As the opioid epidemic continues to take countless lives, it is apparent that efforts to prevent substance-use disorders are every bit as important as improving access to treatment. Consequently, communities in our area are considering spending more money on prevention programs such as Drug Abuse Resistance Education (DARE) and its newer program called keepin' it REAL. Before communities invest their limited financial resources in such programs, they should take the time to evaluate the effectiveness of the programs under consideration.
DARE was founded in 1983 and rapidly became the primary program designed to combat the ever-present dangers of substance abuse. The DARE program placed community police officers in classrooms of fifth- and sixth-graders with the aim of increasing their self-esteem, which would in turn enable kids to resist the temptation to use drugs. DARE was especially popular with politicians and law-enforcement officials.
By 2003, DARE was part of the curriculum in 80 percent of U.S. schools. But despite its widespread popularity, numerous studies demonstrated that it did very little to curb drug abuse and, in some cases, may have made the problem worse.
Despite their initial resistance to evidence-based studies that demonstrated the ineffectiveness of their program, DARE officials regrouped and formulated a new curriculum — keepin' it REAL. The acronym “REAL” stands for “Refuse, Explain, Avoid, Leave.” The new program has been met with mixed reviews, with most experts acknowledging that it is better than the original DARE program but not nearly as evidence-based as it purports to be.
The new program is not as “abstinence-based” as the previous DARE program and focuses more on the development of good decision-making skills. To its credit, keepin' it REAL highlights the importance of grounding substance-use prevention programs in their audiences' cultural attitudes, values, norms and beliefs.
Despite claims that keepin' it REAL is evidence-based, there is no scientific evidence to support that this is true. Further, there is simply no empirical evidence to support or refute the effectiveness of the program. The Substance Abuse and Mental Health Services Administration (SAMHSA) ranks its “readiness for dissemination” at just a 1.5 out of 4.
Without any demonstrably effective national programs on the horizon, it will be the responsibility of individual school districts to decide whether to invest in programs like keepin' it REAL. I suspect that this new program will — at best — show only a minimal effect in reducing substance-use disorders and the marginal benefit may not be worth the cost.
There are other evidence-based prevention programs, but none of them have the name recognition that the DARE programs have. Some of these include LifeSkills Training; the California Healthy Kids Resource Center; Safety First: A Reality-Based Approach to Teens and Drugs; The Cochrane Collaboration; and SAMHSA's National Registry of Evidence-based Programs and Practices.
I would encourage school boards to engage in the relatively cumbersome and laborious process of carefully evaluating prospective programs rather than choosing a particular program because it currently seems popular.
Dr. Mitchell West is medical director of addiction services for Allegheny Health Network.