Expanded Perspectives on Drug Education

Extension professionals in many states, recognizing they have a contribution to make in the war against drugs, have identified drug education as a high priority. Illinois Cooperative Extension's drug educational program is broad-based and believes "...the most promising approaches to drug prevention are comprehensive programs that involve schools, communities, parents, students, and law enforcement...."1

Illinois Extension's approach to drug education reflects the view that the drug problem involves far more than the abuse of illegal substances such as "crack" or heroin. It also includes the misuse of medicinal drugs which, according to Goodstadt,2 is our most widespread and serious drug problem. Though both categories of drugs are potentially dangerous, one group consists of illegal substances while the other is made up of drugs with legitimate therapeutic applications.

Programs that broadly address the drug problem, including the misuse of legally obtained medicinal drugs and abuse of illegal street drugs, should distinguish between the concepts of abuse and misuse. Drug abuse is the intentional and nontherapeutic use of any psychoactive (mind-affecting) substance, including alcohol, that adversely affects the user's well-being. Drug misuse is inappropriately prescribing or using therapeutic drugs, is unintentional, and those involved aren't seeking psychoactive effects.

What may initially appear to be a clear distinction between the abuse of illegal drugs and the misuse of therapeutic drugs becomes blurred on closer examination. For instance, some people obtain medicines legally, but intentionally use them to achieve an altered state of mind. That practice constitutes drug abuse, even though the medication is obtained legally. Users of multiple drugs sometimes combine illegal and legal substances. Another example that confounds the legal-illegal and abuse-misuse distinctions between drugs is alcohol, a substance that qualifies as a drug. It's available legally in most communities, but its sale and consumption are illegal in some locations, at certain times of day, for those underage. Esssentially, both legal and illegal drugs, whether they be intentionally abused or accidentally misused, can be harmful.

Perhaps the most significant programmatic implication of this expanded view of the drug problem is how it greatly broadens the audience base in Illinois. No longer are prevention efforts limited to youth, their parents, and others who work with young people. It's no secret that older adults often have difficulty relating to the youth drug scene. But, when exposed to the broader view of drugs, older adults begin to appreciate how their personal misuse of medicines implicates them in the overall drug problem.

Basically, the Illinois drug educational program focuses on three primary audiences-older adults, early adolescents, and parents of school-age youth-each of whom has a prominent role in battling drug misuse and abuse.

Problems associated with medicine misuse range from minor annoyances to life-threatening situations, often resulting from adverse reactions to single medicines or the interactive effects of multiple medicines. The National Council on Patient Information and Education (NCPIE) reports Americans over the age of 65 years make up about 12% of the population, but consume nearly one-third of all medicines. Moreover, NCPIE estimates that up to one-half of the nearly 400 million prescriptions dispensed to older adults are used incorrectly.

Illinois Extension staff developed a program for Extension homemakers to promote the safe use of medicine by rural, older women (age 60 years and older). Since limited data are available on the use of therapeutic drugs in rural populations, our initial activity consisted of a needs assessment survey of noninstitutionalized, ambulatory older women (n = 187) in 10 rural Illinois counties. The survey was done to determine the extent of medicine use and identify patterns of misuse that could be modified by educational interventions. Survey results, including the following, document the potential for medicine misuse and are being used in the development of educational materials and strategies:

• Among prescription users (n = 163), 76% were using more than one prescription, 16% were using more than four, and seven percent were using more than six.

• Thirty-one respondents reported obtaining prescriptions from more than one doctor.

• Thirteen percent of those using multiple prescriptions relied on more than one pharmacy to provide those medications.

• Three of four prescription users also used non-prescription medications on a regular basis, and nearly 25% of those individuals hadn't informed their doctors they were using these products.

University-based Extension staff developed medicine misuse program materials. Those materials and training in how to use them will be made available to Extension field staff responsible for implementing local programs.

A major part of our drug abuse prevention effort is embodied in Project Drug Free (PDF), a research and demonstration project involving youth making the transition from elementary to junior high or middle school.

Description. With funding from the U.S. Department of Education, PDF focuses on gateway drugs (alcohol, marijuana, and tobacco). The program was first implemented in 1987, and is currently under way in four schools from three different counties. The state-level Extension mental health specialist helped develop the initial grant proposal, served as project director, and is a member of the PDF staff. County Extension advisers (agents) helped form local advisory boards, used their media outlets to publicize PDF, and incorporated drug education activities in their ongoing programs.

Project Drug Free classroom experiences involve much more than traditional drug education. Skill development in the areas of assertiveness, problem solving, peer resistance, and decision making is an integral part of the program. Moreover, classroom teachers provide activities designed to improve students' study skills and enhance self-esteem, both of which are thought to ease the transition to middle school and increase the probability of success in school. Lack of academic success and a negative school experience are factors that increase the risk of drug abuse among youth.

Evaluation. A pre- and post-test quasi-experimental design, involving intervention and comparison (control) schools, was done to determine the effects of Project Drug Free on student knowledge, attitudes, peer resistance skills, and drug-taking behavior. Using analysis of covariance and controlling for pre- test scores, we concluded the program had a positive impact on student knowledge and attitudes. There were no effects on student peer resistance skills. Other data indicate students in the intervention school show significantly lower rates of drug usage when compared to their counterparts in comparison schools.

Parent Involvement. Unlike many other school-based drug abuse prevention programs, PDF involves a parent education component consisting of a series of meetings and newsletters. Topics such as "understanding your early adolescent," "communicating with kids," and "parents as role models" are addressed.

Involving parents at the intervention school was assessed at the end of the initial year of the project. A random telephone survey of sixth grade parents (n = 42) showed 83% were aware of Project Drug Free and, in most cases, they learned about it through their children. Four-fifths of the parents had talked to their children about drugs and about 60% rated those discussions as "good" or "very good." Interestingly, over half the parents reported that PDF "definitely" improved the quality of discussions between them and their sixth-grade children.

Community Involvement. Involvement of key agency representatives, community leaders, and other interested parties is vital to the success of Project Drug Free. Accordingly, broadly represented community advisory committees were organized in areas where PDF was implemented. Those advisory groups serve as sounding boards for PDF staff and participate in the parent education phase of the project. Representatives from the medical community, Extension, drug rehabilitation, public health, parent groups, service organizations, and enforcement participate on the advisory committees. One unanticipated result of bringing together such a diverse group of individuals was an increased awareness of drug abuse prevention activities throughout the community. It's indeed surprising how little one group knows of another even when their efforts are directed toward the same goal within the same community.

In the early developmental stages of PDF, a close working relationship was developed with the Association of Illinois Middle Schools (AIMS). In preparation for Project Drug Free, teachers and administrators participated in a five-day professional development program in conjunction with the AIMS Summer Institute. The local Rotary Clubs provided $9,000 to support teachers who attended the summer institute, exemplifying the degree of community support for PDF. Rotary also provided $7,500 to develop a videotape featuring Project Drug Free and encouraging other Illinois communities to develop similar programs. Copies of the videotape have been provided to several Illinois communities. In addition, copies of an extensive dissemination report were sent to all school districts in Illinois during January 1991. The report provides a rationale for the components of PDF and a detailed description of how communities can replicate the program.

What has evolved in Illinois Extension is a program that addresses both the abuse of illegal substances, such as marijuana, "crack," and heroin, and the misuse of medicinal drugs, particularly among older adults. A second characteristic of the Illinois approach involves school, families, and community groups and agencies-an excellent approach for several reasons. For example, parents aren't only made aware of what's happening in their child's classroom, but they learn how to reinforce concepts being taught in school. And, cooperation among community groups and agencies has helped immeasurably in identifying resource people, locating sources of funding, avoiding program duplication, and understanding what's happening throughout the community in the area of drug education.

1. U.S., Department of Education, Schools Without Drugs (Washington, D.C.: U.S. Government Printing Office, 1989).

2. M. S. Goodstadt, "Drug Education: The Prevention Issues," Journal of Drug Education, XIX (No. 3, 1989), 197-208.