People: A Literature Review andAnalysis by Allen & Clarke Policy and Regulatory SpecialistsLtd, Ministry of Youth Development, 2003.

The purpose of the literature review is to inform futurework in this area. Therefore the opinions and recom-mendations expressed in the literature review andreproduced here do not necessarily represent the officialviews of the Ministry of Youth Development.

Published by

Ministry of Youth DevelopmentPO Box 10-300, Wellington, New Zealandwww.myd.govt.nz

ISBN 0-478-25018-5

December 2003

This document was designed and produced byThe Church Ltd. It has offered final year design andphotography students an opportunity to gain commercialexperience in a structured and mentored environment.

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