A truly great article on the ideals of “Drug Education” over at The Atlantic. (I highly recommend reading the original at The Atlantic via the link above- the story is heavily populated with links that are themselves worth checking out).
If Not D.A.R.E., Then What?
Moving away from “Just Say No” and towards a more nuanced understanding of drug education
STEPHIE GROB PLANTE AUG 28 2014,
I grew up in the 1990s, the era of mandatory D.A.R.E. and Just Say No. Local law enforcement stepped inside the classroom to instruct us kids, their message clear: “All drugs are bad.”
My dad, Dr. Charles Grob, one of the country’s leading clinical researchers studying the potential benefits of psychedelic-assisted therapy, didn’t agree. As the director of child and adolescent psychiatry at Harbor-UCLA Medical Center, and with the approval of the Food and Drug Administration and the Drug Enforcement Administration, he’s led several investigative studies of drugs branded by D.A.R.E. in my youth as “bad,” including MDMA (“Ecstasy” or “Molly”), psilocybin (“shrooms”), and ayahuasca.
His colleagues—many of whom I’ve known since I was very young—have added marijuana, ketamine, ibogaine, and even LSD to their impressive roster of studies as well. Investigation of these substances had previously been shuttered, thanks in large part to Timothy Leary’s Pied Piperism during the 1960s, but the 90s initiated a renaissance of government-sanctioned psychedelic research that continues to this day.
The results of recent studies have been positive. Take psilocybin, for instance. In studies positing that psilocybin can reduce anxiety for end-stage cancer patients, ease the symptoms of obsessive-compulsive disorder, and treat alcohol abuse, the data is encouraging. Psilocybin, if used appropriately, could be a viable medicine. Or, consider MDMA. Dr. Michael Mithoefer’s study using MDMA-assisted therapy to treat individuals suffering from PTSD found reduced symptoms in 83 percent of subjects in the active treatment group, versus 25 percent of subjects in the control group. The pilot study’s success has led to approvals for a new follow-up study treating military veterans suffering from PTSD.
There are a variety of takeaways from these studies, but one is clear and consistent: Many of those “bad” drugs aren’t always bad.
I grew up on the fringes of psychedelia. My dad and I never drove a Winnebago to Burning Man (though we were invited to do so). And he’s not a hippie. He wears a tie, not tie-dye, to work, and is impressively risk-averse, advocating safety and harm reduction above all. But despite his conservatism and determination to disprove the cultural stereotype that “drug research” must be shorthand for personal recreational use, it’s only recently that his work, though completely legal, has been met with interest rather than skepticism by the mainstream. As a child I watched him flourish in a community of his peers, but worried what other kids in my school—and my D.A.R.E. officer—might think if they learned what my father did for a living.
I had my own supplemental drug education experience, my other D.A.R.E.
My family made the regular pilgrimage to a bohemian oasis called Asilomar for the Association for Transpersonal Psychology’s annual conference. There, adults watched slideshow presentations that explored the inner dimensions of the human brain while us kids explored nature—hiking, stargazing, and building stone dams in a nearby creek. As a teenager, I accompanied my dad to book signings, conventions organized by the Drug Policy Alliance (DPA) and Students for Sensible Drug Policy, and The Psychedelic Salon, a Friday night speaker series in a homey Venice Beach bungalow, where people promoted a more expansive conversation around drugs. Everyone everywhere told me that my dad was “so cool.”
I agreed with them. My dad was cool because he respected me. He and my mom started talking to me about drugs when I was very young, and supplied me with all the facts they knew.
I memorized the chemical name for MDMA at age eight—3,4-methylenedioxymethamphetamine—and I’ll never forget it. I knew about the problem of rampant drug substitution, and that kids who thought they were buying one thing could very well end up with something else. I understood that when my dad and other researchers emphasized the value of “set and setting,” what they were really saying was “doing drugs at a party, with other drug novices, where risk of dangerous drug combinations is high, is pretty damn stupid.” No scare tactics were needed; the plain facts my dad gave me scared me enough.
My parents taught me that certain otherwise illicit substances had value as medicines in beta-testing, and I decided for myself that recreational use could damage the long-term goals of the therapy-assisted movement. I trusted that my parents told me the truth, and in turn, my parents trusted me to make smart decisions.
Yes, I was a kid with zero medical background. And yes, I was repeating back what my parents preached. But this was the school of thought they raised me on, just as my classmates learned lessons from their parents. We were just taught to believe different things.
The open dialogue at home clashed considerably with D.A.R.E.’s straight and narrow instruction at school. My dad, along with fellow parents who worked in his field, eschewed “Just Say No” for a comparatively holistic motto: “Just Say Know.” For them, the drug question requires a more nuanced answer than the word “no” can allow. To be sure, the slogan’s blanket villainization of drugs undermined their lifelong work, but its fear-driven simplicity also caused problems for the kids it meant to guide.
“The messaging since 1983 has been fairly consistent,” says Dr. Marsha Rosenbaum, director emerita of the DPA’s San Francisco office. “‘Drugs are bad and use equals abuse.’” The problem, she says, is that this model contains “no harm reduction component. There’s no ‘if you choose to do this, not that you should, but if you do, here’s what you should know.’ There’s no Plan B. There’s no fallback strategy.” Rosenbaum penned an educational booklet geared towards parents called Safety First that offers a “reality-based approach” to drug education. A new edition is due out in September. “We’ve got to tell the truth,” Rosenbaum writes. “Because if we don’t, teenagers will not consider us credible sources of information.”
It’s hard to recall exactly what we learned in D.A.R.E. I remember that my class’s police officer wore shorts as part of his uniform everyday, taught us that marijuana causes holes in the brain, and one day restrained a kid named Tommy, who jokingly lunged for his gun holster. Nothing invokes fear of the law like an armed police officer handcuffing your sixth-grade classmate. Otherwise, my drug education experience was utterly forgettable.
In 2001, the United States Surgeon General issued a statement on D.A.R.E. declaring that, “children who participate are as likely to use drugs as those who do not participate,” and categorized what was once the mainstay of federally funded drug education as an “ineffective primary prevention program.” Funding, however, remained in effect throughout the 2000s, with President Bush promoting the position of “Drug Czar” to Cabinet-level status. President Obama demoted the position to non-Cabinet level status in 2009, a move that both reflected the changing landscape of public opinion on drug policy, and coincided with substantial cuts to D.A.R.E.’s federal budget.
“D.A.R.E. [currently] receives zero federal funding,” says Ron Brogan, northeast representative for D.A.R.E. America. “The past five years we lost all federal funding, as funds for prevention have been cut across the board.”
In 2012, D.A.R.E. replaced its “Just Say No” slogan with “Keepin’ It REAL.” “REAL” is an acronym for “Refuse, Explain, Avoid, and Leave.” The new program’s efficacy is currently under internal evaluation, with its elementary school program midway through a five-year longitudinal study, and a high school program in development. The curriculum now, Brogan says, is “more about making good decisions than [discussing] specific drugs.”
Brogan maintains that the recent shift was not a response to the Surgeon General’s 2001 report: “We tend not to respond directly to critics, but rather keep up with the current science involved.” When researchers Dr. Richard Clayton and Dr. Christopher Ringwalt published studies in the 1990s that “came out in the press as very negative criticism of D.A.R.E.,” says Brogan, D.A.R.E. listened, and ultimately invited both scientists onto D.A.R.E.’s advisory board. “Prevention evolves over time, and D.A.R.E. tries to keep up with current trends and recommendations.”
The current trend toward marijuana legalization, however, is somewhat of a complicated issue for D.A.R.E. “We are unalterably opposed,” says Brogan of the recent law passages in Washington and Colorado. “Suffice it to say, we are an abstinence program.” In response to the question of whether D.A.R.E. adheres to its original messaging that all drug use is drug abuse, Brogan offered no comment.
D.A.R.E.’s website reflects some of the ambivalence of an organization at a crossroads, caught between a broad-based mission statement (“Teaching students good decision-making skills to help them lead safe and healthy lives”), changing times, and conflicting viewpoints. It features an article both recognizing medical marijuana’s legitimacy and voicing concern that “despite the known benefits of marijuana in easing patient pain—and the potential revenue that sales could generate for hospitals … hospitals run the risk of violating federal law.” But there’s also a piece by the CEO of the National Association for Drug Court Professionals (NADCP) on the site that stands decidedly against medical marijuana, using quotation marks around the words “safe” and “medicinal.”
In effect, D.A.R.E. no longer seems to offer a unified voice or philosophy, and the site serves more as a forum for instructors than a source of guided curriculum.
“Because it’s expensive and hasn’t proved effective, a lot of communities are backing away from D.A.R.E.,” says Rick Doblin, executive director of the Multidisciplinary Association for Psychedelic Studies (MAPS). “Still, D.A.R.E. is constantly changing [its] model and saying, ‘Now it works.’ Are they trying to learn? Or are they trying to immunize themselves to criticism?”
Despite D.A.R.E.’s waning relevancy, no salient drug educational program has emerged on a national scale to fill the hole left by its downsizing. This is troubling to scientists who both disagree with D.A.R.E.’s abstinence-only messaging, and advocate prevention education. “To me, it’s a public health issue,” says Dr. Julie Holland, editor of The Pot Book and Ecstasy: A Complete Guide. “People do risky things and we need to teach them how not to do them.”
According to Dr. Stephen Ross, director of addiction psychiatry at New York University, much of the problem remains in the misallocation of federal funds. “Seventy percent of federal funding continues to go to enforcement,” says Ross. “Only 20 percent [goes] to treatment and 10 percent to prevention. … Why not 60 percent to prevention and 40 percent to treatment?”
One prevention approach currently finding traction in psychotherapy is motivational interviewing (MI), “a collaborative, goal-oriented method of communication with particular attention to the language of change.” The National Institute on Drug Abuse (NIDA) has supported studies investigating MI’s efficacy in substance abuse prevention, and has circulated literature to clinical supervisors and therapists. But the technique has yet to make a strong foothold in the public school system. A recent one-year follow-up study “failed to demonstrate that an adequately implemented MI booster was of incremental value.”
In the absence of widespread, effective, federally-funded drug education, the onus has fallen largely on parents to spearhead drug education reform, says Doblin. “The parent movement of the 1980s led to Nancy Reagan, and Just Say No, and D.A.R.E., and D.A.R.E. led to misinformation. What we don’t really have yet is a new parent movement.”
There may not be an imminent large-scale movement as Doblin prescribes, but there is a small one, one that foregoes the zero tolerance model—bolstered by D.A.R.E.’s police officer instructor base—that focuses on enforcement and discipline, and remains prevalent in mainstream secondary school policy.
This school-based program rejecting the “first-strike-you’re-out” rhetoric is UpFront, which works with at-risk kids in California.
“These kids all know the truth, so why lie?” says Chuck Ries, founder of UpFront, a student assistance program. First established at Oakland High School in 1997, UpFront advocates candid conversations—talking about harm reduction in a safe environment. “Once [the students] realized we were legit, not cops, the kids who were normally marginalized suddenly became the experts in the room. They got to share hard fought knowledge in a way that was accepted by the group.” Many of those same experts went on to become paid instructors in UpFront themselves, alongside licensed therapists hired by Ries.
But the stock market crash of 2008 and the building of a new local health clinic that required the resources normally allocated to UpFront ultimately moved the program out of Oakland High School and into a consulting firm operating on a contractual basis.
“If money were available it’d be easy to find schools willing to participate,” Ries says. “The schools want these programs. The students want these programs. But it’s a different story when the schools are responsible for funding the programs themselves.”
Rosenbaum and the DPA agree. “Student assistance programs like Chuck’s are an invaluable resource. If you could have that in every school, we’d be taken care of.”
The common thread among effective programs, it seems, is honesty.
“Isn’t it interesting,” says my dad, a.k.a. Dr. Grob, “how all these kids of my colleagues—leading figures in the research wing of the drug culture movement—how these kids are completely straight? That none of you guys are into drugs? That says something.”
Past modes of drug education have opted to emphasize the risk and minimize the possibility of medicinal benefits. But saying “this is what we know” is not an invitation for recklessness—it establishes trust and communication.
Drugs were never objects of titillation for me. They were never branded as taboo, so I never sought out that forbidden fruit. Still, I grew up in the real world. I faced many hard choices head-on. But because my dad provided me with accurate information, and framed that information in a medical context, I learned the boundaries without needing to personally test them. And although I am what my dad and his colleagues refer to as “drug naïve,” I felt equipped with the right tools to both counsel friends recovering from bad trips, and offer advice to friends who, in my mind, were planning risky experimentation. My dad recently reminded me of an episode in high school where I successfully dissuaded a friend from picking some desert-growing jimson weed, boiling it as a tea, and drinking it. I warned him that the likelihood of disorientation and hypertension were high, and that he could seriously injure himself or others as a result. And he listened to me.