May 29, 2020
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Don’t forget these proven efforts to prevent drug use

Pablo Martinez Monsivais | AP
Pablo Martinez Monsivais | AP
President Donald Trump and first lady Melania Trump, left, leave the East Room of the White House in Washington, after speaking on the opioid crisis.

There were many welcome recommendations in the report released in November by President Donald Trump’s commission on opioid addiction.

The President’s Commission on Combating Drug Addiction and the Opioid Crisis called for allowing inmates access to medication-assisted treatment in jail and continued treatment upon release. It recommended that people with substance use disorders who violate their probation terms by using substances be diverted into drug courts as opposed to prison. Among the 56 recommendations, it also called for more funding for addiction research.

But it could have gone further in its calls for enhancing prevention programming — especially at schools, which often find themselves dealing with the effects of the opioid epidemic whether they wish to or not.

In many cases, programs based in research are not just good for preventing or delaying drug use, but strengthening children’s social connections, ability to manage their emotions and decision-making skills.

To its credit, the report does mention specific interventions that have been shown to be effective, such as the Good Behavior Game for elementary schools, which rewards teams of students when they stick to classroom rules. Over time, students play the “game” for longer periods or at different times of the day, during various activities and in different locations. Teachers eventually hold off on giving rewards until the end of the day or week. The point is for children to learn that they are expected in all settings and at all times to show good manners.

One study found participating in the program was associated with reduced use of heroin and cocaine in early adolescence. Another study found it significantly reduced drug and alcohol use among males in particular.

The commission’s report also highlights LifeSkills Training, a school-based intervention for adolescents that teaches self-management and social skills, and how to deal with pressure to use drugs, alcohol and tobacco. Students examine how their self-image affects behavior and learn how to reduce stress and anxiety, overcome shyness and make good choices in tough situations.

The program has been evaluated in more than 30 scientific studies involving more than 330 schools or sites and 26,000 students in suburban, urban and rural settings, and has been shown to cut short- and long-term use of tobacco, marijuana and drugs, and reduce risky driving and fighting.

But while the commission’s report discusses these prevention programs, and others, it stops short of saying what the federal government’s obligation should be to make sure schools know about them and use them. While they are vastly less expensive than treatment or incarceration later in life, there is still a cost.

The Center for the Study and Prevention of Violence at the University of Colorado Boulder estimates the Good Behavior Game costs $81 per student in the first year, while LifeSkills Training costs $17 per student in the first year.

Instead of pushing for investing in these effective programs, the commission chose to advocate for two prevention measures: increased use of a screening tool to identify at-risk youth who may need treatment and a national public education campaign. The campaign would aim to raise awareness that addiction is not a moral failing but a chronic brain disease, and that treatment is available. While it’s a good message, mass advertising campaigns like this haven’t been particularly effective in the past.

They “can at most make a modest contribution to turning around the opioid epidemic, with some risk of making it worse if the lessons of past failed antidrug campaigns are not heeded,” wrote Austin Frakt, director of the Partnered Evidence-Based Policy Resource Center at the V.A. Boston Healthcare System, and Keith Humphreys, a professor at Stanford University School of Medicine, for The New York Times on Nov. 1.

“But the safest bet is that the results will be between those two end points: zero. To fight the opioid crisis, public money is probably best spent elsewhere.”

Instead of spending the money on a national campaign, it would be better to spend it on programs for youth that are already known to work.

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