Information, teaching and education in the primary prevention of drug abuse among youth in Denmark

Sections

ABSTRACT
Introduction
Educational approaches in prevention
Risk-oriented teaching method
Person-oriented teaching method
Situation-oriented teaching method
Education and re-education of schoolteachers
Discussion
References .

Details

Author: P. SCHIØLER
Pages: 57 to 65
Creation Date: 1981/01/01

Information, teaching and education in the primary prevention of drug abuse among youth in Denmark

P. SCHIØLER Chief Consultant to the Ministry of Education on Alcohol and Narcotic Problems, Copenhagen, Denmark

ABSTRACT

This paper describes briefly new approaches to drug abuse prevention. The basic principles are discussed in relation to their application in a community-oriented programme. Some details about the education-of-the-educators programmes are given. It is strongly stressed that concerted community action is necessary to bring any of the activities to success. Co-ordination of timing and attitudinal consent are prerogatives for the positive effect of these programmes.

Introduction

Youthful drug abuse became a serious problem in Denmark in 1962. In 1967 an official Information Service came into being through the efforts of the Ministry of Education. It was, from the beginning, evident that the Government of Denmark had a responsibility to provide accurate and appropriate information to the public. However, the office in the Ministry of Education suffered from a lack of relevant knowledge on which to base its activities. In 1971 the Government ordered an expansion of activities which resulted in a partial decentralization with eight regional offices being distributed around the whole country. The Ministry of Education's office assumed a co-ordinating role and undertook to supply new information. Shortly afterwards the Governmental Commission on Drug Abuse among Youth established another central secretariat which also offered some information services. This effort has been steadily growing ever since, but no local representatives have been established.

In 1976 the Social Welfare Act introduced a reform of the administration responsible for social aid, pensions, revalidation and numerous other branches of the social welfare system. On the basis of this Act, the treatment of addicts was decentralized and the counties assumed responsibility for treatment. Some municipalities and some private organizations have run treatment centres, but these have mostly been affiliated to the official treatment facilities.

The prevention of drug abuse among youth had already been studied in 1967. It quickly became clear that the concept of prevention should be seen as a concerted effort involving central authorities as well as local administrations, organizations, institutions and individuals. The problem of drug abuse appeared in different forms in different localities.

Further study soon showed that prevention cannot be restricted to information, teaching and education alone. Without ongoing education, meaningful employment, and appropriate challenges in leisure time activities youth are very much at risk.

At that time the drug abuse problem was confined to the use of cannabis (mainly hashish) and experiments with central stimulants. Although alcohol was used by far more young persons and more regularly, the problem identified was the use of drugs which were more or less unknown to the adult population. Only relatively rare cases of more serious misuse of drugs and intoxicants were observed, usually raw opium and illicitly obtained hypnotics, analgesics, neuroleptics and lysergide. This group of drug users was small and inhomogeneous. However, it quickly grew during the years 1969- 1973 and has been increasing slowly and steadily again since 1976.

It is with this development of the Danish drug scene in mind that the following programme of preventive activities should be seen.

Educational approaches in prevention

The classic approach to the production of teaching materials in health education or drug education was discussed in meetings convened by the United Nations [ 1] and the United Nations Educational, Scientific and Cultural Organization (UNESCO) [ 2] in 1972. Already at that time it was considered that drug abuse was not only a pharmacological behaviour, but had an important psycho-social component. It was considered that drug education should be carried out as a part of health education, preferably fully integrated in the total curriculum of the school at all levels. In a meeting convened by the International Council on Alcohol and Addictions (ICAA) at Montreux in October 1973, drug education in the United States of America and Europe was thoroughly assessed [ 3] . The important concept of accountability [ 4] was also discussed.

At that time Denmark undertook to collaborate with other countries in the area of drug education. A long and important collaborative study was initiated between the Ministry of Education in Denmark and the Institute for the Study of Drug Dependence (ISDD) in the United Kingdom of Great Britain and Northern Ireland. This study has been ongoing ever since and certain aspects have been published elsewhere. [ 5] - [ 7]

Risk-oriented teaching method

In 1973, the most common approach was the so-called risk-oriented teaching method. In this approach the focus was on the pharmacological properties of the drugs. The aim was to produce aversion, fear, anxiety and feelings of guilt. In a study of the pedagogical effects of this type of teaching, it was found in both Denmark [ 8] and the United Kingdom [ 5] that this approach had little preventive effect. The approach was applied to students from 13 to 16 years of age.

Person-oriented teaching method

A number of programmes used another approach, the so-called person-oriented teaching method. In this approach, the focus was on the personal properties of the individual. There may be genetic differences between individuals, some being more vulnerable than others, i.e. a person who has grown up in unfavourable family conditions with bad housing and insufficient education may be more likely to develop alcohol and drug related problems. Evaluation of this approach [5, 8] in the two countries showed similar results to those obtained for the risk-oriented method.

Situation-oriented teaching method

In experimental teaching in 1958-1962, the author found that health education based on biological facts was insufficient in the age groups of 16 years and over [ 9] . A new dimension had to be considered. This was the situation in which an individual exists when falling ill, being intoxicated, becoming unemployed etc.

The term "situation", as defined in 1969, refers to a condition in which a human being finds himself as a result of a long string of episodes in which the condition may be changed. The factors that may change the condition may act through social, psychological or somatic interactions. Thus the condition is not only physically and mentally defined, but also socially, i.e. in relation to one's surroundings. This means that "situation" refers to both the individuals' past development as well as to their present situation, when offered drugs, when present in a classroom, when having to make a choice or a decision about some behaviour and its alternative.

If teaching follows the situation teaching method it will:

  1. Be project oriented;

  2. Discuss decisions, in order to develop decision-making skills;

  3. Educate on the risks of the use of drugs as seen from the point of view of the user's ability to make decisions;

  4. Relate to the social and the psychological conditions the users find themselves in when having to choose or when actually using drugs.

The situation-oriented method has been introduced by several contemporary programmes. These are:

  1. Education and re-education of schoolteachers;

  2. Creation of a co-ordinated set of teaching materials for the populations of school pupils from 7 to 19 years of age;

  3. Offering precise information to parents and other adults in the community with the aim of providing equivalent factual knowledge to youths and adults;

  4. Informing politicians at various levels, in municipal councils. Parliament and Government, about this concerted action.

The philosophical background to these programmes has been published in detail elsewhere [10-13]. In the text which follows the programmes will be briefly described.

Education and re-education of schoolteachers

Over a period of 14 years, several courses were offered and some 6,000 teachers trained.

In 1981 a new set of courses started entirely based on the situational approach. A large number of these courses will be run during the coming years. These courses are essentially placed in a community setting and are jointly sponsored by the municipality in collaboration with the Ministry of Education.

The main course uses 10 modules over five consecutive days from Monday to Friday as shown in the schedule below.

A special textbook on general and specialized knowledge has been written [ 14] but it is still in draft form and is tested. The experience gained will later be incorporated into the text and the book will then be published and distributed to schoolteachers at all levels in Denmark.

The draft textbook was distributed to every participant one month before the course started together with a basic book on health education - a manual for teachers entitled "Health Careers" by Dorn and Nortoft [ 15] . This book was developed simultaneously in Denmark and the United Kingdom as a joint effort, although the two language editions are not precise translations of each other. It is written so as to cover the same issues throughout in a way in which not only the facts, but also specific cultural conditions are recognized· In preparing the two language versions of the book a constant stream of "anglifications" and "danifications" rather than a translation passed between the authors in London and Copenhagen. This was done in an attempt to make a thorough cross-cultural approach to the joint study.

"Health Careers" was written at a time when teaching course was being tested in a number of secondary schools in Denmark and the United Kingdom and follows the principles of the situational education method.

Distribution of 10 modules over five consecutive days

Period

Monday

Tuesday

Wednesday

Thursday

Friday

  1 3 5 7 9
Morning
Opening
Situational approach
Production phase
As module 5
General debate among participants of the course
1st hour
Drugs and their effects
 
(a) 1-5 years in school
Teaching material all modules
2nd hour
Psychological and social implications
(b) 6-7 years in school
(small groups)
 
School boards, community councils, other political authorities for information and decision
3rd hour
Actual issues
(c) 8-10 years in school
 
(c) 8-10 years in
Presentation in plenary school
  2 4 6 8 10
Afternoon
         
1st hour
Structured group discussion of previous teaching experiences in drug education
Attempts to visualize new teaching material pre- pared in collaboration with students (mainly 8- 10 years in school)
As module 5
Common meeting with authorities from:
Participants only
adult education social welfare human services school authorities police other (local) administrations and interested organizations
What do we plan for the immediate future?
       
2nd hour
Plenary discussion connecting previous experiences with potential new approaches
     
Logistic assessment of course, closing

The above schedule shows that the three main events of the course are (a) discussion of the success or shortcomings of previous practice in teaching; (b) production of teaching material to be used in the participant's own classroom as a basis for the pupils' or students' own research for information in the community (village, rural district, block of houses, street or block of streets); and (c) meetings with the administrators in the community at the municipal or country level to establish contact between the school and surrounding community, followed by a presentation of the results to leading politicians and the school boards involved.

This course has proved successful in several ways:

  1. The teachers felt after the course that they had acquired enough knowledge to be able to teach the subject, to explain the news in the media, and to discuss matters of a personal nature with both the students and their parents;

  2. The teachers felt that their teaching could be made relevant to local conditions;

  3. Contacts with other public officials, politicians, the media, and other relevant groups have facilitated a better understanding of these groups' needs and their requirements from the school.

It is, perhaps, too early to attempt a full evaluation of this type of concerted action. However, it is clear that evaluation should include such parameters as attitudinal vectors, knowledge of drug effects, and decision-making skills. Evaluation cannot merely involve studies of drug-use patterns and other behavioural trends as the effect of teaching on these patterns will probably take time, possibly two to three years. Already it has been found that many more students were able to formulate clear viewpoints based on rational considerations.

Teachers find this type of course useful and the municipal councils seem to be ready to invest sufficient financial resources. Costs are not high since participants live at home during the evenings while courses take place in normal working hours.

Creation of a co-ordinated set of teaching materials for several age groups

Health education, and therefore drug education, is compulsory and is integrated in several ways in the total curriculum of primary and secondary schools in Denmark. Materials and teaching methods are decided on by the teachers in consultation with the parents represented on the school board.

Drug education is regulated at both national and local levels, thus ensuring that local conditions and specific needs can be taken into consideration. National regulations are designed to ensure that a minimum of knowledge is taught everywhere. Prototypes of textbooks, films, video and other audio-visual and teaching material may be (and have been) produced centrally not for general use, but rather to introduce the subject and stimulate discussion.

In this way, the situational approach to teaching is rapidly spreading to a large number of municipalities. The manual for teachers used in Denmark [ 15] helps to implement this approach.

Information to parents

Parents and other adults are given information on the course and its content in an effort to ensure optimal dialogue between generations in the home. Peer groups of students as well as groups of parents tend to create their own isolated sets of knowledge and attitudes.

Information to political leaders

This is an essential part of any project of this type. Political attitudes do not originate exclusively from factual knowledge; many other factors come into play. By keeping politicians informed of actual developments, co-ordination between teaching and other developments in the area of reduction of illicit demand for drugs can be ensured.

Discussion

As mentioned above, no prevention is possible without a broad spectrum of concerted action involving information, teaching, education, as well as the activities of the police and customs and the services provided by medical and social institutions.

Some drug education programmes in other countries have been initiated as isolated units with no contact with activities in other sectors of the public service. These other sectors may be equally as active, but their information may differ in timing and content, thus causing a certain amount of confusion. Upon evaluation these programmes are found to have had no effect on the patterns or prevalence of drug use. This may be the reason for the frequently published claim that prevention through information is of little or no value. There are, however, measurable outcome indicators which show the effects of preventive programmes. These are:

  1. Increased knowledge about drugs, including the nutralization of panicand overreaction as well as the establishment of an improved dialogue between youth and adults;

  2. A stagnation in the increase of drug use. This has been observed in Denmark in relation to the use of LSD, amphetamine and phenmetrazine. However, from the methodological point of view, this stagnation is difficult to measure in absolute figures;

  3. The unfortunate fact that the heaviest damage done by drug abuse is found among the lowest socio-economic groups. This reflects a situation where prevention in the form of teaching and education, and other preventive activities such as leisure, sports and games, are less likely to be available to these groups;

  1. Increase in credibility of information. It is obvious that if preventive efforts were successful, the large majority of youth will give more credit to the information received. This credibility can spread to other types of information.

Details of concerted preventive activities may be found in a report by the author to UNESCO on the co-ordination of preventive activities within schools with those aimed at youth of the same age group but out of school [ 12] . Several types of shorter teaching courses have been used for youth club leaders, teachers of extramural studies, leaders and instructors in sports clubs, scouts and other youth activities. By 1982 one type of course will be used throughout the entire country. It is important to note that a new educational principle has been introduced in these programmes and that new developments present a challenge to many professional teachers. It is their enthusiasm that has carried these studies through the extremely difficult situations. However, only time will show how the project will develop when the newer methods become routine. The hope is that we may use the principle of concerted community action in a constant process of review and renewal in the years ahead.

References .

001

Drugs in Modern Society: Community Reactions to Drug Use by Young People (United Nations, Division of Social Affairs) (UN/SOA/SEM/48/Misc.8/Rev. 1 ).

002

Meeting on Education in More-Developed Countries to Prevent Drug Abuse, UNESCO, Paris, 11 - 20 December 1972. No. (ED/MD/26).

003

International Congress on Drug Education, 14 - 18 October 1973, Montreux, Switzerland, Resource Material.

004

Accountability in Drug Education: A Model for Evaluation, L. Annette Abrams, Emily F. Garfield and John D. Swisher, eds. (Washington, D.C., Drug Abuse Council Inc., November 1973).

005

Nicholas Dorn, Teaching Decision-Making Skills about Legal and Illegal Drugs (London, Institute for the Study of Drug Dependence, 1978).

006

Nicholas Dorn , Anne Thompson and Kirsten Hvidtfeldt, The DEDE Project (London, Institute for the Study of Drug Dependence, 1977).

007

Bente Nortoft, DEDE 3 Projektet : Evaluering af laererkursusmateriale til rusmiddel-undervisning (København, Undervisningsministeriet, 1979).

008

Bente Nortoft, Drejer det sig om livet mellem lo og 14? Paper til Nordisk seminar om socialisering af børn og alkohol, Helsingfors, 3 - 5 September 1980.

009

Peter Schiøler, Report to the Ministry of Education on Experimental Teaching in Natural Science, 1962.

010

Peter Schiøler, Socio-Economic Changes that Influence the Problems of Substance Use, Paper presented at the 6th International Institute on Prevention and Treatment of Drug Dependence, Hamburg, 30 June 1976.

011

Peter Schiøler, Educational Methods and Goals, Paper presented at the 2nd National and Regional Conference on Drug Abuse, All Indian Institute on Medical Research, New Delhi, 10 - 15 March 1980.

012

Peter Schiøler, Drugs of Every Type in Education Inside and Outside the School System, Report to UNESCO, Copenhagen, 1980.

013

Peter Schiøler, Prevention - Some Principles, Paper presented at ALC 80, an International Conference on Alcoholism, University of Bath, 20 - 24 September 1980.

014

Peter Schiøler, Almen Stoflaere - viden om stofferne (København, Undervisnings-ministeriet, 1981).

015

Nicholas Dorn and Bente Nortoft, Health Careers; A Teachers' Manual (London, Institute for the Study of Drug Dependence, 1981). (In English. A Danish edition has been published by the Committee on Health Education, Copenhagen, 1981.)