What schools can do to prevent drug and alcohol misuse

Drug and alcohol misuse among young people is on the decline, yet cuts to services that help to educate and support at-risk children threaten to derail the progress. Here, Zofia Niemtus looks at what schools can do to keep things heading in the right direction
5th April 2019, 12:03am
How Schools Can Help Maintain A Low-level Alcohol Use

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What schools can do to prevent drug and alcohol misuse

https://www.tes.com/magazine/archived/what-schools-can-do-prevent-drug-and-alcohol-misuse

It’s Monday morning and 30 teenagers have dragged themselves into your lesson. They do not look awake, let alone ready to learn, and you can understand why: you were, after all, a teenager once. You know teenagers experiment with drink, and sometimes drugs. A weekend of hedonism is clearly scuppering your attempts to get them to remember even the basic plot of Romeo and Juliet.

But such a conclusion would be unfair and misguided. Teens, actually, are not as hedonistic as they once were. Today’s young people are far more likely to abstain from such pursuits than the current crop of teachers were as teens, continuing a steady decline in alcohol and drug consumption over the past decade among young people in the UK and other high-income countries. It has led to today’s young people being labelled the “new Puritans”.

For example, the Youth Drinking in Decline investigation at the University of Sheffield revealed the number of 11- to 15-year-olds who had ever had an alcoholic drink fell from 61 per cent in 2003 to 38 per cent in 2014 (NHS figures do show an upswing to 44 per cent in 2016, although the data is not directly comparable owing to a change in the survey question). In 2001, 88 per cent of 16- and 17-year-olds reported that they drank alcohol, while in 2016, only 65 per cent did.

They don’t like piña coladas

So, what is going on? Has all the good work in schools around alcohol and drug awareness finally paid off or has all this occurred despite what is happening in the classroom? And are there lessons we could learn from the decline that could help us to reduce the numbers further still?

Of course, the kids could just be telling the adults what they want to hear. But John Holmes, a reader in alcohol policy in the Sheffield Alcohol Research Group, believes this is unlikely. In his view, the statistics seem reliable.

“There is a risk that young people may misreport their drinking, but there are two arguments against this,” he says. “First, we are interested in the trend over time and there is no reason to think that misreporting has worsened so as to create the apparent reduction in drinking.

“Second, there is evidence, from studies in other areas, that young people’s reporting is reasonably accurate - for example, when their responses on whether they smoke are checked using biological tests on their saliva.”

And so, he says, it seems that we really are in an age of more negative attitudes towards alcohol, and “a much-improved picture with regards to young people’s drinking”.

It’s a similar story with drug use, which is also on a long-term downward trend. The Home Office’s latest survey on drug misuse puts the estimate for people aged 16-24 who have taken any illegal drug in the past year at 19.8 per cent, a significant drop from the 1996 figure (when the survey began), of 29.7 per cent. Cannabis remains by far the most popular illegal drug, with 16.7 per cent of 16- to 24-year-olds having used it in the past year, followed by cocaine (6 per cent) and ecstasy (5.1 per cent).

That said, Ian Hamilton, a senior researcher in mental health at the University of York working on the relationship between drug use and mental health, says the overall picture may be positive but it is more nuanced than it initially seems.

“It is on a steady downward trend,” he acknowledges. “One of the things that can get lost in school drug education is that the norm is for young people not to use drugs. But for those who do, it seems like they’re developing more serious problems. Although, generally, young people seem to be more abstinent than previous generations, we are seeing more of them presenting to specialist drug treatment. It’s a bit of a paradox - we’ve got usage going down in the population but treatment going up.”

There could be a number of reasons for this, he continues. It may be that young people are more aware of drug treatment options and how to access them, or it could be that they are ending up in treatment as a result of other issues. “The primary problem can be a whole range of social things, like mental health, but drug and alcohol treatment is where they end up,” he says.

“We have to consider that this is against a backdrop of austerity, where services have been cut to the bone. Just as the police are seeing more and more people with mental health problems, drug and alcohol services are seeing the same, because other services aren’t there to pick young people up. So, those figures might not be a true reflection of what is happening.”

There are also unknowns around what is happening to cause the reduction in alcohol and drug misuse generally, Holmes says. Schools may not be able to claim all of the credit, or perhaps any.

“We don’t really know what is driving this,” he says. “The reality is that it is probably a mixture of things. It could be to do with changes in how young people are being parented, with better relationships between parents and children. The internet and technology might be playing into this, too. There’s the ‘substitution of time’ element, so young people might be spending more time online, and simply spending less time in the places out and about where they might be drinking.”

Then there is the issue of the economic crisis, he continues. Not only has this limited the amount of money that young people have access to, it’s also changed the way that they think about their futures. They’re aware that they need to get good qualifications to be competitive in a tough labour market, making them “much more future-oriented than they once were”.

Boris Pomroy, chief executive of drug and alcohol misuse prevention charity Mentor, agrees. “This is a really sensible, risk-aware group of young people,” he says. “They’re a much more switched-on cohort across the board. It’s never been less cool to use drugs; that’s the social norm now.”

The drugs don’t work

He recalls a conversation with a parent, whose daughter had gone to Reading Festival last summer to celebrate the end of her GCSEs. The 16-year-old told her mother that she’d been offered a variety of drugs, from cannabis to ketamine, as often as every 20 minutes. Her friends bought some, but she opted not to because she remembered hearing about the importance of knowing where drugs have come from to minimise the risk. She didn’t know the dealers, so she decided she didn’t feel safe enough.

“Young people face those kinds of decisions all the time when they’re growing up,” Pomroy continues. “And those are the moments we’re working towards: when they’re at a festival or in a club or at a house party, and they’re not sure what to do. It’s about giving them the confidence, resilience and knowledge to make an informed choice - the right choice for them.”

This is known as a social influence model, and its aim is to equip students with the skills and knowledge to keep themselves safe, whether or not they decide to use alcohol and drugs.

It’s a far cry from the earliest known school education about drugs, alcohol and tobacco, which began in the US. Schools preached to students that all three should be avoided entirely because of the risks they posed, both physical and moral. This shaped the direction of drug and alcohol education in the US (and the UK) for generations afterwards.

Its echo is clear in the “Just Say No” approach popularised in the 1980s by Nancy Reagan, then First Lady, and which was taken up across the globe - even popping up in a 1986 Grange Hill storyline about heroin addiction - despite research suggesting it had no impact on drug use. And it’s a model that still persists in some schools.

Richard Midford is a psychologist and former professor of health in education in Australia, and he has spent decades exploring various approaches to drug and alcohol education. He says abstinence and scare tactics are simply ineffective.

“The idea of the policeman standing in front of a class saying ‘don’t do drugs’ appeals to people,” he says. “It looks like it’s sending a strong message, but it doesn’t work. It’s been tried for 60 years, but the strong message that drugs will kill you doesn’t necessarily align with kids’ experiences. They may have experimented or know other kids who have experimented and haven’t had dire consequences, so they tend to be sceptical about hard-line messages.”

Show me the way to go home

So, what should schools be doing? Midford cites research suggesting that programmes focusing on harm reduction, rather than abstinence, can be beneficial. He gives the example of a teenager at a party. If a harm reduction programme didn’t stop him from drinking six beers but stopped him from driving home afterwards, that would be considered a success as the harm is lessened.

This is more applicable for alcohol than other drugs, he explains, owing to its wide availability and social acceptability. (There has been far less research into a harm-reduction approach to illegal drugs, he continues, owing to the controversial nature of such an approach.)

However, a 1995 study reviewed school-based drug abuse prevention programmes and came up with 11 components that were found to be most effective. Recommendations included making sure that programmes are theory-driven and research-based, that they offer adequate training for teachers and that they are supported by broader family, community and media components.

Drug education sessions should be developmentally appropriate, it says, as well as culturally sensitive, and offering “normative education about drug use”.

“It’s important to provide conservative norms for students,” Midford explains. “If you ask students to guess what percentage of 15-year-olds have ever drunk alcohol, they will often say around 80 per cent, when it’s actually more like 40 per cent. With drugs and alcohol, and with sex, too, kids tend to think that everyone else is doing it except them. Whereas if you start to give them accurate information about what’s actually happening, they get a sense that they’re not that different. That’s powerful.”

Just as important, he says, is the method of delivery. “Even if you’ve got the right content in terms of giving accurate information about things, you can’t just use the traditional didactic method to get it across to kids,” he explains. “It’s got to be skills-based, focused on problem-solving and developing safety skills, allowing kids to talk to each other about what goes on. It should be facilitated by a teacher, but ideally with a lot of the interactions between students themselves.”

And it needs to be regular, not just an occasional personal, social, health and economic education (PSHE) session, he says. He cites a controlled trial he worked on known as Drug Education in Victorian Schools. The programme took a harm-minimisation approach, using skills-focused, interactive pedagogy over 18 lessons in two years, with lessons “building on each other over time”. The programme achieved good results, he continues, with a follow-up study finding a statistically significant reduction in students’ alcohol consumption and harm even after it was finished.

However, not everyone is as yet convinced by such an approach, with some academics believing the research needs more time to paint a picture of what schools should be doing.

David Foxcroft, professor of community psychology and public health at Oxford Brookes University, is one. “Those social development programmes seem to work in some settings but not others and we’re not totally clear on why it varies,” he says.

“That’s where researchers need to focus their attention over the next five to 10 years.

“That said, there are some indications about the sorts of things that can be effective and those things usually involve early intervention, so that young people are set on to a slightly different developmental trajectory. That puts them in a better place when they mature into early adolescence in terms of engaging with risky behaviours, including drugs and alcohol.”

The idea of early intervention is one that was adopted in a large-scale project in Iceland. Youth drinking and drug-taking were previously a huge issue in the country but levels have dropped dramatically.

Harvey Milkman is a professor of psychology at Metropolitan State College of Denver and Fulbright professor at Reykjavík University. Back in 1998, he explains, “young people would be roaming around the streets of Reykjavik, sometimes rowdy, sometimes obviously drunk, sometimes sick drunk”, which was “very disturbing to the population”.

Hence a group of community activists, youth practitioners, social scientists and politicians joined forces with the government to tackle the issue.

In Iceland, they run an annual youth survey, in which young people aged 10 to 16 answer questions about a huge variety of topics, including drug and alcohol use, leisure activities, feelings about school, family relationships and mental health. The answers are anonymous and the response rate is consistently above 80 per cent, offering a huge amount of rich data to work from.

“We saw that users of drugs spent less time with their parents, had negative peer groups, poor school attachment and very limited after-school activities,” Milkman explains.

And so they inverted these ideas to create a multi-pronged solution. Every school became required to have a parental organisation and talks were hosted on improving family bonds. Laws were passed to increase the age at which alcohol and cigarettes could be bought, and curfews were introduced to keep children under 16 off the streets after 10pm.

But perhaps most crucially, Milkman explains, government funding for leisure activities, such as sport and arts, was increased, offering alternative ways to feel belonging, and decrease anxiety and other mental health issues.

“A lot of the success of it has been institutionalising after-school activities,” Milkman explains. “The compliance rate is about 90 per cent and is supported by teachers and coaches. But the real genius of the Icelandic model is that it’s not national, it’s community by community. Conditions in each community are different and so the data is correct on individual municipalities down to 1,000 kids, or even as low as 500. That data is analysed and given back to the community and stakeholders in the municipality, and they come up with approaches based on the resources they have.”

The results speak for themselves: between 1998 and 2016, the rate of daily cigarette smoking among Iceland’s 15- and 16-year-olds fell from 23 per cent to 3 per cent; the rate of ever having tried cannabis fell from 17 per cent to 5 per cent; and the rate of having been drunk in the past 30 days declined from 42 per cent to 5 per cent.

It could be, then, that the huge array of extracurricular activities put on by schools are as crucial - if not more so - as the messages children may receive in PSHE.

So, are schools getting it right? Can they take credit for the drop in alcohol and drug misuse among teens? It’s a tricky one to judge. We still don’t really know the best ways of talking to teens about such issues, though we know more than we did. More research is needed to discover if Midford is correct and, if he is, there will certainly be schools that need to shift their approach. The number of drugs- and alcohol-focused PSHE lessons Midford talks of as being required is also far greater than many schools currently provide (in some schools, PSHE rarely takes place at all).

Then there is good evidence from Milkman and others that giving pupils other things to focus on, making them feel a sense of belonging and purpose through sport and the arts, and dealing with mental health challenges early, all make a difference. Schools are certainly excellent in all of these areas, but their ability to provide all those things is being ever more constrained by ever tighter budgets and a lack of continuing professional development for staff.

Support ‘falling away’

And, finally, early intervention is becoming increasingly difficult owing to the cuts to other services, such as Child and Adolescent Mental Health Services, having a knock-on impact on schools that means the most vulnerable to alcohol and drug misuse are not getting the help they need.

“The risk isn’t evenly spread,” says Pomroy. “It’s highest within the poorest demographics, the most vulnerable young people. It’s a real challenge with these children; there’s a loss of hope and aspiration, and drugs and alcohol can give a feeling of control and escape. And this is happening at a time when other support services are falling away. ”

Will all this mean that rates of drug and alcohol misuse among young people are likely to begin to rise again? It is impossible to say. But Pomroy is sure that a shift in attitude is essential if we are to minimise the impacts of the above. Often, he says, we fail to see children who use alcohol and drugs as victims. But, actually, that is what they are.

“We need to take a more curious approach to young people involved in drugs and alcohol rather than a punitive one,” he says. “We have to look at them first and foremost as vulnerable, not as troublemakers or criminals.”

Zofia Niemtus is deputy commissioning editor (maternity cover) for Tes

This article originally appeared in the 5 April 2019 issue under the headline “Breaking bad habits”

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