NIDA Notes, December 3, 2015, By Eric Sarlin, M.Ed., M.A., NIDA Notes Contributing Writer, National Institute on Drug Abuse
The Life Skills Training (LST) prevention intervention, delivered in 7th grade classrooms, helps children avoid misusing prescription opioids throughout their teen years, NIDA-supported researchers report. Coupling LST with the Strengthening Families Program: for Parents and Youth 10–14 (SFP) enhances this protection. Dr. D. Max Crowley from Duke University, with colleagues from Pennsylvania State University, evaluated the impacts of LST and two other school-based interventions, All Stars (AS) and Project Alert (PA), on teens’ prescription opioid misuse. The researchers drew the data for the evaluation from a recent trial of the PROmoting School-community-university Partnerships to Enhance Resilience (PROSPER) prevention program. PROSPER is led jointly by Richard Spoth at Iowa State University and Mark Greenberg at Penn State University, with research funding from NIDA.
The new evaluation also disclosed that communities that implemented LST in the PROSPER trial more than recouped its cost in reduced health, social, and other expenditures related to teen prescription opioid misuse. The researchers recommend that communities consider implementing LST plus SFP to help control the ongoing epidemic of youth prescription opioid misuse. LST was the only intervention of the three tested that was effective by itself, and it was most effective when the interventions were combined with SFP.
Lessons That Stick
In the PROSPER trial, 14 communities in Iowa and Pennsylvania each selected the intervention they felt best fit their resources and their youth’ risk profile for drug use and other unhealthy and delinquent behaviors. The interventions are all “universal,” meaning that they are delivered to all children, not just those who are judged to have elevated risk for problems.
All the interventions involve multiple sessions of classroom instruction addressing the social and psychological factors that lead to experimentation with drugs and other undesirable behaviors. In addition, through games, discussion, role-playing, and other exercises, students practice refusing drugs, communicating with peers and adults, making choices in problem situations, and confronting peer pressure. The programs’ curricula focus on helping students to develop practical skills they can apply to resist drug use. Materials such as worksheets, online content, posters, and videos augment all three programs.
Each intervention was delivered to all 7th graders in the schools of the PROSPER communities that selected it. Most of the children and their families also received the SFP program during the prior year, when the children were in 6th grade. In SFP, families gather together to watch videos providing advice and instruction toward enhancing family relationships and communication, fostering parenting skills, improving academic performance, and preventing risky behaviors. Group leaders then conduct follow-up lessons and practice exercises.
Dr. Crowley and colleagues previously reported that smaller percentages of children from the 14 PROSPER communities reported illicit drug use and problematic alcohol use in annual follow-up visits conducted through 11th grade, compared to children from 14 matched control communities that did not use any evidence-based prevention program. As well, fewer PROSPER children reported marijuana use in 12th grade.
Dr. Crowley and colleagues determined that LST’s impact on teens’ prescription opioid misuse made it a good financial, as well as health, investment for PROSPER communities. They reached this conclusion by:
- Estimating the cost to prevent each case of prescription opioid misuse (by dividing the total cost of LST materials, training, etc., by the number of cases prevented).
- Comparing that number to $7,500, which they estimated, based on previously established figures, is the average expenditure incurred by communities for each single case of teen prescription opioid misuse.
These calculations indicated that PROSPER communities that implemented LST laid out $613 and saved $6,887 for each child that the program prevented from misusing prescription opioids. The corresponding estimates for LST plus SFP indicated expenditures of $3,959 and savings of $3,541 per case averted. Even though communities saved less per benefited child with LST alone, the researchers note, their health benefits were greater and their total savings may have been greater with LST plus SFP, because more cases were prevented.
Dr. Crowley says, “This work illustrates that not only can existing universal prevention programs effectively prevent prescription drug misuse, they can also do so in a cost-effective manner. Our research demonstrates the unique opportunities to combine prevention across school and family settings to augment the larger prevention impact.”