Good Practices
Using the Internet for Drug Abuse Prevention
What is Drug Abuse Prevention (DAP)?
This article aims to outline good practices in using information technology, specifically the Internet, for DAP. Any discussion of youth drug abuse prevention is challenging because of variations in definitions within the field. Differences happen because societies' views vary on health, prevention, drugs and the continuum from use to misuse. North America specifically uses the word abuse when talking about drug use and, since a majority of the literature about DAP comes from North America, it is important to clarify this article's assumptions.
In this article, the terms drug abuse, prevention and drug abuse prevention are used with the following corresponding definitions or goals:
Drug Abuse: Use of an illicit drug and the inappropriate use of licit drugs (1).
Prevention: Internalization of social norms is a core function of prevention (2).
Drug Abuse Prevention
Effective drug abuse prevention interventions help:
1. Prevent risk behaviours before drug abuse occurs;
2. Prevent further abuse or addiction from occurring (3).
In addition, the recommendations provided in this article must be placed within the context of programme planning and design. The elements of planning a successful DAP programme do not change because either the programme itself or some elements are online.
Communities, agencies and youth need to work through the following key steps (4):
1. IDENTIFY specific drugs and other youth problems in a community.
2. BUILD on existing resources.
3. DEVELOP short-term evaluation and monitoring goals related to selecting and carrying out the prevention programme.
4. PROJECT long-term goals of the programme so that planning and resource allocation are available into the future.
5. EVALUATE the prevention programme on an ongoing basis.
Why should the Internet be used for DAP?
The Internet currently has 513 million users worldwide, with the fastest growth occurring in countries outside of North America (5). The Internet is becoming more multilingual with 65% of people online made up of non-English speakers. (6) Chinese, Japanese and Spanish are the fastest growing languages online (7). It is becoming easier for youth to find drug-related information and resources in their mother tongue.
And while the issues of access cannot be minimized, youth continue to be one of the highest users of the Internet with 60% (8) of the worldwide youth population having access in comparison to 34% of the total population (8).
Youth are drawn to the Internet for many reasons:
- Other youth are there (5).
- They can get answers to their questions (9).
- They can search for health-related information (10).
The Internet offers many different features appealing to youth (11):
- Web sites: A collection of information, entertainment and interactivity at a unique location or URL (e.g., www.unodc.org/).
- Search Engines: Search engines are databases of web resources that you can search for specific web pages/sites on a specific topic (e.g., searching for 'youth drug abuse prevention' on Google returns 684,000 hits).
- Chat Rooms: These are specialized web sites that allow youth to have instantaneous conversations. The rooms are usually divided by topic or intent (topics include: drug abuse recovery support, sports, drugs).
- Instant Messages: Specialized software that youth use to send instant messages to others registered with the same software (e.g., http://messenger.msn.com/).
- Bulletin Boards: Software that allows youth to read or post questions and information about specific topics. Posting does not happen instantaneously (e.g., CyberIsle [www.cyberisle.org] has a discussion board called HotTalk).
- Email: Software that allow youth to send and receive messages to specific addresses from an email account (e.g., www.mail.yahoo.com).
- Blogs: Specialized web site where a person keeps a diary of what they think, feel and what they have been doing (e.g., www.weblogs.com/).
For the DAP community, the Internet offers additional features:
1. Web sites can cross borders and benefit multiple populations - a web site developed for one community can be used by another, increasing cost effectiveness.
2. The Internet is always on and does not require appointment - it is not limited by traditional time and space. Youth can connect to information, resources or interventions at the best time for them.
3. Web sites can be updated and modified to meet changing needs.
4. Enthusiasm for the technology can connect youth who are traditionally difficult to attract to DAP programmes (9).
5. Expert systems can be created that provide customized feedback options for youth addressing risk and prevention issues.
6. Interactivity of Internet-based resources and information enhance vividness and appeal to youth.
Even without its many advantages, Internet-based DAP is important if for no other reason than because the drug culture itself is online (12) (13). The Internet makes information about drug use available at a faster rate than ever before. Information can be communicated within and across a country's borders in seconds. This speed and scope of communication means youth can form bonds that are not bound by geography but by interest - one of those interests is drugs.
But perhaps the most important reason for going online is because evaluations are starting to prove that Internet-based interventions work (14).
For people interested in creating online DAP programmes, there is still not a large body of literature to draw on. However, there are a number of principles of DAP that have been shown to be effective. Many of these same principles are relevant for online programmes.
Principles of Prevention
The US National Institute on Drug Abuse (NIDA) has outlined principles for research-based drug abuse prevention programming at the community level (15). Internationally, there are many ways of framing the issue of prevention. The principles relevant to any initiative are dependent on the setting (e.g., individual, peer, school, family, community and culture) and on the youth's age.
Themes & Related Principles of Prevention
Risk and Protective Factors
- Enhance protective factors and reverse or reduce risk factors
- Address all forms of drug abuse alone or in combination
- Address the type of drug abuse problem in the local community, target modifiable risk factors and strengthen identified protective factors
- Tailored to address risks specific to population or audience characteristics (e.g., age, gender, ethnicity)
Prevention Planning
- Family-based programmes should enhance family bonding and relationships
- School-based programmes should intervene early to address risk factors (e.g., aggressive behaviour, poor social skills, academic difficulties)
- Community-based programmes should not single out risk populations
- Community-based programmes should combine two or more effective programmes
- Community-based programmes should reach populations in multiple settings with consistent messages in each setting
Prevention Programme Delivery
- Communities adapting programmes to meet their needs should retain core elements of the original research-based intervention
- Programmes should be long-term with repeated interventions
- Programmes should include training for teachers on classroom management
- Programmes should employ interactive techniques
- Programmes should be cost effective
Best Practices and how they relate to the Internet
A number of the outlined NIDA principles illustrate the suitability of the Internet for DAP and/or the need to develop web-based DAP programming.
1. Risk and Protective Factors: Enhance protective factors and reverse or reduce risk factors
A key principle of research-based drug abuse prevention programming is that programs focus on enhancing protective factors - those factors that make the development of drug misuse less likely. Protective factors for youth often include a focus on peer relationships and support (16). This focus reflects the importance of peers to many youth as they seek independence from their family and/or guardians. And while it is difficult to demonstrate the preventive effect of addressing specific protective factors, programming that focuses on protective factors in different environments (school, family, individual, etc) can show positive results (17).
The Internet with its myriad of online communication tools (chat, discussion boards, MSN, email) is an environment where youth connect and interact. Not unlike school or social or religious organizations, youth can connect through the Internet to existing networks and/or plug into new networks of support. Also for some youth, sensitive topics may be more easily questioned or discussed using the anonymity offered by many online communities (18). For prevention programming looking to address protective factors with youth, the Internet offers both an additional environment through which to reach youth, and an opportunity to connect to youth through peer relationships.
2. Prevention Planning: Community-based programmes should combine two or more effective programmes
Comprehensive programming that has been found to be more likely to be effective than single focused activities (17) can occur at many levels. Programmes can target a variety of substance issues and/or reach the target population at many levels (school, family, community and individual). The Internet is ideal for supporting comprehensive programming at all levels.
The structure of the Web with its hyperlink technology allows users to decide how much depth of information they want to access. Through exploring links, users can have very different experiences on the same web site and access very different levels and types of information. In addition, web-based programming can extend the reach of and access to offline programme components. Linkages between web sites and offline programming can be an ideal way to reach out to youth - extending the impact of both the online and offline programming. And finally as outlined above, the Internet is an environment where youth connect. Programming seeking a presence in youth environments needs to consider the Internet as part of a comprehensive programme strategy.
3. Risk and Protective Factors and 4. Prevention Programme Delivery: Tailored to address risks specific to population or audience characteristics. Programmes should employ interactive techniques.
For prevention programming, interactive methods (peer discussion, group problem solving, etc) are recommended, as is creating programmes targeted by factors such as age, gender, culture and development stage (19) (20) (21). The Internet quite simply is all about interactivity and tailored experiences. Through chat rooms, discussion boards, email and other communication software, youth can communicate and connect with peers one-on-one or in a group. Interactive programming allows youth to complete quizzes and surveys online, for example, and immediately receive tailored feedback. Even the experience of a particular web site can be tailored where a youth can choose the look and feel appropriate for them. Alternatively, different sections of a web site can be tailored to support different audiences like teachers, parents and youth.
5. Prevention Programme Delivery: Programmes should be long-term with repeated interventions
While not the only factor, interventions showing long-term impact have included an intense intervention and booster sessions (19). There is also some evidence that community interventions may reinforce school-based programmes (19). The Internet can be an ideal tool for extending interventions and/or adding boosters. Not limited by time and space, web-based programmes and/or programme components can enhance community or school-based programming by reaching youth outside of normal programming time, for example, by providing access to information and resources that supplement the face-to-face experience through email or bulletin boards.
Challenges and Issues of Internet-based DAP
Despite the relevance of the Internet to NIDA's principles for research-based drug abuse prevention programming at the community level, a number of challenges to online DAP programming remain:
1. Evaluation
Evaluation is ongoing. In DAP, school-based programmes have been the most evaluated (2) (22), yet questions remain about long-term effectiveness (19). If online DAP programmes follow available research-based principles, in addition to the limitations of those principles, there are unique features to online programming. There have not been a lot of published evaluations measuring the effectiveness of online resources (14). Evaluation work has been done in the area of smoking cessation (14), and the findings from this research could be adapted to other substances.
2. Impact
Before being able to make the most of the Internet's capabilities, DAP programming must first address the issue of whether or not universal prevention programmes are effective at helping higher risk youth (23). The Internet is a general medium (anyone with access can use it) but its interactivity and tailoring can ensure that appropriate messages are being communicated consistently to specific youth populations.
3. Cultural appropriateness
A fundamental issue in the DAP field is whether prevention resources developed in North America and Europe are appropriate for export to other countries. Since the Internet diminishes borders, this issue will become even more pressing because it will be easy to incorporate resources developed in other cultures.
4. Access
The biggest Internet issue is access. Once access has been established within a country the next hurdle is ensuring that there is equitable access within the country. There is a strong relationship in the USA between low income and lack of access to the Internet (24). This is a particular problem if the more selective or indicated programmes are online but the populations meant to use them do not have access, like:
o Low intensity interventions = general population;
o High intensity interventions = high risk population.
5. Finding quality information on the Internet
Unfortunately, the health information available online is of mixed quality (25). It is easy to find 684,000 responses to the search 'youth drug abuse prevention', but it is difficult to know just what these web sites are saying. Are they promoting true DAP principles or are they selling unproven approaches? This is a significant issue with English language resources; it would be interesting to investigate if the same issue exists with non-English language resources. The health field, in general, continues to struggle with how to address this issue.
Examples of web sites illustrating DAP principles
This section provides some examples of web sites that are meeting the NIDA principles of prevention identified in the Best Practices Section.
The quest to find a web site example that supports all of the NIDA principles continues. With many web sites focussing on providing text-based information on drug effects, the full interactive capacity of the Internet is not currently being used.
1. Enhancing protective factors and/or reducing risk factors:
CyberIsle (www.cyberisle.org)
CyberIsle's discussion board HotTalk is a place for youth to connect to peers for support and advice.
Soy Unica Soy Latina (www.soyunica.gov/)
The web site helps Latin girls enhance their self-esteem and build protective factors to reduce the risk of drug use.
2. Combining two or more effective programmes.
Know the Score (www.knowthescore.info)
Supports community programmes by providing pathways for youth to connect to DAP services in their community (24-hour phone service, directory of resources and links to other resources).
Alcohol.org.nz(http://alcohol.org.nz/hadenough/index.html)
Online survey provides tailored profile of drinking, including indicators of possible problem drinking. Supports community programmes by providing users with ways to connect to prevention services in their community using stages of change model to guide action.
3. Tailored to address risks specific to population or audience characteristics.
Reachout (www.reachout.com.au/default.asp?ti=71)
Includes information about drugs and alcohol. It allows for personalization of web site features (e.g., book-marking, emailing files, journal, etc).
Aunt Stella (www.tarsc.org/auntstella/questions/25.htm)
Has a question about marijuana in a culturally specific context.
Alcohol.org.nz (http://alcohol.org.nz)
Includes areas on the web site tailored to different populations (www.alcohol.org.nz/maori/mihi.html) and interests (www.alcohol.org.nz/sportszone/noflashome.html).
4. Programmes should employ interactive techniques.
Fuel (www.alcohol.org.nz/fuel/game.html)
Web site has fun alcohol party game that allows youth to reflect on the impact of drinking.
Kids Help Phone (www.kidshelpphone.ca)
In the fall, it will be hosting moderated weekly chats with small groups of youth (www.kidshelpphone.ca/en/myself/discussions.asp).
Conclusion and where next
Online DAP offers exciting potential to expand on proven DAP principles as well as to explore new avenues for reaching youth. The challenge for organizations as they embrace the possibility and potential of technology is to remember that technology is just one more tool.
References
1. National Institute on Drug Abuse (2003). Preventing Drug Use among Children and Adolescents: A Research-Based Guide for Parents, Educators and Community Leaders: In Brief, 2nd ed: p: v.
2. United Nations Office on Drug Control and Crime Prevention (2000). World Drug Report 2000.
3. National Institute on Drug Abuse (2003). Preventing Drug Use among Children and Adolescents: A Research-Based Guide for Parents, Educators and Community Leaders: In Brief, 2nd ed: p: v.
4. National Institute on Drug Abuse (2003). Preventing Drug Use among Children and Adolescents: A Research-Based Guide for Parents, Educators and Community Leaders: In Brief, 2nd ed: p: 13.
5. NUA (n.d.). How Many Online: 513 Million? Visited on August 2001: www.nua.com.
6. Global Reach (2003). Global Internet Statistics (by Language). Visited on December 17, 2003: http://glreach.com/globstats/.
7. Global Reach (2002). Evolution of Online Linguistic Populations. Visited on December 17, 2003: http://global-reach.biz/globstats/evol.html.
8. Taylor Nelson Sofres (2002) Interactive-Global eCommerce Report 2002 (survey of 37 countries). Visited on December 17, 2003: http://www.tnsofres.com/ger2002/download/index.cfm.
9. Youthnet (2003). Information and Communication Technology: Web sites, CD-Roms, and online educational projects hold promise for youth.
10. Fox, S., Fallows, D. (2003). Internet Health Resources: Health searches and email have become more commonplace, but there is room for improvement in searches and overall Internet access. Pew Internet & American Life Project.
11. Skinner, H., Biscope, S., Poland, B., & Goldberg, E. (2003). How Adolescents Use Technology for Health Information: Implications for Health Professionals from Focus Group Studies. Journal of Medical Internet Research. 18: 5(4): p: e32.
12. Winickoff, J., Houck, C., Rothman, E., Bauchner, H. (2000) Verve and Jolt: deadly new Internet drugs. Pediatrics. 106(4):829-30.
13. Tong, T., Boyer, E. (2002) Club drugs, smart drugs, raves, and circuit parties: an overview of the club scene. Pediatric Emergency Care. 18(3):216-8.
14. Norman, C., Skinner, H. (2003) Systematic Review of eHealth Behaviour Change Research. Unpublished. University of Toronto: p: 2-12.
15. National Institute on Drug Abuse (2003). Preventing Drug Use among Children and Adolescents: A Research-Based Guide for Parents, Educators and Community Leaders: In Brief, 2nd ed: p: 2-5.
16. Roberts, G., McCall, D., Stevens-Lavigne, A., Anderson, J., Paglia, A., Bollenbach, S., Wiebe, J., Gliksman, L. (2002). Preventing Substance Use Problems among Young People: A Compendium of Best Practices. Canada: Health Canada, p: 21-23. Visited on January 11, 2004: http://www.hc-sc.gc.ca/hecs-sesc/cds/publications/substanceyoungpeople/toc.htm.
17. Roberts, G., McCall, D., Stevens-Lavigne, A., Anderson, J., Paglia, A., Bollenbach, S., Wiebe, J., Gliksman, L. (2002). Preventing Substance Use Problems among Young People: A Compendium of Best Practices. Canada: Health Canada, p: 24. Visited on January 11, 2004: http://www.hc-sc.gc.ca/hecs-sesc/cds/publications/substanceyoungpeople/toc.htm.
18. Skinner, H., Biscope, S., Poland, B. (2003). Quality of Internet Access: Barrier Behind Internet Use Statistics. Social Science and Medicine. 57: p: 875-880.
19. Gilvarry, E. (2000) Substance Abuse in Young People. Journal of Child Psychological Psychiatry. 41 (1): p: 55-80.
20. Roberts, G., McCall, D., Stevens-Lavigne, A., Anderson, J., Paglia, A., Bollenbach, S., Wiebe, J., Gliksman, L. (2002). Preventing Substance Use Problems among Young People: A Compendium of Best Practices. Canada: Health Canada, p: 43. Visited on January 11, 2004: http://www.hc-sc.gc.ca/hecs-sesc/cds/publications/substanceyoungpeople/toc.htm.
21. Roberts, G., McCall, D., Stevens-Lavigne, A., Anderson, J., Paglia, A., Bollenbach, S., Wiebe, J., Gliksman, L. (2002). Preventing Substance Use Problems among Young People: A Compendium of Best Practices. Canada: Health Canada, p: 39-41. Visited on January 11, 2004: http://www.hc-sc.gc.ca/hecs-sesc/cds/publications/substanceyoungpeople/toc.htm.
22. Pentz M.A. (1994). Directions for Future Research in Drug Abuse Prevention. Preventative Medicine. 23: p: 646-652.
23. Griffin, K.W., Botvin, G.J., Nichols, T.R., Doyle, M.M. (2003). Effectiveness of a Universal Drug Abuse Prevention Approach for Youth at High Risk for Substance Use Initiation. Preventative Medicine. 36:p: 1-7.
24. Spooner, T. (2003). Internet Use by Region in the United States: Regional Variations in Internet Use Mirror Differences in Educational and Income Levels. Pew Internet and American Life Project.
25. Eysenbach, G., Kohler, C. (2003). How do Consumers Search for and Appraise Health Information on the World Wide Web? Qualitative Study Using Focus Groups, Usability Tests, and In-Depth Interviews. BMJ 9; 324(7337): p: 573-7.
Prepared by:
Oonagh Maley and Sherry Biscope
Teennet
Toronto, Canada