A group of teenagers from Savio Preparatory High School descends on Government Center Plaza in Boston wearing yellow T-shirts and brandishing bells, noisemakers, and giant alarm clocks. They've come to deliver a message to commuters heading for the subway in the evening rush hour. "Wake up, parents of Boston," they shout. "Wake up to the risks of marijuana."
The message, printed on pads of sticky notes they distribute, isn't new, but the method of delivering it is. This rally by Students Against Destructive Decisions (SADD) is just one example of how prevention programs across the US are trying new tactics or revamping established approaches in an effort to keep young people off drugs and alcohol.
"I think many people are trying to educate about the dangers [of substance abuse], but the message isn't always getting across," says Maria Cardullo, a biology teacher and adviser to the Savio Prep SADD chapter.
That's exactly what prevention experts are concerned about: They want to avoid the "generational forgetting" that can happen when society lets down its guard.
Drug use among young people has been a problem since the 1960s. It peaked in 1981, when 66 percent of American youths had tried illicit substances. The rate gradually fell to 41 percent before rising again.
Now, according to 2001 statistics, 54 percent of students have tried drugs by the time they finish high school. Eighty percent say that they have consumed alcohol, according to the University of Michigan's Institute for Social Research.
Perhaps more alarming is the fact that children start experimenting with alcohol at younger and younger ages. By age 12, 20 percent of students have tried alcohol. That figure rises to 50 percent by the time they've reached eighth grade.
Drug use has also shifted geographically. In the past, substance abuse was primarily a problem in cities. Now, students in rural areas are much more likely to use drugs than their urban counterparts, according to the National Center on Addiction and Substance Abuse at Columbia University in New York.
While the field of prevention science has existed only 30 years or so, researchers believe that they have already learned some important lessons.
"We continue to understand more about the pathways into drug use and how important it is to intervene early, to interrupt the trajectory that leads into drug usage," says Wilson Compton, director of prevention research at the National Institute on Drug Abuse.
Dr. Compton and other experts agree that more research is needed, but they have identified four prevention fundamentals:
1. Education must be ongoing and span a child's entire school career.
2. It should be interactive, age-specific, family-focused, and target the particular drugs that are available to students. Whatever drug issues a community may be struggling with, prevention experts stress the need to make the solution fit the clientele. The first step is learning how to communicate in ways that young people will respond to.
3. Besides classroom programs that provide teens with scientific information about drugs, programs should teach skills that increase self-confidence and show youngsters how to refuse drugs and alcohol.
4. Marijuana should not be viewed as less threatening than drugs such as Ecstasy or cocaine. Today's marijuana is more potent than it was in the late 1970s and early '80s, and it remains the most widely used drug by teens. (Sixty percent of teens in drug-treatment programs are hooked on pot.) It may also be a "gateway" that leads to experimentation with other substances.
But beyond these fundamentals, there is still much to be learned.
For the past 16 years, DARE (Drug Abuse Resistance Education) has been in the forefront of prevention efforts.
Begun in Los Angeles in 1986, the program uses specially trained police officers to teach in 80 percent of the country's school districts. The curriculum calls for once-a-week visits over 17 weeks, usually to fifth- or sixth-grade classes.
While DARE is the most far-reaching program, it has been criticized by some observers for not producing noticeable differences in teen behavior. So it is changing with the times in an effort to better serve its audience.
A new curriculum, developed after an extensive study by researchers at the University of Akron, has been tested with seventh-graders in half a dozen cities. The revised DARE, which is less lecture-oriented and offers greater interactivity, has proved more effective in teaching teens how to decline offers to use drugs. Another change is that the program now involves teachers working alongside police, and provides for follow-up reinforcement when students reach high school.
Drug Strategies Inc., a nonprofit research institute that annually grades prevention programs, gives the current DARE program a "B." But it awards higher marks to newer, more innovative approaches.
Receiving an "A" for its work with middle-schoolers is Project Northland, sponsored by Minnesota's Hazelden Foundation.
Using research conducted in a part of Minnesota that led the nation in alcohol-related fatalities, the program targets students in Grades 6 to 8. After three years of participation in Project Northland, monthly drinking among eighth-graders was 20 percent lower than for students in a district that didn't participate in the program, and weekly drinking was 30 percent less.
Project Northland involves group discussions, role playing, games, problem-solving, and projects tackled by small groups.
They've found that same-age peers, selected by the students, are more successful than teachers in conveying "social information concerning alcohol use."
It also has a home project, in which 90 percent of parents have participated.
The program is now introducing a six-week curriculum called Class Action, which is aimed at high schoolers. In it, students will learn the consequences of underage drinking by consulting experts as they represent a "plaintiff" in a hypothetical court case.
Keys to Change, a new prevention program developed by James Prochaska, a professor of clinical and health psychology at the University of Rhode Island, takes advantage of students' enthusiasm for computers. Dr. Prochaska, who has received an Innovators Award from the Robert Wood Johnson Foundation, developed a multimedia program that uses laptop computers to coach teens in how to resist high-risk behavior such as drug use.
While this strategy, being tried in the health classes of 14 Rhode Island high schools, might seem impersonal, it can be tailored to individual students who haven't begun drug use, or are in the early stages of using illegal substances. It's highly confidential (not even classmates know where other students are in the program), and the teens can be totally open in their interactions, not worrying about being judged or evaluated by another person.
One section teaches generic strategies for changing behavior, and the others target drug and alcohol use. Students work on the computer program only six times over two years, which allows them plenty of time to change their behavior in stages.
"The whole prevention field has evolved from a 'do what feels good' approach to assessing community risks and protective factors to build programs based on these," says Ruth Sanchez-Way of the US Substance Abuse and Mental Health Services Administration. In other words, when trying to help young people resist the temptation to use drugs and alcohol, one approach isn't going to work in every community or with every child.
What may work well for many youths, however, are programs that teach self-management skills and strategies that will help them avoid risky behaviors. One of the leading examples of this approach is LifeSkills Training, a school-based program developed by Gilbert Botvin of the Institute for Prevention Research of the Weill Medical College of Cornell University in New York.
It includes lessons on everything from resisting drugs to relaxation skills. "Once kids have been able to use a skill effectively, two things happen," Dr. Botvin says. "They feel more confident and empowered, [and] so they're better able to handle themselves in situations when they're asked to smoke, drink, or use drugs."
This ability is especially needed now, says White House drug czar John Walters, because of the presence of aggressive, prodrug peer groups in many schools. "It's not just a small fringe group in some schools, but some of the best and most prominent students," he says. "Their opinions and attitudes are fed by the larger culture, by the Internet, by drug legalization campaigns that suggest that societal standards against drug use are heavy-handed, unnecessary."
Other students, therefore, must feel empowered to step forward and say, "This isn't right, this isn't healthy," Mr. Walters says.
Students are receptive to this message, says Ms. Cardullo, the teacher at East Boston's Savio Prep, who has been teaching drug education for 26 years.
Many of these students, such as Jason Javeli, a freshman at the school, are active in SADD chapters.
Why? The reason, he says, is simple: He doesn't want to jeopardize a bright future, including college plans, by using drugs, so he doesn't hesitate to share what he's learned of substance abuse risks.
"I have friends who use drugs, and it's uncomfortable to go to their house because their parents don't trust them anymore," he says. "I'd never want to lose the trust of my parents."
That is a good thing, according to experts. In fact, it can be a major weapon in the drug war, says Stephen Wallace, SADD's national chairman and chief executive officer. "The fact is, parents have a tremendous influence on the decisions their teens make."
Increasingly, prevention experts are making use of parental influence. This is why a major part of the current ad campaign by the National Youth Anti-Drug Media Campaign is directed toward parents. The message is simple: Parents should resolve to set standards for their teenagers and stick to them.
Research shows, after all, that kids who learn at home about the dangers of drugs are half as likely to try or continue to use drugs as students who don't get guidance or information at home. Also, when drugs are avoided in the formative years, they may never present a challenge thereafter.
What's important to remember, says Howard Simon of the Partnership for a Drug-Free America, is that in spite of eye-rolling and door-slamming, teens don't want to cross their parents, and they consider disappointing Mom and Dad among the biggest risks in using drugs.
But the ad campaign also has a second target: teens.
In the past, ads were more focused on 12- and 13-year-olds, in the belief that it was best to catch them early.
Now, ads target mid- to older teens, who may be under more social pressure to join the crowd. This allows for more forceful messages, says Walters.
Reaching this group is critical, because many young people begin to try drugs and alcohol between seventh and eighth grades, according to a new SADD-Liberty Mutual "Teens Today" survey. And marijuana use by eighth graders has doubled in the past 10 years.
But knowing who to target is only the first step. Walters says it's important to avoid the over-the-top scare tactics of an earlier era, since these sometimes didn't square with what teenagers observed in their own lives or in the lives of others.
"We are continuing to explain the dangers," he says, "but if you make statements that are distortions, they don't work."
One big challenge, he adds, is the low cost and ready access of illicit drugs. To combat this, the federal government plans a major escalation in efforts to disrupt the drug trade.
Walters says the government will target the vulnerabilities of major trafficking networks - how they move money, transport their products, communicate, and manufacture and refine drugs.
Previous administrations have also tried to wipe out the drug trade - with limited results. While hoping that the government is successful this time, experts say that the best solution to the problem is to end demand, one student at a time.
For more information on alcohol- and drug-prevention strategies, see these websites.
Partnership for a Drug-Free America
Drug Abuse Resistance Education (DARE)
Leadership to Keep Children Alcohol Free
Students Against Destructive Decisions
Office of National Drug Control Policy