Education to prevent child and adolescent substance abuse has been the focus of a variety of school-based programs and approaches through the last three decades (Kreft, 1998). In the early days of prevention education, young people were shown what drugs looked like, with warnings about what evil would befall them if these drugs were taken. In the 1980s, peers and adults were portrayed as vicious culprits exposing innocent children to drugs in the "just say no" campaigns. The more recent focus has been on concurrently teaching refusal skills and bolstering self-esteem with the belief that these will suffice to prevent experimentation with drugs. The problem with all of these prevention approaches is that there is no firm evidence that they work (Kreft, 1998; Lynam et al., 1999). Kids continue to use drugs, and at earlier and earlier ages. The use of alcohol among teens has remained relatively stable in the past few years, with 51.3% of high school seniors, 38.8% of 10th graders, and 24.6% of 8th graders reporting some use in the last 30 days. In addition, the use of cigarettes among girls has risen sharply, and the use of marijuana has more than doubled since 1991 (St. Pierre, Mark, Kaltreider, & Aikin, 1997).
The professional school counselor is left to search out effective and proven prevention programs for addressing substance-abuse issues in the schools. Research has suggested that prevention programs that include an examination of relevant social and environmental factors may be more effective at preventing alcohol and drug use than programs that focus primarily on refusal skills (Homonoff, Martin, Rimpas, & Henderson, 1994).
In a prior study (Coker & Borders, 2001), the author and a colleague examined trend data gathered from the National Education Longitudinal Study (U. S. Department of Education, 1996) in an attempt to identify those environmental and social factors that appeared to guard against substance-using behavior, specifically problem drinking. The results identified four salient features: (a) positive, supportive relationships with parents; (b) involvement in community-based activities; (c) a positive school climate; and (d) relationships with positively influencing peers. Scales (1998), in a study through the Search Institute, found comparable features.
The 4-fold Prevention Program
This article describes a substance-abuse prevention program, 4-Fold Prevention, designed to specifically focus on four primary areas of social support--parents, schools, communities, and peers. This program enhances positive and supportive relationships among children and influencing adults and peers by opening the lines of communication about attitudes and beliefs regarding alcohol and other drug use. The 4-Fold Prevention program is nested in recent and relevant research suggesting that enhancing relationships with positively influencing adults and peers during pre-adolescence significantly impacts decisions to not use alcohol and drugs (Homonoff et al., 1994; Weishew & Peng, 1993).
A lesson plan and a student workbook provided the structure of the program. (See Table for an abbreviated lesson plan for the six sessions.) The lesson plan included group activities centered around discussions of family relationships, community opportunities, positive peer relationships, feelings about school, and drug information. The program also contained outside-group activities in which the students interviewed parents, school faculty, community members, and other peers about drug attitudes and beliefs. In addition, students completed guided activities with their identified team, which consisted of a family member, a school member, a community member, and a peer member. A student workbook was provided to each participant and was used to help guide students through both the in-group and outside-group activities.
The author completed a pilot test of the 4-Fold Prevention program with elementary school-aged students from an urban, at-risk elementary school (K-5) in the southwestern United States. Two fourth grade classrooms were selected for participation. Nine students participated in the program over a 6-week period and completed pre- and post-test instruments. Thirteen students from the two classrooms acted as a control group and also completed the pre- and post-test instrument. The efficacy of the program was evaluated through the collection of both qualitative data and quantitative data. Qualitative data were gathered through observation, interviews, and examination of student responses in the student workbook.
Ongoing observational data were gathered after each group meeting with participants. Participants were also interviewed after the program for their reactions to the experience, and their responses and writings in the student workbook were examined for relevant information.
Participants were asked to interview a teacher or counselor at their school regarding perceptions about youth alcohol and drug use [Lesson 2]. The majority of students chose their classroom teacher. Most participants indicated they enjoyed talking to their teacher about something other than "schoolwork." Many students also expressed an interest in having their teacher focus more on alcohol and drug issues in the classroom. As part of their examination of school climate, participants were asked to brainstorm ideas to share with the principal on how to make their school more "kid friendly." Participant ideas for enhancing school climate at their school included: creating peer mediation groups so older students could help younger students resolve conflicts; addressing issues of violence, gangs, and "bullies"; and having small group discussions within classrooms about drugs, alcohol, and violence. Student suggestions were consolidated in a letter from the group members to the principal. The participants were excited about their ideas being seen and considered by their principal.
The component of the program that was perceived as most beneficial by a majority of the participants was the family member interview and designing the family alcohol and other drug policy [Lesson 3]. Student interviews with parents about drug and alcohol issues seemed to open the door to further communication between participants and their parents. Several parents indicated their concern over drug use in the neighborhood, and their child's potential exposure to such use. Parents also showed enthusiasm about creating a family drug and alcohol use policy with their children. Most of the completed policies were comprehensive in nature and were signed by all family members living in the household.
The community involvement component was the most difficult of the 4-Fold features to complete for participants in the program [Lesson 4]. Students had a hard time identifying a trusted adult in their communities. In addition, the majority of students did not have much contact or access to adults outside of their families. Most of the participants were not aware of opportunities for community-based activities in their neighborhoods. Since the elementary school where the program was implemented serves a lower socioeconomic neighborhood, community-based resources were not readily available. It would be important in future examinations of the program to help provide stronger links to community resources for students.
None of the participants identified drug use as a problem among peers [Lesson 5]. This experience is consistent with nationally reported experiences of children at this age (Guthrie, Loveland-Cherry, Frey, & Dielman, 1994). During pre-adolescence, it is still the experiences and perceptions of the parents that seem to account for greater influence among youth. During early adolescence, however, use among peers accounts for greater influence on drug-using behavior (Guthrie et al., 1994).
Overall there was a strong connection and sense of belonging among participants. The students were engaged, interested, and exalted about their participation in the groups. There was a general openness and willingness to talk about families, experiences with alcohol and drug use, and personal perceptions of alcohol and drug use among the participants, which could speak to the benefits of conducting such a program in a small group setting. The students adhered to the confidentiality agreement and stressed the Importance of keeping discussions "private."
Students were asked during the final session what they found most helpful during the program. The two most salient features included opening the lines of communication with parents about drugs and alcohol and having a safe, confidential setting at school during which discussions about drugs and alcohol were encouraged.
Implications for School Counselors
School counselors are often the gatekeepers of substance-abuse prevention in schools. Mainstream counselor duties such as group counseling and classroom guidance provide counselors with opportunities to implement prevention programs. The 4-Fold Prevention program holds promise as a new prevention approach for both classroom and small group settings.
With chemical experimentation and exposure to alcohol and drugs occurring at younger and younger ages, the elementary school counselor is in a perfect position to begin implementing proactive programs that provide students with a better foundation from which to make decisions about alcohol and drug use. Given further examination of its potential efficacy--including follow up with current project participants, implementation across grade levels, and implementation with larger sample sizes--the 4-Fold Prevention program could serve as an effective prevention alternative for school counselors.
- Coker, Kelly, Four-Fold Prevention: Strategies to Prevent Substance Abuse Among Elementary School-Aged Children; Professional School Counseling; Oct 2001; Vol. 5; Issue 1.
Reflection Exercise #8
The preceding section contained information
about prevention of substance abuse among elementary school-aged children. Write
three case study examples regarding how you might use the content of this section
in your practice.
What type of prevention program is more effective than programs that focus on refusal skills? Record the letter of the correct answer