Drugs: Education, Prevention and Policy

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The Effectiveness of Primary School Drug

Education

Charlie Lloyd, Ruth Joyce, Jane Hurry, Mike Ashton

To cite this article: Charlie Lloyd, Ruth Joyce, Jane Hurry, Mike Ashton (2000) The Effectiveness
of Primary School Drug Education, Drugs: Education, Prevention and Policy, 7:2, 109-126, DOI:
10.1080/dep.7.2.109.126

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Drugs: education, prevention and policy, Vol. 7, No. 2, 2000

The Effectiveness of Primary School Drug Education

CHARLIE LLOYD, RUTH JOYCE, JANE HURRY & MIKE ASHTON

Joseph Rowntree Foundation, The Homestead, 40 Water End, York YO30 6WP, UK

ABSTRACT Early use of drugs such as tobacco and alcohol is associated with later drug
misuse and the age of initiation into drug use is falling in the UK and elsewhere. Arguably
educational interventions must start in the primary school in order to maximize any
preventive impact yet such education is underdeveloped and poorly researched. This article
reviews the (mainly US) literature on the effectiveness of school-based educational
interventions targeted at children below 11 years of age with the objective of preventing
illicit drug use. Such evaluations are rare partly because they require a long timescale
before impacts become measurable. The major (but still small-scale) British study to date
suggested that a broad-based, life-skills programme could help prevent drug use. Other
British studies have demonstrated the feasibility of implementing drug education in the
primary school and some have recorded improvements in variables thought to relate to
later drug use/ problems. Outside the UK, studies of two popular approaches (DARE and
Life Education Centres) have been generally inconclusive or disappointing. However, there
is evidence that long-term, intensive programmes, especially those which involve parents
and the wider community and employ interactive teaching styles, can have a lasting and
worthwhile impact on later drug use. Recommendations are made for UK practice based
partly on these ® ndings.

Introduction
There is a large, well-trodden and mostly American literature on the impact of
drug education programmes. Reviews have generally concluded that while many
approaches have failed in the past, some more recently developed programmes
have been shown to have an impact on drug use. Successful approaches have
tended to be intensive (Kumpher, 1997 ), interactive (Kumpher, 1997; Tobler &
Stratton, 1997 ), multiply focused on parents and communities, as well as schools
(Pentz et al., 1989; Tobler & Stratton, 1997 ) and based on life skills (Botvin et al.,
1995; Kumpher, 1997; McGurk & Hurry, 1995 ).
Rather than attempting to prevent drug misuse in a permanent sense, these
approaches tend to focus on delaying onset of drug misuseÐ in particular the
onset of experimentation with so-called `gateway’ drugs: tobacco, alcohol and
cannabis. Gateway theories of drug misuse suggest that usage of one drug
predisposes a young person to use another, often perceived as more serious,
drugÐ so that smoking tobacco could be seen as gateway activity to smoking
cannabis and cannabis use could be seen as a gateway to other illegal drug use.
According to this view, drug use `careers’ are seen as a series of steps, with users

Drugs: education, prevention and policy ISSN 0968± 7637 print/ISSN 1465± 3370 online # 2000 Taylor & Francis Ltd
http://www.tandf.co.uk/journals
110 C. Lloyd et al.

passing though a predetermined sequence of drug use stages. There is a

considerable amount of research to support the notion of certain stages in drug
misuse: tobacco useÐ and to a lesser extent alcohol useÐ has repeatedly been
found to be a predictor of cannabis use (Hawkins et al., 1992; Kandel & Logan,
1984; Leitner et al., 1993). Furthermore, the age at which drugs are ® rst used
appears to be associated with the nature of future drug use. Thus early onset in
use of illicit drugs has been found to be associated with drug problems (Anthony
& Petronis, 1995; Fergusson & Horwood, 1997; Kandel & Yamaguchi, 1993;
Newcomb et al., 1987; Robins & Przybeck, 1985 ). This association has led
researchers to suggest that `early prevention efforts targeting the avoidance of
youths’ initiation with alcohol and cigarettes may reduce the use of marijuana,
and prevention of early use of marijuana may reduce involvement with other
illegal drugs’ (Werch & Anzalone, 1995 ). See also Guy et al. (1994 ).
What has been explored less thoroughly in the many literature reviews and
commentaries on drug education is the issue of targeting, particularly with
respect to age. The large majority of drug education approaches are aimed at
sixth, seventh or eighth grade pupils in the American schooling systemÐ that is
children aged between 11 and 14. In the UK the main focus of drug education is
on secondary schools. However, research both here and in the USA has shown
that initiation into smoking tobacco often occurs before this age is reached
(Balding, 1997; Kandel & Logan, 1984; Swachi, 1989; Turtle et al., 1997). Recent
survey ® ndings indicate that the average age for ® rst trying a cigarette was 11 in
1995 (Turtle et al., 1997 ). It would therefore appear that many of the American and
British primary prevention programmes may be poorly targeted, concentrating as
they do, on secondary school-age children. Moreover, if, as is suggested by the
available research on drug trends among young people (Balding, 1997), the age of
initiation is decreasing, the mismatch between the delivery of drug education and
the key stage in adolescent experimentation with drugs must be increasing. A
review of 108 drug education packages available in the UK has pointed out that
`on the whole, the evidence strongly points towards an ever younger substance
misusing population . . . If educational preventive measures are to be effective

What are `Life skills’?

In a report on a UK primary school drug education programme life-skills
approaches were de® ned as those which
`seek to have an effect mainly through promoting a range of social
skills. However, they embrace a variety of approaches that have in
common the underlying assumption that drug use is at least partly
due to poor coping strategies, decision making skills and the like.
They are based on a knowledge of risk factors for drug use/abuse
developed on the basis of research conducted over the past two
decades. It is within this broad approach that the most successful
drug abuse prevention programmes can be found though they are
not universally effective’ (McGurk & Hurry, 1995 ).

Box 1.
 Primary School Drug Education 111

Draw-and-write: revealing the mind of the child

The draw-and-write technique explores young children’s conceptions by
asking them to make drawings illustrating a particular theme or story line.
The drawings may be captioned and the characters’ thoughts and words
may be included, much as in cartoons. By avoiding the need for children to
articulate in abstract verbal terms the method has revealed that surprisingly
young children have clear views on what drugs are and what drug users
and dealers look like and how they behave.

Box 2.

they should show a parallel trend in the age group they tackle . . . such a trend
has not been the case in the UK’ (Swadi, 1989 ).
There is also a growing body of researchÐ mainly using the `draw-and-write’
technique (Welton & McWhirter, 1998 [1] (Box 2)Ð showing that children as
young as 5 have some knowledge and understanding about drugsÐ including
medicines, tobacco, alcohol, volatile substances and illegal drugs.
Nevertheless, preventive drug education is by no means universally instituted
in British primary schools. In a survey of schools carried out by the Professional
Association of Teachers in 1995 (PAT, 1995) over 81% of those primary schools
that responded to a questionnaire appeared to have no drug education policy [2].
In a more recent survey of a sample of primary and secondary schools by Her
Majesty’s Chief Inspector of Schools (1997 ), 43% of the responding primary
schools reported having a drug education policy. While it is clear that some
primary schools have implemented good preventive programmes, in many cases
involving life-skills approaches, it is dif® cult to establish how widespread such
good practice is.
As a recent survey in Avon found, one reason for the reluctance to involve very
young children in drug education is fears among school teachers (as well as
parents) of drug education in primary schools `raising too much awareness
amongst their young charges’ (Dawson, 1997 ). This report quotes one head
teacher who reported: `I do feel sad that the primary child is forced to grow up
so quickly in a world of sex, drugs and violence. . .’. Another `common argument
against [primary school drug] education is that increasing a child’s awareness of
drugs might increase their curiosity and result in more experimentation’ (Greer,
1989). Some of the reluctance to involve younger children in drug prevention
would therefore appear to be due to a wish to `protect their innocence’ and to
avoid sparking an interest in drugs where there was no interest before. Another
reason involves the potential for the negative labelling of schools: head teachers
can fear that the introduction of drug education will be interpreted as an
admission that the school has a drug problem.
The rest of this review will concentrate on the limited number of evaluations of
primary school interventions that have been uncovered.

Evaluations of Primary School Interventions

There are very few evaluations of primary school drug education in this country
and where they have been undertaken, they have largely focused only on process
112 C. Lloyd et al.

or intermediate outcomes (such as changes in knowledge, attitudes or social

skills). A fundamental problem faced by evaluators of primary school drug
prevention projects is the delay involved in measuring drug use outcomes. A
project delivered to 10-year-old children cannot be expected to have a measurable
impact on cannabis use for 4± 5 years. This poses considerable problems for
evaluators, as policymakers, programme implementers and research funders are
rarely prepared to wait this long for results. The following, selective review
concentrates only on school-based approaches that focus in the main on children
aged 10 years or younger, and in the case of research from outside the UK, on
research that has focused on outcomes. Only evaluations of programmes that
have included a focus on illicit drug use have been included (this excludes a large
number of programmes focusing only on tobacco, and a few that have focused
only on alcohol) [3].

British Evaluations
The one British study that has attempted to measure the impact of primary school
drug education on behaviour is the evaluation of Project Charlie (Hurry & Lloyd,
1997). Project Charlie is a broad-based, life-skills programme targeted at primary
school children, which incorporates training in resistance skills, peer selection,
decision making and problem solving, self-esteem enhancement and the provi-
sion of information. The evaluation included a long-term follow-up of primary
school pupils exposed to the programme in 1992, to assess its impact on the drug-
related knowledge, attitudes and behaviour of those aged at least 13.5 in 1996
after they had reached secondary school. Due to the way the programme had
been implemented, the design of the study was complicated, but a number of
comparisons could be made of those that had received Project Charlie and those
who had not:

Comparison 1. One sample of 44 pupils had been randomly assigned by class to

either receive Project Charlie or act as a `control’, and receive no drug education
at primary school (34 of these pupils were successfully followed-up in 1996). This
allowed the most powerful test of the programme, comparing 20 Project Charlie
children with 14 controls.

Comparison 2. A second sample of 24 pupils who received Project Charlie were

matched with 24 pupils who did not receive the programme (42 pupils were
successfully followed-up in 1996 ). Thus 21 Project Charlie pupils were compared
with 21 matched controls.

Comparison 3. The above samples were combined with an additional, large

comparison group of 233 pupils who had not received the Project Charlie
programme, consisting of all the pupils who happened to be in the follow-up
pupils’ secondary school classes in 1996.
Findings showed that:
. Project Charlie pupils in comparison 1 were signi® cantly less likely to have
used tobacco than controls. They were also less likely to have taken illicit or
illegal drugs, but this was not statistically signi® cant.
. Similar but statistically insigni® cant trends were found in comparison 2.
 Primary School Drug Education 113

. Both tobacco and illicit/illegal drug use were signi® cantly less common among
the Project Charlie pupils in comparison 3.
. While there was no evidence of Project Charlie children having more decision-
making skills at long-term follow-up, they did show a signi® cantly greater
ability to resist peer pressure than controls in comparisons 1 and 2.
. Project Charlie had no long-term effect on knowledge but did have an impact
on attitudes, with Project Charlie pupils expressing more negative attitudes to
drugs than controls in comparisons 1 and 3.
With regard to the signi® cance of these ® ndings, it should be emphasized that the
samples were small. As the authors pointed out, further research is needed to
replicate these ® ndings with larger samples.
Other British studies have focused on process rather than outcomes. A report
on the development and piloting of a `media-based information resource’ for
children aged 9± 10 years found it was successful in achieving a number of
objectives, including enabling the children to understand the concept of danger-
ous drugs, consider the options available to them in potential drug-taking
situations and make a choice from these options (Baker & Caraher, 1995 ).
All 366 primary schools in Avon were sent questionnaires asking about drug
education in general and their use of a particular drug education resource, Drugs
Education: a practical guide for primary school teachers, which had been circulated to
all schools (Dawson, 1997). Of the 201 schools that responded, over a third had no
formal drug education policy, but very high percentages responded favourably to
the need for drug education in primary schools. Responses to the Practical Guide
were positive: 97% of respondents who had used it thought that it had
contributed to classroom teaching on drugs and 95% found it very useful in
teaching drug education in their school.
Another study examined the impact of Drug Abuse Resistance Education
(DARE) on children in year 6 (9± 10 years) attending a school in Mans® eld
(Whelan & Moody, 1994 ). DARE is a US drug prevention programme delivered
by police of® cers and targeted at elementary school children (5± 12 years). In the
USA, DARE has proved immensely popular, where it is the most widely used
school-based drug prevention programme (Rosenbaum et al., 1994 ), and it is
gaining a considerable momentum in the UK (Potter, 1996 ). The DARE pro-
gramme draws on a range of theories and approaches: it includes a life skills
element (focusing in particular on resistance skills), but also includes information
on drug use, self-esteem building and decision making. The Mans® eld evaluation
focused on three schools, one of which had opted to implement the programme,
with the other two acting as comparison schools. The researchers tested pupils’
knowledge and attitudes to drugs using a pre- and post-intervention question-
naire based in part on the `draw and write’ technique (Wetton & McWhirter,
1998), and concluded that `no general patterns of development in knowledge and
attitudes were found to have resulted in pupils who received the DARE inter-
vention, as compared to those who had not received the intervention’. However,
there were some individual developments in knowledge and awareness, such as
the children exposed to DARE being more likely to recognize that drugs can be
harmful. While stressing the short-term nature of their research, the authors drew
attention, among other things, to the need to make the social skills aspects of the
curriculum more drug-speci® c and the need to `develop more the interactive
components of the curriculum at the expense of ``inputs’’ from the DARE of® cers’.
114 C. Lloyd et al.

An assessment of the needs of the teachers, pupils and parents of 18 middle

schools in Northumberland was used as the basis for a new drug education
programme aimed at the schools’ 1428 year 5 pupils (aged 9± 10 ) (Paxton et al.,
1988). Assessment questionnaires were obtained from 185 teachers and 1442
parents, and pupils took part in a draw-and-write exercise. Teachers were then
given a half-day of training and later delivered a programme within a single
`intervention week’, consisting of four daily sessions lasting four hours each over
Monday to Thursday. Parents’ evenings were arranged in each intervention
week, to inform them about the programme, give them information about drugs
and involve them in their children’s drug education; 317 took part in the parents’
evenings. The evaluation showed that teachers reported improved drug-related
knowledge and con® dence; pupils gave more realistic responses to drug dis-
covery scenarios; and parents showed more con® dence and support for drug
education.
The few reports in the UK into the use of same-age or slightly older pupils to
deliver drug education mostly amount to informal process evaluations. The
approach has promise (see the report below on the Australian Illawarra pro-
gramme ) but is tricky to implement and needs careful planning. One British
report frankly described how at secondary school level things can go badly wrong
(with chaos and disruption in the classroom) if pupils do not have a range of
teaching skills as well as drug knowledge, and suggests that slightly older pupils
are more likely to be respected as a `peer leader’ than pupils from the same year
group (Nash, 1996 ). This seems to be borne out by a later report of a similar
project in which such problems were not reported (Parkin & Haynes, 1998 ). A
recent UK report on peer education in general suggests that teachers ® nd
handing over control to pupils an uncomfortable experience (Peer Education
Survey), while the authors of a US review argue that peer drug education is
sometimes not fully implemented because teachers are uncomfortable with
interactive methods such as role play (Black et al., 1998).
Commonly the impacts of the experience are easiest to demonstrate for the
peer educators rather than their peers, though such impacts may none the less be
positiveÐ in fact, they may be the chief outcomes.
In one of the few UK reports of peer drug education involving primary school
pupils the education took the form of a play performed by year 10 and 11
secondary school pupils to an audience of year 6 pupils (Leigh, 1997 ). It needed
the support of special funding in the form of a GEST grant and the authors stress
the work the recipient schools had to put in to prepare for and follow up the
drama. The younger audience appears to have enjoyed the experience and to
have retained some clear safety and anti-drug messages. An interesting point was
that one of the secondary schools used the play as an assessed piece of year 11
drama work, giving it a `legitimate’ place in the curriculum. A conference of
professionals which looked at the work suggested that it might be cascaded down
the age range.
Focusing drug education work on producing materials such as posters, lea¯ ets,
videos and events such as plays has the potential for the dual impact of educating
about drugs and also about media vehicles for conveying messages about drugs.
It also creates an output which can be used to involve and inform parents and/or
other pupils. In process terms this seems to have been successful with the last
year of a primary school where year 6 pupils produced a video shown to parents.
Perhaps because the makers contrived to show nearly all the children in the
 Primary School Drug Education 115

video, parental attendance at the event was high. Focus groups held with the
children 6 months after they had left the primary school suggested they had
retained some key messages. For them the real learning outcomes had been in
knowledge and understanding of drugs and in a greater con® dence in their own
abilities to deal with new situations, particularly those in which drugs might be
on the menu.

Research Elsewhere
When a signi® cant gap is encountered in the British research literature on a
particular subject, commentators tend to turn to the much larger American
research literature for answers. However, surprisingly few American studies
have been undertaken which have focused on drug prevention with primary
school-age children. While a number of researchers and commentators have
recently highlighted the importance of targeting younger school children
(Leukefeld & Clayton, 1994; Nagel et al., 1996; Porter-Serviss et al., 1994; Werch
& Anzalone, 1995 ), few projects that have actually done so have been evaluated.
One notable exception is DARE which, on account of its widespread use, has
received considerable research attention. The following section is divided into
three: evaluations of DARE; evaluations of Life Education Centres; and
evaluations of other drug prevention projects aimed predominantly at pre-
adolescent children.

DARE
In the USA, DARE is usually delivered in the penultimate or ® nal year of
elementary school (i.e. children aged 10± 12 ). The programme is taught by
uniformed police of® cers and consists of 17 weekly lessons, lasting between 45
and 50 minutes each. While a number of evaluations of DARE have been carried
out, `there have been few rigorous evaluations of DARE, and the best studies
have left important questions unanswered’ (Rosenbaum et al., 1994 ). The ® ve
most rigorous studies published in academic journals are summarized below [4].
. In North Carolina while DARE had the intended impact on attitudes to drugs,
there was no impact on actual drug use or intentions to use. However, the
period between the baseline survey and the post-test survey was very short,
making this latter ® nding unsurprising (Ringwalt et al., 1991).
. South Carolina researchers found that DARE had an impact on alcohol use and
drug-related attitudes but not on use of tobacco or cannabis. However, again,
the period between pre- and post-tests was short (20 weeks) (Harmon, 1993 ).
. In Illinois a temporary impact on tobacco and alcohol use was reported, but one
year after the programme this effect had disappeared. The authors pointed out
that even with their longer-term follow-up, drug use was still rare in their
sample, making the discernment of any impact dif® cult (Ennett et al., 1994a;
Rosenbaum et al., 1994).
. In Kentucky pupils were followed up for 5 years. Researchers found a
temporary effect of DARE on attitudes toward drugs, the capability to resist
peer pressure and estimates of peer drug use one year after exposure to the
programme. However, this ® nding disappeared in longer-term follow-ups, and
116 C. Lloyd et al.

there was no impact on drug use or attitudes 5 years after the programme
(Clayton et al., 1996).
. In Colorado Springs DARE had no signi® cant impact at 3-year follow-up.
However, at 6-year follow-up the researchers found an impact on `outsider’
drug use, i.e. amphetamines/barbiturates, LSD, cocaine, inhalants and other
illegal drugs, but for males only (Dukes et al., 1995, 1996, 1997).
All these studies have their strengths and weaknesses but a weakness common to
all is the lack of detailed process evaluation, with the assumption that DARE has
been faithfully implemented in each school. A second criticism is the lack of
information on what happened to `control’ groups; these evaluations probably
consisted of a comparison between DARE and some other programme or group
of programmes, rather than a comparison of DARE with nothing. Comparative
research projects should be designed in future, which explicitly compare DARE
with other, recognized drug education approaches.
However, putting these issues to one side, what can we say about the
effectiveness of DARE? It would appear that the programme can have a short-
term impact on drug-related attitudes and, possibly, a short-term impact on
alcohol and tobacco use. Such in¯ uences on `soft’ drug use seem to disappear in
the long term, but one study has shown an impact on `hard’ drug use by males 6
years after programme delivery. However, this has only been found in one study,
and as the researchers themselves point out, additional research on the longer-
term effects of DARE is required.
DARE’S unconvincing results to date may be partly due to its teaching style. An
analysis of 120 drug prevention programmes in a slightly older age group (11± 14 )
has led US researchers to conclude that approaches incorporating interaction
between the pupils are superior to didactic approaches where the teacher mainly
imparts information to the pupils and any activities are teacher-to-pupil rather
than pupil-to-pupil (Black et al., 1998).
Two papers have suggested that DARE’s lack of impact relative to other
approaches may be due to its not adopting the interactive styles of teaching
seen in other programmes, and that perhaps one reason for this is that police
training and ethos does not suit them to this approach (Ennett et al., 1994b;
Williams & Keene, 1995).
Seen more broadly, this has implications for drafting in outside speakers or
drug experts to undertake drug education lessons who may be not be skilled in or
comfortable with allowing children leeway to interact and even lead the educa-
tion process, particularly in the contentious area of illegal drugs. Some may prefer
a less `risky’ but seemingly less effective didactic approach.

Life Education Centres

Life Education Centres (LECs) are mobile drug education units, delivering on-site
drug education to pupils at primary and secondary schools. The LEC project
started life in a chapel in Sydney, Australia in 1979. By 1989 there were 16 ® xed
centres and 46 mobile classrooms in Australia and by the mid-1990s, LECs were
delivering drug education to children all over the world, including 250,000 British
children (Quine et al., 1992; Stephenson et al., 1988; Tudor-Smith et al., 1995).
LECs provide preventive drug education for children aged between 3 and 15
years old (Life Education Centres, 1997 ). While in Australia, the original LECs
 Primary School Drug Education 117

seem to have focused on alcohol, tobacco and analgesic use (Hawthorne et al.,
1995), in this country, LECs target both legal and illegal drugs. The approach
taken is eclectic, but focuses in particular on teaching children how drugs affect
their bodies, and how to make responsible decisions about themselves and their
bodies. However, as well as providing information, LECs teach decision-making
skills and attempt to build children’s self-esteem. Recent formulations of the LEC
approach have been `based on the social in¯ uences approach’ (Wheller, 1995).
Methods used include an impressive array of audio-visual aids, including
puppets and illuminated models of body systems and organs.
LECs provide a multi-level approach to drug education, offering different
components for each year of education. A key feature of the approach is to
link-in with the drug education going on in schools, complementing rather than
replacing existing drug education. Teachers are encouraged to provide prepara-
tory and follow-up sessions to the LEC visit, which only aims to provide an
intervention lasting between 30 minutes and two hours (Tudor-Smith et al., 1995 ).
As with DARE, the evaluation of LECs has proved a highly sensitive and
contentious process. However, unlike DARE, the published evaluations have not
been of a very high standard. Two process evaluations of LECs have shown the
project to be popular with the large majority of teachers taking partÐ who, in
both studies, referred to the apparent, positive effect on the children taking part
(Stephenson et al., 1988; Tudor-Smith et al., 1995 ). A number of studies have
examined outcomes more directly, but each of these studies has had serious
methodological ¯ aws (Quine et al., 1992; Stephenson et al., 1988; Tudor-Smith et
al., 1995 ). Even in the most sophisticated evaluation, the schools involved were
not randomly selected to receive LEC and the authors had to rely on multivariate
statistical techniques to control for differences between LEC and comparison
schools (Hawthorne et al., 1995 ). The safest conclusion that can be drawn from
these evaluations is that, while LECs appear to be popular with children and
teachers the question of their impact on behaviour is an open one.

Other Approaches
While a number of studies have shown an impact of drug education on the
attitudes, knowledge, resistance skills and intentions of pre-adolescent children
(Ambtman et al., 1990; Church et al., 1990; Corbin et al., 1993; Jones et al., 1995;
Wiener et al., 1993 ), very few have adopted a suf® ciently long-term design to
examine the impact of such programmes on behaviour. Four such studies are
brie¯ y described below.
One of the most interesting and promising of the evaluated programmes is the
Illawarra Drug Education Programme, in New South Wales, Australia. This
involves teaching, group work, peer education and parents. The programme,
which focuses on alcohol, tobacco and illicit/illegal drugs is targeted at the last
year of Australian primary school, year 6 (10± 11 year olds) and begins with a
parents’ evening at the school, during which the programme is introduced to the
parents. The children are then introduced to the programme by year 7 peers who
have completed the programme the year before. Then six teaching units are
delivered, spread over several weeks, including work on decision-making stra-
tegies, information on problems associated with drug misuse, alternatives to drug
misuse, social pressures to take drugs, issues relating to conformity, assertiveness
and peer resistance skills. Over this period, there is a second parents’ evening.
118 C. Lloyd et al.

After the teaching phase of the programme, which takes up between 12 and 16
hours of teaching time, children work together in groups to produce various
drug-related materials and produce a short piece of drama. This process takes up
another 12± 16 hours of school time and culminates in a third parents’ evening,
where the materials and dramas are presented. On leaving primary school, the
pupils return during their ® rst year of secondary school and introduce the
programme to the next year of grade 6 pupils.
Four follow-up surveys evaluating this programme found that four and a half
years after exposure to the project, signi® cantly lower proportions of the
programme group had ever used tobacco or cannabis, compared to controls.
For those that had used tobacco, levels of tobacco use were lower in the
programme group, although this effect weakened over the 4-year follow-up.
There was no impact on level of use of cannabis, but there was a delayed effect on
level of alcohol use, with programme participants showing a signi® cantly
decreased level of alcohol use in the ® nal survey. The author concludes that
`an early education programme based on psycho-social principles can show
positive changes in what is the most important aspect of all: drug taking behav-
iour’. He emphasizes that drug education should be multi-component in nature,
involving parents and peers as well as teachers, be of long duration and include
booster sessions or continuing drug education into secondary school (Wragg,
1990, 1992 ) [5].
The `New Hampshire Study’ consisted of a comparative evaluation of two drug
prevention approaches and a control in three separate rural communities. The
® rst drug prevention approach consisted of a drug education curriculum de-
signed to provide teenagers with skills to overcome social pressures to use drugs;
the second consisted of this curriculum plus a wider community approach,
including a parenting course and the development of a community task force.
Across the three communities, 1200 children in grades 4, 5 and 6 (ages 9± 14) were
given questionnaires in 1987 and again in 1990, when they were in grades 7, 8 and
9. Questions were asked about their drug use, attitudes and beliefs about drugs,
and psycho-social risk factors for drug use (such as family relationships and friends’
drug use) . Results showed that while neither of the interventions had an impact on
the onset of cannabis use, the comprehensive community intervention reduced
regular cannabis use by over 50%. Without this community reinforcement the
education programme on its own did not have a statistically signi® cant impact.
Unfortunately outcomes were not broken down by different age groups so the
impact on primary school-age children cannot be derived (Stevens et al., 1996 ).
`Say Yes First’ was a 5-year programme aimed at high risk pupils in four rural
school districts. It involved teacher training and the delivery of a wide-ranging
substance abuse prevention programme, which included comprehensive health
education with skill-building activities for all children and academic improvement
and enhancement programmes for `at-risk’ children (de® ned as such by an
assessment based on risk factors). A range of parent-focused approaches and
`alternative, drug-free activities’ were also delivered. Case-managers were as-
signed to high risk youths and carried out assessments and home visits. The
programme was delivered to a cohort of young people as they progressed from
grade 4 (9± 10 years) to grade 8 (13-14 years) and was evaluated ® rstly, by
examining the impact of the degree of programme participation on drug use (a
¯ awed measure due to the likely association between motivation to participate
and drug use ). More convincingly, a comparison was also made of drug use
 Primary School Drug Education 119

among the cohort exposed to 4 years of the programme, having reached grade 8,
with the drug use of the previous three grade 8 year groups. Signi® cant decreases
were found in the proportion of pupils who had ever used alcohol and the
proportion of pupils who had used alcohol, crack/cocaine or steroids within the
past 30 days (Zavela et al., 1997 ).
Project CARE was targeted at high-risk pupils in grade 4 (9± 10 years). Teachers
® ll out a risk assessment form for each pupil, reporting school attendance, grades,
behaviour problems, suspensions, suspected personal and family substance use,
parental involvement in their education and unkemptness of appearance. On this
basis, high-risk pupils were de® ned and randomly allocated either to receive
CARE or to a control group. The CARE intervention consisted of life-skills
education in groups; one-to-one sessions with prevention specialists; activity-
based `® eld trips’; family visits; parent groups; a residential summer camp and
family activities (such as `pizza parties’ and `talent shows’ ). Drug use ® ndings
were disappointingÐ ever use of cigarettes and `wine coolers’ (a form of volatile
substance abuse) being signi® cantly higher among the CARE group compared with
controls. However, it should be noted that drug use rates were low and that there
were problems with loss of pupils in the control sample (Hostetler & Fisher, 1997).
A further challenge that targeting poses is the relative lack of sophistication that
present drug education programmes offer. This lack of sophistication may be one
of the reasons why drug users are more critical of the drug education they receive
than the abstainers (Parker, 1998). This issue becomes more pertinent at second-
ary age, as young people’s use grows, and gives even more reason for focusing
programmes at younger pupils.

Conclusions and Implications for Practice

A key conclusion is that, despite numerous pleas for further work and research
targeting primary school children, there is a surprising lack of well-conducted
evaluations in this ® eld. In particular, we need more long-term studies of primary
school drug education.
With regard to the impact ® ndings, this review does give some grounds for
optimism. In Australia, evaluation of the Illawarra Drug Education Programme
suggests that life-skills approaches targeted at primary school-age children can
have an impact on future smoking, alcohol consumption and illegal drug use
(Wragg, 1990, 1992 ). The Project Charlie evaluation in this country lends support
to this conclusion (Hurry & Lloyd, 1997 ) as does the New Hampshire study in the
USAÐ albeit with additional community and parental components (Stevens et al.,
1996 ).
There are a number of practice issues and recommendations we can make
based as far as possible on the research reviewed above but also on what we
know of how the education system in the UK is organized:

1. Drug Education Should Start in Primary School

Whilst this claim remains contentious within many sectors of our community,
there is growing evidence that drug education, alongside other curriculum areas,
needs to be developed and delivered with very young children at a time when it
is more likely to in¯ uence patterns of attitudes and behaviours. It is also import-
120 C. Lloyd et al.

ant, particularly for early years teachers to recognize that information/knowledge

about drugs is only one element of a drug programmeÐ other elements such as
developing the language and skills to identify feelings and communicate these to
others plays a signi® cant role (SCAA, 1995).
Information on where children are `starting from’ in their awareness of drugs
(gained through techniques such as `draw-and-write’ ) can guide teachers and
others to develop and design a curriculum which addresses the particular needs
of the pupils who receive it, reducing the threat of introducing too much
sophisticated and unnecessary information at an inappropriate stage.
. Local Education Authorities and Drug Action Teams should recognize the need
to target the primary sector and ensure the prioritization of activities which
encourage and enable schools, governors and parents to develop and support
drug education with young people.
. Primary schools should be encouraged to build drug education into their
development plans.
. Initial Teacher Training Institutions need to include drug education in their
programmesÐ especially for primary sector teachers.
. School brochures should make reference to the school approach to drugs.

2. Approaches Based on Life Skills Appear to be Most Effective

This conclusion comes out of both primary and secondary school evaluations
undertaken in a number of countries.
The use of a life-skills model is not a new concept to many classroom teachers,
or to those who are in positions to train them. There remain, however, blocks in
educational systems and classroom practice which mitigate against their use.
. Schools may want to consider auditing their social and life-skill development
activities.
. Primary schools should encourage development of a personal, social and
health education curriculum.
. Schools need ¯ exibility to manage their timetables which has been reduced by
the restrictive nature of the assessment and testing targets on which their
performance is judged.
. Although drug education has some place in the science curriculum it is a
knowledge and information base that has the statutory status, and not the skill-
based element. Until there is a fundamental change within the recon® guration
of the curriculum which enables a skill base to be introduced, there will be little
opportunity for life skills to receive the necessary curriculum space.
. Initial teacher training courses show passing, if any, reference to the inclusion
of life-skills training in their programmesÐ this, and inservice training needs of
teachers will have to be addressed.

3. Projects Should Seek to Involve Parents and Communities

Programmes that involve parents in primary school drug education appear to be
more effective. Parents of primary school children may also be more inclined to
take part in school-based drug education than parents of older children.
 Primary School Drug Education 121

. Parental involvement in the general education experience of their children is a

challenge in all areas, equally so in drug education. The fall-off rate of parental
involvement at secondary age, as children develop different patterns of getting
to and from school and move through increasing stages of independence poses
challenges. Innovative ways need to be developed to ensure that parents are
informed, involved and supportive.
. When teachers choose or develop their own drug education resources, it is
important to consider what opportunities there are to involve parents.
. Schools developing or reviewing their drug policy should involve parents
widely in that process.
. Parental involvement can be a route to and one aspect of wider community
reinforcement of the drug education effort. Spreading activities and support
beyond the school gates may help prevent school-based activities being `over-
powered’ by the wider environment.

4. Peer Approaches: promising but tricky

The Illawarra programme included a peer education element whereby pupils
who had received the programme and gone on to secondary school returned to
introduce the programme to the ® nal year students in their old primary school.
With a very overcrowded curriculum agenda, space for opportunities such as
this are likely to be limited, especially if cross phaseÐ it is more likely to be
accommodated within single phasesÐ e.g. year 6 working with year 5 in primary
school. Doubling up on the peer educators’ work as an element in the mainstream
curriculum is one tactic which can help create the curriculum space but there
remains a need to prepare and follow up the recipients of the education.
Despite the promise of some early results, peer education is a relatively new
innovation in teaching methodology, remains largely ill de® ned and unproven,
and there are potential pitfalls if the peer educators are not suf® ciently prepared.
These may be mitigated by using slightly older pupils trained not just in drug
knowledge but in the teaching skills needed to maintain attention and order in a
class of younger near-peers.
To encourage thorough and rigorous research and development of this as a
teaching and learning style is long overdue on the effectiveness agenda.

5. Drug Education Needs to Continue into Secondary School

There is a need to link up primary school input with secondary school input, as
research suggests that project impacts fade quite quickly over time.
The need to build links between schooling phases is recognized as being key
in areas besides drug education. Schools have developed strategies to assist,
such as families of schools which cross phases and the appointment of liaison
of® cers have made some differencesÐ to get information sharing on drug
education on those agendas would be important. One example in Britain
(see Box 3) used common staff training programmes across primary to secondary
levels to facilitate a consistent approach to drug education and drug-related
incidents.
122 C. Lloyd et al.

Achieving Consistency
In the mid-1990s a group of 28 schools in the outer west area of Newcastle
from across the compulsory teaching age range undertook an initiative on
drug education. Unusually the schools (® rst, middle and high ) have transfer
ages of 9 and 13 so had banded together for mutual support. They formed a
Drug Education Working Group in 1995 as a sub-group of the Head
Teachers’ Group. This ® rst developed and then with some success imple-
mented a common area approach:
This vision developed into six intentions:

. promote healthy attitudes and lifestyles;

. provide a programme of drug education appropriate to the age
of the child;
. adopt a consistent approach to the handling of drug-related
incidents;
. provide support and information for parents;
. train teachers and governors in drug issues;
. work alongside other groups in the community.

Associated activities were identi® ed, particularly the development,

articulation and implementation of an area-wide `Substance Misuse
Policy Statement’.

The initiative was largely implemented via common staff train-

ing programmes:

. . .training sessions were run by experienced teachers from the

outer west area. At the training sessions it was agreed that a
common approach for drug education should be adopted by all
outer west ® rst schools; the same was agreed by the middle schools
and the high schools. To ensure smooth progression between
levels, ® rst and middle, middle and high schools met together.
Activities, learning outcomes and appropriate subject areas were all
identi® ed for relevant key stages. Time was given for people to
look at and evaluate a variety of resources available for health
education, particularly drugs issues. Strategies used in schools to
teach drug education were shared and discussed, as were attitudes
and experiences and coordinators were given time to consider how
they would progress in their own schools. The staff attending
these training sessions felt that they had been very valuable and
successful.
The report also notes the counter-pressures of curriculum crowding and low
funding priority, and that OFSTED inspection reports sometimes forced
prioritisation of other topics (Carlin & Dixon, 1997).

Box 3.
 Primary School Drug Education 123

6. Interactive Approaches are More Effective than Didactic Ones

This carries major implications for teacher trainingÐ both initial and inservice.
A refocusing on to teaching methodology rather than subject expertise may be
necessary.
It also requires the development of school systems supportive of this teaching
style. Practical issues such as the in¯ uence teachers have over decisions about
class size and choice and ¯ exibility of rooms are important.
Sophisticated assessment, monitoring and recording tools for this style of
teaching will also need to be considered to ensure that what is being taught is
achieving the prescribed aims.
Interactive teaching styles make heavy demands on classroom management.
Outside speakers/visitors may not have the necessary skills to achieve this and
their use should be carefully planned, monitored and evaluated.

7. Universal Versus Targeted Approaches

Some projects in the USA have attempted to target `high-risk’ young people.
Evidence for the effectiveness of these approaches is equivocal and focusing on
particular individuals runs the risk of labellin g them and further amplifying their
risk behaviour. However, it should be noted that many `high-risk’ pupils, though
later absent or excluded from secondary school, will still be attending primary
school and can be reached with universal approaches.
. Figures of school exclusions and truanting continue to rise at both primary and
secondary stages. Strategies which support schools to retain pupils of all ages
are vital to the effectiveness of any education process.
. If targeting of particularly vulnerable young people was recognized as being
effective, practical, and morally and ethically acceptable it would need sig-
ni® cant improvement in assessment procedures with subsequent training and
support implications, as well as more sophisticated education programmes
credible to high-risk youth, a proportion of whom may already have consider-
able personal experience of drugs and drug users.

8. Long-term, Intensive Programmes are More Likely to be Effective

Hardly a surprising ® ndingÐ but one that raises the question of the relative
importance of drug education. Time spent on drug education means time taken
away from other education. Nevertheless, there is probably more opportunity for
intensive drug education within primary schools than secondary schools.
OFSTED evidence is showing certain critical stages in the education process
where there is less ¯ exibility within the curriculum (Greer, 1989; Her Majesty’s
Chief Inspector of Schools, 1997 ). At Key stage 3Ð the ® rst years of secondary
schoolingÐ there is less opportunity for any ¯ exibility, with so much pressure
from the statutory elements of the national curriculum, with a little more space at
Key stages 1, 2 and 4. This does not bode well for revisiting at secondary school a
programme delivered at primary level. Some signi® cant relaxing of curriculum
pressure is necessary to ensure time for this area of work.
124 C. Lloyd et al.

Notes
[1] The technique explores young children’s conceptions by asking them to make
drawings illustrating a particular theme or story line. The drawings may be
captioned and the characters; thoughts and words may be included, much as
in cartoons.
[2] It should be noted that the sample was probably not a representative one: it
consisted of members of PAT that responded to the questionnaire sent out
with the Association’s journal.
[3] This is because the current review updates that in Hurry & Lloyd (1997)
which focused on illegal drugs.
[4] See Hurry & Lloyd (1997 ) for a more detailed discussion of the ® rst four of
these evaluations.
[5] See Hurry & Lloyd (1997) for more information on these studies.

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