The health and social costs associated with alcohol and other drug (AOD) use are considerable and fall most heavily on young people [1
]. This in itself is an argument for early AOD prevention programs. School drug education offers the potential to prevent problems by equipping young people with the knowledge and skills to make responsible decisions about AOD use, and it has near universal reach in developed countries where the great majority of young people attend secondary school [4
]. However, historical approaches to school drug education have not been particularly successful at reducing AOD use [5
]. This then poses the question as to whether effectiveness should be measured by abstinence or reduced use, or whether harm reduction is a more realistic and useful measure. Harm reduction programs offer greater promise of achieving worthwhile benefit because they have the flexibility to select strategies on the basis of evidence of effect. Within this model abstinence or reduced use strategies may be chosen if there is evidence that they reduce harm, but they are not goals in their own right [8
The School Health and Alcohol Harm Reduction Project (SHAHRP) demonstrated the effectiveness of a skills based, harm reduction intervention. Students who received the SHAHRP program experienced 22.9% less alcohol-related harm than their control peers [9
]. A more recent study of computerised harm reduction prevention similarly reported that alcohol consumption, risky drinking and alcohol-related harms increased to a lesser extent among female intervention students, although there was no program effect among male students [10
]. A related study that targeted cannabis, as well as alcohol, found that weekly alcohol consumption of intervention students decreased, while that of their control peers increased. The frequency of drinking to excess also increased to a lesser extent among the intervention students [11
Drug education has developed considerably in Australia over the past decade. However, evidence-based practice tends to be best reflected in demonstration programs that focus on a single drug type, such as alcohol [9
]. The most recent findings have not been brought together in a mass drug education program that targets all forms of drug use and can be readily accommodated within a secondary school health curriculum. Past classroom-based programs have not well exploited the important influence that parents have on their children in terms of AOD choices and the likely benefits of increased communication on this issue [13
]. Finally, while most Australian school drug education programs are grounded in the research literature and principles of effective practice there has been insufficient attention to the pedagogy required to deliver effective classroom lessons [14
]. Drug education is most effective when inclusive, interactive teaching strategies actively engage students in the learning process [14
]. However, reviews of drug education program implementation consistently identify a breakdown in fidelity when learning tasks are interactive [16
This research study seeks to extend earlier Australian harm reduction education research by investigating the prevention effects of a single program for both licit and illicit drugs. The size and nature of the intervention have been tailored to facilitate incorporation within an already crowded school curriculum. It draws on the recent literature as to the common elements in effective school drug education programs [19
]. It seeks to incorporate the social influence of parents through structured home activities that complement the classroom lessons. It emphasises the use of appropriate pedagogy through two days of training, where participatory delivery of each lesson is modelled to ensure teachers are equipped to teach the program as intended. All these elements have been trialled and refined during the course of a two year pilot program that was undertaken in four Victorian government secondary schools (three intervention and one control) [23
The intervention at the heart of this study is grounded in social learning theory, which posits that human learning occurs in a social context [24
]. In this model, drug use is socially learned through modelling, imitation and reinforcement, and influenced by an individual's cognitions, attitudes, and beliefs. The corollary is that drug education can use the same learning processes to equip students with the skills to recognise these influences and develop a repertoire of counter behaviours. Social learning theory underpins all of the most effective school drug education programs, and a number of researchers have indicated that it should be the model of choice in any prevention program [7
The intervention also draws on two other theoretical models, poststructuralist subjectivity and cognitive dissonance. Poststructuralist subjectivity theory provides a way of understanding how students' self concepts, and hence their approach to drug use, can change. Cognitive dissonance theory provides a way of understanding how students resolve conflicting ideas on drug use.
Poststructuralist subjectivity theory refers to the ways in which the social world is involved in shaping an individuals' sense of self [26
]. It posits that cultural norms and expectations shape the individual's sense of who they can or should be, and identifies the importance of a 'sense of belonging' to identity formation [28
]. In this process of subjectification, identity is continuously under construction, maintenance and re-construction, and hence open to change, particularly change that is social and collective in nature. Thus participatory and collective learning methods become the vehicle for the creation of new norms and possibilities in the peer group [14
Festinger's theory of cognitive dissonance posits that contradictory cognitions, or cognitive dissonance, cause mental discomfort [30
]. This serves as a driving force that compels a person to adopt new thoughts or beliefs, or to modify existing beliefs, so as to reduce the amount of dissonance between cognitions. The education intervention used in this study does not tell students what they should think or how they should behave in terms of drug use. Rather, it provides a social learning process whereby the students reach their own conclusions through exploration of drug use issues. By guiding students through an interactive discovery process that involves articulation of responsible drug use behaviour their ownership of that behaviour is reinforced and they are less likely to behave in a contrary manner.
Aims and hypothesis
The aim of this study is to develop and assess the effectiveness of a comprehensive, evidence-based, harm reduction focused school drug education program for year eight and nine students by undertaking a cluster randomised trial with 21 secondary schools in the Victorian state of Australia. The specific hypothesis is that while the intervention students may not be any less likely to take up use of alcohol, tobacco and illicit drugs they will be more likely to consume in a less risky manner and experience less harms associated with use.