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Substance Abuse Treatment Modalities: Literature Review

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Drug and Alcohol Education

Education about the effects of drug and alcohol use is offered to participants on the premise that they lack accurate information about their actions and adverse effects (Marlatt & Gordon, 1980; Miller & Hester, 1986). Although equivocal, there is evidence to suggest that abusers are less knowledgeable about the negative consequences of substance use compared to non-users (e.g., Senn, 1983). The presumption is that an increase in the knowledge of problems associated with drug and alcohol use will change attitudes toward use of alcohol and drugs.

Drug and alcohol education is a normal component of most substance abuse interventions, for offenders and non-offenders alike (Montagne & Scott, 1993; Peters, May II, & Kearns, 1992). It can be offered as a single prevention program to individuals who are just beginning to experience problems or who are at high risk for encountering substance use difficulties. Alternatively, education can be incorporated as a component of multimodal treatment programs with participants who present serious substance abuse difficulties.

Recent reviews have found little evidence to suggest that drug and alcohol education programs have much impact on changing substance use behaviour (Eliany & Rush, 1992; Foon, 1988; Miller & Hester, 1986; Montagne & Scott, 1993). Although of some concern, it is not necessarily surprising that education alone does not change the actual behaviour of drug or alcohol use (Tobler, 1986; Uecker & Boutilier, 1976). In examining the effectiveness of education, the challenge is to establish the appropriate target: change in knowledge, attitudes or actual behaviour (Montagne, 1982). There is still considerable lack of understanding or appreciation for the three domains and research has still not determined what, and how much of what, that is learned in one domain influences another domain (Leukefeld & Bukoski, 1991). As Montagne and Scott (1993) and others (e.g., Miller & Hester, 1986) have implied, the evaluation of effectiveness should coincide with the program goal. In terms of drug and alcohol education, if the stated purpose is to impact on knowledge and attitudes, then these are the domains to be evaluated, not drug and alcohol-using behaviour. Alternatively, if the goal of education is to change substance use behaviour, then actual use of drugs or alcohol should be the outcome examined. Consequently, the efficacy of education will be dependent on the outcome to be achieved.

Recognizing the cautions in the interpretation of effectiveness, the following is a review of evaluations conducted on drug and alcohol education, including single component and more comprehensive multi-component programs. Senn (1983) examined the impact of substance abuse education as a component of an aftercare program. A group of former abusers, half of whom had been incarcerated, participated in the university substance abuse education course. Results showed a significant increase in drug and alcohol knowledge, a significant reduction in drug and alcohol use attitudes, but no significant reductions in actual drug use. It was concluded that education should be offered to abusers with the intent of changing knowledge and attitudes, rather than attempting to influence drug and alcohol-using behaviour.

Duguid (1987) reported on the impact of the Prison Education Program offered to drug-involved federal offenders by Simon Fraser University. Interestingly, the program curriculum did not focus solely on drug and alcohol education. The activities included virtually all on-campus activities at the liberal arts colleges. An evaluation comparing 65 student inmates to 65 non student inmates showed that 50% of the non students returned to prison within three years of release whereas only 16% of the students returned. Although substance use knowledge and return to drug and alcohol use were not analyzed, the results suggest that the education program had a sizable impact on post-release success for the drug-involved inmates.

A number of studies have focused on the impact of educational intervention for impaired drivers. Vingilis et al (1981) randomly assigned drinking drivers with multiple offences to either an educational program or a control group. Compared to the control group, the educational group showed significant increases in knowledge and attitudes scores between pre- and post-test administration. However, after 3.5 years, no differences existed between the two groups on traffic safety measures.

Jamieson and Stone (1991) examined the performance of impaired drivers who were placed on probation and court-referred to participate in driving while intoxicated (DWI) education programs. In comparison to the recidivism level of 35% for offenders who do not receive the DWI training (Fredlund, 1989), Jamieson and Stone (1991) found that of the 331 participants who completed the education programs, only 10% were rearrested for DWI within a 2-year follow-up. Moreover, some evidence was available to suggest that program success could be predicted based upon the offenders' attitude toward change.

Aside from impaired driving education programs, recent emphasis has been placed on providing educational intervention to substance-abusing offenders as an alternative to custodial sentencing (Cochrane et al., 1988; Greer et al., 1990). Greer et al. (1990) examined the impact of alcohol education courses offered to court-referred young offenders. Control groups who received no intervention were matched to 3 course groups: (1) a behavioural course that focused on skill acquisition, drinking/offending analysis, and subsequent behavioural modification, (2) a talk-based course that included non-didactic, non-directive group discussions of alcohol abuse and subsequent offending, and (3) an information-based course that provided information on alcohol consumption. Results showed that clients in the talk-based and information-based courses reduced, although non-significantly, subsequent alcohol consumption while participants in the behavioural course achieved significant reductions compared to the control group. Follow-up interviews found that only the behavioural course significantly reduced post-treatment conviction rates and self-reported offending.

In summary, drug and alcohol education appears to be effective in shifting attitudes and knowledge related to use. The available evidence regarding actual behaviour change suggests that education as a single program is generally not effective in reducing levels of use. This conclusion is consistent with other reviews (Eliany & Rush, 1992; Montagne & Scott, 1993) and highlights the need to differentiate substance abuse problem levels of clients referred to education programs. Education as a sole component should only be offered to individuals who are just experiencing difficulties or who may be at risk for developing substance abuse problems. The intent would not be to change the pattern of use but rather provide the necessary information to maintain the low risk pattern of use. Alternatively, it has been argued that education may benefit serious substance abusers if incorporated into more multi-faceted programs (Montagne & Scott, 1993). Currently though, there is a lack of adequate studies to assess the contribution of education in more comprehensive programs.

References for Drug and Alcohol Education:

Cochrane, S., Baldwin, S., Greer, C., & McCluskey, S. (1988), “Alcohol education courses and offenders: Update of U.K. services”, Alcohol and Alcoholism.

Davidson, P. R. (1983), “Short-term impact of the Alberta impaired drivers' program on the knowledge and attitudes of participants” Alberta: Alberta Alcohol and Drug Abuse Commission.

Duguid, S., (1987), University Prison Education in British Columbia, British Columbia, Canada: Simon Fraser University.

Eliany, M., & Rush, B. (1992). The effectiveness of prevention and treatment programs for alcohol and other drug problems: A review of evaluation studies. (Unpublished report). Ottawa: Health and Welfare Canada.

Foon, A. E. (1988), “The effectiveness of drinking-driving programs: A critical review”, The International Journal of the Addictions, 23(2), 151-174.

Fredlund, E. V. (1989), “The impact of DWI education in Texas”, Austin: Texas Commission on Alcohol and Drug Abuse.

Greer, C., Lawson, A., Baldwin, S., Cochrane, S. (1990), “Alcohol abuse and the young offender: Alcohol education as an alternative to custodial sentencing”, Journal of Offender Counselling, Services and Rehabilitation, 15(1), 131-145.

Huebert, K. (1990), “IMPACT: Measuring success”, Alberta: Alberta Alcohol and Drug Abuse Commission.

Jamieson, J. D., & Stone, W.E. (1991), “Predicting DWI education success”, Federal Probation, March, 1991.

Jeune, R., Huebert, K., Slavik, W., Brown, C., & Mah, B. (1988), “IMPACT: Program development studies” Alberta: Alberta Alcohol and Drug Abuse Commission.

Leukefeld, C. G., & Bukoski, W. J. (Eds.), (1991), “Drug abuse prevention intervention research: Methodological issues”, (NIDA Research Monograph 107). Washington, D.C.: Governmental Printing Office.

Montagne, M. (1982), “Evaluating educational programs: A comparative design”, Evaluation and Health Professions, 5, 477.

Miller, W. R., & Hester, R. K., (1986), “The effectiveness of alcoholism treatment: What research reveals”, In W.R. Miller & N. Heather (Eds.), Treating addictive behaviours: Processes of change, New York: Plenum Press.

Montagne, M., & Scott, D. M. (1993), “Prevention of substance abuse problems: Models, factors, and processes”, The International Journal of the Addictions, 28(12), 1177-1208.

Peters, R. H., May II, R. L., & Kearns, W. D. (1992), “Drug treatment in jails: Results of a nationwide survey”, Journal of Criminal Justice, 20, 283-295.

Senn, K. (1983), “Effects of short-term rehabilitation on alcohol consumption and drinking-related behaviours: An eight-month follow-up study of drunken drivers”, The International Journal of the Addictions, 15(6), 821-838.

Stalonas, P. M., Keane, T. M., and Foy, D.W. (1979), “Alcohol education for inpatient alcoholics: A comparison of live, videotape and written presentation modalities”, Addictive Behaviours, 4, 223-229.

Tobler, N. (1986), “Meta-analysis of 143 adolescent drug prevention programs: Quantitative outcome results of program participants compared to a control or comparison group”, Journal of Drug Issues, 16(4), 537-567.

Uecker, A. E., & Boutilier, L. R. (1976), “Alcohol education for alcoholics: Relation to attitude changes and posttreatment abstinence”, Journal of Studies on Alcohol, 37, 965-975.

Vingilis, E., Chung, L., & Adlaf, E. M. (1981), “An evaluation of a prevention programme for drinking and driving called R.I.D.E.”, In L. Goldberg (Ed.), Alcohol, Drugs and Traffic Safety. Sweden: Almquist and Wiskell International.