THE CHALLENGE V9 N5
RAND’s Drug Policy Research Center studies
prevention’s effectiveness
T he United States’ drug control policy
has historically focused on law en-
forcement efforts to control drug traffick-
ing and use of illicit drugs. The bulk of the
$40 billion budget has been used for pro-
grams that control the amount of illicit
drugs that comes into the U.S. to longer
sentences for drug dealers. But more and
more, the U.S. public is supporting preven-
tion as a drug control policy issue. With
that in mind, RAND’s Drug
Policy Research Center
(DPRC) undertook the pow-
erful question: “How effec-
tive is prevention and at what
price?”
In its new publication, “An
Ounce of Prevention, A
Pound of Uncertainty,”
DPRC seeks to clarify the
issue of prevention pro-
grams’ effectiveness. After
studying the cost-effective-
ness of two drug control
strategies — law enforce-
ment and treatment — DPRC
determined that it was time to
analyze drug prevention pro-
grams as another aspect of
drug control spending. Al-
though there is little evalua-
tion of drug prevention
programs currently in print, DPRC was
able to determine that school-based drug
prevention programs are, in fact, cost ef-
fective, although the results are filled with
doubts.
To begin its research, DPRC chose re-
duction in U.S. cocaine consumption as the
objective of the nation’s drug control ef-
fort. Cocaine is considered the most prob-
lematic illicit drug in our country, and
although most school-based programs tar-
get marijuana, alcohol, and tobacco con-
sumption, DPRC was able to calculate
future consumption of cocaine by drug
prevention program participants based on
reductions in marijuana use. It is also noted
that DPRC’s previous cost-effective stud-
ies on law enforcement and treatment fo-
cused on these two strategies’ abilities to
reduce cocaine consumption. And there-
fore, studying prevention’s ability to re-
duce cocaine consumption allowed for
comparison of the various drug control
strategies.
To arrive at its conclusions, DPRC first
considered two model school-based pre-
vention programs and created a calculation
to determine just how effective these pro-
grams are in reducing cocaine consump-
page 4
THE CHALLENGE V9 N4
tion in the programs’ participants. The two
programs reviewed are Life Skills Training
and Project ALERT. These programs were
plest way to learn this number is to divide
total consumption by number of people
who initiated cocaine use for a set period.
chosen because DPRC wanted “best prac- Other methods were described in the re-
tice programs,” so it could look at what port, which include variables such as
prevention could do, versus what preven- heavy users versus light users, and were
tion had been doing. The two programs taken into consideration when calculating
have been recognized as excellent pro- the range of numbers for this factor.
grams and both have clear documentation Factor number 3 is where the informa-
about program participants, program con- tion from Life Skills Training and Project
tent, and evaluations. ALERT comes into play. Although neither
program has data on lifetime
An Ounce of Prevention, cocaine consumption,
A Pound of Uncertainty DPRC took the figures for
reduction in marijuana initi-
by Jonathan P. Caulkins, ation. From that it used in-
formation from NHSDA
C.Peter Rydell, Susan S.
which shows that delays in
Everingham, James Chiesa, marijuana initiation lowers
and Shawn Bushway, 1999. likelihood of ever using co-
caine and, for those who do
Available from RAND use it, lower levels of con-
Distribution Services sumption. DPRC then had to
consider the permanence of
(telephone: 310-451-7002; the prevention program’s ef-
FAX: 310-451-6915). fect on reducing cocaine
consumption, and again de-
This document may be viewed termined a best case sce-
on-line at www.rand.org/ nario (100% permanence) to
publications/MR/MR923/. a worst case scenario (0%
permanence).
The discount factor
(number 4 in the calculation) is there to
CALCULATING EFFECTIVENESS show that people would rather have bene-
DPRC’s calculation is a multiplication fits from a program sooner rather than
of eight different factors contributing to later, and the discount factor accounts for
prevention’s effectiveness at reducing co- the benefits of prevention that accumulate
caine consumption. These factors are: over time. Factor number 5 accounts for
1. Proportion of persons who would have the positive influence a prevention pro-
ever used cocaine, times gram can have over people not participat-
2. Lifetime cocaine consumption per user, ing in the program — by influencing those
times around the program participant. DPRC ar-
3. Percentage reduction in cocaine use due rived at this data by relating it to the num-
to prevention programs, times ber of heavy and light users in a given
4. Discount factor, times period. The market multiplier relates the
5. Social multiplier, times fact that reduced consumption by program
6. Market multiplier, times participants creates reduced demand for
7. Causation/correlation ratio, times the drug, which increases the amount of
8. Scale-up factor. law enforcement relative to the amount of
Throughout the discussion of this calcu- use.
lation, DPRC provides a low, middle, and Factor number 7 appears in the calcula-
high estimate for each factor. This was tion because there are ways in which a pro-
done because of uncertainties in securing a gram’s effect may be overestimated. For
dependable number for each factor. Factor instance, if the program only affects mari-
number one was based on information ob- juana use, but not whatever drives cocaine
tained from the National Household Sur- use, future reduction in marijuana initia-
vey of Drug Abuse (NHSDA), which tion may imply nothing about future co-
reports on the numbers of people using co- caine use. Thus, factor number 7. Factor
caine in a given year. Factor number 2 was number eight is included in this report be-
more difficult to determine because there cause DPRC wanted to analyze the possi-
is no literature on this statistic. The sim- bility of national implementation of a

prevention program. However, it had noth-
ing on which to base this number in terms
of the degradation of a program when
widely implemented — therefore, more
uncertainty.
After analyzing all this data, DPRC es-
timated that prevention programs could re-
duce lifetime cocaine consumption
between 2 and 11 percent. This is a small
proportion, DPRC recognized, but it em-
phasized that these numbers were derived
from years when the current cocaine epi-
demic is already in full swing. Had pre-
vention programs been given to students
years before this epidemic started, these
numbers could be higher.
BENEFITS VERSUS COSTS
To ascertain just how cost-effective pre-
vention was in comparison to other drug
control strategies, DPRC wanted to learn
how many kilograms of cocaine consump-
tion was reduced per million dollars spent
on the program. Two steps were taken to
arrive at this number. One, DPRC multi-
plied the percentage reduction by the aver-
age lifetime amount of cocaine that
program participants would be expected to
consume in the absence of prevention.
Two, taking this number and dividing it by
the cost of the program per participant. To
reach this latter number, the researchers
considered not only the costs of the pro-
gram materials and teacher training, but
also the lost learning factor (students using
The Challenge is on-line — visit www.thechallenge.org
to view the latest issue or download archived issues
Principle #2: Establishing goals to define your way
“At the fork in the road,
Alice asked the Cheshire
Cat which road to take. The
Cheshire Cat asked, ‘Where
do you want to go?’ To
which Alice replied, ‘I don’t
know.’ ‘Then,’ said the Cat,
‘It doesn’t matter which
way you go.’’’
prevention time instead of time for other
academic pursuits). The “best estimate”
results showed that prevention could re-
duce cocaine consumption by 7 to 60 kilo-
grams per million dollars spent.
This number allowed for the compar-
isons to other drug control strategies. Pre-
vention’s best estimate is higher than law
enforcement’s longer sentences for federal
defendants and domestic enforcement of
typical dealers, but was not as high as
treatment in reducing cocaine consump-
tion.
OTHER ISSUES ADDRESSED IN
THIS STUDY
In its publication, DPRC spent time
evaluating the worth of prevention by ask-
ing if a dollar invested in a prevention pro-
gram would yield at least a dollar in
benefits. Using outside research that esti-
mated the social costs of cocaine use in
terms of health, crime, and other costs, the
benefit-cost ratio for prevention worked
out to be between 64 cents and almost
$5.60 for every dollar spent. Their mid-
range, and preferred, estimate was approx-
imately $2.40 for every dollar spent.
Prevention programs also have other
non-cocaine-related benefits that DPRC
pointed out in this study. Such programs
have also been proven to reduce cigarette
and alcohol consumption, as well as reduc-
tions in participation in gangs, teen preg-
nancies, and school dropout rates. And so,
Continued from page three
END WITH THE BEGINNING
IN MIND
There must be a process in place from
the beginning to gather data on the effec-
tiveness of each strategy and to evaluate it.
It is critical to know how much progress is
being made toward the council’s devel-
oped goals. Determining the best measures
to indicate the quality with which goals are
achieved should occur at the start of the
goal-setting process. As the goals are de-
veloped, the measuring device for their
achievement must also be developed. It
is against these measuring devices that
both progress and ultimate achievement
can be assessed.
The United Way of America has given
us a great example of clarity at the begin-
ning for success at the end—the United
Way fund-raising thermometer. Measure-
ment and evaluation are not always quite
so concrete and simplistic. But they are al-
THE CHALLENGE V9 N5
DPRC concluded that it is high likely that
model school-based prevention programs
are a good investment in terms of generat-
ing at least a dollar’s worth of benefits for
every dollar spent.
A final discussion focused on the possi-
bility of a nationwide implementation of a
prevention program. DPRC notes that this
is clearly affordable. “It would cost about
$550 million to offer it to all 3.75 million
children reaching seventh grade in any one
year. That is only a small fraction of the
$40 billion the nation annually spends on
drug control,” the report says.
IN CONCLUSION
RAND’s Drug Policy Research Center
has put together a very sound argument for
further study into the question of preven-
tion’s effectiveness. DPRC shows its read-
ers that prevention can reduce cocaine
consumption, though at relatively small
amounts. But because prevention is not
that expensive, it compares well to other
drug control strategies in terms of cost-ef-
fectiveness. As DPRC notes, “implement-
ing model prevention programs seems
justifiable in the sense that the benefits
produced would likely outweigh the costs
of the resources used.”
Source: An Ounce of Prevention, APound
of Uncertainty; by Johnathan P. Caulkins,
et al.,1999.
Reported by Jill Lewis-Kelly, ACDE.
ways essential. Not only does such evalua-
tion measure the success, it is also a key to
sustaining the energy, commitment, and
effort of the individuals involved. As
progress is measured and goals are
achieved, each individual involved is re-
warded simultaneously through the sense
of self-efficacy they feel having been a part
of the success.
Dr. Judi Kosterman has been employed as a
high school teacher, counselor, principal,
school district superintendent, and universi-
ty professor. Her doctorate is in Educational
Leadership and Addiction Studies from
Seattle University. In 1990, she was the
State Drug Czar of Washington State. Dr.
Kosterman joined the Community Anti-
Drug Coalitions of America (CADCA) as
Vice President for Training & Technical As-
sistance in 1994. In 1999, she joined the
White House Office of National Drug Con-
trol Policy as the Assistant Director of the
National Youth Anti-Drug Media Campaign.
page 5
THE CHALLENGE V9 N4

Drug Strategies updates Making the

Grade guide for educators
rug Strategies is a non-profit research search and were agreed upon by the six- n Actively involve the family and the
D institute dedicated to promoting more person panel of experts convened by Drug
effective approaches to drug problems and Strategies. The experts believe that these
community, so that prevention strategies
are reinforced across settings;
supporting private and public initiatives elements should be part of a comprehen- n Include teacher training and support, in
that reduce the demand for drugs through sive strategy in the school, the home, and order to assure that curricula are deliv-
prevention, education, treatment, and law the community in order for youth to re- ered as intended; and
enforcement. In 1996 it published “Making ceive a consistent prevention message. The n Contain material that is easy for teach-
the Grade: A Guide to School Drug Pre- elements state that effective prevention ers to implement and culturally relevant
vention Programs.” This guide graded curricula should: for students.
over 40 school-based prevention pro- n Help students recognize internal pres- Making the Grade also points out that
grams, giving each program a final grade sures (i.e., wanting to belong to the there are four prevention approaches that
from A through F, after reviewing the ef- group) and external pressures (i.e., peer have not been shown to reduce alcohol, to-
fectiveness of their content among other attitudes and advertising) that influence bacco, or other drug use, according to the
things. them to use alcohol, tobacco, and other prevention research of the past two
Last spring, Drug Strategies brought drugs; decades. These ineffective strategies are:
forth a newly updated and ex- n Scare tactics and moralistic
panded version of its popular appeals;
Making the Grade guide. This n Curricula that rely solely on
new version is a very attractive information on drugs and
product, much like the earlier their dangers;
version, and now takes into ac- n Curricula that only work to
count more aspects of school- promote self-esteem and
based prevention curricula, such emotional well-being, with-
as a community component, to out providing training in re-
make it a very thorough assess- sistance skills and normative
ment of prevention programs education;
that are available to schools. The n Single shot assemblies and
new guide is offering hope to testimonials by former ad-
prevention practitioners. The dicts may reinforce a nega-
original guide found that 35% of Making the Grade: A Guide to School Drug Prevention tive norm that “everyone
the curricula received an A or B, Programs, by Drug Strategies (1999), $14.95 uses drugs” at some point in
in the new guide, that number is their lives.
52%. (See chart for top graded Call Drug Strategies to order (telephone: 202-289-9070) This resource guide for edu-
programs). For more information, visit the Drug Strategies Web site, cators and prevention practition-
To create the revised edition www.drugstrategies.org ers discusses the evaluations of
of the guide, Drug Strategies the various programs that Drug
convened a panel of six preven- Strategies reviewed for publica-
tion experts throughout the country. The n Facilitate development of personal, so- tion. Even though many of the programs
panel identified critical issues in drug cial, and refusal skills to resist these studied had some form of evaluation , only
abuse prevention. Together with Drug pressures; 14 of the 50 programs assessed had evalu-
Strategies, the panel also developed de- n Teach that using alcohol, tobacco, and ation studies that were rigorous enough for
tailed assessment systems for collecting in- other drugs is not the norm among the guide’s standards. This represents 28%
formation about family components, teenagers, correct the misconception of the curricula studied, up from 21% in
fidelity of implementation, availability of that “everyone is doing it,” and promote the original guide. The researchers for this
teacher training, and any evaluation stud- positive norms through bonding to guide were looking for evaluations that
ies that were available for each of the pre- school and constructive role models; had extensive studies; were published in
vention programs reviewed. The programs n Provide developmentally appropriate peer reviewed journals; and used pretest
chosen for this publication had to have a material and activities, including infor- and posttest control group designs measur-
curriculum that offered classroom educa- mation about the short-term effects and ing reductions in alcohol, tobacco and
tion to prevent alcohol, tobacco, and other long-term consequences of alcohol, to- other drug use. For the 14 programs meet-
drug use; had to be nationally available; bacco, and other drugs; ing the evaluation criteria, Making the
and had to provide Drug Strategies the cur- n Use interactive teaching technique, such Grade thoroughly covers the results of
riculum materials for review. as role plays, discussions, brainstorm- each programs’ evaluation, thus helping
Using a 52-item coding system, the re- ing, and cooperative learning; prevention practitioners in schools deter-
searchers judged prevention approaches on n Cover necessary prevention elements in mine which program works for what par-
how effectively they address nine elements at least eight well-designed sessions a ticular drug problem.
that are important to prevention programs year (with a minimum of three to five How a program is implemented is con-
that work. These elements have been iden- booster sessions in one or more suc- sidered very important to Making the
tified from two decades of prevention re- ceeding years; Grade’s assessment of why prevention

4

programs work. The guide discusses this
factor in its introduction. It recognizes that
it is difficult to measure how a program is
implemented in the real world. Many eval-
uations cannot ensure that teachers are im-
plementing the curriculum fully. It does
suggest that effective programs can more
completely guarantee proper implementa-
tion if the program provides: teacher man-
uals with explicit guidance about what
material is essential; well-developed
teacher training and support, including
toll-free technical assistance numbers; and
evaluation tools, including observation
forms and checklists to assess how com-
pletely the lesson is implemented.
As far as individual program discus-
sions go, Making the Grade provides easy
to read charts and descriptions for each
one. It divides the reviewed programs into
four different categories: comprehensive
health curricula, K-12 drug prevention cur-
ricula, elementary and middle school drug
prevention curricula, and middle and high
school drug prevention curricula. Each
section begins with narrative descriptions
of the programs, including comments from
researchers about strengths, areas for im-
provement, special features, and family
and community components, as well as
contact information and curricula focus.
From there readers turn to the visually
pleasing charts where the programs are
The Challenge is on-line — visit www.thechallenge.org
to view the latest issue or download archived issues
Establishing goals to define your way
“At the fork in the
road, Alice asked the
Cheshire Cat which
road to take. The
Cheshire Cat asked,
‘Where do you want to
go?’ To which Alice
replied, ‘I don’t know.’
‘Then,’ said the Cat, ‘It
doesn’t matter which
way you go.’’’
graded according to the overall quality of
the curriculum context, evaluation, imple-
mentation issues (including ease of admin-
istration and teacher training), rehearsal
getting the A grade:
nMichigan Model n
nAlcohol Misuse Prevention Program n skills. Lastly, there are charts for grading
n Life Skills Training n
n Project ALERT n
n Project Northland n
n Project TNT n
n Reconnecting Youth n
n STAR n
getting the B grade:
n Actions for Health n
n Choosing Health High School n
n Comprehensive Health
for the Middle Grades n
n Great Body Shop n
n Growing Healthy n
n Know Your Body n
n Quest: Skills for Growing n
n Quest: Skills for Action n
n Teenage Health Teaching Modules n
n D.A.R.E. n
n Drugs & Alcohol Curriculum Modules n
n Get Real About Tobacco n
n Here’s Looking at You n
n Prime Time n
n Too Good for Drugs II n
n All STARS n
n Minnesota Smoking Prevention Program n
Continued from page three
END WITH THE BEGINNING
IN MIND
There must be a process in place from
the beginning to gather data on the effec-
tiveness of each strategy and to evaluate it.
It is critical to know how much progress is
being made toward the council’s devel-
oped goals. Determining the best measures
to indicate the quality with which goals are
achieved should occur at the start of the
goal-setting process. As the goals are de-
veloped, the measuring device for their
achievement must also be developed. It
is against these measuring devices that
both progress and ultimate achievement
can be assessed.
The United Way of America has given
us a great example of clarity at the begin-
ning for success at the end—the United
Way fund-raising thermometer. Measure-
ment and evaluation are not always quite
so concrete and simplistic. But they are al-
ways essential. Not only does such evalua-
THE CHALLENGE V9 N4
and role plays, the year it was created
and/or revised, and the cost of the pro-
gram. The next set of charts cover the cur-
riculum’s coverage of awareness and
resistance skills, including normative edu-
cation, social influences education, adver-
tising pressures education, and refusal
the curriculum’s coverage of personal and
social skills. The guide studies these skills:
decision making, stress management, com-
munication skills, social skills, and as-
sertiveness skills.
As the Safe and Drug-Free Schools Pro-
gram (SDFSP) codifies its Principles of
Effectiveness, publications like Making
the Grade: A Guide to School Drug Pre-
vention Programs are a welcome tool. As
more and more SDFSP grantees worry
about Principle #3 which requires the
grantee to use research-based programs,
Making the Grade has perhaps set a stan-
dard for prevention researchers when as-
sessing the effectiveness of school-based
programs.
Making the Grade: A Guide to School
Drug Prevention Programs, Drug Strate-
gies, 1999, $14.95.
reported by Jill Lewis-Kelly
American Council for Drug Education
tion measure the success, it is also a key to
sustaining the energy, commitment, and
effort of the individuals involved. As
progress is measured and goals are
achieved, each individual involved is re-
warded simultaneously through the sense
of self-efficacy they feel having been a part
of the success.
Dr. Judi Kosterman has been employed
as a high school teacher, counselor, princi-
pal, school district superintendent, and
university professor. Her doctorate is in Ed-
ucational Leadership and Addiction Stud-
ies from Seattle University. In 1990, she
became the State Drug Czar of Washing-
ton State. Dr. Kosterman joined the Com-
munity Anti-Drug Coalitions of America
(CADCA) as its Vice President for Training
& Technical Assistance in 1994. And then
in 1999, she moved to the White House
Office of National Drug Control Policy as
the Assistant Director of the National
Youth Anti-Drug Media Campaign.