DARE – Drug Abuse Prevention that doesn’t work

  • DARE (Drug Abuse Resistance Education) is the largest school-based drug abuse prevention program in the United States.
  • 80% of school districts across the country teach the DARE curriculum, reaching an estimated 26 million children (1).
  • Every year, over $1 billion goes into keeping the program running. A billion dollars may be a small price to pay to keep America’s children drug-free, but there is plenty of evidence to suggest that DARE isn’t doing what it’s supposed to.

What is DARE?

dareFounded in 1983, DARE began as a 17 week long course taught to 5th and 6th graders. The course is taught by a uniformed police officer who teaches the students about drug use and gang violence. The DARE curriculum includes role-playing, written assignments, presentations, and group discussions.

DARE uses a zero tolerance policy towards drug use. Students are told to adopt mottoes like “Drug free is the way to be” and “Just say no to drugs!” Pictures of blackened lungs and drunk driving accidents are methods used to discourage experimentation. The focus of the program is clearly flat out refusal. Students are not taught what to do if they are already experiencing problems with drugs.

Is DARE effective?

The effectiveness of DARE has been called into question since the early 90s. A meta-analysis of 11 studies conducted from 1991-2002 shows no significant effect of DARE in reducing drug use (1). Several studies have even reported an opposite effect, with DARE leading to higher rates of drug use later on in life. Reports from the California Department of Education, American Psychological Association, and U.S. Surgeon General all label DARE as ineffective.

The results seem clear, but statistics don’t seem to be enough to convince concerned parents and policy makers to shut down any drug abuse prevention program. With drug use on the rise, it seems that DARE is here to stay. But perhaps getting rid of DARE isn’t the best option. The framework and funding already exist for a potentially successful prevention program. Maybe all we need to do is apply some science and develop new techniques that will provide results.

*It should be noted that in 2001, DARE made substantial revisions to its program under the title “New DARE.” The effects of these revisions have yet to be measured, so we’ll wait and see.

 

Citation:

1. West, S.L., O’Neal, K.K. (2004) Project D.A.R.E. Outcome Effectiveness Revisited. American Journal of Public Health. 94(6)

Saving lives made easy – Treating opiate overdose with intranasal naloxone

oxycodone-addiction-big1Contributing co-author: Andrew Chen

Imagine that you and your friend have been using heroin (or another opiate). A few hours go by and you notice your friend is progressively becoming more and more unresponsive. You check on him and find that his breathing is shallow, his skin is cold, and his pupils are constricted. You recognize these as signs of opiate overdose and call for help. Now what?

Well… If you had some naloxone around, you might be able to treat the overdose and save your friend’s life before the paramedics even arrive.

Naloxone hydrochloride (naloxone) is the standard treatment for opioid overdose. Naloxone works by blocking opioid receptors, thereby removing opioid agonists, such as heroin or oxycodone, from those same receptors. As a result, the overdose is reversed and death is prevented.

What makes naloxone great is that it has no potential for abuse. In fact, it makes the user feel pretty crappy.

Naloxone is typically delivered through an injection, which makes it pretty much useless in many situations. However, it can also be delivered using an intranasal spray device. This intranasal form of naloxone is getting lots of attention recently because it is relatively easy to administer.

In 2006, The Boston Public Health Commission (BPHC) implemented an overdose prevention program, providing training and intranasal naloxone to 385 individuals deemed likely to witness an overdose. These individuals were often family members of opiate users or drug-using partners.

15 months later, the BPHC conducted a follow-up:

  • Contact was made with 278 of the original participants.
  • 222 reported witnessing no overdoses during the 15-month span.
  • 7 had their naloxone stolen, lost, or confiscated.
  • 50 reported witnessing at least one overdose during the 15-month span. Together, these 50 individuals reported a total of 74 successful overdose reversals using intranasal naloxone!

The BPHC program is not the only example of successful use of naloxone in opiate overdose prevention programs. Similar programs have popped up in Chicago, New York, San Francisco, Baltimore, and New Mexico.

Unlike injections, using a nasal spray isn’t rocket science. All of the participants in the BPHC program were trained by non-medical public health workers, which makes the idea relatively cheap. As the data shows, the participants were able to effectively recognize an opiate overdose and administer intranasal naloxone. By targeting at-risk populations and providing proper training, distribution of intranasal naloxone can help in saving lives.

For more information, check out our post Addiction and the brain part IV – Opiates

Citation:

Doe-Simkins, M., Walley, A.Y., Epstein, A., & Moyer, P. (2009) Saved by the nose: Bystander-administered intranasal naloxone hydrochloride for opiod overdose. American Journal of Public Health. 99(5)

Two Million Dollars a piece – The cost of drug use and violence

The average cost to society of a lifelong criminal = About $2 million

I’ll get into more of this in later posts (I already talked about the cost of addiction prevention versus treatment versus enforcement), but if that cost of drug use and violence doesn’t cry out for a better application of money to prevention and addiction treatment, I don’t know what does.

At that cost, even if a treatment method costs $10k per client, it only needs to work for 1 out of 200 people to break even, and benefit society while doing so. In reality, our success rates are much higher than .5% (1/200) and closer to 15%-25%. When you take into account the fact that average cost of a month in addiction treatment (residential, outpatient treatment is much cheaper) is indeed about $7000-$10,000, it seems silly not to avoid the cost of crime by greatly reducing drug use, and hence criminal behavior.

NIDA, the government’s top agency for drug and alcohol abuse research recommends three months of treatment, but even then, success rates as low as 2% would leave us with a profit by providing treatment. Screw it, even a whole year of treatment would save us money if it succeeded but I can tell you that funding for that kind of addiction treatment length is almost non-existent, especially when compared to the actual need.

So with success rates about 20 to 30 times higher than our break-even point, we would literally benefit, and I’m talking financially, from helping people with treatment as expensive as $100,000 or more (as long as it worked). One of the things I’ve learned in all my work has been that while some individuals are actually interested in helping people, yes, even if they’ve been dirty drug addicts who have commited crimes, almost everyone cares about money. So forget for a second about all the social justice arguments to be made for helping addicts and think about the cost savings to our society… It makes sense.

True, true, not all drug users who would enter treatment would become lifelong offender, but if you’re still keeping tabs, even if only 1/20 or so do, we’re more than breaking even here. In fact, with our prison populations exploding as more and more drug users enter the system, I bet we’re in for some real savings.

Citation:

Dodge, K. A. (2008) Framing public policy and prevention of chronic violence in American youths. America Psychologist, 63, 573-590.

About Addiction: Prescription drugs, Alcohol prices, and prevention among teens

You know you care about addiction, and you know you love reading addiction news and research – A3 does it all for you and gathers things up in a nice little package we call our weekly “about addiction” post. It’s the fastest way to get the information you want, even if you didn’t know it was out there!

Prescription Drugs, drug safety, and sales

Reuters– Walgreen’s offers its customers a convenient way of disposing of their prescription drugs. This allows individuals to safely dispose of unwanted or expired drugs. The way that the program works is to place the unwanted prescription drugs in an envelope and send it to a medication incinerator. Controlled substances however are excluded from the program, I guess they’re afraid of bags of heroin and cocaine showing up at Walgreen offices?

Wales online– After being bugged to see if a man was in possession of illegal drugs, a number of men were sentenced to 48 years in jail for selling heroin. This undercover investigation lasted for six months, revealing a magnificent economy of drug use, abuse and profit.

Discovery News– Authorities discovered that eight illicit drugs, including cocaine, ecstasy, and methamphetamines, were detectable in the waterways of a Spanish national park. They’re worried about the threat of the drugs’ side effects to animals, but I have to say it makes me wonder why so many drug addicts are dumping their drugs there…

Alcohol Prices

Telegraph (U.K.)– A “price fixing”  system for alcohol prices has been suggested in the U.K., which is supposed to help reduce binge drinking encouraged by bottom priced alcohol. Economics experts in England suggest that all the policy will likely do will be increase profits for store that sell cheap alcohol. If our work here is any indication though, driving alcohol price up (as much as 100% in some stores) will certainly have an effect on some drinkers.

Health DayTax increases in alcohol prices may aid in alleviating alcohol problems. A study was conducted which showed that increasing the alcohol prices will result in significant reductions in many of the undesirable outcomes associated with drinking. So next time you go to buy alcohol and the price is too high just think of all the help you’re providing the community.

Addiction interventions and addiction treatment of teens

Time to act!- Perhaps one of the most important ways to prevent an addiction from happening is to catch it in its early stages and prevent it from ever developing. This website promotes primary prevention of as a means of addiction intervention and urges parents to act as soon as possible if you think your child is using drugs or alcohol.

DBtechno– Children who have regular meals are less likely to drink (read our coverage of teen drinking). This was attributed to parents having better, more consistent, interactions with their children at the dinner table. Kids who did not eat regular meals were twice as likely to drink and use cigarettes. Talk about a great way at starting on an addiction intervention early on in life – a nice relaxing dinner, and maybe some dessert…

ABC News– This article tells of the ill effects that alcohol can have to a child when alcohol is consumed during pregnancy. It tells the story of one family who could not stand their child’s “out of control behavior” likely brought on by FAS (Fetal Alcohol Syndrome). Read All About Addiction’s coverage of drinking during pregnancy.

Addiction Inbox– A great article using Dock Ellis’ perspective on LSD. Ellis is now speaking to inmates in correctional facilities, telling his story of how he was addicted to drugs and alcohol while playing baseball.

Black tar heroin – Pure Death

Back in the 70s, heroin was mostly filler, and the good stuff was 5% pure or so. Nowadays a new, more potent, version of the stuff is killing people all around the country with widely varying purities as high as 90%.

What makes black tar dangerous

When heroin was weak, shooting it was the best way to get high, which kept many people away from it. But this relatively new stuff (it’s been around California for a while), brought in from Mexico and known by the name Black Tar, is strong enough to make smoking, or snorting, it a viable option for a nice long high. It’s a much easier sell for the dealers too – no more ugly needles, they tell their customers you can “just smoke it like weed,” which is true until you get hooked.

Black Tar HeroinLike any other form of heroin, black tar will cause some serious changes in a user’s body and brain, messing with the body’s pain, digestion, and mood systems. The problem is that at these purity levels, the chance of a user overdosing are much higher too, and that’s where the body-count comes in.

The stuff is cheap, at least in relation to the old heroin that used to come in from the far-east, but the body count’s mounting and the problems only getting worse. Heroin overdose death rates have gone up at 20%-50% and they’re still going strong. Many of the people who are most concerned about this are hoping that heroin doesn’t bring about the same epidemic that crack did in the 80s.

Avoiding death by talking

As usual, I don’t believe in running away from a problem like this. Instead, this is exactly the kind of thing that education, information, and a good dose of harm reduction can fix. We need to make sure people know that the potency of this stuff can kill you. The only way to make sure that less people die from black-tar heroin is to let them know that they need to be careful with it because one mistake can mean death.

I’m hardly ever the “just say no” type and I think that in this situation, an approach like that will leave us in deeper and deeper trouble. The AP article I based this on talked about yearly seizures of heroin quadrupling to 86 kilograms across the U.S.-Mexico border last year. By comparison, cocaine seizures in 2008 totaled more than 8000 Kilos! I can tell you one thing, as someone with experience as a drug dealer, getting 86 kilos across the border isn’t that hard with the amount of Mexican corruption and “help” dealers can get. Where’s there’s money, there’s a way, and it seems that this heroin trend is offering up some money.

Calderon honoring dead in drug warIt’s that experience of mine that makes me believe we have to work towards understanding addiction and who develops it, and getting better at prevention, intervention, and treatment. Try as we might, solving this problem by the supply side isn’t going to work, I don’t care how hard Calderon is willing to fight.

Addiction stories: Alcohol, marijuana, crime, and John’s life

The following story was shared by a young reader. I was first drawn to it because it mirrored mine to a large extent. Fortunately, John decided to pull out before he let his life go down as far as I allowed myself to go. For that, and for his courage in sharing his story, I applaud him.

John’s addiction story

My name is John and I am an alcoholic and a raging drug addict. I’m seventeen years old and only used for about 2 and a half years, but that was more than enough for my life to fall to pieces because of my addiction.

When I was fourteen I got a little drunk for the first time. I hated the way the alcohol tasted, and I hated how it made me so sick. The effects were nice, but I wished that I could get them without having the unpleasant side effects.

I found a solution to this problem at age 15 with marijuana. Within my a few months of my first time smoking, I was getting high multiple times every single day. My friends were changing rapidly because the ones who really cared didn’t approve of my heavy usage. I responded to this by getting new friends. Around this time I also became addicted to stealing in order to support my addiction and also in order to look cool by having a lot of money. My friends and I would get high and drunk and then go out at night and steal hundreds and hundreds of dollars from people’s unlocked cars.

I began selling pot at age 16. Dealing was a new experience for me. I won’t lie and say it wasn’t fun – it was, definitely. But the rush of making heaps of money and being loved by all your peers becomes an addiction in itself. I was dealing pretty heavily, for a high schooler selling pot – some days I would sell a thousand dollars worth of it at school. Afterward, I lived what I thought was a carefree and safe lifestyle; I smoked weed with friends all day, and eventually we moved onto harder drugs.

My usage increased heavily and I began using other drugs as well. I slowly began trying all the things I said I would never do, and before long, my life was absolutely governed by cocaine, alcohol, prescription medications, and lots and lots of pot. I got really into cocaine a few months into it – and then everything changed. Walls fell down; suddenly opiates weren’t anywhere near as scary to me, hence my common run-ins with Vicodin, Valium, Percocet, and Oxycontin. None of the prescription pills had the same kind of power coke had over me, though; my teeth still chatter sometimes when I start craving the rush of that manipulative white powder going up my nose. Cocaine is a pretty serious drug, and I was hooked before I even realized what was happening. This is unlike my experience with getting hooked on pot and booze; with those, I could recognize the kind of path I was going down, but I just couldn’t stop. There is a reason coke is called a “hard drug” – because you’ll fall for it. Hard. People go into with the mindset that they can handle it. Maybe some people can. I, however, am not one of those people – the second I pop a pill or blow a line, all I can think about is getting more to keep my buzz going.

Of course I also began getting into trouble with the law. February 16, 2009, I was arrested for the first time after picking up a couple ounces of weed. I met some buddies in town to smoke, but they didn’t inform me that they had vandalized a building at a school earlier. Before I knew it we were being followed by policemen. They caught up with us, encircled us in cop cars, causing a roadblock, and searched all of us. They immediately found my bag of weed and cuffed me, along with all my buddies. I played the innocent child, though, and got off with a possession charge.

The second arrest took place only four months later. I was back to my old dealing ways – by now I was suicidal, addicted to all kinds of drugs, and had no faith in other people. I got high and brought an ounce of weed with me to school, and was found by the school officer in a bathroom stall, selling a few grams to a 14 year old. I was arrested with intent to sell, endangering a minor, possession on school grounds, and possession of marijuana. Also, I was expelled from school. I began saying I was going to kill myself to gain some sympathy, at which point I was placed in a 2 week long mental ward. After that, it was off to rehab for me, where I had sex, did drugs, lied and stole.

A few days after getting out of treatment, I was using again. I remember feeling like an empty shell – I would stay up for days at a time, stealing, lying, and using people to get my drugs and liquor. My family thought I was sober at this point, and I began at a character-based boarding school in August.

I brought a lot of pot with me and resisted everything the school was trying to offer me. Once the pot ran out, I began huffing up to 2 cans of computer duster every day, along with a daily dosage of booze and a whole lot of cough medicine.

I hit bottom on November 16, 2009. As far as I’m concerned, that’s the most important day of my life – that was the day I finally decided I had had enough. I called up my mother, crying and saying I was really done this time, but she didn’t believe me (who could blame her). So I then called up an old friend who I knew was heavily involved in a 12-step group. This man is my sponsor today. We work our program together, and maintain daily contact.

At almost 90 days sober, I can honestly say I have never been so grateful and serene in my entire life. If you’re reading this and you can relate to my story, please know that there is a way out of the twisted insanity that is drug addiction and alcoholism. I should be dead right now, but I’m still here – as far as I’m concerned, that’s proof enough for me to believe in a loving Higher Power. As long as I remember to help other addicts, talk to my sponsor, work my 12 step program, and remain honest, I don’t have to drink and drug today. And to me, this is a miracle.

A little insight

John’s story mirrors that of many other addicts: Early innocent use followed by the dissolution of self-imposed rules about what one will, and won’t, engage in. Cocaine might seem scary at first, but after a lot of weed, alcohol, and some ecstasy, it might just lose that edge. As I’ve talked about in other posts, there are quite a few common personality issues that make it even less likely that a future addict will say no to increasing degrees of abuse.

Once again I want to make a point that I think it important: Drugs are the road, but not the problem per se when it comes to addiction. The vast majority of people who try drugs don’t get addicted to them – What we need to get better at is understanding the process by which those who do, develop problems. This includes earlier identification, better targeted prevention, and more effective treatment. That’s my take on all of this at least.

Enforcement Vs. Prevention and Treatment – Solving our addiction problem requires all three

A pair of handcuffs is not an unfamiliar picture for many drug addictsThe U.S. policy regarding the drug problem is still centered mainly on the enforcement of its drug laws and intervention in the drug supply both within the U.S. and in neighboring countries. There is no question that this “crusade” has had an impact. Importing a kilogram of cocaine into the US costs approx $15000 (an average kilogram sells for $10,000-$15000) while sending a regular package weighing the same costs about $100 (1).

The result of the focus on enforcement

Still, the recent assassination of the Mexican “drug czar”, and the escalation of violence just south of the U.S.-Mexico border point to another fact: Where there’s money, there’s a way. Drug cartels will find a way to deliver their product as long as customers are waiting on the other side of the border. One of the battles in this war has to be fought on the prevention/intervention side. Dr. McLellan’s selection as deputy drug czar brought with it a lot of hope regarding the role of treatment in the big-picture. Still, bureaucracy moves slowly, and there have been few visible changes in policy to date, aside from the well needed symbolic nature of dropping the term “War on Drugs” from our lexicon.

What about treatment?

Unfortunately, health insurance companies in the United States rarely covers any of the cost involved in drug treatment, even though at least 42 states require them to do so by law! Even when they do, insurance companies often limit coverage to 30 days of residential treatment. I’ve made it clear before, but I feel that the notion that 30 day treatment can work needs to be removed from our consciousness (2). I realize this may require hypnosis…

Anyway, without funding, the hope of making drug treatment truly affordable and accessible is small and dwindling as it requires more medical treatment, which is obviously costly. I hope that this aspect of health care coverage finds its way into the ongoing debate, especially given the high, and increasing prevalence of drug abuse in this country.

As it stands, the U.S., with little more than 5% of the world’s population is consuming somewhere between 50%-70% of the world’s drugs. Talk about a problem with our GDP…

And prevention?

I can tell you, without a doubt, that saving someone from ever becoming an addict is the biggest cost saver in this entire equation. It would remove crime costs, treatment costs, and incarceration and court costs right out of this whole thing. The problem, obviously, is that we don’t know with certainty who will, and who won’t, become an addict. There are some recent advances, and I think that as technology (specifically imaging), and our knowledge (specifically about genetics and its interaction with environmental stress), improves we will be able to do a much better job of this.

I work on some projects that assess the cost benefit of treating rather than merely jailing drug users (prop 36 in CA). I can’t wait for us to have the knowledge to allow for the same analyses regarding prevention.

Citations:

(1) Reuter & Pollack (2005). how much can treatment reduce national drug problems?

(2) McLellan, Lewis, O’Brien, & Kleber (2000). Drug Dependence, a Chronic Medical Illness Implications for Treatment, Insurance, and Outcomes Evaluation.