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R E V I E W

Drug and Alcohol Review (September 2012), 31, 731–736

DOI: 10.1111/j.1465-3362.2012.00420.x

REVIEW

Australian school-based prevention programs for alcohol and other

drugs: A systematic review dar_420 731..736

MAREE TEESSON, NICOLA C. NEWTON & EMMA L. BARRETT

National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia

Abstract
Issues. To reduce the occurrence and costs related to substance use and associated harms it is important to intervene early.
Although a number of international school-based prevention programs exist, the majority show minimal effects in reducing drug
use and related harms. Given the emphasis on early intervention and prevention in Australia, it is timely to review the programs
currently trialled in Australian schools.This paper reports the type and efficacy of Australian school-based prevention programs
for alcohol and other drugs. Approach. Cochrane, PsychInfo and PubMed databases were searched.Additional materials were
obtained from authors, websites and reference lists. Studies were selected if they described programs developed and trialled in
Australia that address prevention of alcohol and other drug use in schools. Key Findings. Eight trials of seven intervention
programs were identified. The programs targeted alcohol, cannabis and tobacco and most were based on social learning
principles. All were universal. Five of the seven intervention programs achieved reductions in alcohol, cannabis and tobacco use
at follow up. Conclusion. Existing school-based prevention programs have shown to be efficacious in the Australian context.
However, there are only a few programs available, and these require further evaluative research. This is critical, given that
substance use is such a significant public health problem. The findings challenge the commonly held view that school-based
prevention programs are not effective. [Teesson M, Newton NC, Barrett EL. Australian school-based prevention
programs for alcohol and other drugs: A systematic review. Drug Alcohol Rev 2012;31:731–736]

Key words: alcohol, drug, prevention, school-based, adolescent.

impaired educational performance and early school

Introduction
Alcohol and other drug use is common in Australia and
the burden of disease, social costs and disability asso-
ciated with use is considerable [1–3]. The peak of this
disability occurs in those aged 15–24 years and corre-
sponds with the typical age of initiation of alcohol and
drug use [3,4].
More than one-quarter of Australian teenagers aged
16–17 years put themselves at risk for short-term
alcohol-related harm at least once a month, and 17%
use an illicit drug at least once a year [1]. The high
prevalence and early initiation to drug use is a risk
factor for the development of substance use disorders,
comorbid mental health problems, juvenile offending,
dropout, all of which negatively impact on both current
functioning and future life options [5–7].
To reduce the occurrence and cost of such problems,
it is important to intervene early before harmful pat-
terns of drug use are established and begin to cause
disability [8,9]. Most prevention-based programs have
been implemented in the school setting as educators
can reach large audiences at a time while keeping costs
low. Recently, the National Preventative Health Task
Force released recommendations that emphasised a
greater effort on reducing alcohol use as a major public
health initiative in Australia. The role of general prac-
titioners in prevention efforts are likely to be enhanced,
particularly through new programs such as Medicare

Maree Teesson BA(Psych), PhD, Professor, Nicola C. Newton, BPsych (Hons), PhD, Research Fellow, Emma L. Barrett, BPsych (Hons), MPsych,
Research Associate. Correspondence to Professor Maree Teesson, National Drug and Alcohol Research Centre, University of New South Wales,
Sydney, NSW 2052, Australia. Tel: +61 (02) 9385 0333; Fax: +61 (02) 9385 0222; E-mail: m.teesson@unsw.edu.au
Received 12 August 2011; accepted for publication 22 December 2011.

© 2012 Australasian Professional Society on Alcohol and other Drugs

732 M. Teesson et al.
Locals, which emphasise opportunities for linkages
between general practitioners and their communities
including schools [10].
There are two common approaches to drug preven-
tion and early intervention, the ‘targeted approach’ and
the ‘universal approach’.The targeted approach involves
developing and delivering prevention programs to target
specific populations, such as individuals at greatest risk
for developing substance use problems. Universal pre-
vention is aimed at all students, regardless of their level
of risk for drug. Universal programs offer the advantage
of being delivered on large scales and as such, they have
the potential to reduce substance use and harm in a
greater audience.
Although an array of international school-based pre-
vention programs exist [11–17], the majority show
minimal effects in reducing drug use and related harms
[18–20]. The two most common factors which impede
on program effectiveness are the focus on abstinence-
based outcomes [21,22] and implementation failure
[23,24]. Given the emphasis on early intervention and
prevention in Australia, it is timely to review the pro-
grams currently developed and trialled in Australian
schools. This paper reports a systematic review of trials
of program efficacy, and draws conclusions about the
success of school-based interventions in addressing the
harmful effects of alcohol and drug use.
Methods
Data sources
The PubMed, PsychInfo and Cochrane databases were
searched in July 2011, with the key search terms ‘school-
based OR school*’, ‘alcohol OR cannabis OR drugs OR
Psychostimulants OR ecstacy OR amphetamines’, and
‘Australia*’. Programs were included if they addressed
alcohol or drug use in a school context. Only programs
developed in Australia and overseas programs that had
been trialled in Australia were included in the review.
The grey literature was also searched using the Alcohol
and Drug Council of Australia databases.The authors of
each program were contacted and invited to provide
unpublished outcome data to be included in the review.
Data abstraction was completed independently and the
process was not blinded.
Study quality
Study quality was assessed using a validated measure
that assesses quality against three key criteria: randomi-
sation, double-blinding, and withdrawals and dropouts
[25]. Quality ratings can range from 0 to 5. Intervention
© 2012 Australasian Professional Society on Alcohol and other Drugs
trials within schools rarely receive scores above 3 as
double-blind conditions and full randomisation are
often not possible [26].
Outcome measures
Trials were considered effective if significant differences
were reported between the intervention and control
group for three outcomes: knowledge, use of alcohol or
drugs, and frequency of alcohol/drug use at post-test or
follow up.
Analysis
For continuous outcome measures, effect sizes are
reported. Odds ratios are reported for dichotomous
outcome measures. Effect size was estimated using
Cohen’s d [27], which was calculated by subtracting the
mean intervention score from the mean control score,
and dividing the result by the pre-intervention pooled
standard deviation. This method is consistent with a
previous review on anxiety and depression programs
[26]. A formal meta-analysis was not possible due to
the small number of trials with follow-up data and
available data quality. Odds ratios were extracted from
papers where possible or authors were contacted for
data and they were calculated by the authors of the
current paper.
Results
Overall, eight trials of seven prevention programs were
identified. All of these programs were universal pro-
grams which were delivered to all students in a year
group, regardless of their level of risk for alcohol or
drug use. The programs tended to adopt a harm mini-
misation goal, and be based on the social influence
approach or cognitive behaviour therapy. The ‘social
influence approach’ is derived from the belief that
young people start to use drugs as a result of social and
psychological pressure from peers, family and the
media [28,29]. This approach relies on the assumption
that young people do not have sufficient skills and
knowledge to recognise and resist such pressure. For
that reason, the ultimate goal of the social influence
approach is to teach young people to avoid using drugs
by resisting external pressure and increasing coping
skills [9]. The cognitive behavioural therapy approach
focuses on assisting individuals with analysing their
irrational or negative patterns of thinking, emotional
reactions and behaviours. Two programs also focused
on family, peer and school community influences build-
ing on whole-school changes.
Table 1 presents each program and its outcome
data and quality. Three additional cannabis prevention
 Table 1. Australian school-based prevention and early intervention programs for alcohol and drugs
Number in Targeted Quality
Program Trial Design Type intervention group drugs Alcohol (ES/OR) Tobacco (ES/OR) Cannabis (ES/OR) rating

SHAHRP McBride et al., RCT Universal 1111 Alcohol Significant effects. Overall — — 2
2004 [30] alcohol consumption ES
0.16, and binge drinking ES
0.18
CLIMATE: Alcohol Vogl et al., 2009 RCT Universal 611 Alcohol Significant effects. Average — — 3
[31] alcohol consumption ES
0.23, and binge drinking ES
0.20
Newton et al., RCT Universal 397 Alcohol Significant effects. Average — — 2
2009 [32] alcohol consumption ES
0.16, and binge drinking ES
0.05
Resilient Families Shortt et al., 2007 RCT Universal 1013 Alcohol No significant effect. Any — — 2
Intervention [33] alcohol use OR 1.01
(0.78–1.30)
CLIMATE: Alcohol Newton et al., RCT Universal 397 Alcohol and Significant effects. Average — Significant effect. 3
and Cannabis 2009 [34], cannabis alcohol consumption at Frequency of
Newton et al., 6 month F/U, ES 0.18, and cannabis use at
2010 [35] 12 month F/U, ES 0.38, 6 month F/U, ES
Binge drinking at 12 months 0.19, and 12 month
F/U, ES 0.17 F/U, ES 0.31
Life Education Hawthorne et al., Quasi-experimental Universal 1700 Alcohol and No significant effects. Ever No significant effects. — 0
1995 [36] tobacco drunk more than a full glass Ever smoked OR 1.2
OR 1.4 (1.1–1.8); drunk (0.9–1.4); past
more than a full glass in month smoker OR
past month OR 1.3 1.6 (1.2–2.3)
(0.9–1.8); usual number of
drinks OR 1.4 (1.0–1.9)
Gatehouse Project Bond et al., 2004 RCT Universal 1335 Tobacco, alcohol Significant effects. Any Significant effects. Any Significant effects. Any 3
[37] and cannabis drinking OR 0.83 smoking in year 10 use in year 10 OR
(0.55–1.28); regular OR 0.84 0.75 (0.54–1.05);
drinking OR 1.02 (0.64–1.11); regular incident weekly use
(0.62–1.68); binge drinking smoker OR 0.72 OR 0.72
OR 0.94 (0.63–1.39) (0.52–1.00) (0.39–1.33)
Health Promoting Hamilton et al., RCT Universal 1700 Tobacco — Significant effects. — 2
Schools 2005 [38] Regular smoker OR
0.51 (0.36–0.71);
past month smoker
OR 0.69
(0.53–0.91)

Significant/no significant effects were derived from publication. ESs were reported when outcome use was measured continuously and ORs were reported when outcome use was measured dichotomously. For each
trial, outcomes were measured at different follow-up occasions and the ESs and ORs were calculated accordingly. For the SHAHRP intervention, ESs were reported at the 32 month F/U. For the CLIMATE Schools:
Alcohol Module, the Vogl et al. [31] paper reported ESs 12 months following the intervention and the intervention was effective for women only, and the Newton et al. [32] paper reported ESs 6 months following the
intervention. For the CLIMATE Schools: Alcohol and Cannabis Module, ESs for alcohol and cannabis were calculated at immediate post-test (6 months after baseline) for the first paper, and at 12 months following
the intervention for the second paper. For the Health Promoting Schools project, ORs were reported for the 20 month F/U. For the Gatehouse Project, ORs were reported for the 30 month F/U. For the Life Education
project, ORs were calculated for effects approximately 5 years after baseline. For the Resilient Families Intervention, the OR is for intervention versus control school in predicting any alcohol use adjusting for baseline
Systematic review: Alcohol and drug prevention

alcohol use. The unadjusted OR as reported in the paper is 1.11 (confidence interval 0.84–1.46). ES, effect size; F/U, follow up; OR, odds ratio; RCT, randomised controlled trial.
733

© 2012 Australasian Professional Society on Alcohol and other Drugs

734 M. Teesson et al.
programs were identified as being used by Australian
schools, including the REDI (Resilience Educations
and Drug Information) package, the ‘Cannabis and
Consequences’ program, previously known as ‘Can-
didly Cannabis’; and ‘Cannabis: Know the Risks’. The
outcome and evaluation data on measures of drug use
for the programs have not been released and therefore
the effectiveness of these programs cannot yet be
determined.
Of the identified programs, only the CLIMATE
Schools Alcohol Module had been evaluated more than
once. Of the eight trials, seven targeted alcohol and five
were associated with a reduction in the consumption of
alcohol. The effect sizes for between-group differences
on alcohol consumption were available for the positive
trials and ranged from 0.16 to 0.38. Two trials targeted
cannabis and both trials were associated with some
reduction in cannabis use. In one trial the evidence was
only modest [37], and in the other trial the intervention
was effective in reducing frequency of cannabis use only
[34]. Two trials targeted tobacco and both were associ-
ated with modest and positive outcomes (regular
smoker odds ratio 0.51–0.72).
The majority of trials targeted students in their
second year of high school (13–14 years of age). The
follow-up period in the successful studies ranged from
6 to 30 months and most program gains were main-
tained over the follow-up period. Control groups in the
trials received usual health classes involving syllabus-
based drug education during the year. Overall, study
quality was weak, with few studies rated as 3 or above
(Table 1).
Discussion
There are now a number of Australian school-based
programs for the prevention of alcohol and drug use that
provide evidence of positive outcomes. The effect sizes
for controlled trials are small (0.16–0.34) and odds
ratios are similarly modest (0.83–1.02). All but two of
the seven interventions demonstrated positive out-
comes. The effectiveness of trials persisted for at least
6 months for the positive trials. Overall, there are at least
a small number of Australian school-based prevention
programs which produce mid-term modest reductions
in alcohol. There are very few trials in tobacco and
cannabis and none have been published for other drugs.
In this review study, quality was assessed against
three key criteria: randomisation, double-blinding, and
withdrawals and drop-outs. Quality ratings ranged from
0 to 3, with three trials scoring a 3. Intervention trials
within schools rarely receive scores above 3 as double-
blind conditions and full randomisation are often not
possible.
© 2012 Australasian Professional Society on Alcohol and other Drugs
While the effect sizes in school-based prevention for
alcohol, tobacco and cannabis are modest, they
compare favourably with effect sizes for trials on
anxiety and depression prevention. A recent review
identified 24 Australia efficacy or effectiveness preven-
tion trials for anxiety and depression with effect sizes
ranging from 0.18 to 0.83 [26].
There is considerable caution in the literature
regarding school-based prevention programs for
alcohol and drug problems. While the number of Aus-
tralian trials identified in this review is small, the
studies report results consistent with prevention in
depression and anxiety and indicate that research and
further development in this area should be encouraged.
This is particularly relevant, given the development
of computer-delivered prevention interventions. A
common impediment for the effectiveness of drug and
alcohol prevention programs is implementation and
dissemination of these programs to real life settings.
These obstacles are a challenge to both implementa-
tion and research. A number of the interventions
reviewed are delivered through computers or over the
Internet. This medium offers major advantages over
traditional implementation methods for school-based
prevention programs as it requires limited staff training
and preparation time, guarantees consistency, is easy
and flexible to deliver, and engages and maintains
student interest and involvement. Furthermore, the use
of computers guarantees that the content is delivered
in its complete form. The adjustments and alterations
that can occur when programs are delivered by teach-
ers and adapted to suit their own teaching style are
therefore less likely when delivered by computers
[23,32]. This is critical as such adaptations can mean
essential components of programs are not delivered or
are significantly changed. However, the inflexibility of
computer-delivered interventions may also be seen as a
limitation in that educators and teachers are unable to
adapt the programs to best suit the needs of their par-
ticular school and students. Further, online programs
may also not be available to those schools which are
less well resourced. Internet-based program delivery
remains a promising framework for the provision of
school-based education and prevention in the future.
A potential limitation of the trials reviewed in the
present study is that outcome measures relied solely on
student self-report. However, studies have found the
self-report of behaviours such as substance use among
adolescents is highly consistent with behavioural obser-
vations [39].
All of the interventions in this review were universal
programs designed to reach all students and were not
designed to target high-risk students specifically. To
improve program efficacy it may be useful to combine
universal programs with targeted programs.There are a

number of recently developed targeted programs devel-
oped in the UK which have been found to be effective
in reducing levels of alcohol use and illicit drug use in
high-risk students [40,41]. Combining such programs
would offer a way of preventing drug use at the whole of
school level as well as targeting and maximising preven-
tion outcomes for high-risk students.
A significant limitation of the present review is the
relatively small number of papers to review. A recent
review of the international literature on universal
school-based prevention programs for alcohol misuse in
young people identified 41 trials from North America,
six from Australia, six from Europe, one from India, one
from Swaziland and two carried out in multiple coun-
tries [42]. Specifically six of the 11 trials evaluating
alcohol-specific interventions showed some evidence of
effectiveness compared to the standard school curricu-
lum, including two Australian-based interventions
included in this paper [31,34]. The Australian-specific
findings in this review for alcohol are consistent with
international work. Also consistent with this interna-
tional review, a specific limitation of this review is the
differing lengths for follow ups (6 months to 5 years).
This may bias against those with longer follow ups in
that those with longer follow ups may have associated
lower effect sizes. The length of follow up is provided in
Table 1 for comparison. The programs reported in this
review are universal programs. It is possible that the
effect sizes observed in these studies at a universal level
are conservative. Unfortunately information on the
effect sizes obtained in high-risk adolescents was not
available for us to examine this.
Despite the considerable individual and societal
burden of alcohol and drugs, there are relatively few
trials of prevention programs in Australia. Even more
concerning is that it appears that the poorer quality
prevention programs are those which are implemented
in schools. To date, there are few schools implementing
the programs which are supported by the evidence.
Acknowledgements
Maree Teesson is funded on Australia National Health
and Medical Research Council Research Fellowship;
Nicola Newton is a UNSW Vice Chancellor Post-
Doctoral Research Fellow. Funding for this paper was
supported by an NHMRC project grant APP1004744.
Conflict of interest
Maree Teesson and Nicola Newton are authors on three
of the eight studies included in this review. Emma
Barrett is not an author on any of the studies included
in this review.
Systematic review: Alcohol and drug prevention 735
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