How To Find The Right Drug and Alcohol Rehab Center

By: Jon Arnold

When you, a family member or loved one is battling against the demons associated with drug and/or alcohol abuse, rehabilitation is needed to get back on a healthy track. Turning to the healing properties of a drug rehab or alcohol rehab center can bring about the lifestyle and behavioral changes associated with leaving negative influences to the wayside.

There are numerous drug and alcohol rehab centers across the United States. Sometimes, a patient may even choose treatment outside of the country. Rehabilitation is a very emotional and a mental roller coaster that takes every ounce of restraint and focus. It is the responsibility of alcohol and drug rehab centers to find the medium and motivation for each patient to embrace recovery. Each and every individual that walks through the door of a clinic or enters a program is unique.

Different Clinic and Program Approaches

Since no two patients are alike, drug and alcohol rehab programs and procedures differ. While some rely heavily on prescription drugs and other medical techniques, there are other methods of treatment that utilize holistic or natural approaches. When evaluating a potential drug or alcohol rehab center, there are several different types of treatment programs to consider. Substance abuse is a delicate issue and each drug of choice is dealt with in a different manner. For instance, sleeping pill addiction will not be treated in the same way as crystal meth addiction.

One of the main decisions regarding the type of alcohol or drug rehab center to consider is the length of necessary treatment. With short-term rehab clinics, a patient may become a resident and undergo various medical approaches for several weeks. They may also receive drug-free outpatient services. When longer-term care is needed, several outpatient treatments are available as well. A patient may also choose to live in a residential community treatment center to ensure continue drug-free success. Some residents may choose or need to spend years at these types of facilities.

The issue of medication and other drug treatment options come into play when choosing a drug rehab clinic, as seen through what is called maintenance treatment. For example, a heroin addict may receive an oral dose of methadone to help block the effects of their abused drug of choice. The methadone helps to eliminate the cravings that many addicts encounter through physiological demands on their body. Some people are leery of methadone treatments because this drug in itself can be addicting.

When it comes time to locate the best drug rehab and alcohol rehab centers within your grasp, doctors and other health professionals will give you what is called a referral. You may receive one or two to choose from, but they are usually the most viable options of treatment for you to consider. When budget is of no concern, some people will look into treatment options both near and wide. Some drug and alcohol rehab centers are more private than others, offering certain luxuries that state officials cannot afford. There are numerous brochures and websites to scan when you are able to pay more for your treatment options.

What to Expect With Treatment

Very rarely do you see drug rehabilitation without some sort of approach towards psychological repair. Even though drugs can be purged from the physical parts of the patient, it is the mental barriers and breakdowns that continue the vicious cycle of drug abuse. Most drug rehab and alcohol rehab programs will treat the mind, body and soul of a patient. This is the best approach towards increasing the success rate for when patients are released onto the world.

It is also much healthier for the patient to receive well-rounded treatment so that they may achieve stronger, more positive outcomes. It is the goal of rehab centers to make sure patients equip themselves with the tools and strength needed to resist temptation and face the threat of relapse.

While at a drug or alcohol rehab center, you will encounter a trained professional who knows the ins and outs of drug addictions. Physicians and therapists become important fixtures on the road to recovery. They will ask you many different questions and may even perform a series of medical tests. This will assist in the accurate assessment of your personal characteristics. It will aid in deciding on the appropriate drug rehabilitation program that you will benefit the most from. You could face inpatient, outpatient, residential, and/or short-stay treatment.

Helping Rehabilitated Patients Succeed

It is the responsibility of the newly rehabilitated patient to take control over the things that affect their life. Surrounding themselves with positive influences and adhering to outpatient counseling and programs is a must. Family and friends should be supportive and aware that the potential of relapse is never too far behind. A circle of support and encouragement is crucial to long term success.

For a newly released drug or alcohol rehab patient, one day at a time never made more since than now. Each morning should be greeted with individual care and concern. They may need a lot of help to continue their success. Love, understanding, and support is all friends and family can give; the rest is up to the rehabbed individual.

Article Source: http://www.afroarticles.com/article-dashboard

Jon Arnold is a computer engineer who maintains many websites to pass along his knowledge and findings. You can read more about Drug and Alchohol Rehab at his web site at www.rehab-alcohol-drug.com/

About Drug Rehabilitation Centers in New Jersey

New Jersey drug rehabilitation centers assist substance abusers with detoxification and recovery from drug addiction. The term "drug" is defined here as any addictive chemical including alcohol, tobacco, prescription pharmaceuticals and illegal narcotics. The New Jersey Division of Addiction Services (DAS), a division of the Department of Human Services and the central organization for addiction recovery in the state, defines addiction as "a chronic, progressive, and often fatal disease characterized by irrational thoughts and habitual behaviors," but the DAS recognizes that the disease is treatable.

Features

Drug rehabilitation centers in New Jersey are as varied in scope and focus as our universities and hospitals. Facilities may specialize in substance abuse and recovery, or they may treat cases in conjunction with broader mental and behavioral health services. Many offer clinical and emotional support, while others provide only detoxification and medical attention. Treatment facilities are religious, like Catholic Charities in East Brunswick, or secular. Some centers are associated with local hospitals such as Raritan Bay Medical Center Behavior Services in Perth Amboy, but most are independent organizations providing customized recovery care.

Function

In addition to standard detox and recovery, New Jersey treatment facilities provide drug abuse education, occupational and life skills training, emotional and psychological support, and community reintegration. Rehab centers help patients recover physically and emotionally from the ravages of addiction, and then prepare them for a clean, productive life as fully functioning members of society. Addiction issues are approached differently based on the type of care and rehabilitation required.

Types

The DAS identifies 12 types of drug and alcohol abuse treatment. They are:

1. Hospital-based detoxification--Detox services administered and managed by a licensed general or specialized hospital. Service providers are associated with a local hospital, and may offer in-patient or out-patient detoxification.

2. Non-hospital-based detoxification--Detox services administered and monitored in a licensed residential (non-hospital) treatment facility. Service providers are not associated with a hospital, but are licensed by the state and capable of providing in-patient as well as out-patient detoxification.

3. Residential short-term--A licensed non-hospital facility that provides a structured recovery environment and professional clinical services that address addiction and lifestyle issues for recovering addicts.

4. Residential long-term or therapeutic community--A licensed non-hospital facility that provides a structured recovery environment and professional clinical services that address addiction and lifestyle issues for recovering addicts. This program utilizes the structure of a community to reintegrate the patient into society with specific focus on education and vocational skills.

5. Extended care--A licensed non-hospital facility that provides room and board for 60 days or more. The structured environment addresses addiction, interpersonal skills and emotional development with an emphasis on work therapy.

6. Partial hospitalization--A licensed freestanding, non-hospital and non-residential facility providing a structured environment 20 hours per week over a minimum of four separate occasions. Services include substance abuse counseling, education and community support.

7. Intensive out-patient--A licensed, non-residential facility providing clinically intensive programs. Services include individual, group and family counseling, and education for a minimum of nine hours per week.

8. Out-patient--A licensed, non-residential facility providing scheduled individual, group and family counseling for less than nine hours per week. Patients have access to medical and support services.

9. Methadone maintenance--Also referred to as opioid pharmacotherapy. A licensed facility utilizing methadone, LAAM2 or other approved pharmaceutical to maintain patients addicted to heroin or similar opiates. These facilities also provide medical monitoring, lab testing, clinical assessment and intervention.

10. Out-patient detoxification--Planned withdrawal implemented by gradually decreasing doses of the problem drug.

11. Halfway house--Licensed facility providing six months or more of room, board and support services. Treatment is intended to assist patients with adjusting to regular patterns of life via education, vocation and independent self-monitoring.

12. Group recovery homes--Not licensed by the state. Facilities are also referred to as transitional homes or three-quarter Houses. Patients rent living space and offer each other support services. A boarder must abstain from drugs and alcohol to remain a resident. Oxford House is the recommended provider in New Jersey. For a list by county of

Benefits

Rehab facilities are conveniently located, with multiple centers in each of New Jersey's 21 counties. Most licensed centers receive state and county funding from the DAS to offset costs and reduce rates. Payment methods and funding resources include:

* Private health insurance
* Military insurance (VA,TRICARE, etc.)
* Medicaid
* Medicare
* Self pay/sliding scale
* Payment assistance
* South Jersey Initiative (SJI)
* NJ Access Initiative (NJAI)
* Drug Court (DC)
* DUI Initiative (DUII)
* Work First New Jersey (WFNJ)
* Dept. of Youth & Family Services (DYFS)
* MAP Program

Considerations

The Division of Addiction Services evaluates, regulates and licenses drug rehabilitation treatments, programs and facilities throughout New Jersey to ensure hygienic, professional care. Before beginning any treatment program, make sure the facility is licensed and current with the DAS.

• New Jersey Division of Addiction Services
• New Jersey needle exchange program
• List of group recovery homes

Written by John Farley

Source: essortment.com

The "Rock Bottom" Myth - Learn How to Raise the Bottom

The "Rock Bottom" Myth - Learn How to Raise the Bottom
This whole idea of "hitting bottom" is out of date. Some people will wait years-even decades-for their friend to reach this mythical point in their alcohol and drug use. But why wait for them to "hit bottom"? Why not help them by raising their bottom?

Ezine Articles by Joe Herzanek

EEG Spectral Changes in Treatment Naïve Active Alcoholics

G. Fein, Ph.D and J. Allen, B.A

Neurobehavioral Research, Inc., Corte Madera, CA

Address reprint request and correspondence to: Dr. George Fein, Neurobehavioral Research, Inc., 201 Tamal Vista Boulevard, Corte Madera, CA 94925, Tel: 415.927.7676, Fax: 415.924.2903, Email:george@nbresearch.com

Abstract

Background

The present study examines the EEG spectra of actively drinking treatment naïve alcoholics (TxNA).

Methods

EEGs were gathered on 51 TxNA’s and age and sex-matched controls during eyes-closed conditions. Participants were excluded for lifetime diagnoses of psychiatric or substance abuse disorders. Power for the theta to high beta bands was examined across midline electrodes.

Results

The TxNA sample exhibited a nexus of disinhibited traits associated with the vulnerability to alcoholism, and had developed alcohol dependence, but no other diagnosable psychiatric or substance abuse disorders. The TxNA subjects evidenced higher power for all EEG bands compared to controls. The magnitude and anterior-posterior extent of the group differences varied across bands. Within the TxNA group, EEG power was negatively correlated with average and peak alcohol drinking duration and average and peak alcohol dose.

Conclusions

Increased EEG power across the theta to high beta bands distinguishes TxNAs without comorbid diagnoses from controls. These effects varied across bands in their magnitude and spatial extent, suggesting that there are different effects for the different EEG spectral generators. We hypothesize the increased power in these individuals is a trait difference associated with the inherited nexus of disinhibited traits and its manifestation in alcoholism.

Based on the strong negative correlations with alcohol use variables, we speculate that decreases in EEG power are a morbid effect of long-term alcohol abuse. We acknowledge that this hypothesized effect of alcohol abuse on EEG power is opposite to the increased EEG power we hypothesize is associated with alcoholism and its inherited nexus of disinhibited traits. An implication of this model is that with continuing alcohol abuse, the increased EEG power in TxNAs will eventually be overpowered by the effects of long-term severe alcohol abuse. This model predicts that in very long-term alcoholics EEG power would be equal to or lower than that of age and sex comparable controls.

Keywords: Resting EEG, power spectra, alcoholism, treatment naïve, aging

INTRODUCTION

Given the EEG’s high heritability and its dramatic response to alcohol intoxication, the EEG has been studied extensively as a trait marker for the genetic vulnerability to alcoholism. Many studies have reported increased slow alpha activity as a response to ethanol ingestion in both men and women (Cohen et al., 1993; Ehlers et al., 1989; Lukas et al., 1986; Lukas et al., 1989), and some have revealed changes in theta, and fast alpha activity as well (Ehlers et al., 1989; Lukas et al., 1986; Volavka et al., 1985). The background EEG is highly heritable (e.g., (Van Baal et al., 1996), as is alcoholism (Begleiter and Porjesz, 1999; Foroud et al., 1998; Foroud et al., 2000; Reich et al., 1998). Moreover, the heritability of the EEG recorded post alcohol administration is even higher than that recorded under resting conditions (Propping, 1977; Sorbel et al., 1996). In alcohol challenge studies, Ehlers and Shuckit reported elevated beta in FHP (family history positive) vs. FHN (family history negative) men 90 minutes post ethanol (Ehlers and Schuckit, 1990) and a decrease in fast alpha post-ethanol in FHN, but not FHP subjects (Ehlers and Schuckit, 1991).

Several studies have examined EEG power as a trait marker for alcoholism, comparing individuals at high vs. low risk for developing alcoholism, with varying results. In a recent study, Rangaswamy et al. found increased beta power in FHP individuals (Rangaswamy et al., 2004). Pollock et al. (Pollock et al., 1995) reported increased beta power in older FHP subjects compared to age- and gender-matched controls. Ehlers and Shuckit found elevated baseline fast alpha in FHP subjects (Ehlers and Schuckit, 1991). In contrast, Finn and Justus found that the offspring of alcoholics showed reduced alpha power and elevated beta power compared to FHN controls (Finn and Justus, 1999). Finally, Cohen et al. found no alpha or beta EEG power differences between FHP vs. FHN samples (Cohen et al., 1991).

Compared to the studies of high-risk samples, there have been relatively few studies of alcoholic samples. Rangaswamy et al. found increased theta power in alcoholics (Rangaswamy et al., 2003), as well as increased low beta power in male alcoholics, and increased mid beta power in female alcoholics (Rangaswamy et al., 2002). Pollock et al. examined the EEG spectra (delta through beta), and found increased theta amplitude for recovered alcoholics, but no differences for any other band (Pollock et al., 1992). These EEG spectral studies included large numbers of participants with comorbid substance abuse disorders, antisocial personality disorder, and depression, all factors independently associated with abnormal EEG power (Bauer and Hesselbrock, 1993; Costa and Bauer, 1997; Knott et al., 2001; Newton et al., 2003; Petersen et al., 1982).

Finn et al. (Finn et al., 2000) reported that social deviance proneness and excitement/pleasure seeking account for a significant portion of the relationship between a positive family history of alcoholism and later alcohol abuse. Current theories propose that disinhibition is a fundamental mediator of the inherited predisposition toward alcohol dependency (Begleiter and Porjesz, 1999; Cloninger, 1987; Sher et al., 1991; Tartar et al., 1985). It has been proposed that behavioral phenomena such as psychopathy, antisocial and impulsive traits, and alcoholism, should be viewed as variable expressions of a generalized disinhibitory complex (Gorenstein and Newman, 1980). Several studies have reported that EEG power in externalizing disorder samples is similar to that seen in FHP samples. Excessive theta activity has been associated with a number of indicators of disinhibited personality, such as antisocial personality (Mednick et al., 1981), attention-deficit/hyperactivity disorder (Barry et al., 2003), borderline personality disorder (Russ et al., 1999), and criminality (Petersen et al., 1982; Raine et al., 1990). Excessive theta activity is thought to indicate cortical underarousal and has been associated with measures of low autonomic arousal (Raine et al., 1990). Some theorize that excessive theta reflects delayed cortical maturation and poor behavioral control that often leads to disinhibited behavioral syndromes such as antisocial personality and substance abuse (Ishikawa and Raine, 2002). Alpha power has been reported to be increased in persons with extroverted personality traits (Wall et al., 1990).

The current study examines eyes-closed resting EEG power in treatment naïve actively drinking alcoholics (TxNA) compared to age- and gender-matched controls. This study excludes participants with lifetime diagnoses of comorbid psychiatric or substance abuse disorders. Participants were currently drinking, met current DSM-IV-R criteria for alcohol dependence, and had never sought treatment for alcoholism; in fact none of the TxNA participants self identified as alcoholics. This sample is more representative of alcoholic dependent individuals in the general population than are treated samples. We have shown that they come from a different population than treated samples, with less severe drinking histories in the first four to five years after meeting criteria for heavy drinking (Fein and Landman, in press). During this period, long-term abstinent alcoholic men and women drank an average of 210 and 134 drinks per month while TxNA men and women drank an average of 165 and 98 drinks per month. In the current study, we examine the TxNA sample’s EEG spectra, and its association with age and drinking variables.

METHODS

Participants

All participants were recruited from respondents to postings, mailings, newspaper ads, ads on an Internet site, and referrals from other participants. The study involved a sample of treatment naïve, actively drinking, alcohol dependent (TxNA) individuals, and a control sample (C) matched on a one-to-one basis on gender and age with the TxNA sample. The TxNA group was recruited by advertising for ‘heavy social drinkers’ or ‘men and women who have a high tolerance for alcohol’. None of the TxNA participants labeled themselves alcoholics, and we never used the word alcoholism in referring to these participants, either in our advertisements or in their assessment procedures.

The TxNA group (n= 51) was comprised of 20 women and 31 men between the ages of 19 and 50 (mean = 31.9, SD = 8.0). Table 1 presents subject demographics, alcoholism family history measures, and alcohol use variables and a measure of the number of symptoms of externalizing disorders and two personality measures of deviance proneness, the CPI (California Psychological Inventory Socialization Scale (Gough, 1994)), and MMPI-2 Pd (Minnesota Multiphasic Personality Inventory 2 Psychopathic Deviance Scale (Hathaway, 1989)).

Table 1 Characteristics of Participant Groups

The inclusion criteria for the TxNA group was that they meet lifetime DSM-IV-R (American Psychiatric Association, 2000) criteria for alcohol dependence, that they were currently drinking, and that they have never sought treatment for alcoholism. DSM-IV criteria for alcohol dependence were assessed from an initial phone interview with the subjects. Participants were asked a series of questions taken from the DSM-IV-R criteria for alcohol abuse and dependence. If a subject answered “yes” to three or more of these questions at any time in the same twelve-month period, he/she met criteria for alcohol dependence. Similar questions were asked for all other drugs used more than experimentally to exclude individuals who met criteria for abuse or dependence on other drugs. Inclusion criteria for the C group was a lifetime drinking average of less than 30 alcohol containing drinks per month, and never having exceeded 60 drinks per month (a standard drink was defined as 12oz. beer, 1.5 oz. liquor, or 5 oz. of wine).

All participants were given a computerized psychiatric diagnostic evaluation (Computerized Diagnostic Interview Schedule (Robins, 1998)) and psychological assessments. Separate lifetime use data was gathered for alcohol and all drugs used more than experimentally (using the timeline follow-back methodology of the Lifetime Drinking History Questionnaire (Skinner and Sheu, 1982; Sobell and Sobell, 1992)). Participants also had their medical history reviewed, had a blood draw to test liver function, and completed the Family Drinking History Questionnaire, based on the Family Tree Questionnaire by Mann et al., (Mann et al., 1985). We derived two measures from the Family Drinking History Questionnaire: the number of first degree relatives that were identified by the participant as problem drinkers, and the proportion of first degree relatives that were identified as problem drinkers. Post-alcohol withdrawal hyper-excitability (PAWH) was implemented partway through the study, after which it was administered to all TxNA subjects (n=28). PAWH was measured using a self-report questionnaire where subjects estimated (on a 0 to10 point scale) the frequency and distress caused by physical and psychological symptoms experienced during alcohol withdrawal. For the frequency estimate, a 0 meant never, 1 corresponded to 10 % of the times one ceased drinking, up to a 10 which indicated the symptom was experienced 100% of the time one ceased drinking. For the degree of distress caused by the presence of the symptom, a 0 meant not at all distressing, a score of 5 meant somewhat distressing, and a 10 meant “unbearable.” The symptoms were compiled from the Diagnostic Interview Schedule (DIS) (Robins, 1998), the alcohol dependence scale (Skinner and Allen, 1982), and SSAGA interviews (Bucholz et al., 1994). We computed the average frequency and intensity over eight symptoms that measure PAWH: i) shakes (hands tremble, shake inside); ii) feel tense, nervous or anxious; iii) feel fidgety or restless; iv) have trouble concentrating v) heart pound or beat rapidly; vi) feel hypersensitive to stimuli (e.g. light, sound, touch); vii) have difficulty sleeping; and viii) have memory problems.

Exclusion criteria for both groups were: 1) history or presence of an Axis I diagnosis on the DIS, 2) history of stroke, diabetes, or hypertension that required medical intervention, 3) significant history of head trauma or cranial surgery, 4) clinical or laboratory evidence of active hepatic disease, 5) Wernickes-Korsakoff syndrome, 6) a history of drug dependence other then caffeine or nicotine, or 7) current substance abuse other then alcohol (aside from caffeine and nicotine). As noted above, substance abuse and dependence were determined from the phone interviews where follow-up questions were asked for all drugs (other than caffeine or nicotine) where the subject acknowledged more than experimental use.

Each subject was informed as to the nature of the study and procedures and signed a consent form prior to their participation. Participants were to complete a total of four sessions that included clinical, neuropsychological, electrophysiological and neuroimaging assessments. All participants were to abstain from drinking for 24 hours prior to each lab visit, and a Breathalyzer was administered before each session. No participants in the current study had positive Breathalyzer results (>.000) on any of their study sessions. Other drugs of abuse were not tested for. For the purposes of this study, we are examining only the data during the eyes closed resting portion of the EEG session, which took place on the third visit. All participants who completed a session were paid for the session and any travel expenses. Participants also received a completion bonus if they completed all four sessions of the study.

EEG Recording and Artifact Reduction

As noted above, participants were given a Breathalyzer upon arrival at the EEG lab; a 0.000 Breathalyzer result was required to continue the session. Participants were seated comfortably in a sound attenuated room. The computer screen, used in presenting stimuli for other EEG/ERP experiments, was turned off. The participants were asked to relax with their eyes closed for five minutes. Over the course of the study, two EEG acquisition systems were used, a 40-channel system (n = 87) and a 64-channel (n = 15). Only the midline electrodes, which were common to both systems, were examined for this study. Reference was the right ear for all recordings, and ground was 4 cm above the nasion for 40-channel caps and 8 cm above the nasion for 64-channel caps. EEG data was acquired using the NuAmps (NuAmp, Neuroscan, Inc.) single-ended 40 channel amplifier and Scan 4.2 Acquisition Software (Neurosoft, Inc.) for the 40-channel recordings. The NuAmps amplifier had a fixed range of ±130 μV sampled with a 22 bit A/D converter where the least significant bit was 0.062 μV. For the 64-channel recordings, EEG data was acquired using the SynAmps2 (SynAmps2, Neuroscan, Inc.) amplifier and Scan 4.3 Acquisition Software (Neurosoft, Inc.). The SynAmps2 amplifier had a fixed range of ± 333 μV sampled with a 24 bit A/D converter where the least significant bit was 0.019 μV. Electrode impedances were maintained below 10 kΩ. The sampling rate was 250 samples per second, and activity was recorded for 5 minutes. Data from control subjects whose data was collected using the different amplifier systems (NuAmps, SynAmps2) were examined, and revealed no differences associated with the different acquisition amplifiers. Vertical eye movements were recorded by electrodes above and below the left eye for later reduction of ocular artifact.

Raw data were processed offline using the Edit Program in Scan 4.3 (Neurosoft, Inc.). Data from the first and last minute were discarded and the analysis was performed on the middle three minutes of recordings. Ocular artifacts were removed using the ocular artifact reduction algorithm (ARTCOR) implemented in Scan4.3 (Neuroscan, 2003). Data were then bandpass filtered between 0.5 and 30Hz at 48 dB/Octave. Power spectra was computed using the Scan4.3 AVERAGE procedure which computes a standard power spectrum adapted from the Cooley-Tukey method, on 512 sample epochs (2.044 seconds in duration) using a 10% cosine taper. Average power spectra were then aggregated for six frequency bands: theta (3 to 7.5 Hz), low alpha (7.51 to 10 Hz), high alpha (10.01 to 12 Hz), low beta (12.01 to 16 Hz), mid beta (16.01 to 20 Hz), and high beta (20.01 to 28 Hz). A natural log transformation was applied to the absolute power data to normalize the distributions.

Statistical Analysis

This paper only examines the midline recordings common to all participants (Fz, FCz, Cz, CPz, Pz, Oz). Repeated measures ANOVA was carried out on the log power dependent variables using the General Linear Models procedure in the Statistical Analysis System (SAS Institute, 1990), with age, group and gender as between-subject effects and EEG band and electrode as repeated measures. The association of band power with age and alcohol use variables was analyzed using Spearman correlations. Because alcohol use duration is partially confounded with age (older participants have had a longer life in which to drink), associations of EEG measures with alcohol use duration and with age were examined using partial correlation analysis (i.e., association of EEG measures and age with alcohol use duration partialled out, and association of EEG measures and alcohol use duration with age partialled out).

RESULTS

Group Differences in Demographic and Subject Variables

Table 1 presents the demographic, alcohol use and subject variables for men and women in each group. As noted above, the TxNA group and controls were matched for age and gender with age ranging from 19 to 50 years. The groups were also similar in education. The TxNA group had more first degree relatives who were problem drinkers (F₁,₉₈ = 6.72, p < .02), but this effect was not very large, with group membership accounting for only 6.2% of the variance of the number of first degree relatives who were problem drinkers. As expected, the groups differed on alcohol use measures (group membership accounted for 5.2% of the variation in duration of active drinking, 64.1% of the variance of average lifetime drinking dose, 59.8% of the peak dose variance, and 58.7% of the variance of the drinking dose in the 6 months immediately prior to the study. The TxNA group compared to Controls had a larger number of externalizing symptoms (the sum of Antisocial Personality Disorder and Conduct Disorder symptoms on the DIS (Robins, 1998)), with group membership accounting for 8.5% of the symptom count variance (F₁,₉₈ = 9.96, p<.003). They also showed more evidence of deviance proneness on both the California Psychological Inventory (CPI) socialization scale (Group accounting for 21.7% of the variance (F₁,₉₈ = 27.85, p < .0001) and the MMPI Psychopathic Deviance (PD) scale (Group accounting for 9.5% of the variance (F₁,₉₈ = 10.31, p < .002).

As described above, PAWH was measured using a self-report questionnaire where participants estimated (on a 10 point scale) first, the frequency and then, the distress level of physical and psychological symptoms experienced during alcohol withdrawal. The TxNA’s mean score (± sd) for the frequency of withdrawal symptoms was 2.46 ± 1.6, meaning that, on average they experienced withdrawal symptoms after drinking 24.6% of the time. On the distress level scale (10 point scale), a zero indicated that the withdrawal symptoms bothered the participant “not at all”, a three indicated that the symptoms were “a little bothersome” and five indicated that the symptoms were “somewhat bothersome”. The mean score for distress was 2.91 ± 1.89, indicating that the participants typically found the distress of withdrawal symptoms less then “a little bothersome”. There were no significant associations between EEG power and withdrawal measures.

EEG Power

Analysis of between-group effects (between subject variance)

In the between subjects analysis (power averaged across bands and electrodes), group membership accounted for 4.0 % of the log power variance (F_1,93 = 4.4, p < r =" −.22,">1,93 = 5.1, p <>1,93 = 3.0, p < .09), with men having lower EEG power than women.

Analysis of repeated measures effects

The analysis of repeated measures indicated the well known large differences in power between the EEG bands (accounting for 33.3% of the within-subject across band variance, F_5,465 = 51.43, p < .0001), and across electrode sites (accounting for 6.9% of the within-subject across electrode variance, F_5,465 = 8.34, p < .0001). There were also electrode by group interactions (accounting for 5.6% of the within-subject across electrode variance, F_5,465= 6.75, p < .0005), and band by electrode by group interactions (accounting for 2.5% of the within-subject across bands and electrodes variance, F_25,2325 = 2.63, p < .02); both of these effects indicate that differences in power between the groups varied across bands and electrodes. Figure 1

presents this data. The strongest group differences were observed for low alpha and mid beta, where the TxNA group had higher power at all midline electrode locations except the most frontal (Fz). The TxNA group showed higher power at the central-posterior sites (CPz, Pz, Oz) for high beta. For theta, high alpha, and low beta the TxNA group had higher power at CPz and Oz, with a trend towards higher power at Pz.

Fig. 1 Displays group differences in EEG power for each band at each midline electrode location. For presentation purposes the inverse of log (power) has been used to show the results as power on a natural log scale. *, **, ***: p < .05, p < (more ...)

There were band by age interactions, electrode by age interactions, and group by band by electrode by age interactions (all F_5,465 > 4.88, p < .002) indicating that the correlations with age differ across groups, bands, and electrodes. In order to better understand this data, we computed age correlations for each group at each electrode within each band. Table 2. presents these associations. In the controls, there were only a few age associations. For high alpha, there was a negative association at Fz, as well as trends for negative associations at FCz and Oz. For low beta, a positive association with age was observed at CPz, with a trend at Cz. Similarly, positive associations between age and power were observed at these same electrode locations for mid and high beta.

Table 2 Association of EEG Power with Age and Lifetime Drinking Duration

Within the TxNA group, the age associations were consistently negative, and showed strong patterns across electrodes within specific bands. Strong negative correlations with age were observed at all midline electrode sites for theta, high alpha, and low beta power. For mid-beta power, negative associations were observed only at Oz, and for low alpha and mid beta power only a trend for a negative correlation at Oz was observed.

Since age may potentially be confounded with lifetime drinking duration (older participants may have had a longer time to drink), we examined the association between lifetime drinking duration and power measures in the TxNA group. There were strong negative associations between power and lifetime drinking duration for theta, high alpha, and low beta at all electrode sites, and for low alpha power and mid beta power at Oz, with a trend for high beta at Oz (see Table 2). Within the TxNA group, we next examined the associations between age and power with lifetime drinking duration partialled out. These partial correlations were close to zero (see Table 2). Because negative associations with age were not seen in controls, the simplest explanation for this pattern of results is that these negative associations in the TxNA group of age with EEG power are a consequence of the negative association of abusive drinking with power.

In a search for additional evidence supporting this hypothesis, we examined the association between lifetime drinking dose (drinks/month) and the power measures within the TxNA group. Table 3 presents these associations. There were strong negative associations at all electrode sites of the alcohol dose variables with low beta, mid beta, and high beta, as well as negative associations with low alpha power at Fz, FCz, Cz, and CPz, with a trend for an association at Pz. Negative associations were also evident for high alpha power at the frontal electrodes, with a trend for a negative association for theta power at Pz and Oz. These negative associations between alcohol dose and power measures is consistent with the hypothesis that the negative associations of power measures with age and with lifetime duration of drinking in the TxNA group are a consequence of abusive drinking rather than of age per se.

Table 3 EEG Power Associations with Lifetime Drinking Dose (Average Drinks/Month)

The few associations observed between power and lifetime drinking dose in the controls were more sporadic, weaker, and positive rather then negative. These positive associations and trends were seen for theta power at CPz, low alpha power at Cz, CPz, Pz, and Oz, and mid beta power at Oz. It is of interest that in the controls, the effects of moderate or light drinking may have the opposite effect to that seen in the alcohol dependent sample, with alcohol use actually increasing EEG power.

In the TxNA group, the measures of alcohol use over the six months prior to study were very highly correlated with the average lifetime dose measures (r = 0.93). For this reason, we did not examine the associations of recent alcohol dose with EEG measures since the results would have been entirely redundant with the results for average dose. Finally, we found no associations of the power measures with either of the family history of alcoholism measures (number of first degree relatives with alcohol problems and percent of first degree relatives with alcohol problems) all r’s < |.22|, p > 0.12.

DISCUSSION

Central Findings

The central finding in this study was that TxNA alcoholics evidence higher power than controls across the theta to high beta bands, with the magnitude and anterior-posterior extent of these effects varying across bands. The largest and most widespread effects were for the low alpha and mid beta bands, where the effects were present for all electrodes posterior to Fz. For the other bands, the effects did not extend as anteriorly and were of smaller magnitude. These differences in the effects across bands indicate that the effects are not a simple global increase in EEG power, but rather are specific and different effects for the various bands. Given that we asked all subjects to abstain from alcohol for 24 hours prior to the EEG session, no subjects had positive breathalyzer tests on the day of their EEG study, and that on average our TxNA subjects reported experiencing withdrawal symptoms only about one quarter of the time, we believe it is highly unlikely that their EEG results reflect the effects of post alcohol withdrawal hyperexcitability.

In the introduction, we reviewed the literature showing that there is a nexus of disinhibitory traits, deviance proneness, externalizing symptoms, and a positive family history for alcoholism that often appear together and are strongly associated with alcoholism and other substance abuse. In its more severe manifestations, this nexus is represented in alcoholics with comorbid psychiatric, other substance abuse, and antisocial diagnoses. In addition, a relatively common set of EEG characteristics has been associated with the various aspects of this nexus.

The population studied here is unique with regard to this nexus discussed above. All participants met criteria for alcohol dependence (alcoholism), yet they had at most a minimally greater family history for alcoholism than controls. Individuals with comorbid antisocial personality disorder, conduct disorder, depression, anxiety, or other substance abuse disorders were excluded. The TxNA sample came from a population with a history of early abusive drinking (in the first five years immediately after meeting criteria for heavy alcohol consumption) that was 30–40 % less in average and peak dose than treated samples (Fein and Landmann, in press). They had an increased rate of externalizing symptoms and psychological evidence of deviance proneness compared to controls, although these rates were markedly less than those of treated samples (Fein et al., 2004). Our hypothesis is that the population studied is composed of individuals with less severe manifestations of the nexus described above who have gone on to develop alcohol dependence but no other diagnosable psychiatric or substance abuse disorders. We believe our results show that this select population is characterized by increased EEG power across the theta to high beta bands.

While the sample studied (TxNA) was advantageous in that it is more representative of alcoholics in the general population in that it is an untreated sample free of comorbid disorders, there were limitations inherent in studying this sample. We did not examine severe active alcoholics, and although it is possible that our sample represents severe alcoholics in the relatively early stages of their alcoholism, previous examination of this population suggests that this is in fact a different population from alcoholics typically studied. Furthermore, the sample studied reported experiencing relatively minor withdrawal symptoms. Although it is beneficial to be able to show that it is highly unlikely that our results are associated with alcohol withdrawal, our results are silent on the EEG effects of more severe withdrawal that may be present in samples with greater alcoholism severity.

There are other limitations to the current study. In hindsight, we should have assessed for caffeine or nicotine dependence or recent caffeine or nicotine use to determine the degree to which such use or dependence could have influenced our EEG results. Finally, since our TxNA sample is almost by definition in denial about their alcoholism, it is also highly likely that they would be in denial with regard to alcohol problems in their first degree relatives. Their data regarding the family history of alcoholism assessment is highly suspect and may be a gross underreporting of alcohol problems in their extended families. Therefore, the negative findings regarding the association of the EEG power measures with the family history of alcoholism should be discounted.

Our data support the hypothesis that an effect of long-term alcohol abuse is to negatively impact the substrate underlying EEG power. Negative associations between EEG power and alcohol use variables (both dose and duration), suggests that a reduction in EEG power is a morbid effect of accumulating alcohol abuse. We acknowledge that this hypothesized effect of alcohol abuse is opposite to the increased EEG power effect that we hypothesize is associated with the inherited nexus of disinhibited traits that conveys a vulnerability to alcoholism. The current subjects were studied at the relatively early stages of this process, before these morbid effects of chronic alcohol abuse can overpower the trait-related increased EEG power present in this sample of alcoholics.

With continuing alcohol abuse, we would expect to see the trait of increased EEG power in alcoholics overpowered by the effects of long-term severe alcohol abuse. In other words, in longer term and more severe alcoholics, we hypothesize that we would not see the increased EEG power observed in the current study. In the most severe and longest-term alcoholics, we hypothesize that we would see an actual reduction in EEG power. We have been studying a sample of long-term abstinent treated alcoholics in whom we can test these hypotheses.

Footnotes

This work was supported by Grants AA11311 (GF) and AA13659 (GF), both from the National Institute of Alcoholism and Alcohol Abuse. We also express our appreciation to the NRI recruitment and assessment staff, and to each of our volunteer research participants.

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The NARCONON™ drug education curriculum for high school students: A non-randomized, controlled prevention trial

Richard D Lennox
Psychometrics Technologies, Incorporated, 2404 Western Park Lane, Hillsborough, NC 27278, USA

and

Marie A CecchiniIndependent Research Consultant, 10841 Wescott Avenue, Sunland, CA 91040, USA

Background

An estimated 13 million youths aged 12 to 17 become involved with alcohol, tobacco and other drugs annually. The number of 12- to 17-year olds abusing controlled prescription drugs increased an alarming 212 percent between 1992 and 2003. For many youths, substance abuse precedes academic and health problems including lower grades, higher truancy, drop out decisions, delayed or damaged physical, cognitive, and emotional development, or a variety of other costly consequences. For thirty years the Narconon program has worked with schools and community groups providing single educational modules aimed at supplementing existing classroom-based prevention activities. In 2004, Narconon International developed a multi-module, universal prevention curriculum for high school ages based on drug abuse etiology, program quality management data, prevention theory and best practices. We review the curriculum and its rationale and test its ability to change drug use behavior, perceptions of risk/benefits, and general knowledge.

Methods

After informed parental consent, approximately 1000 Oklahoma and Hawai'i high school students completed a modified Center for Substance Abuse Prevention (CSAP) Participant Outcome Measures for Discretionary Programs survey at three testing points: baseline, one month later, and six month follow-up. Schools assigned to experimental conditions scheduled the Narconon curriculum between the baseline and one-month follow-up test; schools in control conditions received drug education after the six-month follow-up. Student responses were analyzed controlling for baseline differences using analysis of covariance.

Results

At six month follow-up, youths who received the Narconon drug education curriculum showed reduced drug use compared with controls across all drug categories tested. The strongest effects were seen in all tobacco products and cigarette frequency followed by marijuana. There were also significant reductions measured for alcohol and amphetamines. The program also produced changes in knowledge, attitudes and perception of risk.

Conclusion

The eight-module Narconon curriculum has thorough grounding in substance abuse etiology and prevention theory. Incorporating several historically successful prevention strategies this curriculum reduced drug use among youths.

Background

Effective education is needed to address today's burgeoning substance abuse problem

Although the annual, benchmark study, Monitoring the Future (MTF) [1], has measured small declines in drug use during the past few survey years, the estimated 13 million youths aged 12–17 in the U.S. who become involved with alcohol, tobacco and other drugs annually remains high compared with the declining trend seen during the 1980's which ended in 1992 [2].

Problem areas include the estimated $22.5 billion that underage consumers spent on alcohol in 1999 (of $116.2 billion total) [3]; an alarming 212 percent increase in the number of 12- to 17-year olds abusing controlled prescription drugs between 1992 and 2003; and youth initiation of pain relievers estimated at 1,124,000 in 2001, second only to marijuana initiation at 1,741,000 [2]. Controlled prescription drugs (including OxyContin, Valium and Ritalin) are now the fourth most abused substances in America behind only marijuana, alcohol and tobacco.

When prevention efforts fail it is not at small cost. In 2005, lifetime prevalence rates for any drug use were 21%, 38%, and 50% in grades 8, 10, and 12, respectively [1]. Although it can be argued that not all students who try drugs will develop problems, in 2002 the alcohol abuse and dependence-related costs for lost productivity, health care, criminal justice, and social welfare were estimated at $180.9 billion [4].

For many youths, substance abuse precedes academic problems such as lower grades, higher truancy, lower expectations, and drop out decisions [5]. In fact, the more a student uses cigarettes, alcohol, marijuana, cocaine and other drugs, the more likely they will perform poorly in school, drop out [6,7] or not continue on to higher education [8].

Consistent with the goals and public health agenda of the Office of National Drug Control Policy (ONDCP) and the Department of Education, the Narconon program's ultimate goal is to prevent and eliminate drug abuse in society. Research has shown that preventing or delaying initiation of alcohol or other drug use during early adolescence can reduce or prevent substance abuse and other risk behaviors later in adolescence and into adulthood [9,10]. However, there is still much discussion regarding what policy and strategies to employ toward this goal.

For the past 30-years, Narconon drug prevention specialists have delivered seminars aimed at supplementing existing prevention efforts by further illustrating materials covered in school curricula. In 2004, Narconon International developed an eight-module drug education curriculum for high school ages based on the research and writings of L. Ron Hubbard as incorporated into the secular Narconon drug rehabilitation methodologies. Program developers analyzed post-program student feedback, surveys collected as a quality management practice that has been in place since program inception and continues today, in light of evidence-based practices and prevention theory to create a stand-alone, universal (all youths) drug education curriculum for high school ages aimed at addressing key problem areas.

The eight module Narconon drug education curriculum for high school ages incorporates a unique combination of prevention strategies with content addressing tobacco, alcohol, marijuana and common "hard drugs." Health motivation, social skills, social influence recognition and knowledge-developing activities address a number of risk and protective factors in the etiology of substance abuse and addiction. The aim of this study was to assess the program's ability to change drug use behavior, attitudes and knowledge among youths and evaluate the components of the Narconon drug prevention curriculum against prevention theory.

Methods

Description of the sample

The Narconon program recruited 14 schools from two states. Schools were assigned to education or control groups based on similarity of school size, community size and general ethnicity. Schools also agreed to complete three testing points: Baseline, approximately one month later, and a six month follow-up. The full Narconon drug education curriculum was implemented either after completion of the baseline survey (education condition) or after completion of the final six month survey (control condition). Fidelity of curriculum delivery was verified by facilitator report.

After obtaining parental consent, there were 236 control group and 244 experimental group students in Oklahoma, with 295 control group and 220 experimental group students in Hawai'i. Voluntary assent and confidentiality were explained to the students. After the baseline survey, one charter school of 26 participants withdrew from the study for scheduling reasons. No provision was made to adjust representation by gender or potentially interesting ethnic or risk groups.

The study protocol and consent forms were reviewed and approved by Copernicus Group IRB (Protocol HI001). Human participant protections certified survey staff assigned each student a unique identification number based on a classroom roster. For confidentiality, students marked their answers on standard bubble answer forms labeled only with their unique identification number. The roster and identification code was used to give students the same identification number at each survey point, thus permitting comparison of answers given on each measurement occasion – a sampling strategy that provided the necessary statistical power to identify differences in tested variables among a universal classroom population, where the majority of youths do not use drugs. Completed answer forms were placed by each student into a security envelope, sealed, and returned to survey staff for mailing to the Principal Investigator for scanned data entry, data management, and statistical analysis.

Drug education intervention

The study design called for each of the schools recruited to the experimental conditions to receive the complete drug education curriculum. Professionally trained facilitators followed a codified delivery manual and completed a daily compliance report. Codified Narconon drug prevention curriculum materials help the facilitator implement the program according to specific standards, maintaining program fidelity.

Outcome measures

The primary outcome measure was last 30-day substance use using the Center for Substance Abuse Prevention (CSAP) Participant Outcome Measures for Discretionary Programs designed for outcomes evaluation in CSAP funded substance abuse prevention programs which is recommended for use in a pre-test/post-test design. (Form OMB No. 0930-0208 Expiration Date12/31/2005) [11]. Questions were directed to frequency of use of twenty two drugs of abuse including twelve questions from the Monitoring the Future Survey [1].

Secondary outcomes assessed by the CSAP instrument included perception of risk, attitudes and decisions about drug use including five questions from the Monitoring the Future Survey that ask about perceived harm from substance use; and four questions from the Student Survey of Risk and Protective Factors [11] that ask about drug use attitudes. In addition to calculating change in behavior and beliefs among individuals, these questions permit comparisons to state and national norms.

Additionally, the program developers recommended 25 questions that were appended to the CSAP survey for the purpose of assessing whether drug education concepts covered by the Narconon program are correctly understood by each program recipient, to what extent they are retained at follow-up points, and whether or not students could apply key program concepts. The program developer questions were designed to examine proximal effects including the ability of the program to educate by examining recall of program material, as well as give an impression of student capacity to apply program skills such as self-reported ability to communicate their beliefs on substance use, recognize and resist pressures to use substances, and make decisions.

Statistical analysis

The non-randomized design – where it cannot be assumed that groups assigned to experimental and control conditions will be equal – calls for a conservative analysis. For this reason the study utilized Analysis of Covariance (ANCOVA) of the change scores from baseline, controlling for initial drug use as well as changes in the school populations as covariates. The autocorrelation among the classroom clusters was statistically accommodated through use of a nested treatment effect, in which the treatment effect was nested within the classroom effect. Type III sum of squares deviations between the baseline characteristics of both groups were used in all post-treatment statistical comparisons of the treatment and control group, thus statistically controlling for any differences existing at baseline and removing any effects caused by pre-existing differences between the two test conditions that might confound the results. In this way, the analysis is aimed at establishing the statistical strength and reliability of assigning any measured differences at the six-month post-treatment follow-up to the drug education received by the experimental group rather than any attempt to quantify those changes.

Results

Evaluation of Narconon curriculum components

Table 1 outlines the eight curriculum sessions against key constructs used by many drug prevention programs. The interactive curriculum imparts science-based information from fields as diverse as toxicology, forensic science, nutrition, marketing, pharmacology, and many others. Program materials include audiovisual support and clear lesson plans that are to be delivered in their entirety combined with quality management tools such as anonymous student questionnaires for each session and a facilitator's log sheet to list any session problems and/or questions. Facilitator training emphasizes the importance of effective communication as well as creating an environment in which students may ask questions, discuss personal situations, and actively participate.

Table 1. Constructs in the Narconon Drug Education Curriculum for high school students.

Tests for selection bias: Demographic representation and drug use characteristics of groups at baseline

A total of 995 students out of a possible 1106 were recruited based on informed parental consent. Of these 726 completed both the baseline assessment and the six-month follow-up. The main sources of attrition were students not available on the day of survey and students no longer enrolled at the study school at the six month follow up.

Although selection of sites for "no treatment" attempted to match the demographic composition at intervention sites with respect to residence state, age, and general economic group, this strategy does not guarantee that the two types of sites are free from selection bias. Table 2 presents demographics composition of the control and treatment groups. Students frequently indicated several ethnic categories. The ethnic make-up of this group is particularly interesting as the evaluation includes a number of typically under-represented groups; however, the size and scope of this study do not make analysis of individual ethnic groups feasible.

Table 2. Demographics.

The drug use portion of this questionnaire determines general usage levels for the various drugs (except for cigarettes and smokeless tobacco). For example, "On how many occasions during the last 30 days have you used marijuana ..." is answered on the scale: "1" = 0 occasions, "2" = 1–2 occasions, "3" = 3–5 occasions, "4" = 6–9 occasions, "5" = 10–19 occasions, "6" = 20–39 occasions, and "7" = 40 or more occasions. From this, Table 3 shows the means for both groups to be slightly higher than 1 or "0 occasions", indicating some degree of drug use but a high proportion of individuals not using substances, or that substance.

Table 3. Drug use at baseline: Comparison of means between treatment and control groups.

Comparison of the means on the drug use measures between the treatment and control groups prior to receiving any drug education, as seen in Table 3, show that the two groups do not differ significantly on any of the drug abuse measures, suggesting that any difference seen at follow-up was unlikely to be caused by pre-existing differences.

Effects of the Narconon drug education curriculum on drug use compared with sites that have not yet received the curriculum

At follow-up, as shown in Table 4, students in the drug education program, but not the control group, had moved toward less drug use for virtually all of the drug use types. Given the similarities of group drug use behavior measured at baseline, this pattern alone supports the reliability of the differences created by the drug education curriculum.

Table 4. Drug use at six month follow-up: Comparison of means between treatment and control groups.

A number of drug use reductions achieve statistical significance. Characteristics of the specific tests indicate the effectiveness of the program. The areas of alcohol, tobacco and marijuana use in the past 30 days are particularly relevant to high school populations: Amount of cigarette use showed the strongest effect (F = 3.89, df = 11, p < f =" 3.39," df =" 11," f =" 3.35," df =" 11," f =" 2.28," df =" 11," p =" 0.010" f =" 2.12," df =" 11," p =" 0.017," f =" 1.87," df =" 11," p =" 0.040" f =" 169," df =" 11," p =" 0.073,">

Among the "hard drugs," use of amphetamines was somewhat prevalent among these youths and was significantly reduced by the curriculum (F = 2.35, df = 11, p = 0.008). Reduction in use of amphetamines without a prescription approached significance (F = 1.59, df = 11, p = 0.098).

The differences between the drug education and control groups are consistent with the literature on universal, classroom-based types of intervention [12] where drug use data is obtained by self-report and levels of substance use are high among only a small subgroup of youths [13].

Influence of the Narconon drug education curriculum on perception of risk and attitudes about drugs or drug use compared with sites that have not yet received the curriculum

Survey questions for decisions regarding drug use, changes in perceptions of risk and attitudes regarding drug use and means of the answers for each group at follow-up along with the significance values are presented in Table 5. Corresponding percents of students answering in an anti-drug fashion are presented for each question in Tables 6, 7 and 8.

Table 5. Means of attitudes and beliefs responses at six month follow-up.

Table 6. Decisions regarding drug Use: Percent of students in each group who gave a "drug free" answer.

Table 7. Perception of "harmfulness" of drugs: Percent of students in each group who answered "great risk."

Table 8. Disapproval of drug use: Percent of students in each group who answered "wrong" or "very wrong."

Six months after participating in the program, controlling for baseline differences, there was a much greater tendency for the control group to plan to get drunk in the year following the six-month follow-up compared with the drug education program group (F = 1.65, df = 11, p = 0.003) as well as a stronger decision to smoke cigarettes among the control group. (F = 1.33, df = 11, p = 0.008) In comparison, the drug education treatment group stated a stronger commitment to a drug free lifestyle than the control group (F = 1.82, df = 11, p = 0.048).

At six month follow-up, four out of five questions assessing risk of harm were statistically significant. Significantly more students in the drug education group indicated great risk to the question "how much do people risk harming themselves (physically or in other ways) if they try marijuana once or twice (F = 6.55, df = 11, p < f =" 9.41," df =" 11," f =" 1.91," df =" 11," p =" 0.035).

Although a greater percent of students who received the Narconon drug education curriculum indicated great risk of harm from smoking one or more packs of cigarettes per day, and having one or two drinks each day, the mean answer for that group indicated slightly less risk than answered by the control group (F = 5.79, df = 11, p < f =" 2.27," df =" 11," p =" 0.010">

Among the questions assessing whether students believed drug use was "wrong" or "very wrong" for someone their age, the drug treatment group felt that dinking liquor, smoking cigarettes, and using LSD, etc., were more wrong at follow-up than did the control group (F = 3.15, df = 11, p < f =" 4.12," df =" 11," f =" 3.96," df =" 11,">

Competency in absorbing the material covered in the Narconon drug education curriculum compared with sites that have not yet received the curriculum

The ability of the intervention to impart knowledge was tested by examining students' ability to correctly answer nineteen items designed to assess assimilation of program content and six questions assessing their ability to apply program messages to drug use decisions and behaviors.

As shown in Table 9, six-months after receiving the drug education program, significantly more students who received the drug education curriculum were able to give answers consistent with the program content for all nineteen items, controlling for differences at baseline. Of interest, students in the drug education program improved their understanding that alcohol is a drug (F = 6.03, df = 11, p < f =" 4.24," df =" 11," f =" 8.79," df =" 11," f =" 3.53," df =" 11," f =" 5.73," df =" 11,">

Table 9. Percent of students who gave a correct answer to program content questions.

However, "addiction only happens once you can't stop," was scored "true" more often among the control group than among the treatment group (F = 2.95, df = 11, p <>

Of the six questions assessing student decisions and behaviors, three produced significant change. Students in the drug prevention group were more likely to indicate that they knew enough about drugs to make decisions (F = 2.77, df = 11, p = 0.002,). Interestingly, recipients of drug prevention indicated a greater current ability to resist pressures to take drugs (F = 2.77, df = 11, p = 0.002) although the question assessing past resistance to drug use pressures was answered similarly between both groups at all time points. There was also a larger shift in the number of students who indicated "false" to the statement "drugs aren't really that bad" (F = 1.91, df = 11, p = 0.035).

Because a rather large percent of students in both groups answered the questions correctly at baseline, no further analysis was done to separate groups based on competency.

Discussion

The purpose of this study was to evaluate the capacity of the Narconon drug education program to produce a long-term impact on students' drug use behaviors in a universal (all student) classroom setting. To a large degree, baseline survey responses were similar to drug use patterns seen in large national surveys. After controlling for pretest levels of use, at six months after receiving the drug prevention curriculum students in the drug education group had lower levels of current drug use than students in the comparison group. Significant reductions were observed for alcohol, tobacco, and marijuana – important categories of drug abuse for this population – as well as certain categories of "hard drugs" including controlled prescription drugs, cocaine, and ecstasy. The results in Table 4 show a clear and reliable tendency among every category tested for the drug education program to produce reductions in drug use behavior.

This is encouraging in light of the evaluation being designed to provide a "real world" test of the Narconon program under the normal conditions of operating a classroom based intervention. Inherent barriers to administering the program and evaluation while schools were in session, including assessing its effectiveness with self-report questionnaires, leads to modest measurable differences between the drug education groups and the control groups with relatively large error terms.

The use of the CSAT survey methodology does not make quantifying the reductions in drug use possible and that was not an aim of this evaluation. Importantly, by testing a universal audience, rather than selecting groups of high risk students, the mathematical differences between student responses in each category remained modest due to the majority of students indicating no drug use at baseline.

The CSAP questions testing the hypothesis that changes in attitudes and beliefs would be modified by the drug education program, argue for a mediating effect on substance use. Interestingly, the questions aimed at discerning whether new knowledge was obtained and retained over time, although indicating an overall pre-existing acquaintance with the data, nonetheless categorically produced the most statistically significant changes.

Primarily an education strategy (Center for Substance Abuse Treatment classification [14]), the Narconon program includes approaches that align with key prevention theories. Throughout the curriculum, persuasive communication is emphasized as the means to impart each component [15]. Competency enhancement is accomplished through student interaction [16] and after-school personal inspection of media and other environmental influences aimed at addressing social influences. Science based information is presented, and students complete exercises aimed at developing their ability to assess the correctness of messages presented as information from a variety of sources.

Originally researched on cigarette use by Evans and colleagues in 1976, social influence theory was one of the first strategies to produce an impact on drug use behavior. This theory posits that alcohol and other drug use among young people is primarily a social behavior strongly influenced by social motives, a complex and reciprocal interaction between both personal and environmental factors including both overt and covert pressure from friends and others to conform to what is depicted as the group norm. A major departure from previous approaches to tobacco, alcohol, and other drug abuse prevention; Evans work emphasized increasing awareness of the various social pressures promoting drug use, including media influences [17,18].

One well-popularized aspect of today's social influences model is the focus on social resistance skills training. However, programs based primarily on resistance training have shown mixed results [19,20]. While this is not a focus of the Narconon program, students who received the curriculum were more likely to say they could now resist pressures to use drugs compared with those who did not receive this program. Interestingly, both groups answered similarly about their ability to resist pressures in the past.

Instead of directly practicing resistance skills, the Narconon drug education curriculum provides an opportunity for youth to inspect a myriad of positive, negative and often conflicting messages regarding drugs and their abuse, messages that often include incorrect and conflicting information about drugs and their effects. Program developers believe that prevention effectiveness is currently compromised by the pervasiveness of conflicting messages, including popular prevention approaches that do not communicate a consistent message.

Attempts to promote abstinence contrast with other messages heard in and out of school. For example, the notion that "everyone will experiment" has lead to various, sometimes controversial, practices aimed at reducing harm [21]. Goodstadt argues that dichotomies such as "licit" versus "illicit" drugs, or simply "good" versus "bad" drugs, result in ambiguities and problems [22]. Petosa adds that legal definitions designating certain recreational drug as "licit" for adults but "illicit" for adolescents may encourage young people to use those drugs to demonstrate their transition to adulthood [23]. The current prevalence of media advertising for prescription medications sends another powerful message [24], one complicated by the fact that commonly prescribed medications are too often used in ways substantially inconsistent with diagnostic guidelines [25,26].

Although students may "know" a certain datum about drugs, conflicting messages such as these may cause that datum to be minimized or rejected entirely unless placed in correct context or inspected relative to other information. To address this, the program teaches about the often subtle pro-drug advertising and other environmental messages aimed at increasing tobacco, alcohol and other drug consumption; contrasting these pro-drug messages with true scientific facts about drug effects on the body, mind, emotions, and enjoyment.

Program facilitators purposefully encourage students to arrive at their own conclusions regarding the data presented based on each student's own observation of the topic under discussion. Facilitators do not tell students what to think, rather, they teach students how to observe.

Another environmental influence addressed by the Narconon program includes more accurate awareness of family and peer drug use patterns. The program includes modules to review and discuss personal observations and provide opportunity for youth to work out what are correct and pro-survival norms.

Media, family, peer and other environmental influences become the subject of competency enhancement activities included in the Narconon curriculum. Competency to observe is applied during after-school practicals and becomes subject of the subsequent group discussion. These take home assignments and classroom activities are also aimed at developing broader personal and social skills with peers, family and community members. Research supports the use of activities that improve interpersonal relations, self esteem, communication, and other skills as directly applicable to substance use as well as many other adolescent problems. Such activities appear to generally enhance program effects [27,28].

With respect to the importance of knowledge, while many early prevention programs gave individuals accurate facts about the harmful effects of alcohol and other drugs, theorizing that those individuals would reduce or avoid drug use because it was in their own best interest to do so, studies of this generic information-only or awareness model have led to one of the very few universally agreed-upon facts in the prevention field: That is, for the vast majority of individuals, simple awareness through passive receipt of health information is not enough to lead them to alter their present behavior or reduce their present or future use of drugs [29,30].

According to Botvin and Botvin [12,16]., inclusion of information remains a necessary component of substance abuse education, although information alone is not sufficient to reduce or prevent use. Evans stresses the importance of attention and comprehension of the contents of the message [15]. Narconon program developers posit that true information correctly communicated can lead to changed behavior by changing the perceived value or social acceptance of that information.

Since inception, Narconon prevention training materials have emphasized correct communication of information and interaction with the communicator. Facilitator training aligns with the five component communication persuasion model described by McGuire [31]. According to this theory, to be effective an educator must get and hold the listeners' attention, must be understandable (comprehension), must elicit acceptance on the part of the person exposed to the message (yielding), the acceptance must be retained over time (retention), and thereby be translated into action in appropriate situations. Testing the ability to choose a correct answer only begins to answer the question of the perceived value and usefulness of that information. To that end, the incorporation of persuasive communication into facilitator training and multi-media program components is suggestive. In theory, the communication of science-based information regarding the nature and effects of drugs can assist students in developing judgment and awareness, but only to the extent that the message sent is very real to youths and delivered in a way that students respect and can appreciate. Measurements of student satisfaction that include affective reactions (e.g. enjoyment, content value) should be further explored as they may reveal important shifts in perceptions about the information itself that would not be detected in simple "true/false" questions.

This theory is supported by a previous evaluation of 1045 post-program student surveys, published in 1995, with findings that the Narconon program format was engaging and appreciated by youths [32]. Participants also reported heightened perceptions of risk – including a shift in attitude among the borderline group of students who held the view that they might use drugs in the future. Eighty six percent of the students in this category stated that the session they had attended changed their mind; most stating that they were now more concerned about the effects of drugs or that they had not realized that drugs were so damaging.

In addition to analyzing elements of content and implementation, a recent synthesis of characteristics common to exemplary prevention programs by Winters, et al. [33] raises the issue of management structure and sustainability. Narconon International's corporate and regional offices provide centralized management and assistance to ensure that local prevention offices receive meaningful attention and support. In addition to the questionnaire used in this study, Narconon program staff continued to collect their own feedback evaluations for ongoing quality management. Staff interaction with teachers and community members helped the schools further reinforce the prevention messages.

The report by Winters, et al. [33] points out the broad lack of programs aimed at high school years and, interestingly, the need for multiple sessions in future years to reinforce the message. The Narconon high school curriculum helps fill this need. Existing materials for younger ages should also be developed into an age appropriate curriculum to provide a continuum of educational resources. As the program further develops its training materials for professional facilitators it may consider also making them appropriate for peer leader groups who may particularly benefit through improved communication skills. The program should also develop appropriate universal booster sessions and provide educator consultation.

Project findings may have policy implications regarding both setting goals and objectives for prevention programs as well as evaluating their success. For example, the Safe and Drug-Free Schools and Communities act of 1994 includes "slow recently increasing rates of alcohol and drug use among school-aged children by 2000" among the six performance indicators chosen for assessing program accomplishments. It also expects prevention to "realize continuous improvement in the percentage of students reporting negative attitudes toward drug and alcohol use between now and 2002". Further, this act is subject to requirements of the Government Performance and Results Act of 1993 (GPRA) in requiring local and state education agencies to monitor program effectiveness, for which the CSAT instrument is a recommended tool sanctioned by the National Institute on Drug Abuse (NIDA), and the Substance Abuse and Mental health Services Administration (SAMHSA). Unfortunately, the instrument is unable to quantify change in drug use and does not assess completely the factors that might lead to such a change, factors that may include change in knowledge and the perceived value of that knowledge.

As current youth drug use levels remain high, it is clear that much more remains to be learned regarding effective drug abuse prevention. What works best; what goals additional to reduction in youth drug use – if achieved – constitute an effective program; how to measure achievement and the extent to which a school-based implementation strategy can counter other influences remains under discussion.

Conclusion

As an intensive, eight-module, educational curriculum, the Narconon program has thorough grounding in theory and substance abuse etiology, incorporating several important and historically successful prevention components. This supports the prediction that participants in this classroom-based program would change their behavior regarding drugs of abuse. Further, the Narconon network provides a strong organizational structure to foster sustainable and high fidelity program implementation.

In this evaluation, the Narconon drug education curriculum produced reliable reductions in drug use a full six months after completion of the drug education program and in every category of drug use tested. A third of these questions – those assessing the drugs most commonly used by youths; alcohol, tobacco and marijuana as well as "hard drugs" – showed statistically significant reductions in use. The reductions achieved with both amphetamines and non-prescription use of amphetamines are important given recent increases in availability and initiation of these drugs. The reliability of the reductions measured in drug abuse behavior provide the most relevant support for the Narconon drug education curriculum.

The program's ability to produce reductions in drug use behavior appears to be through correcting prevalent but false messages while empowering youth to observe, draw their own conclusions, and potentially also improves interpersonal skills contributing to the development of appropriate group norms. These changes may result in shifts in perception of risk and corrected attitudes as individuals and as a group. However, the mechanisms of action for this program should be further explored using sensitive instruments and analyses designed to test this hypothesis. Although the CSAP questionnaire underwent an extensive development process, isolating effective components of drug prevention programs may require a more robust methodology, particularly in light of the theory constructs of this program.

The Narconon drug education curriculum for high school grades shows clearly positive results and sends an important and powerful message promoting abstinence. Given the significant reductions in drug use behavior, the scientific content and social influence theory underlying the program materials and their implementation, and the strong, centralized management by Narconon International, this program is very promising and fills a vital need in substance abuse prevention.

Competing interests

M Cecchini wishes to disclose that between 2000–2002 she was the Executive Director of a Narconon center engaged in delivering substance abuse prevention programs; familiarity with program operations made it possible to coordinate independent field data collection with ongoing prevention efforts and assisted in describing the history and development of the program.

Authors' contributions

RL is Principal Investigator and developed the study design, statistical analysis and interpretation, and drafted sections of the manuscript.

MC coordinated the independent field data collection staff with scheduled drug education program delivery, ensured compliance with procedures to protect human subjects, and drafted sections of the manuscript.

Both authors read and approved the final manuscript.

Please send all reprint/proof correspondence to Marie Cecchini, 10841 Wescott Avenue, Sunland CA 91040.

Acknowledgements

The authors acknowledge the Association for Better Living and Education, Narconon International, Narconon of Hawai'i and Narconon of Oklahoma for project support.

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Source: substanceabusepolicy.com