Earlier Alcohol Prevention?

EurekAlert tossed up a press release from the University of Minnesota yesterday with the provocative title: “U of Minn researchers find primary alcohol prevention programs are needed for ‘tweens’” and the even more eye-popping subtitle “Study recommends that prevention programs occur as early as third grade.” What, you may ask, is the problem this is intended to solve?

The study found that adolescents who already use alcohol are less receptive to prevention programs aimed at all students. Intervening at earlier ages, specifically between third and fifth grade, would allow for truly universal anti-alcohol messages that would also provide support for high-risk students.

“Children who use alcohol in sixth grade respond differently to messages about alcohol use than those have not used alcohol,” said Keryn Pasch, M.P.H., Ph.D., University of Minnesota School of Public Health and first author of the study. “By sixth grade it’s too late; we’ll miss many of the at-risk kids.”

It’s not clear to me, though, that this is the right solution to the problem. That is, if “adolescents who already use alcohol are less receptive to prevention programs aimed at all students,” it seems like the problem might be with the prevention programs, rather than an indication that the intervention is coming too late.

I can’t say that I’m up on the very latest in alcohol prevention programs, but the stuff I remember seeing as late as the mid-90’s definitely seemed susceptible to the “Reefer Madness” problem. That is, the message was, basically “If you use alcohol, you will inevitably and immediately wreck your life.” Presented with any of the ample evidence that alcohol is not, in fact, cyanide– adults who drink without problems, older students who drink without spectacular ill effects, trying alcohol without dropping dead instantly– students then write the entire program off as a giant pile of crap. They then end up ignoring advice about more sensible and responsible use of alcohol, and wind up doing more damage to themselves than they might’ve without the program.

It’s possible that alcohol prevention programs have become substantially more sophisticated since the last stuff that I saw (I haven’t seen what the Student Life people here use). The anti-drug ads I see on tv have certainly gotten worlds better than what I remember as a kid– the “anti-drug” spots are actually pretty good, in a slightly corny way. The emphasis isn’t on trying to scare kids with the negative consequences of drug use, but rather on the more positive things they could be doing rather than doing drugs.

The fact that the programs they’re talking about don’t work on kids who have already tried alcohol, though, makes me wonder if it’s not still a scare-based program at the core. In which case, it’s not clear to me that starting to scare the students at earlier ages is really a useful solution.

12 thoughts on “Earlier Alcohol Prevention?

  1. Exactly right. This was the whole problem with the “Just Say No” campaign. It was built around the message that if you do drugs, your life will immediately asplode. Turns out that’s not exactly true. In most cases the problems don’t show up for quite a while. So it ends up being a paper tiger.

    It also rather begs the question, doesn’t it? If the programs don’t work on kids who have tried alcohol… shouldn’t they be developing programs that do work on these kids, rather than racing them to the bottom?

  2. Our culture is currently arranged such that for anyone under 21 alcohol is this Big Evil Forbidden Thing, but it’s also considered a Party Essential, at least (wink, wink) for anyone old enough to buy it legally. The latter viewpoint is hammered home repeatedly in popular culture and advertisements for alcoholic beverages. Which is why the anti-substance abuse campaigns we typically produce in this country (I haven’t seen a recent program about alcohol abuse either, but the ones I remember are along the same lines as your recollection) tend to approach “Reefer Madness” hysteria.

    It’s true that alcohol abuse does have a serious potential downside, but because of prohibition for under-21s kids have no safe and legal way of learning to deal with the risks. (More than one European-born scientist of my acquaintance has pointed this out to me.) And people wonder why binge drinking is such a problem among college students, the majority of whom are legally underage.

    So I definitely agree with you: the solution is not to produce these Puritanical don’t-touch-this-stuff campaigns for ever younger kids who simultaneously see society promoting alcohol as essential for a good time, but to design a better program for those kids who are at risk for becoming abusers–many but not all of whom are the ones who this study shows the ad campaigns aren’t convincing.

  3. Preaching abstinence is waving red flags at bulls. Kids viscerally know Official truth is all lies.

    To impose jackbooted State morality re recreational pharmaceuticals, enforce their use in school. Give kids swill to guzzle. The next week make it “all natural tobacco” cigarettes. Week following it is sterile syringes, latex rubber tubing, and find your own vein. You’ll have a mob of ankle-biter Puritans within a month.

    Showing 20 hours of “aged to perfection” pornography as sex ed. won’t work. A teenaged male will hump road kill. True biological imperatives – as opposed to behavioral excursions – cannot be thwarted. Celibate Roman Catholic priests are homosexual pedophiles. Squeeze a balloon and it bulges elsewhere.

  4. coupla points

    Chad you are conflating all kinds of issues here. worst is the notion that just because a strategy to reduce the number of kids drinking works at less than 100% efficacy means that it “doesn’t work”. false. the idea that any program is “doing more damage”, by actually increasing drinking I presume?, is of course testable but I doubt you’ve read over the data on that. my read suggests there is going to be a very big data hole trying to test that particular hypothesis by lit search, btw.

    which brings me to the usual. and no, I’m not bashing my head against you fizzycysts-with-bio-envy types, just a note for those that are a little less agenda driven. we do not have to rely on our seat of the pants, N=1 or N=small-college-res-living or N=my-high-school-buds or any of that. Not that gut feelings aren’t a great place to start the inquiry. Not that gut feelings can’t sometimes provide a critical backstop on navel-gazing research traditions. But. Still. A simple trip to PubMed or GoogleScholar and some judicious searching will show you that yes there ARE studies trying to look at direct relationships between intervention strategies, drinking attitudes and drinking behavior in the target populations.

    getting back to this study, you are trying to generalize these 6th-grade focused results to the more general problem. probably an error. the article points out

    Clearly, sixth grade users are significantly different than nonusers on nearly
    every risk factor that is examined

    a point that is captured in the press release but not emphasized enough. As you go up through the grades, last-12-month drinkers and nondrinkers become more similar as drinking becomes more normative in the population.

    how does this relate to anti-drinking messages? The 6th grade drinker is unusual in that they are much more likely to have the whole host of enviornmental and genetic variables stacked against them. “messages” may have little chance to affect change in a sub-population at the very highest of risks. point being that it may not be possible for any practical “message” based intervention to do anything. This does not mean that messages cannot be effective in other subpopulations of interest. again, this is not good evidence that any particular intervention strategy works or does not work in the larger sense you seem to be using.

    in the general population based perspective, there is some evidence that just say no, scared straight and the like work. I was essentially a lifelong skeptic of just say no, etc, having been at a, er, critical age when Nancy R started with this agenda. I have been delving into the data in recent years (monitoringthefuture.org is a great place to start for those interested) and I have three observations that bring me to reconsider

    -downward trends for most adolescent drug use suspiciously tied to the mid 80s.

    -the canonical “scared straight” effect for me was a massive decrease in cocaine incidence and increase in “dangerous” attitudes associated with, you guessed it, Len Bias.

    -some minor MDMA stuff of similar nature in 2002 testifying not to an accurate message but rather very likely to the tremendous play an inaccurate paper received.

    I would suggest that these broader trends need to be examined before we can so easily dismiss the effect of things that to our gut seem silly or even counterproductive. need we remind you Chad that there is no way in hell that you are representative of the general population, being a fizzycyst and professor and all that?

    to wrap up, my gut feeling is with yours, i.e., that at some point with adolescent drug use, we start to lose the audience by our lies-to-children. i posted on this before actually. my point here is that there are actual data available for some of this and our gut feeling can be wrong in some particulars or even whole-scale.

  5. Chad you are conflating all kinds of issues here. worst is the notion that just because a strategy to reduce the number of kids drinking works at less than 100% efficacy means that it “doesn’t work”. false.

    From the last link in comment #3, Results section:

    “The school districts receiving the prevention program had significantly lower scores on the Tendency to Use Alcohol Scale (indicative of less likelihood of drinking) at the end of Grade 8 than did students in the comparison school districts among all students in the cohort (n = 1901) and among those students who reported no use of alcohol at baseline (n = 1176). There were no differences found between students who reported alcohol use at baseline (n = 712).”

    That’s not partial effectiveness, that’s “doesn’t work.”

    in the general population based perspective, there is some evidence that just say no, scared straight and the like work.

    From the same link, in the introduction:

    “Results indicated that the primary effect of DARE was a change in commitment to not use substances. This change significantly mediated the behavioral effects; however, DARE’s effect on the mediator was small. Also, DARE only had significant behavioral effects on tobacco use, it did not have significant effects on alcohol use, illegal drug use, steroid use, inhalant use, and drug selling and dealing. ”

    Now, you can quibble that DARE is not really a “scared straight” program, but stories about the failure of DARE through exactly the failure mode I mention in the post are what I had in mind when I wrote that. So it’s nice to get some confirmation that I’m not just pulling this out of thin air.

  6. The fact that the authors of this study do not make the same conflation error that you made in your post is irrelevant to my point. Your comments quite obviously attempt to apply this study to the more general case of anti-drug messages. You are postulating the universal inability of “scare” approaches to prevent alcohol (ab?)use and using this as a confirmatory example. I think the reality is a bit more complicated.

    So it’s nice to get some confirmation that I’m not just pulling this out of thin air.

    I was not suggesting one’s gut feeling is not correct in some cases. Just that it is not correct in all cases. You were apparently arguing from your gut feeling and just because you happened upon some post hoc confirmation does not make it correct to do so. The apparent effect of the Len Bias affair on cocaine use is really quite dramatic.

    One plausible alternative hypothesis is that even if a program intends to use “scared straight”, the real question is whether the target audience is, in fact, scared. This, I think, will probably be more in line with your underlying thesis given your comments regarding “ample evidence that alcohol is not cyanide”.

    Interestingly, IV heroin is not “cyanide” either. Of course, in the absence of a constant bombardment of apparently nonproblematic heroin use the “scare” message is more likely to take hold.

    A close comparison of the real conditional probability of negative outcome (acute fatality, addiction, pick your outcome) given various recreational drugs versus perceptions of risk/harmfullness and actual drug sampling is another area to consider. It becomes hard to think of plausible alternatives other than “scared” that are at the root of why some drugs of abuse are sampled more widely than others.

  7. I work in advertising. Which, I guess is a euphemism for “I make ads.” Years ago, I worked on a pitch to try to win the anti-tobacco public service message. In the research portion of the pitch, we learned that numerous studies had shown that anti-tobacco efforts consistently increase tobacco usage among teens, compared to no messaging at all. This is presumably due to the pretty universal truth that anything an adult tells a teen not to do immediately becomes a cool thing to do.

    So my conclusion was of course that the best thing to do would be nothing at all. But that doesn’t exactly do much for one’s advertising career – this was a multi-billion dollar account. So my backup idea was to do anti-anti-smoking advertising. Essentially showing people who were the antithesis of cool using cigarettes, and leave it at that. Nothing else. No message – just accountant types smoking while they talked about their in laws. Didn’t fly though.

  8. First, I was struck by how little work any of the “journalists” did in the articles I found through Google. All of them basically parroted the press release.

    I did turn up several descriptions of Project Northland. One of them seemed quite worth the read:


    I was quite pleased to see that they make the point that alcohol can kill. That seems to have missed its mark with even more of the current crop of college students than it did with my generation. It is different if you first drink with adults who know the risks and share them, than if you start with other 12 year olds who don’t.

    It is not “scared straight” or “just say no”, but I can see how this program could work with one audience and not another, particularly when all of the psychological and familial factors are taken into account. I think the point of the article is that money on one-size-fits-all programs is wasted after a certain point. One conclusion could be that, once a significant fraction of students are drinking, you need a different program for the drinkers. I am amazed that 17% of 6th graders are drinking. That could be enough to create the illusion that everyone is drinking, a key reason for social renorming (which will work with one group but not with the other).

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