Background Since drug addiction is recognized as a chronic, relapsing disease, primary interventions should aim to reduce first use, or prevent the transition from experimental use to addiction. Experimental use affects mainly adolescents: school appears therefore to be the appropriate setting for such interventions. The aim of our review is to evaluate the effectiveness of school-based programs in improving knowledge, developing skills, promoting change, and preventing or reducing drug use. Methods The search strategy was elaborated according to the Cochrane Collaboration method, and applied to MEDLINE, EMBASE, ERIC, PSYCHINFO, Cochrane Library, ACP Journal Club, CDAG Register in February 2004. Bibliographies and personal contacts were used to find other relevant studies. Randomised Controlled Trials and Controlled Clinical Trials were reviewed. Quality of included studies was assessed. Interventions were classified as skills, affective, and knowledge-focused. Results Twenty-nine RCTs were included. 28 were conducted in the USA; most were focused on 6th-7th grade students, and based on post-test assessment. Compared with usual curricula, skills based interventions reduce drug use (RR=0.81; 95%CI: 0.64,1.02), marijuana use (RR=0.82; 95%CI: 0.73,0.92 - test for heterogeneity p=0.37) and hard drug use (RR=0.45; 95%CI: 0.24,0.85), and improve decision making skills (SMD=0.78; 95%CI: 0.46,1.09), self-esteem (SMD=0.22; 95%CI: 0.03,0.40), peer pressure resistance (RR=2.05; 95%CI: 1.24,3.42) and drug knowledge (WMD=2.60; 95%CI: 1.17,4.03). Affective interventions improve decision making skills (SMD=1.35; 95%CI: 0.79,1.91) and drug knowledge (SMD=1.88; 95%CI: 1.27,2.50). Skills-based interventions are only better than affective ones in self-efficacy (WMD=1.90; 95%CI: 0.25,3.55). Knowledge-focused programs improve drug knowledge (SMD=0.91; 95%CI: 0.42,1.39). No differences are evident for skills vs knowledge-focused programs. Affective interventions improve decision making skills (SMD=1.22; 95%CI: 0.33,2.12) and drug knowledge (SMD=0.60; 95%CI: 0.18,1.03) better than knowledge-focused programs. Conclusions Skills based programs help to deter early drug use. The replication of results with well designed, long term randomised trials, and the evaluation of single components of intervention (peer, parents, booster sessions) are the priorities for research. All new studies should control for cluster effect.
The effectiveness of school-based interventions in preventing illicit drugs’ use
VIGNA-TAGLIANTI, Federica;BORRACCINO, Alberto;ZAMBON, Alessio;VERSINO, Elisabetta;LEMMA, Patrizia;
2005-01-01
Abstract
Background Since drug addiction is recognized as a chronic, relapsing disease, primary interventions should aim to reduce first use, or prevent the transition from experimental use to addiction. Experimental use affects mainly adolescents: school appears therefore to be the appropriate setting for such interventions. The aim of our review is to evaluate the effectiveness of school-based programs in improving knowledge, developing skills, promoting change, and preventing or reducing drug use. Methods The search strategy was elaborated according to the Cochrane Collaboration method, and applied to MEDLINE, EMBASE, ERIC, PSYCHINFO, Cochrane Library, ACP Journal Club, CDAG Register in February 2004. Bibliographies and personal contacts were used to find other relevant studies. Randomised Controlled Trials and Controlled Clinical Trials were reviewed. Quality of included studies was assessed. Interventions were classified as skills, affective, and knowledge-focused. Results Twenty-nine RCTs were included. 28 were conducted in the USA; most were focused on 6th-7th grade students, and based on post-test assessment. Compared with usual curricula, skills based interventions reduce drug use (RR=0.81; 95%CI: 0.64,1.02), marijuana use (RR=0.82; 95%CI: 0.73,0.92 - test for heterogeneity p=0.37) and hard drug use (RR=0.45; 95%CI: 0.24,0.85), and improve decision making skills (SMD=0.78; 95%CI: 0.46,1.09), self-esteem (SMD=0.22; 95%CI: 0.03,0.40), peer pressure resistance (RR=2.05; 95%CI: 1.24,3.42) and drug knowledge (WMD=2.60; 95%CI: 1.17,4.03). Affective interventions improve decision making skills (SMD=1.35; 95%CI: 0.79,1.91) and drug knowledge (SMD=1.88; 95%CI: 1.27,2.50). Skills-based interventions are only better than affective ones in self-efficacy (WMD=1.90; 95%CI: 0.25,3.55). Knowledge-focused programs improve drug knowledge (SMD=0.91; 95%CI: 0.42,1.39). No differences are evident for skills vs knowledge-focused programs. Affective interventions improve decision making skills (SMD=1.22; 95%CI: 0.33,2.12) and drug knowledge (SMD=0.60; 95%CI: 0.18,1.03) better than knowledge-focused programs. Conclusions Skills based programs help to deter early drug use. The replication of results with well designed, long term randomised trials, and the evaluation of single components of intervention (peer, parents, booster sessions) are the priorities for research. All new studies should control for cluster effect.
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