Prevention Said Better Than Penalties in Discouraging Drug Abuse
School-based initiatives similar to programs that have kept 7th graders from taking up cigarette smoking offer a more promising means of countering adolescent drug use than do tougher drug-enforcement laws, according to a new report on drug-abuse prevention.
The report suggests that the recent anti-drug efforts of the federal government may be misdirected and recommends a readjustment of federal spending to provide more funding for "prevention" programs. Because the supply of drugs can never be eliminated, the report says, the government should focus on reducing the demand for drugs.
"The most encouraging evidence comes from the success of school-based programs to prevent cigarette smoking," say the authors of "Strategies for Controlling Adolescent Drug Use," a broad review of the scientific literature on drug use and the effectiveness of current anti-drug programs.
Prepared by the Rand Corporation, a private nonprofit research institute in Santa Monica, Calif., the report was funded by a $300,000 grant from the Conrad N. Hilton Foundation. Basing their conclusions on 15 months of research, the authors of the report--J. Michael Polich, Phyllis L. Ellickson, Peter Reuter, and James P. Kahan--are critical of the federal approach to combating drug use.
According to the report, of the $1 billion the federal government spent on anti-drug programs in 1982, more than 70 percent was devoted to law enforcement, while only a small amount went to prevention programs. "Our analysis suggests this emphasis should be reversed," the report states. "Prevention appears to be more promising than the other methods of drug control."
Federal efforts to restrict the supply of illicit drugs and drive their price up to prohibitively high levels has been effective only to a point, the report says. "We are bailing out the ocean with a thimble," Mr. Polich said in a statement issued last week. "So far, police pressure has succeeded in making some drugs expensive and difficult to obtain, but there are very real limits to what law enforcement can accomplish."
The most significant conclusion they draw from their research, the authors write, is that the supply of drugs can never be eliminated.
Most drug supplies originate in other countries, and even increased efforts to control drug smuggling would have little impact on the flow, according to the report.
"Interdiction expenditures rose from $83 million in 1977 to $278 million in 1982," the report states. "Consequently, large quantities of marijuana and cocaine are now seized at the borders and on the seas, perhaps 10 to 30 percent of all drug shipments.
"However, the impact on the drug market has not been commensurate," the report continues. "For one thing, large quantities of drugs are readily available overseas to replace any shipments that are confiscated. More important, the price structure for all illegal drugs is steeply graduated, with prices rising quickly as shipments move through the chain from producer to retailer.
"A gram of pure cocaine, for instance, is sold for $5 to $10 by a Peruvian refiner and for $50 by a U.S. importer 'on the beach,' but for $625 at retail," the authors write. "Thus, even large price changes at the import level--say, increasing the importer's selling price from $50 to $100--add only a small amount to the ultimate retail cost.
"As a result, we find that even doubling the current seizure rate would probably increase the price of a marijuana cigarette, now selling at 75 cents retail, no more than 9 cents--hardly enough to discourage much consumption," the report says.
Similarly, cracking down on drug retailers would have little impact on the price of illicit drugs and would also be prohibitively expensive, according to the report; to reduce drug supplies by even 15 percent would require tripling investigative resources, an increase in spending of $800 million.
Because reducing the supply of illicit drugs is so difficult and expensive, the report suggests a "preventive" approach aimed at reducing demand. But it asserts that until recently, preventive programs have failed to significantly affect drug use among adolescents.
"In 1973, the National Commission on Marijuana and Drug Abuse concluded that 'no drug education program in this country, or elsewhere, has proven sufficiently successful to warrant our recommending it,"' according to the Rand study. "In 1980, the situation was little different: A review of more than 100 programs reported that 'by far the largest number of studies have found no effects of drug education upon use.'"
But the failure of those programs is not the preventive approach itself, but the "incorrect assumptions about why adolescents begin using psychoactive substances," the report says. The early prevention programs, based on the theory that children used drugs because they were ignorant of the dangers, simply provided information on the health risks of using drug, the Rand authors note.
The success of recent preventive programs designed to discourage cigarette smoking, however, indicates that knowing the dangers of drug use will do little to prevent adolescents from using drugs, according to the researchers.
"Warnings about future disease are likely to fall on deaf ears," the report states. "Recent longitudinal studies have tracked the process by which adolescents start using drugs and 'social' influences are the main influences on adolescent drug-taking.
"Young people have a strong desire to appear 'grownup' and independent. If drug use is defined as an adult activity and adolescents see older youth or adults taking drugs, they are more likely to imitate that behavior in an attempt to claim a mature status." Young people also are "present-oriented," the report states. "They are more concerned with their life at school, their current social milieu, and their acceptance within the adolescent social group than with the long-term risks of their actions."
Thus, preventive programs based on a "social-pressures" model have been more successful, the report states.
The researchers point to numerous studies of programs that focus on the social influences that promote cigarette smoking, familiarize adolescents with the pressures to smoke, and teach them techniques for dealing with those pressures.
The first such anti-smoking program, developed by the psychologist R.I. Evans, involved showing students films about children of the same age who did not smoke. The characters in the movies provided 7th graders with information about social influences and resistance techniques. The program also emphasized the short-term consequences of smoking, such as bad breath and discolored teeth.
In one program, studied by researchers at Stanford University, students who had received the training smoked less than those who had not.
"Two and a half years after the training, 15 percent of the students who did not receive the special program had smoked in the past week compared to only 5 percent of those who did receive it--a two-thirds reduction in the proportion of adoles-cents engaged in regular smoking,'' the researchers found.
Other studies of programs in Texas, New York, Minnesota, and Ontario, Canada, have produced similar findings, according to the Rand study. Such programs probably can be used successfully to prevent the use of other drugs as well, the report states.
Based on the Rand report, the Conrad N. Hilton Foundation is planning to provide the research firm with an additional $1.1 million to fund 30 field projects to test the prevention program's effectiveness in curtailing other types of drug use.
A spokesman for the foundation said that if the early results are promising, the foundation will fund up to four additional years of testing, with the possibility of a major nationwide effort that would ultimately require resources from a consortium of private foundations.
"Drug abuse accounts for billions of dollars in health-care costs," said Donald H. Hubbs, president of the foundation. "Official statistics undoubtedly underestimate the true extent of the problem, and its cost in human suffering is incalculable."
According to statistics from "Drugs and American High School Students, 1975-1983," a study released this month by the National Institute on Drug Abuse, drug use among high-school seniors is fairly common. (See Education Week, Feb. 15, 1984).
Fifty-seven percent of the seniors surveyed reported having used marijuana; 35 percent said they had used stimulants; 93 percent said they had used alcohol; and 71 percent said they had smoked cigarettes.