Using the cumulative strategies model for drug abuse prevention: A small group analysis of the choices program
- Författare
- Horn KA, Kolbo JR
- Titel
- Using the cumulative strategies model for drug abuse prevention: A small group analysis of the choices program
- Utgivningsår
- 2000
- Tidskrift
- American Journal of Health Studies
- Volym
- 16
- Häfte
- 1
- Sidor
- 7
- Sammanfattning
IA Cumulative Strategies Model for drug abuse prevention employs a process by which two or more drug abuse prevention strategies are used conjointly, such that each strategy targets two or more factors that place children at high risk for drug abuse. This model was examined using an innovative multiple component program called CHOICES. CHOICES emphasizes the reduction of risk factors that are characteristic of a high risk population of children of alcoholics and predictive of drug abuse. Using a repeated measures multiple baseline design, the results small group analysis indicate that the Cumulative Strategies Model inherent to the CHOICES program is an effective risk reduction strategy for a high risk population of children of alcoholics. Children who received two components of the program showed greater improvement in self esteem, social skills, and attachment to school than children who received one component or no intervention.
It is widely supported in the literature that children affected by familial alcohol abuse are more likely than other children to experiment with, use, or abuse alcohol, tobacco, or other drugs (ATOD) early in life (Ackerman, 1994; Hawkins, Catalano, & Miller, 1992; Sher, Walitzer, Wood, & Brent, 1990; Wilson & Blocher, 1990). Often these children develop a range of affective, behavioral, cognitive, and social problems, many of which are directly associated with an increased risk for drug abuse (Hawkins et al., 1992; Elmquist, Bell, & Associates, 1995; Noll, Zucker, & Fitzgerald, 1992). For example, these children may experience diminished levels of self esteem and negative self-attitudes, and use isolation or withdrawal as a means of coping (Anderson & Quast, 1983; Botvin et al., 1989; Brake, 1988; Goldman & Rossland, 1992; Johnson et al., 1990). Many of these children present poor school readiness and performance, low bonding and attachment to school, and low involvement in extracurricular activities (Hawkins & Catalano, 1992; Gottfredson, 1981; Johnson et al., 1990). Additionally, the dysfunction associated with familial alcohol abuse often results in poor interpersonal and social skills, low social attachment, and favorable attitudes toward ATOD use or abuse among children (Hawkins & Catalano, 1992; Weintraub, 1991; Wilson & Blocher, 1990).
Paralleling a trend toward substance abuse prevention that addresses multiple risk factors in multiple domains, a Cumulative Strategies Model (Horn & Kolbo, 1995; Horn & Kolbo, in press) was developed. This model is grounded in a number of specific principles intended to guide prevention program development. The four principles of intervention that are central to this model include: (1) early vs. later intervention; (2) multiple vs. single risk factors; (3) comprehensive vs. isolated strategies; and (4) multiple vs. single risk-focused strategies. More specifically, successful prevention strategies will: (1) focus on younger children; (2) offer specific risk-focused rather than generalized interventions; (3) address a range of behavioral, psychological, and cognitive risk factors that are common to children from ATOD abusing families and predictive of ATOD abuse, and (4) consist of multiple comprehensive components that target two or more risk factors conjointly. A detailed description of the principle of the Model can be found elsewhere (see Horn & Kolbo, in press).
An evaluation of the Cumulative Strategies Model was possible through the examination of an intervention called CHOICES (Children Having Opportunities in Courage, Esteem, and Success). CHOICES is a multicomponent prevention program (see Horn, 1996; 1997a; 1997b; Horn & Kolbo, 2000 for detailed program information) designed for a high risk population of third and fourth grade children who are affected by familial alcohol abuse. Following the principles and guidelines of the Cumulative Strategies Model, CHOICES is school-based, with intensive intervention directed toward high risk children who have needs that exceed traditional drug abuse prevention programs. While the long term goal of the CHOICES is to prevent the onset of ATOD, there is an equally important investment in the immediate process of promoting happier and healthier childhoods. Thus, the immediate and long term objectives of the program are to: (1) improve self esteem; (2) increase social skills; (3) promote attitudes that are unfavorable to ATOD abuse; and (4) increase attachment to school.
CHOICES is comprised of three components: Structured Support Groups (SSG), Healthy Lifestyle Peer Mentors (HeLP'M), and Academic Channels to Ensure Success (ACES). Only the SSG and HeLP'M components are pertinent to this current study. All components are described in detail elsewhere (see Horn & Kolbo, 2000). The CHOICES SSG curriculum is comprised of 11 sessions. SSGs meet at least 1 hour each week for approximately 11 weeks. Specific sessions include: (1) All About CHOICES; (2) Learning About Feelings; (3)Recognizing Feelings; (4) Expressing Feelings; (5) Knowing Me; (6) Knowing My Family; (7) About Smoking; (8) About Smokeless Tobacco; (9) About Alcohol and Other Drugs; (10) Coping the Best I Can; (11) Deciding for Me. Led by school counselors, meetings take place outside of the general classroom in a place that affords privacy, such as the school counselor's office. The HeLP'M component matches third grade children who are participating in the on-going SSG with fourth grade children who: (1) complete at least nine sessions of the SSG; (2) attend at least three follow up/training sessions; and (3) want to be mentors. HeLP'M provides fourth grade children with an opportunity to enter positive mentoring relationships with third grade peers who are also affected by familial alcoholism. Mentors are trained (by counselors) to provide a positive peer interaction that is comprised of five stages: (1) Passwords; (2) Exchange of Greetings; (3) Feelings Check In; (4) Peer's Choice and (5) Closing. Once they are matched, mentors and mentees are expected to interact for 30 minutes once a week. Meetings are arranged by the children and are approved by their teachers and the school counselor.
Since the assumption of the Cumulative Strategies Model is that two or more strategies are more effective than one in reducing risk, it seems logical that children who receive two or more components of CHOICES experience greater risk reduction than children who only receive one component or none. As such, the study described herein examined the differential effects of two of the components (SSG and HeLP'M) on the four targeted risks factors. The primary hypothesis was that, compared with the other study groups, children in the SSG + HeLP'M training group would demonstrate greater improvement in: (1) self-esteem; (2) social skills;(3) attitudes toward ATOD use (i.e., less favorable attitudes toward use); and (4) attachment to school. The secondary hypotheses were that: (1) children in the SSG would show greater improvement (in 1-4 above) than children who received peer mentoring only and those who received no intervention; and (2) children in the mentor only group would show greater improvement than children who received no intervention.