Project Towards No Drug Abuse (Project TND)
Program Summary
Project Towards No Drug Abuse (Project TND) is an effective drug abuse prevention program that targets heterogeneous samples of high school-age youth. Reductions in cigarette smoking, alcohol use, marijuana use, hard drug use, and victimization have been revealed at one- and two-year follow-up periods.
Program Targets:
Project TND is a drug abuse prevention program with a focus on high school youth, ages 14 to 19. It has been tested at traditional and alternative* high schools using true experimental designs.
Program Content:
A set of 12 in-class interactive sessions that provide motivation-skills-decision-making material targeting the use of cigarettes, alcohol, marijuana, hard drug use, and violence related behavior. The topics are:
- Active Listening
- Stereotyping
- Myths and Denials
- Chemical Dependency
- Talk Show
- Marijuana Panel
- Tobacco Use Cessation
- Stress, Health and Goals
- Self-control
- Positive and Negative Thought and Behavior Loops
- Perspectives
- Decision-making and Commitment
The 12 classroom-based lessons, approximately 40 to 50 minutes each, are designed to be implemented over a four-week period. The instruction to students provides cognitive motivation enhancement activities (to not use drugs), detailed information about the social and health consequences of drug use, and correction of cognitive misperceptions. The instruction also addresses topics including active listening, effective communication skills, stress management, coping skills, tobacco cessation techniques, and self-control to counteract risk factors for drug abuse relevant to older teens.
Program Outcomes:
Project TND has been tested in three true experimental field trials, involving two or three conditions in each trial (one or two program conditions that were compared to a standard care control condition). Approximately 3,000 youth from 42 schools participated across the three trials. At one-year follow-up, relative to comparisons, participants who received the 12-session program experienced:
- A 27% prevalence reduction in 30-day cigarette use.
- A 22% prevalence reduction in 30-day marijuana use.
- A 26% prevalence reduction in 30-day hard drug use.
- A 9% prevalence reduction in 30-day alcohol use among baseline drinkers.
- A 6% prevalence reduction in victimization among males.
Program Costs:
The Project TND Teacher’s Manual costs $70, and student workbooks cost $50 for a set of five. There are optional materials, described under “Funding and Program Costs,” which can also be purchased. A two-day training, which includes the trainer’s fee and travel, is $2,500.
* In California, traditional schools are called comprehensive schools, and alternative schools are called continuation schools. These terms will be used interchangeably throughout the text.
The information for this fact sheet was excerpted from:
Sussman, S., Rohrbach, L., & Mihalic, S. (2004). Project Towards No Drug Abuse: Blueprints for Violence Prevention, Book Twelve. Blueprints for Violence Prevention Series (D.S. Elliott, Series Editor). Boulder, CO: Center for the Study and Prevention of Violence, Institute of Behavioral Science, University of Colorado.
2004 (Updated 08/2006)
Program Background
Drug abuse reflects an accumulation of adverse consequences (e.g., social, legal, role and physical hazard). Adolescent drug users frequently meet criteria for substance abuse disorders, including dangerous behavior, failure to take on appropriate roles, drug related illegal behavior, and negative social consequences. Adolescents may also report binges of drug use, which lead to adverse events such as overdoses, accidents, and other dangers (e.g., unsafe sex and violence). Drug-using teens have a higher probability of entering adult roles prematurely, including marrying, having children, and divorcing early in life. They are often ill prepared for these adult roles because they often drop out of high school, seek jobs requiring little skill, and show relatively less stability of employment. Drug-using teens also report committing more crime, including theft and vandalism.
Teens who use drugs may develop unusual beliefs that interfere with solving problems, coping adaptively, and achieving goals, and these beliefs subsequently lead to greater social isolation and depression. Although drug involvement may not serve as the sole source of all these troubles, the prevention of drug abuse has potential for limiting these other adverse consequences. In addition, decreasing drug problems will undoubtedly improve development into young adulthood.
It is an important challenge in health education research to create a school-based substance abuse prevention curriculum development process that facilitates a precise evaluation of the workings of its components. Often, evaluation occurs only after the whole curriculum is developed. Not using an empirically grounded curriculum development process is of concern because an "intuitive" approach may confound the experience and biases of the health education researcher and health educator (curriculum writer) with that of the student-consumer. To strengthen the scientific foundation and practical utility of a multi-lesson prevention curriculum, an iterative development and evaluation approach is recommended. The lessons selected in Project TND after numerous contrasts among activities were consistent with a motivation-skills-decision making perspective of targeted prevention.
Not all youth use drugs, and most youth who use drugs do not abuse them in adulthood. Project Towards No Drug Abuse (Project TND) is based on the premise that prevention programs are more cost-effective when they target youth that are most likely to abuse drugs in the future rather than targeting much larger numbers of youth, many that will not abuse drugs. It is not surprising that one of the most difficult but important tasks in the minds of many drug abuse prevention practitioners is to intervene with youth at highest risk for future drug abuse.
Targeted Programs: Which Youth Are the Ones Targeted?
Applicability of substance abuse prevention programming to higher risk populations relies on definitions of risk. This term could refer to a disadvantaged socioeconomic group, children of substance-abusing parents, risk-takers, those suffering academic problems, and persons targeted by drug promotions (e.g., for cigarettes and alcohol), among others. A common way of defining an at-risk population is to specify some minimum level of drug use or percentage of drug users within a social environment. Risk for drug use increases as the percentage of drug users within a large (e.g., school, community) or small (e.g., peer group) social environment, increases. Youth in a social environment that includes high levels of drug use tend to increase their own use of drugs as well. For example, schools differing in the percentage of users at baseline reflect different levels of risk for subsequent use. Thus, some prevention programs target alternative high schools because these tend to have high levels of substance use.
Programming developed for regular high school youth generally is referred to as “universal” programming when all youth participate regardless of the level of risk. Programming developed for alternative high school youth is referred to as “selective” programming because these teens are at relatively higher psychosocial or behavioral risk for drug abuse. Project TND was shown to work for both populations. Thus, it can be considered a universal program when implemented in the traditional high school setting since all youth are targeted, and a selective program (targeted for those at higher psychosocial risk for drug abuse, who have not yet started using drugs) when delivered in an alternative school setting. Community-based programs could also be either universal or targeted programs, depending on the clientele being served.
The Difference between Targeted Prevention and Cessation. Targeted (secondary) prevention attempts to keep persons from crossing the “invisible line,” where they “funnel” into a cycle of addiction and accumulation of negative consequences. Cessation programs (sometimes referred to as tertiary prevention) take the stance that a behavior has occurred with definite and perhaps irreversible negative consequences. The goal is to stop the behavior, permit recovery from the damage, learn how to prevent relapse, and learn how to live with permanent changes (e.g., neurotransmitter dysfunction, drug-related injury). It is not clear exactly where tertiary (indicated) prevention ends, however, and where cessation begins. For example, an early version of the Project TND curriculum did not achieve effects on cigarette smoking, possibly because 46% of the sample already smoked cigarettes daily (while not engaging often in some other drug use). In a revised curriculum, a smoking cessation component was added to the program, and then an effect on cigarette smoking was achieved. Cessation material can appear with prevention material to maximize program effectiveness. Careful program developmentcan help determine the best mix.
Steps in Program Development: The Chain Model
Program development is only as strong as its weakest link. Health behavior program development involves two central ideas. The first concept is that programs are developed beginning with certain theoretical notions of participants' crucial needs and relevant mechanisms of change. The second concept is that the movement from theory to the completed program involves a series of steps or stages. A six‑step "program development chain" model was utilized for our work.
Step 1: Elaborate the theory. Determine the antecedents of the health problem behavior; the consequences of the target behavior; and how to counteract the problem behavior, its antecedents, or its consequences.
Step 2: Develop a pool of promising activities to test that might counteract the problem behavior, its antecedents, or its consequences.
Step 3: Screen the program activities described above through efficacy studies.
Step 4: Determine the workability of the most favorably rated activities from the previous step through impact studies of single activities or sessions.
Step 5: Construct and pilot test the program.
Step 6: Pilot test outcome measures, including measures that mediate program effects.
Based on these theoretical perspectives, various program development studies were conducted in Project TND (see Sussman, 1996 for a summary of that work). Three types of studies were accomplished in Year One (1992-1993), the assessment interview (and refuse analysis and naturalistic observation), comparison evaluation study, and theme study. These studies provided empirical background for curriculum-constructing activities in Year Two, and represented Steps 1, 2, and 3 of the Chain Model. These studies indicated a clear preference for novel versus social influence activities. In particular, a "talk show" delivery modality which discussed the effects of drug use addiction and drug use and driving, and two cognitive perception-type activities (attitudinal perspective taking and stereotyping) were preferred. Of the social influence-type activities, decision making and effective communication lessons were preferred (Dent et al., 1996).
Three types of studies were accomplished in Year 2 (1993-1994), component study, school-as-community development, and pilot study. These studies provided empirical background for main efficacy trial implementation activities in Year 3. Across these program development studies, Steps 4, 5, and 6 of the Chain Model were completed. The component study indicated that, for future work, we could develop a self-instruction delivery modality of the program that would be rated of equal quality to a health educator-delivered program. However, when both types of sessions were placed in the same program in the pilot study, it was evident that lessons should be classroom-oriented. Previous self-instruction lessons, while well-received when provided along with other self-instruction material and compared with classroom instruction as a between-groups variable (in Year 2, Study 1), were not as well-received as classroom-oriented material when both were offered in the same curriculum. The final health educator-delivered curriculum delivery system consisted of three lessons per week (TND-1, a 9-session program). The first trio of lessons helps the student to obtain an open mind to further material (listening, stereotyping, myths and denial), the second trio of lessons instructs students in chemical dependency issues (chemical dependency, talk show, stress-coping), and the third trio of lessons motivates alternative means of coping (self-control, perspectives, decision-making and commitment).
In the next project, six months were dedicated to the addition of three additional sessions which focused on tobacco use cessation and marijuana use consequences (TND-2, a 12-session program). Two rounds of pilot studies were completed and sessions written and revised during this time (1997-1998). A single tobacco use cessation session, which also provided additional quit-material should the student want it, provided learning effects and was perceived as moderately helpful. Use of a “talk show” that included a scientist and a panel of persons who had been affected by marijuana use provided knowledge change, and were perceived as helpful to highlight the negative effects of this drug. Finally, a session was developed that highlights how positive thinking could lead to positive action, and how negative thinking could lead to negative action. In addition, this session highlighted that these thought-decision-behavior loops could demonstrate how people may confuse cause and effect pertaining to drug use (e.g., does one use marijuana because one is bored, or is one bored because one relies on use of marijuana for fun to the exclusion of other activities). This work is described in more detail by Sussman, Dent, and Stacy, 2002.
To summarize the work that transpired across TND-1 and TND-2, some of this program development work indicated that, among comprehensive social influence-type lessons, relatively strong knowledge or belief changes are found for listening, physical consequences, and decision making lessons, whereas refusal assertion learning and practice lessons are rated as relatively very weak. Other work, which compared social influence-type lessons with other, novel lessons, indicated a clear preference for novel versus traditional social influence activities. In particular, a "talk show" discussion of the effects of drug use addiction and drug use and driving, and three motivational-type activities (attitudinal perspective taking, stereotyping, and health as a value) are preferred. Of the social influence-type activities, decision making and effective communication lessons are preferred. Also, it was possible to develop a single session that would help instruct tobacco use cessation, and it was possible to highlight some of the more subtle consequences of marijuana use in two additional sessions (e.g., emotional damage).
A model of prevention that has greater relevance for at risk teens incorporates motivation, skills, and decision-making. Relevant programs attempt to enhance students' motivations, skills, and decisions to avoid drug abuse. Ideally, youth learn that stereotypes about drug use are inaccurate, that their own attitudes about drugs may reflect their attitudes about themselves and their health, and that valuing health can facilitate other meaningful goals. In addition, students can learn skills for making changes, including effective listening, communication, and self-control. Finally, they learn to make decisions about their behavior by weighing accurate information about drug use myths, the negative consequences of drugs, and the cognitive process of decision-making. These three basic elements - motivation, skills, and decision-making (“MSD” model) - comprise prototypical targeted prevention programming.
Theoretical Rationale/Conceptual Framework
Project TND made use of many research arenas in development of its prevention programming. These research arenas may be aggregated to include (a) behavioral-therapy-related theories (e.g., modern learning theoretical notions of free operants and signal-event connections), "bonding,” and stress-coping; (b) theories of motivation such as classical ideas of direction and energy components of motivation, and motivational interviewing (c) social-cognitive psychological theories such as various ingroup-outgroup stereotyping, attitudinal perspective theory, health as a value, drug use associations, and the false consensus effect; (d) sociological theories pertaining to belief myth creation such as Neutralization Theory, Mystification Theory, and Perceived Effects Theory; and (e) recovery or chemical dependency treatment-related literature ideas, such as enabling, denial, family roles, and progression of chemical dependency consequences.
The theories and the TND lessons that correspond to each theory are listed in Table 1. Each of these theories are described briefly, as follows.
Behavior Therapy
Modern Learning Theory and Behavior Therapy. Modern learning theory is based on several key concepts including “free operants.” Organisms select among many options in life, each with their own positive and negative consequences. Associations between cues, behaviors, and consequences can be formed under a variety of contextual and temporal events; however the behaviors linked to the most consistently positive consequences will tend to dominate one’s repertoire. To motivate people to select healthy choices the consequences of healthy behavior need to be perceived to be more consistently positive than the consequences of unhealthy behavior. Sources of positive consequences need to be identified, approached, and networked (“bonded”). Thus, instruction on social and life skills (e.g., assertiveness, self-control, resource acquisition) is essential to help one learn how to make such networks, and thereby receive a high frequency of predictable positive consequences for engaging in healthy behavior.
Stress-coping (Shiffman & Wills, 1985). This notion is that cognitive and behavioral means of managing unavoidable negative life events will help people surmount life stresses. Coping skills may be taught to protect (buffer) one from stress prior to a negative event or in reaction to a negative effect. Anticipatory coping may help one best conduct oneself or appraise situations such as to minimize the impact of negative consequences should they occur, whereas reactive coping may help one to cushion one’s reaction to such negative events.
Motivation
According to theories of motivation (e.g., Nezami, Pentz, & Sussman, 2003), there are two components of motivation which underlie youths' decisions to engage or not engage in substance use. First, youth consider why they should not engage in substance use, and should engage in some other behavior ("the direction"). As suggested by Levanthal & Keeshan (1993), any self-regulative system must have a set point or goal, in addition to having the means to achieve this goal state. As stated further by Resnik & Wojcicki (1991), high risk youth "...must be convinced that prevention programs offer a better way than the negative and self-destructive patterns of the past." Youth may become motivated to change in a particular direction when they make explicit their future goals (if their future goals are consistent with a prosocial achievement orientation). Second, youth consider how much effort they are willing to exert to avoid drug use ("the energy"). Perhaps, to understand the energy that youth would exert to not abuse drugs, one should consider, as further stated by Levanthal & Keeshan (1993), "...the various routes perceived as available to attain those goals and satisfy those needs." More specifically, youth may become motivated to work to change when intrapersonal or extrapersonal obstacles are made explicit and youth are instructed on how to surmount them, and are willing to work to surmount them.
Motivational interviewing is a therapeutic tool to induce change in a brief period of time. Eight strategies are identified to motivate the individual to change behavior (Miller & Rollnick, 1991). These strategies are:
- giving advice, through which the problem is identified, the need for change is clarified, and specific change is encouraged;
- removing impediments to change, which are mastered through effective problem solving;
- providing choices, an important antecedent of voluntary commitment to change;
- decreasing desirability for continuation of present behavior by making its costs explicit;
- providing empathy regarding the struggle to change;
- providing behavioral feedback;
- clarifying goals, especially confronting the individual with discrepancies between his/her future goals and present behavior (perhaps the most important aspect of motivation-enhanced programming); and
- active helping, demonstrating genuine interest in the client's change process.
Social Psychological Theories
Ingroup-outgroup Stereotyping (Fishkin et al., 1993). The notion here is that ingroup members perceive outgroup members as more extreme and homogenous than they actually are. For example, high school and college youth are well-aware that they are perceived as more extreme/deviant (“wild”) than they actually are by younger peers or older adults. The stereotyping can lead to a self-fulfilling prophesy if people conform to such stereotypes. Alternatively, awareness of the stereotype can lead to counteracting it.
Attitudinal Perspective Theory (Upshaw & Ostrom, 1984). The theory posits that there are two different aspects of one’s attitudes about behaviors or events. First, one holds a general attitudinal perspective (e.g., as a moderate). Separately, one holds specific attitudes about behaviors or events (e.g., one believes that certain drugs should be legal). It is possible that one’s general attitude about self may appear contradictory with one’s specific attitude. If one is confronted with the discrepancy, one will tend to try to reduce it which, in the present context, could lead to specific anti-drug use statements.
Inaccurate Numerical Estimation (Sussman et al., 1988; MacKinnon et al., 1991). Relative overestimation of drug use prevalence, relative overestimation of peer approval of drug use, and relative underestimation of personal risk for negative drug use consequences may lead to problem use. Biased numerical estimations are predicted by social environmental use and one’s previous behavior. One theoretical conception among others is the False Consensus Effect, in which one assumes that one’s own behavior is more normatively consensual or performed than it actually is.
Faulty Encoding Conceptions (e.g., Stacy & Ames, 2001). Repeated memory association may bias recall. For example, mere familiarity with statements about drug effects, no matter whether they are provided as statements of myth or fact, may alter outcome expectancies regarding drug use effects which are consistent with previously learned statements or behavior.
Health as a Value (Lau, Hartman, & Ware, 1986; Ritt-Olson et al., 2004; Sussman et al., 1993). This notion is that the more a person values health, the more likely the person is to refrain from health compromising behaviors. This construct may moderate the effects of one’s perceived control over health as well as act as a motive for engaging in healthy behavior. For example, if one places importance on good health to better help one achieve life goals, one may be motivated to not abuse drugs.
Sociological Theories
Delinquent Subcultures (Cohen, 1955). Problem behavior is learned through differential socialization and may involve learning rationalizations to justify continued problem behavior. These rationalizations, however, reflect norms which exist in opposition to dominant social values and occur in subcultural groups. Cohen, and some sociologists after him (e.g., Bordua), argued that certain youth subcultures engaged in problem behaviors due to a gross reaction against middle class society, as an expression of a general negativism, and because they found such activities to be a great deal of fun in the short-run.
Neutralization Theory (Agnew & Peters, 1986; Shields & Whitehall, 1994; Sykes & Matza, 1957). A modification of Cohen’s perspective, it is asserted that persons who exhibit problem behavior do internalize dominant social norms. However, norms are viewed as qualified guides for action, limited by situational variables (e.g., killing during war is okay). Techniques of neutralization include denial of responsibility (beyond one’s control), denial of injury, denial of the victim (deserved it), condemnation of the condemners (e.g., as hypocrites), and appeal to higher authorities (loyalty to persons or causes).
Mystification Theory (Lennard, Epstein, Bernstein, & Ransom, 1971). The process of mystification involves the definition of issues and situations in such a way as to obscure their most basic and important features. In our society, behaviors previously defined as normal behavior may become defined as not normal (e.g., mild social anxiety), and drugs may be promoted to fix this behavior. Drugs may achieve their effects by bypassing meaning and means such that the experiential outcome is not the real outcome (e.g., drug induced relaxation is not the same as learning to become more at ease in social situations by learning social skills). Also, the effects of drugs are derived not only by the pharmacological qualities of the drug, but also by beliefs about the drugs and the social context within which drug use occurs. Thus, it is understandable that a variety of myths regarding drug use and its effects can occur.
Perceived Effects Theory (Smith, 1980). Most acts are intended to benefit the actor and some consequences of drug use may be grossly misperceived but may explain initiation of drug use because they appear to benefit the actor. As escalation of use progresses, greater distortions of reality may justify continued use and abuse.
Recovery
Enabling and Denial. Traditional schools of thought tend to view family members of drug abusers as functioning in a dysfunctional system (e.g., Johnson, 1980). For example, family members are considered to assist the drug abuser in continuing to use drugs, without necessarily having awareness of this intent (“denial” of the problem or the family’s role in it, but “enabling” the drug use behavior). If the abuser quits drug use, the family may even facilitate a relapse so as to maintain the current family system dynamics. Also, the drug abuser may not be aware of the impact he or she has on self or others (“denial”). Traditional treatment for the family, aside from confronting the abusers, would be to avoid “enabling” (i.e., acting in ways that support continued drug use, such as “cleaning up” the consequences produced by the drug abusers).
Empirical data indicate that families of alcohol/drug abusers show lower levels of cohesion, expressiveness, independence, intellectual orientation (including problem-solving skill), and active-recreational orientation, and higher levels of conflict (e.g., hostile communication), than do non-drug abusing families. However, these conditions simply relate to existence in a dysfunctional family, across a variety of disorders, not necessarily to use of drugs per se (Sher, 1993). Cohesive and affectionate families have better effects on the drug abusing member’s behavior than disengaged and hostile families. Family members do not tend to decompensate (get worse, themselves) when the drug abuser quits using.
Family Roles. Children of drug abusers tend to exhibit lower achievement behavior, more behavioral problems, and lower self-esteem. There is some tendency to grow up to become drug abusers themselves; although these types of children also are more likely to grow up and avoid drug use more strongly than others. There is little support for the concept of different family roles (e.g., the “hero” or “scapegoat”), although responsibilities for home tasks do tend to shift to the non-abusers, when abusers are not able to carry on their family roles.
Progression. Drug users may progress through several phases as drug use becomes more habitual, addiction is present, and consequences pile up. In traditional recovery movement conceptualization, a progression of use to insanity or death is inevitable if drug use continues. It is clear that use generally progresses from a trial phase, to a recreational phase, to an abuse/mild dependence phase, and a severe dependence phase, depending on the drug, amount of use, and user (Sussman & Ames, 2001), though an inevitable progression to insanity or death is not certain.
Brief Description of Intervention
Project TND is a drug prevention program for high school youth, including youth who are from regular school populations and youth who are from alternative schools. The current version of the Project TND curriculum contains twelve 40-minute interactive sessions taught by teachers or health educators. Sessions provide instruction in motivation activities to not use drugs; skills in self-control, communication, and resource acquisition; and decision-making strategies.
- Session 1 teaches youth how to communicate effectively.
- Session 2 makes high-risk youth aware that they may make themselves more “at risk” for substance abuse by giving in to a self-fulfilling prophecy.
- Session 3 confronts myths that facilitate drug use (e.g., people get “used” to a drug).
- Session 4 provides information about the course of negative consequences associated with chemical dependency.
- Session 5 provides students with an empathetic and cognitive understanding of the negative consequences of drug abuse, through use of a “talk show” activity.
- Session 6 teaches students the consequences of marijuana use through use of a group panel activity.
- Session 7 provides smoking cessation information.
- Session 8 emphasizes the importance of health as a value for a happy life in the long run and ties youths’ current values to health. In addition, it provides coping alternatives to drug abuse.
- Session 9 teaches youth to be aware of different social contexts and match social behavior to the context (e.g., self-control, assertiveness).
- Session 10 shows how positive thinking, choices, and behavior are tied together.
- Session 11 considers that most people hold moderate self-views regarding drug use (as opposed to radical or conservative views), and may create an anti-drug abuse perspective.
- Session 12 motivates youth to think through the pros and cons of drug use and make a commitment to themselves regarding whether or not they desire to engage in anti-drug use behaviors.
| Session Number | Session Title | Theory Types | Specific Theories |
| 1 | Active Listening | Motivation; Social psychology; Behavioral therapy | Motivational interviewing-like questions in Activity 1; Faulty encoding; Effective communications |
| 2 | Stereotyping | Social psychology; Motivation | Stereotyping and inaccurate numerical estimation; Provides awareness of discrepancies in cognition and behavior |
| 3 | Myths and Denials | Recovery; Sociology | Drug use myths (addictive thinking), denial; Delinquent subcultures, neutralization, mystification, perceived effects |
| 4 | Chemical Dependency | Recovery | Progression, drug use consequences facts, family roles, enabling, environmental resources |
| 5 | Talk Show | Recovery; Motivation | Same-age personal stories; family roles, enabling, progression, psychodrama, empathy; Motivational interviewing-like questions |
| 6 | Marijuana Panel | Recovery; Motivation | Personal stories, family roles, progression, empathy, marijuana use consequences facts; Motivational interviewing-like questions |
| 7 | Tobacco Basketball and Use Cessation | Motivation; Behavior therapy | Removing impediments to change; tobacco use consequences facts; cessation techniques along with stress-coping |
| 8 | Stress, Health & Goals | Behavior therapy; Social psychology | Stress-coping; Health as a value and quality of life |
| 9 | Self-control | Behavior therapy; Sociology | Assessment, cognitive coping, assertiveness training, role-playing; Delinquent subcultures |
| 10 | Positive and Negative Thought & Behavior Loops | Behavior therapy | Cognitive coping, stress-coping |
| 11 | Perspectives | Social psychology | Attitudinal perspective |
| 12 | Decision-making and Commitment | Behavior therapy; Recovery | Decision-making and commitment; Empathy and same-age personal stories |
Evidence of Program Effectiveness
Summarized briefly are the subject population characteristics, measures, and results from the one-year follow-ups of the first three experimental field trials of Project TND. Subject sample demographics and baseline behavior rates across the three experimental field trials are shown in Table 2. The methodological designs, hypotheses and results of these three experimental field trials are summarized in Tables 3 and 4.
The first two evaluations were of the nine session curriculum (TND-1). The first evaluation was of continuation (alternative) high schools (CHS), and the second of regular high schools (RHS). The third evaluation was of the 12-session curriculum (TND-II) and was conducted in continuation high schools (CHS).
Overall, in three experimental trials, TND youth, compared to controls, were less likely to use hard drugs. Among baseline alcohol users, the percentage of youth using alcohol was less in the TND group. Findings for marijuana and cigarette use were less consistent, with treatment effects only in Study 3. There were treatment effects for victimization among males in all three studies, and for weapons-carrying for males in two of the studies.
Additionally, TND-1 CHS tested whether a classroom program that added a school-as-community component achieved better outcomes than the classroom program alone. Results demonstrated that the extracurricular school-led activities had no incremental effects above and beyond the material presented in the classroom curriculum. TND-II CHS further tested whether a self-instruction version of the program was as effective as a health educator-led version. The finding that students who received self-instruction performed no better than the control group students led the TND project staff to abandon this mode of deliver.
Table 2. Demographic and Baseline Behavioral Characteristics of Subjects in the Three TND Experimental Trials
| Characteristics of Samples | TND-I CHS (9 sessions - Continuation High Schools) |
TND-I RHS (9 sessions - Regular High Schools) |
TND-II CHS (12 sessions - Continuation High Schools) |
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| DEMOGRAPHICS | ||||||
| % Male | 62 | 47 | 54 | |||
| % Anglo | 37 | 34 | 45 | |||
| % Latino | 46 | 38 | 42 | |||
| % Black | 8 | 26 | 5 | |||
| % Asian | 4 | 1 | 7 | |||
| % Other | 5 | 1 | 1 | |||
| DRUG USE | ||||||
| % Using Cigarettes | 57 | 24 | 57 | |||
| % Using Alcohol | 64 | 36 | 63 | |||
| % Using Marijuana | 55 | 22 | 54 | |||
| % Using Hard Drugs* | 29 | 7 | 30 | |||
| % Using Stimulants | 21 | 2 | 17 | |||
| % Using Hallucinogens | 13 | 2 | 14 | |||
| % Using Cocaine | 8 | 1 | 9 | |||
| VIOLENCE | M | F | M | F | M | F |
| % Weapon Carrying | 60 | 22 | 34 | 15 | 53 | 18 |
| % Victimization | 68 | 40 | 37 | 28 | 60 | 50 |
| N | 1,074 | 679 | 715 | |||
| NOTES: M = males, F = females. Drug use % pertains to any use in last 30 days. Violence related % pertains to any such behavior in the last 12 months. *The Hard Drug Scale includes stimulants, cocaine, inhalants, hallucinogens, and “other drugs” (e.g., depressants, PCP, steroids, heroin, etc.). |
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Table 3. Study Designs and Conclusions of the Three TND Trials
| TND-I CHS (9 sessions - Continuation High Schools) |
TND-I RHS (9 sessions - Regular High Schools) |
TND-II CHS (12 sessions - Continuation High Schools) |
|
| # GROUPS | 3 – Experimental | 2 – Experimental | 3 – Experimental |
| UNIT OF ASSIGNMENT | 21 Schools | 26 Classroom ; 9 th, 10 th, & 11th grades | 18 Schools |
| HYPOTHESIS* | School-activities with classroom (SAC) > classroom only > control | Classroom only > control | Health educator led > self-instruction > control |
| RESULTS* | SAC = classroom only > control | Classroom only > control | Health educator led > self-instruction = control |
| * > means that the effect of the intervention is more positive. | |||
Table 4. Percent Relative Reductions in Prevalence of Problem Behaviors across the Three Experimental TND Trials
| Chacteristics of Samples | TND-I CHS 1 (9 sessions - Continuation High Schools) |
TND-I RHS 2 (9 sessions - Regular High Schools) |
TND-II CHS 3 (12 sessions - Continuation High Schools) |
|
| 1 year | 1 year | 1 Year | 2 Year | |
| HARD DRUG USE | 25 | 25 | 26 | 55 |
| ALCOHOL USE 4 | 7 | 12 | 9 | 9 NS |
| MARIJUNA USE | 2 NS | 1 NS | 22 | 15 NS |
| CIGARETTE USE | 1 NS | 2 NS | 27 | 33 |
| VICTIMIZATION 5 | 23 | 17 | 6 | 13.5 |
| WEAPON CARRYING 6 | 21 | 19 | 3 NS 6 | 6NS |
| NS = Not significant, otherwise values are significant at p <.05, two-tailed test. Formula for prevalence reduction: p (control) – p (treatment) / p (control) x 100 1 Comparisons are between SAC/classroom vs. control. 2 Comparisons are between classroom vs. control. 3 Comparisons are between health educator led vs. control/self-instruction. 4 Baseline users only. 5 Males only. 6 There was a 37% reduction for baseline non-weapon carriers. Drug use refers to any use in the last 30 days. Violence-related measures refer to behavior in the last 12 months. |
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Evidence of Program Delivery Capacity
Since January 2002, the University of Southern California (USC), Institute for Prevention Research, has been disseminating Project TND materials and training workshops. To date, more than 100 school and community organizations across the country have purchased the program materials. The written materials for Project TND are published and distributed by the USC Institute for Prevention Research. An inventory of materials is always available and materials are shipped to purchasers within a standard interval after receipt of a purchase order. Translation of the workbooks into Spanish is being pursued.
At present, the USC Institute for Prevention Research coordinates and conducts teacher trainings workshops. The Institute has a cadre of trainers, all of whom have had experience in delivery of Project TND in high school settings. At the present time, the Institute endorses only those training workshops that are conducted by their own training staff; it guarantees that the training provided by these individuals meet their standards for effectiveness. The Institute is in the process of developing a TND training certification procedure.
Training staff at the Institute are available for technical assistance on program delivery and program evaluation. Materials that may assist program sites in program evaluation, which are available from the Institute, include a classroom observation tool (for process evaluation) and student pre- and posttest instruments (for evaluation of immediate outcomes).
The information for this background sheet was excerpted from:
Sussman, S., Rohrbach, L., & Mihalic, S. (2004). Blueprints for Violence Prevention, Book Twelve: Project Towards No Drug Abuse. Boulder, CO: Center for the Study and Prevention of Violence.
Contact TND
| PROJECT TOWARDS NO DRUG ABUSE (Project TND) |
| For information about program materials and training, contact: |
| Jim Miyano USC Institute for Prevention Research 1000 South Fremont Avenue, Unit 8 Alhambra, CA 91803 Toll-Free: (800) 400-8461 Fax: (626) 457-5856 Email: miyano@usc.edu Website: tnd.usc.edu |
| For information about program research, contact: |
| Steve Sussman Institute for Health Promotion and Disease Prevention Department of Preventive Medicine University of Southern California 1000 South Fremont Avenue, Unit 8, Suite 4124 Alhambra, CA 91803 Phone: (626) 457-6635 Fax: (626) 457-4012 Email: ssussma@usc.edu Website: www.usc.edu |
