Alcohol Awareness Month

Hello again, grownups!  I hope that my last communication, regarding the social media verdicts, their potential implications, and some thoughts about them from the public-health perspective, was useful to you.

April is Alcohol Awareness Month, and the reminder sparked a thought to write to you all about what constitutes effective alcohol misuse prevention.  After all, we’ve been trying to ensure that adolescents make healthy decisions and delay their first use of alcohol as long as we have known there were dire consequences for those who choose to initiate alcohol use when they’re young.  What have we learned in these several decades, and what lessons have we carried forward from history?

What is Effective Alcohol Use Prevention for Youth?

The History of DARE

One answer: we learned a whole bunch about what doesn’t work.  And like usual in human societies throughout time, we had to learn it the hard way – by trying those things very hard, repeatedly.

Based on both my background in psychology and a lifetime of experiencing a large diversity of cultures, I believe it is a universal part of the human condition to resist – mightily – the notion that we are wrong.  We don’t like being corrected; there is a feeling of embarrassment, sometimes even shame, associated with it.  That’s why I’m grateful that prevention of substance misuse is a science: in science, wrong answers (while they still don’t feel good) open pathways to new discovery, to reorganizing our thoughts about the world and all the wonderful life in it, and to change.  Change in behaviors, change in programming, and change in the boundaries we set for our youth.

I was put in mind of the kind of change that comes from ‘getting it wrong’ by a comment a student left following one of our programs.  Ironically, it is this student’s reasoned, constructive criticism that makes me certain Prevention Academy’s objectives were met during their session:

“…[it] sounded more like they were warning people about what the substances do instead of actually wanting to prevent people from using them.  I’m pretty sure everyone knows what these things do.  For more people, I think the best approach would be showing them disturbing imagery for what happens when they do these substances to actually prevent them from doing them.”

From this comment, it’s clear that the Prevention Specialist provided accurate and up-to-date information about the effects of alcohol and other drugs.  This is very important, although our critic’s perspective also bears some merit: having the information alone does not effectively result in healthier behaviors.  (I’ll come back later to how Prevention Academy’s curriculum addresses this.)

How many of you received the kind of instruction that the student recommends instead? I did; in 1992, I received the LAPD's Drug Abuse Resistance Education program, known more popularly as DARE.  It is because of DARE that we now know that such programs as our young student is referring to are not only not effective, they can be risky. DARE’s initial curriculum ran from 1983-1994; over that time, it was adopted by approximately 50% of schools in America. Among evaluations of DARE that were scientifically rigorous enough to report to Congress, outcomes were poor.  These students, when compared to those who’d had programming that was oriented more toward interactivity, were less aware of the harms of drug use; less willing to commit to being drug-free; less likely to show improvement in relevant social skills (see below); and more likely to initiate marijuana use [1].

This is often the way of things in public health: attempts to intervene on health that seem to us like they would be effective wind up having either no effect at all, or wind up driving people towards the unhealthy behavior.  Since 1994, DARE America has been engaged in the effort to deliver only effective programming; since 2012, their keepin’ it REAL curriculum has achieved positive results [2].

Effectiveness and Social Norms

For all of its many ins and outs (factors that determine what specific methods are most appropriate), effective substance abuse prevention always includes 3 objectives: 

1. Educate about the risks attached to substance use in general, particularly but not exclusively recreational substance use, especially (but again not only) while the brain's prefrontal cortex is still developing.

2. Develop the social skills, intrapersonal and social, that serve as protective factors against substance use initiation or the progression of substance use already begun.

3. Inform communities with accurate data about the prevalence of substance use among students’ peer groups to correct false perceptions that overestimate use. 

These false perceptions, also called false normative beliefs, are among the strongest motivators toward substance abuse. Youth hear pleas such as, “I know all of your friends are vaping, but I don't want you to” as a clearly stated motivation to use a drug paired with the instruction not to do so.  Adults deliver an instruction to resist peer pressure; teens receive an unhelpful mixed message to both perceive unhealth as the norm and choose health anyway.

Fortunately for us all: the norm is health. Most students ages 12-18 are making healthy decisions with respect to alcohol and other drugs. It remains a serious area of concern, and the older the students get, the more likely they are to have initiated substance use, and to have experienced a negative consequence as a result.

However, even among high school seniors, most teens do not typically drink alcohol or use other drugs. With respect to alcohol and other drug use, most 12th graders are mostly healthy, most of the time.

Correcting these misperceptions is a very important aspect of substance use prevention. It's called the social norms approach to prevention because we understand the power of these norms.  People tend to do what is normal.  They pay their taxes; they wear their seatbelts; they turn to face elevator doors after entering.

If adolescents believe that alcohol consumption during high school is the norm, they will be more motivated to do that as well.  By correcting this misperception, by showing them proof that health is the norm, we take that motivation to engage in risky behavior and turn it into a motivation to maintain healthy behavior.

It’s Okay to Know More

Bearing in mind that DARE was not just ineffective, it was in some cases harmful, put yourself in the shoes of someone who worked day and night to devise that program, or who trained police officers to go out into communities and connect with school youth and tell them what they believed to be the truth about alcohol and other drug use. 

Consider what it means to have made a good faith effort to do right and promote health among the youth that we all care so much about, whose safety we prioritize above all other things, only to learn that your actions had in fact promoted harm.

I cannot imagine the guilt that they must have felt. It must have taken acts of courage from many people at DARE America and elsewhere not to abandon their cause. Thankfully for the many students receiving the keepin’ it REAL curriculum across the nation, those likely guilty, possibly shamed, maybe even disbelieving health professionals instead went back to the drawing board.  They had committed themselves to promoting youth health and remained committed to that mission through this substantial setback.

And that's the thing we all want, to promote our children’s health, more than anything else we want for them – because that health is a major component in their pursuit of all of the other wonderful things we know they have the potential to achieve.

Parenting involves making decisions, setting boundaries, that outsiders often feel themselves well situated to judge.  I have never met a parent eager to hear another’s critique of those choices, no matter how well-intentioned or constructive.  Because, as noted above, we do not like to be corrected.  I believe firmly that this is, if not part of what it means to be human, certainly part of what it means to live in a society.  For this reason and others, we at Prevention Academy and the EmpowerED Resource Library tend to avoid making absolute statements about any one parenting strategy or boundary relative to alcohol and other drug use.  Many factors outside of our purview inform those decisions; we respect and honor that.  You are the experts on your children; we wish to place our expertise at your disposal, not to direct your choices concerning them.

There is one area of parental decision-making that has been subject to the false normative beliefs I mentioned above, to the harm of children who are being raised with the resulting, permissive boundaries.  In this area, even as we identify as harmful some practices that people previously thought protective, we are still offering resources and expertise, with no directives or judgment.  So if you are a parent who has made particularly permissive decisions about the boundaries you set around alcohol use, please consider the below.

Parental Permission to Drink: Consequences

For generations, it has been perceived among some parents that the safest way to help their teen navigate a relationship (or potential relationship) with alcohol is to introduce them to the drug while under direct adult supervision.  Maybe they believe the overgeneralization that “kids are going to drink,” and that by hosting (allowing on their premises) or even chaperoning (directly supervising) parties where alcohol is served, they are removing or minimizing the risks faced by adolescents who engage in alcohol use with each other without adult supervision.

But remember, health is the norm; only a minority of “kids are going to drink,”. Unfortunately, data shows us that adolescents who have parental permission to drink are more likely to do so, and to drink more frequently in greater volume with more negative consequences.  These include symptoms of alcohol use disorder (AUD), internalizing problems such as an increase in depressive symptoms, and externalizing problems such as peer violence [3].

If I could go back to, say, 1988 as the public health professional I am now (rather than the somewhat less well-informed eight-year-old I was then!) and counsel the administrators of DARE, I would say the same thing I say to parents who look at me with anxiety or frustration when I explain that permitting adolescents to drink under adult supervision is not only not helpful, it may in fact be quite harmful and exposes kids to unnecessary greater risk. I would say, it’s okay to know more.

I have to say this to myself very often. When I make a mistake; when I am confronted about it; whenever I have to adjust my approach to a situation, I remind myself that it's OK to know more. It doesn't mean I was unintelligent before or that I'm particularly wise now. It doesn't mean that I was bad before and I'm good now, in some way. It just means that I know more now.  In my early days in prevention, when I’d occasionally misstate a fact, or be unprepared to answer a question from a student or adult, I would try very hard not to punish myself for the mistake.  I would tell myself, “It’s okay.  Now, I can be more effective at promoting the health of the youth around me than I was before. It's okay to know more.”

Helpful Practices to Learn More

As I mentioned above, parents are often unaware of each other’s rule sets for their kids; they fill in the space where that awareness would be with supposition.  Those suppositions are usually false normative beliefs that other parents are more permissive than you.  It's okay to share with each other as parents in your community what your practices actually are, your boundaries with respect to adolescent engagement with alcohol and other drugs. In fact, it’s highly advisable.  Share what the rules are in your household. Let people know, “This is what we do and it seems to have been working so far. We think our kids are mostly healthy.”

If you're concerned that your rules may need some revision, it’s okay to ask around. See what other parents are doing. We've all heard, and perhaps in the deeps of our youth, we even said it: “Everybody else's parents are letting them _____. Why can't I?” Just as with the perception that most teens are using alcohol, this is usually not the case. Usually, parents set healthy boundaries for kids. That is the norm. It has been the norm for a very long time. The thing that changes is what we understand to be healthy. We now know that all exposure to any addictive substance is risky; that, while the brain is still developing (up until around the age of 25), any exposure of that brain to an addictive substance is particularly risky.  This is why we take pains to celebrate the health all around the youth engaged in the continuous tasks of growing those brains.

Stay Tuned!

As we learn more about alcohol and other drugs, we will continue to share that information everywhere it can be beneficial. That includes communicating with you, parents and guardians and administrators and teachers and counselors who love kids. 

For those of you who may have been permitting alcohol use, whether or not under your supervision, I (still without instruction or judgment) ask you for that act of courage that the DARE administrators undertook as well: the courageous act of saying, “Oops. Well, I know more now; let me do it this way instead.”

This is the beginning of a discussion; Prevention Academy is here to answer any questions you may have and, most importantly, to help you foster the connection with your kids that facilitates communication about these issues. Listen to them with an open mind and an open heart. Let them share their perspectives with you as you share yours with them, as you communicate your boundaries with them. Many of you may learn what adolescent health sounds like these days, and it might surprise you. It has certainly surprised me; I am very proud of this generation of kids. They have navigated difficult things already in their young lives. There is more difficulty ahead, but they are remarkably capable of discussing and promoting their own health, for themselves and each other. 

I encourage you, as the adults who guide and protect them, to invite yourselves into that discussion with them. Share your wisdom. Share your boundaries. Let them share their perspectives. 

Alcohol Awareness Month is a great time to have this conversation – and April is a great time to have Alcohol Awareness Month. As prom, graduation, the last game of the season, the last concert, and the last musical or play approach, adolescents will have new opportunities to take risks, such as afterparties, after-proms and the like. It's a great time for this discussion to celebrate their health, to let them know that you're proud of them for maintaining that expectation. To let them know that you just learned that most of their peers are doing the same thing, and that you love them.

Thanks for taking the time to read this. Again, if you have any questions, please don't hesitate to reach out. The Empowered Resource Library and Prevention Academy are here to be resources for you anytime.

Sources:

[1] Ennett ST, Tobler NS, Ringwalt CL, Flewelling RL. How effective is drug abuse resistance education? A meta-analysis of Project DARE outcome evaluations. Am J Public Health. 1994 Sep;84(9):1394–401. doi:10.2105/AJPH.84.9.1394

[2] Hansen WB, Beamon ER, Saldana S, Kelly S, Wyrick DL. D.A.R.E./keepin’ it REAL elementary curriculum: Substance use outcomes. PLoS One. 2023 Apr 28;18(4):e0284457. doi:10.1371/journal.pone.0284457 PubMed PMID: 37115774; PubMed Central PMCID: PMC10146478.

[3] Pereda B, Caluda-Perdue N, Levy S, Zhang L, Colder CR. Age of onset of adolescent alcohol use with parental permission and its impact on drinking and alcohol-harms in young adulthood: A longitudinal study. Addictive Behaviors. 2025 May 1;164:108271. doi:10.1016/j.addbeh.2025.108271

[4] Miech, R. A., Patrick, M. E., O’Malley, P. M., Jager, J. O. and Jang, J. B. (2026). Monitoring the Future national survey results on drug use, 1975–2025: Overview and detailed results for secondary school students. Monitoring the Future Monograph Series. Ann Arbor, MI: Institute for Social Research, University of Michigan. Available at https://monitoringthefuture.org/results/annual-reports/