Project Alert Helps Even High-Risk Teens Curb Substance Abuse

A RAND Corporation study issued today shows that the widely used Project ALERT program successfully curbs the use of alcohol, cigarettes and marijuana among middle-school students—even those at high risk of substance abuse.

In a study published in the November issue of the American Journal of Public Health, RAND Health researchers found that Project ALERT reduces marijuana and cigarette initiation, alcohol misuse, and recent as well as regular cigarette use.

The study also found that the program helps high-risk youth—those who had already started smoking and drinking by 7th grade. This counters critics of school-based drug prevention efforts who claim such programs fail to affect high-risk adolescents.

"These early smokers and drinkers have substantially elevated risks for increased drug use and a variety of other high-risk behaviors such as violence, unsafe sex, and dropping out of school," said Phyllis Ellickson, the lead author of the report and head of the RAND team that created Project ALERT. "These are precisely the youth who need help the most. Curbing alcohol and cigarette use among these high-risk youth when they are in middle school may help prevent the emergence of more serious problems later on."

The Project ALERT curriculum, which is designated an Exemplary Program by several federal agencies, became available in 1995. It is now used in all 50 states, reaching more than 1 million adolescents each year.

The program is designed to modify the attitudes and behavior of 7th and 8th graders toward alcohol, cigarettes, and marijuana. It targets these three substances because they are the ones that middle-school youth are likely to try first.

The Project ALERT curriculum provides 11 lessons in 7th grade, reinforced with three lessons in 8th grade. The lessons, which are based on the social influence prevention model, help students identify and resist pro-drug pressures and understand the social, emotional, and physical consequences of using harmful substances.

The lessons use videos and interactive teaching methods, such as guided classroom discussions, small group activities, and intensive role-playing, as well as parent-involved homework assignments.

To test the effectiveness of Project ALERT, researchers conducted a randomized, controlled study in 55 middle schools in South Dakota from 1997 to 1999. More than 4,000 students were assigned to either the ALERT classes or to a control group that was exposed to whatever drug prevention measures were in place at their schools.

The researchers surveyed all students about their drug-related attitudes as well as their substance use in the fall of 7th grade and again in the spring of 8th grade. To motivate students to participate in the study and to answer survey questions honestly, students were guaranteed anonymity and data privacy.

The baseline survey of substance use among the 7th grade students showed that about 60 percent had already tried alcohol, about 35 percent had tried cigarettes, and nearly 7 percent had tried marijuana. After the 7th and 8th grade lessons ended, the researchers found that the Project ALERT students had made major reductions in their substance use. Compared with the control students:

• The proportion of new smokers in the ALERT group was 19 percent lower, and the proportion of regular smokers was 23 percent lower.
• Marijuana initiation rates were 38 percent lower for ALERT students who had not tried cigarettes or marijuana at the start of the study, and 26 percent lower for the higher-risk students who had tried cigarettes, but not marijuana.
• Scores reflecting overall alcohol misuse—binge drinking, drinking that led to fights, got students in trouble, etc.—were 24 percent lower for all ALERT students.

When the researchers examined the data by risk groups, they found that Project ALERT had also made inroads with students in higher-risk categories, such as the more-committed smokers and the more-committed early drinkers.

Project ALERT was especially successful with the highest risk early drinkers, substantially reducing their likelihood of experiencing problems from drinking or of engaging in risky forms of alcohol use (such as binge drinking or drinking before or during school). For these students, the scores reflecting overall alcohol misuse, alcohol-related consequences, and high-risk drinking were about 20 percent lower than for comparable students in the control schools.

“Our findings for alcohol misuse indicate that school-based programs have important potential for reducing harms related to drinking,” said RAND researcher Douglas Longshore, who was principal investigator of the evaluation. “The reductions in high-risk drinking and alcohol-related problems such as fighting, impulsive behavior, and school difficulties suggest that programs like Project ALERT can generate a broad range of public health benefits. Few studies have evaluated the impact of middle-school drug-prevention programs on alcohol misuse, and this is an issue that deserves further investigation.”

Even though Project ALERT helped high-risk drinkers, it didn't keep lower-risk students from starting to drink or help them cut back on moderate alcohol use.

“A likely explanation is that curbing any or moderate alcohol use faces difficult odds in societies where drinking is widespread and socially acceptable,” Ellickson said. “Prevention programs stand a better chance of making inroads on less socially acceptable forms of drinking, such as problematic use.”

RAND researchers Daniel McCaffrey and Bonnie Ghosh-Dastidar were also part of the evaluation, which was supported by a grant from the National Institute on Drug Abuse. The Conrad N. Hilton Foundation supported Project ALERT's development and field testing, and program improvements.

Project ALERT is an evidence-based program, meaning that its effectiveness has been demonstrated through rigorous research. Even though U.S. Department of Education guidelines call for implementing evidence-based drug-prevention programs, only 9 percent of school districts are doing so. The program is disseminated to schools through the BEST Foundation for a Drug-Free Tomorrow, which receives grant funding from the Hilton Foundation to subsidize teacher training, technical assistance, and periodic updating of classroom materials.

Project ALERT, which is endorsed by the National Middle School Association, is one of only seven school programs in the country to be designated an Exemplary Program by the U.S. Department of Education. It has also received exemplary ratings from several national organizations and a half dozen other federal agencies, including the Substance Abuse and Mental Health Services Administration, the White House Office of Drug Control Policy, and the Office of Juvenile Justice and Delinquency Prevention.

The Project ALERT website is www.projectalert.com/.