It is clear from numerous reports that drug education in the UK is not up to scratch. Children are supposed to be learning about drugs and alcohol in a subject called Personal, Social, Health and Economic education (PSHE), but currently there is a vague curriculum with lots of freedom given to schools. This means that nationwide the provision is patchy at best and practically non-existent in some localities and schools.
So, what can be done to improve drug education so that children are getting better quality information as well at the development of relevant skill sets? We need a national curriculum of specific, evidence-based education, so that all children get a clear, consistent, message no matter where they are going to school. Currently, the government is in the process of updating the Sex and Relationships guidance for PSHE and it would be useful to do a similar thing for the Drugs and Alcohol element. We want to know what the drug education would be, who would deliver it, who it would be delivered to and what outcomes we want to get.
The evidence-base here is key, because we don’t want to inadvertently do more harm than good or to spend money on useless or irrelevant things. The worst thing would be to launch a new drug education programme and then find out it actually increases the number of kids taking drugs, as well as the associated harms. We also need to be realistic about what can be achieved in schools with the few resources and lack of expertise currently available.
When considering this, we first have to know what we want to achieve: most drug education programmes tend to aim for a reduction in drug use, and thus lean towards a simplistic “don’t do it” approach. This is in line with the insurmountable aim to create a “drug-free world”. But what if we just acknowledged that that is an impossible task and instead aimed for an overall healthier relationship with drugs where those who did take them did so safely? The aim of school-based drug education could be to have an informed cohort who then, based on this knowledge, either abstain or take drugs safely. This could be a better outcome, as less overall drug use does not necessarily mean a reduction in overall harm. In other words, aiming to prevent drug misuse, rather than all drug use.
We spoke to Michael O’Toole, CEO of Mentor UK, one of the country’s leading charities working to prevent drug and alcohol misuse. When asked what sort of interventions are most effective when delivering drug education to young people there were two key factors that he identified, the first being that the education should be ongoing and reflective rather than a singular lesson where the young people are being talked at. It is most effective when it takes place over several weeks and several lessons and it certainly has to be more than one class. O’Toole said:
“Drugs education shouldn’t be a one-off stand-alone lesson, which unfortunately it often is. It is often delivered through an assembly with a police officer or someone in recovery coming into school talking about their experiences. All evidence shows those kinds of one-off approaches are not effective, it should be an interactive series of discussions with the young people.”
The second factor to consider is that early intervention tends to be the most effective, but we need to consider what sort of education is required at different stages. O’Toole said:
“It needs to be age appropriate. Different approaches work better at different stages and, linked to that, is the fact that earlier interventions are better. They should start ideally at primary school but at that level you wouldn’t be talking in any informational way about drugs or the impact of drugs, it would be more about pro-social skills and how to be safe and effective in your relationships with other people. These are the basic building blocks that help build resilience in young people.”
This is a key point, as lost early intervention means that young people who end up on a trajectory where they are developing a problematic relationship with drugs often do not receive help until it is too late. Prevention is always better than treatment after-the-fact, as it not only saves young people and their families from unnecessary suffering, it’s also cost-effective! That is not to say that treatment should not be sufficiently funded as well, as this can provide a more individually tailored response and reduce harm for the most vulnerable people, but preventative measures should be seen as just as important. And education can only be preventative if it is delivered before young people start engaging in risky behaviours.
In the UK, 18% of students do not receive a single lesson about drugs, alcohol and tobacco until aged 14 (according to an Ofsted Report and research by Mentor Adepis). This is despite 80% of students having tried alcohol by 15 and 37% of 15 year olds having tried illicit drugs at least once in their life. This means that there is a significant number of young people who will slip through the cracks, because they have received no education before they start taking part in drug and alcohol use. However, we do of course need to be sensitive that we are not exposing children to content that is inappropriate for their age group or would make them more curious about trying drugs than before.
Professor Harry Sumnall, who works for the Public Health Institute at Liverpool John Moore’s University and is a Professor of Substance Use, suggested that for up to the age of around 14 the education should be centred around more general health and social ‘life skills’ and encouraging young people to think for themselves. Then, once they are older (perhaps in sixth form or university) the education could move away from skills towards the reality of drug use, as there is a greater likelihood of these older young people to be taking drugs or at least be in a situation where others are taking drugs.
Another question that needs answering is: Who should be delivering these drug education programmes in schools? Firstly, it needs to be delivered by people with a good understanding themselves of drugs and the issues around it and tend to work with the kids and take into account their views, rather than just throwing information at them and expecting them to take it at face value. This role could be carried out by teachers if they had the right support, professional development, training and resources available to them. Providing such resources and training is something that Mentor UK specialises in, as well as a number of other organisations.
However, this is not to say that there is not a place for external providers to come in and add to this programme. It is important to consider though, where external speakers are utilised, whether they are the right kinds of external speakers. Often, these talks are delivered by police officers and thus have a very clear emphasis on law enforcement, whereas treatment providers could be an alternative where the focus would be on health.
Currently, treatment services sometimes engage with schools or youth groups to do workshops, but unless drug education is directly in their commission from the local authority they will likely want to save resources and focus on treatment rather than prevention. This is because the government currently measures the ‘success’ of treatment services by the number of people leaving treatment. One policy change could therefore be to make sure that when treatment services are contracted, part of their requirements are to carry out a certain number of drug education sessions in schools.
The last and perhaps the most difficult question – what about the actual content of the drug education? How detailed should it be? Should harm reduction advice be given? The content laid out in the PSHE curriculum needs to be far more comprehensive, where they don’t just talk about the legal aspect of drugs, but discuss why people take drugs, how they make you feel and the potential health risks. However, some argue that, as drug use is still a minority activity, it is not appropriate to be giving specific harm-reduction advice to the whole cohort, instead it would be better to guide them to resources, if they want to access them, or even to deliver additional sessions to ‘at-risk groups’.
For example, the previously mentioned academic Harry Sumnall, argues that the best option would be universal drug education regardless of risk that would centre around developing core skills of critical thinking, responding to risky behaviour etc, plus targeted lessons for ‘at-risk groups’. He suggests that harm reduction might not be appropriate for school, given how drug use is a minority behaviour and we don’t want to normalise it among young people.
For those in secondary school, these core skills could be anything from planning ahead for a situation where there might be drug use to how to make situations safer (where to go if you need help, transport, dosages, presence of a sober friend). It could also involve helping young people to think critically about risk-taking behaviour and to know where to find social and health information for themselves, as well as how to apply it to their own circumstances. Finally, the building of self-esteem and independence can provide young people with relative resistance to peer pressure. Meanwhile, more specific harm reduction advice and interventions could be available for those identified as needing this support.
However, there is a danger that separating young people in this way would needlessly ‘other’ people and the kids identified as ‘at-risk’ may face stigmatisation, so this would have to be done extremely sensitively. It is unclear how the school would be able to differentiate pupils who are ‘at-risk’ from those who are not, especially without a certain level of profiling which could get problematic. There is also a concern that such a policy would reinforce the arbitrary line between ‘legal’ and ’illegal’ drugs, when really the issues that young people experience associated with alcohol are broadly similar to those associated with cannabis and other drugs that young people use.
Obviously if a need was identified with a specific student (in other words, if the school became aware of a drug problem or behavioural issues), they could be referred for an intervention programme. In this way, the universal drug education programme could be alongside more serious drug and alcohol prevention in schools for people showing signs of problematic drug use. However, if the latter group were the only pupils receiving more specific drug education, this could end up missing large numbers of pupils who could really do with the help.
Moreover, the assertion that drug use is a minority behaviour, whilst true to some extent, is becoming a weaker argument as teen drug use increases. The statistics released last week that revealed over 1/3 of 15 year olds have tried an illicit drug indicates that whilst it is a minority of students taking drugs, it is a significant minority and the numbers are only increasing. In fact, this percentage of pupils aged 11-15 who have tried drugs rose from 15% to 24% in just two years.
The argument regarding normalising drug use is valid, but only if normalising it actually increases the incidence of drug-taking, specifically careless drug-taking. Is there any evidence that education does this or that giving harm reduction advice to people who don’t take drugs has a negative effect? To use sex education as a parallel, it has been shown numerous times that specific harm reduction information such as how to use condoms to prevent contracting STIs does help reduce the number of people contracting them. And would anyone object to a young person who is not currently sexually active hearing about condoms? It could be useful for them later in life and is unlikely to trigger a sudden spike in sexual activity.
A study in 2010 collected qualitative data about young people’s routine experiences of drug education in school found that a majority of students could not remember having had any drug education at their secondary school, but that schools were instead adopting new strategies based on surveillance and targeting to control students’ drug use.
The study concluded that:
“It may be possible to increase the priority given to comprehensive drug education and supportive drug policies by modifying the incentive structures that schools work within. New targeted responses are unlikely to be effective at reducing drug-related harm at a population level because of the small number of students researched, and it can be stigmatising. Further research is needed to explore schools’ focus on surveillance and targeted control rather than universal education, and to examine interventions that might ensure schools implement adequate drugs education.
This therefore echoes the concerns that targeting specific groups may be stigmatising for those involved, as well as cheating out others of a valuable education.
Another factor to consider with regards to the content of drug and alcohol awareness sessions is how much should be informational, and how much should be discussion. On the one hand, information is often useful for people to make fully informed decisions about their lives. On the other hand, if you bombard young people with facts and figures about drugs you will often find that there is very poor recall of these facts, and therefore it is unclear whether it will result in any behavioural change.
Instead, if they are encouraged to think critically about drug-related issues, this will deepen understanding and can be applied to a variety of situations. Developing these skills of independent critical thinking can help students to reflect about what they want to decide, understand social pressure, and the consequences of risky behaviour. For example, it may be good to have them consider how decision-making might be impacted when drunk or to rehearse situations in which risky or safe decisions could be made. In this way, whilst the lessons should be unbiased, delivering unbiased education does not necessarily mean just presenting factual information.
We need to make sure we get all this right, which is difficult considering we know very little about the efficacy of different types of drug education so far. To be able to implement evidence-based education we need research – and so, it would be good to start one or even several small-scale pilot studies to get an idea of what the impact of different styles of education would be. The studies would ideally involve implementing a universal drug education programme is a localised area of the country and then, every few years measure the outcomes of the programme. These outcomes could include the level of knowledge that the children have about drugs and alcohol, awareness of local services, rates of use and associated harms, number of young people entering treatment. It would be worth asking the question (again) whether young people even remember getting any drug education, as we really should be doing better than what the previous study found.
There are a number of evidence-based programmes and drug education trials in the UK that can be looked at as examples of good practice, when designing the pilot. One example of a good drug education programme is Mentor’s Alcohol and Drug Education and Prevention Service (ADEPIS), which give support and guidance in the delivery of evidence-based education. It’s a good start, especially as Mentor are specialists in school-based drug education. Mentor UK has been awarded a new three-year contract, jointly funded by Public Health England and the Home Office to continue to develop and deliver its ADEPIS programme for schools and community prevention services.
Another drug-education programme that is using evidence-based campaigns and education, is Rise Above, which aims to delay and prevent risky behaviour in young people by building emotional resilience with the help on online video content. Rise Above Schools similarly provides new PSHE resources to support secondary school teachers when promoting health, well-being and resilience among young people aged 11-16.
This is very goods – however, evidence-based programmes, whilst effective are relatively expensive. If a new approach was to come forwards, it would be prudent to analyse it carefully and see whether it could be implemented more cheaply.
To conclude: What does a good drug education programme look like? It takes place over a period of time rather than as a stand-alone session; it intervenes early, but is age-appropriate; it is more comprehensive than the current curriculum (covers health issues as well as legal ones); and it develops skills as well as presenting factual information. The jury is still out on questions like whether abstinence or harm reduction should be the focus or whether specific harm reduction advice is appropriate for everyone to hear. We should now build on what we know – future research will be extremely important when mapping out exactly what drug education should be delivered to the next generation.
Words by Abbie Llewelyn. Tweets @Abbiemunch.