Treatment Doesn't Work Abstract Research has shown that conventional drug and alcohol treatment may actually cause people to drink and use drugs again. In 1991 Baldwin Research first reported on the poor results achieved by conventional methods of treatment for drug and alcohol problems. In its report it referred to the U.S. Department of Health and Human Services; National Institute on Drug Abuse's 1988 report that indicated "97% of drug addicts become re-addicted within five years after treatment and 82% of alcoholics treated for alcoholism remain abstinent for less than six months" (Baldwin Research Project of 1990, Ã‚Â© Gerald J. Brown, 1991).
Adolescents present special problems with respect to treatment. Whereas the overall population seeking treatment demonstrates a "placebo" affect of about 20% to 30%, no such affect is observed in adolescents post treatment. Studies of conventional treatment of adolescents yielded a 0% success rate over a 14 month period post treatment. All but one of the subjects in the study relapsed within a few weeks post treatment.
In the last fifty years alcoholism and drug addiction professionals, along with related government agencies, have spent millions of dollars proving one simple statement: "Treatment Works." All of the studies that proclaimed "Treatment Works" left out comparing treatment to "no treatment." Enoch Gordis, director of NIAAA, presented at the NYSAASAP Conference in Saratoga Springs, New York in October 1998 that 20% to 30% of alcoholics and drug addicts who undergo treatment recover. Therefore, treatment works! It has been known for sometime now that 20% to 30% of alcoholics and drug addicts recover following a "brief intervention." That is to say that 20% to 30% recover with "no treatment." Thus, the 20% to 30% of recoveries that Enoch Gordis and the rest of the industry are taking credit for are not the result of treatment but the result of the "placebo" effect. The truth, then, is finally clear: Treatment Doesn't Work.
For the purpose of this report "Treatment" refers to programs that use medical and psychological methods to treat alcohol and drug problems.
"Wrong is wrong, even if everybody is doing it, and right is right, even if nobody is doing it." -Bishop Fulton J. Sheen
Conventional treatment for drug and alcohol problems is "wrong," even though everybody is doing it! Saying that this type of treatment is wrong is part of Baldwin Research's mission.
Baldwin Research Institute's mission is to research and develop programs for recovery from drug and alcohol problems, to guide the drug and alcohol treatment industry and be a force for change, to research and develop drug and alcohol abuse prevention programs, and to honestly and objectively educate the public as to the effectiveness of treatment and prevention program with respect to drug and alcohol abuse.
The Baldwin Research Institute, Inc. is a New York State Corporation. The United States Department of Treasury has ruled Baldwin Research Institute to be a tax exempt corporation as described in section 501(c)(3) of the Internal Revenue Code. As such the Baldwin Research Institute is registered with the New York State Attorney General's Office Charities Bureau and The New York State Department of State Office of Charities Registration. Additionally, the Baldwin Research Institute has been approved by the New York State Supreme Court to conduct business as a not-for-profit corporation in the State of New York and has been approved by the New York State Department of Education as an institute conducting alcohol and drug research.
Baldwin Research began its efforts in 1989 when it conducted a study of modern Alcoholics Anonymous. Then in 1990 it began a study of 38 subjects with drug and alcohol problems. This study still goes on today and Baldwin Research will be reporting the 10-year results in year 2000. These studies were initiated to prove or disprove claims by Alcoholics Anonymous of success rates as high as 93% and claims by the treatment industry of success rates as high as 80%. Baldwin Research was able to duplicate the 93% success rate, but could not validate a single treatment program with a success rate greater that 30%.
The most important credential the authors have is being recovered alcoholics and drug addicts. The second most important credential is that none are psychologists, therapists or counselors.
The authors do not offer this work as a research paper, but rather a report of the current state of affairs with respect to the drug and alcohol treatment and prevention. Additionally, the authors do not offer this work as a comprehensive report of those industries in that such a report would require volumes more to address the subject.
This report is designed to provide the reader with enough of an understanding of the industry, along with its attendant successes and failures, to determine for themselves the appropriate course of action in the treatment of people with drug and alcohol problems.
Jerry Brown is a retired corporate executive. Jerry, himself a researcher, has managed several world-class research organizations and corporations. He has served as an executive in a Fortune 100 company as well as President and CEO of several private and publicly traded research companies. Currently he serves as a senior researcher for Baldwin Research.
Mark Scheeren has been a contributor to the research since 1989 and continues to provide guidance and direction to the research work. Mark currently serves as President of Baldwin Research.
It seems that we, meaning the drug and alcohol treatment industry and Baldwin Research, are caught up in a classic Kuhnian paradigm shift. We do not believe our separation with the treatment industry is as simple as a "not invented here syndrome." We believe we are at a point where two well-intended sciences are colliding. Certainly dedicated people in the treatment industry remain convinced that the programs conducted by them are helping many people. However, prior to every paradigmatic shift the existing paradigm ignores the new approach and challenges the incoming paradigm. The reason for the old paradigm to resist is prophetically presented in Kuhn's book The Structure of Scientific Revolutions. He writes, "No part of the aim of normal science is to call forth new sorts of phenomenon; indeed those that will not fit in the box are often not seen at all. Nor do scientists normally aim to invent new theories, and they are often intolerant of those invented by others.1 Instead, normal-scientific research is directed to articulation of those phenomena and theories that the paradigm already supplies." (1Bernard Barber, Resistance by Scientists to Scientific Discovery, Science, CXXXIV, 596-602)
To be sure, we have jointly, and needlessly, taken a path that forces Baldwin Research into conflict with the treatment industry-one of us right, one of us wrong-one of us wins, one of us loses. I am certain the absurdity of the situation has not gone unnoticed by many in the industry. We are both working to help people recover from drug and alcohol problems; how much more effective would it be if the treatment industry and Baldwin Research were to join forces. Baldwin Research's staff is sufficiently "out-of-the-box" to research and develop, without prejudice, new technologies for the treatment of drug and alcohol problems. Many organizations in the treatment industry have the financial wherewithal to conduct that research. But these organizations lack the independence necessary to be true to the research and not to the existing paradigm, a paradigm that has been proven not to work.
Historically, the treatment industry and government agencies have spent billions of dollars in research. Tragically, the research has not been to find the most effective treatment for alcohol and drug problems, but to prove that the methods that are currently being used are effective. This phenomenon is exactly what Kuhn observed in all other sciences. That is: the current science (methods) can be studied and refined but cannot be replaced. Thus, when new studies prove the current methods ineffective and challenge the established paradigm with more effective and innovative methods, the established paradigm must protect its existence by rejecting the "new," setting aside facts, logic and truth. This, then, is the environment, into which our conclusive research that "treatment doesn't work," and our new methods must compete. Nevertheless, the compelling truth is simply this: existing paradigms always yield to new paradigms. This is true because it is the nature of things.
This document is in process. By December 2001 it is expected to be revised five separate times with the first revision scheduled for March 2000. Each revision will have its own forward that will describe the information that is added, revised and updated.
In this first release we present research that definitively demonstrates conventional drug and alcohol treatment of adolescents is of no value. Moreover, such treatment of adolescents is actually detrimental to the family unit causing deep-seated resentments on the part of the adolescents who are "forced" into treatment and even deeper seated resentments by family members when the adolescent begins using again.
We will also discuss the CALDATA Study, the Chapman-Walsh Study, the 1998 New York State Office of Alcoholism and Substance Abuse Services Study, and the NIAAA Match Study. These studies all have severe flaws in their efforts to prove that "treatment works." For example, Andrew Mecca, Director of the CALDATA Study, asserts that self-reporting by drug addicts is reliable. He bases his assertion on a 1989 report by R.L. Hubbard, et al. that states, "Studies of the reliability and validity of responses to surveys by drug abusers show that addicts provide generally truthful and accurate information." Nothing could be further from the truth. As the old joke observes: "you can always tell when an alcoholic or drug addict is lying-their lips are moving."
However, we consider the most important subject of this release is the news that few, if any, people with drug and/or alcohol problems benefit from drug and alcohol treatment programs. Further, this document will show why subjecting a person with a drug or alcohol problem to conventional treatment is a complete waste of time and money and may actually be a cause of relapse.
You will note that within the framework of this document verbatim inserts of other documents and studies have been used. The reason for the verbatim inserts is to ensure that the work of the researchers and authors used in this report are not misquoted or misrepresented by using isolated quotes that may, out of context, say something different than what was intended. Additionally these inserts contribute to the readability and credibility of the report, and we are grateful to those organizations and individuals that allowed us to use their information.
Baldwin Research Institute's mission is to research and develop programs for recovery from drug and alcohol problems, to guide the drug and alcohol treatment industry and be a force for change, to research and develop drug and alcohol abuse prevention programs, and to honestly and objectively educate the public as to the effectiveness of drug and alcohol abuse treatment and prevention programs.
The Baldwin Research Institute has been conducting studies on drug and alcohol abuse treatment since 1989. The Institute is a not-for-profit New York State corporation that conducts research and develops programs for recovery from alcohol and other drug problems. The Baldwin Program, developed during the last eight years, is unique; it should not be confused with conventional treatment programs. "Conventional treatment" is defined as methodologies promulgated by the New York State Mental Hygiene Law and the Office of Alcoholism and Substances Abuse Services' (hereinafter "OASAS") Regulations. The dramatic difference between the Baldwin Program and conventional treatment is demonstrated best by their respective results.
Before discussing this data, it is important to understand parameters that affect the results. Some factors that affect the relapse rate are marital status, employment status and financial status. The least likely to relapse after treatment is a married, employed, middle-class alcoholic or drug addict. This seems to be born out in the Chapman-Walsh study where all of her subjects were employed by General Electric and in the Taylor and Associates Study where all the subjects were married. The Baldwin Study agreed with the Chapman-Walsh Study and the Taylor and Associates Study for the specific group each studied, that is, the "employed, middle-class" group and the "married" group, respectively.
However, the Baldwin Study cited other studies that demonstrated random sampling exhibited a significantly lower success rate than sub-groups of the random sample where the sub-groups were employed, middle-class, and/or married. (The Baldwin Research Project of 1990, G. Brown, 1991)
There also exist certain anomalies in the data that need to be understood. In 1982 the Vaillant and Milofsky Study reported a 19% success rate over 27 years. This study did not fit with the results of other studies. In 1983 Vaillant reported in another study of 685 alcoholics that success rates were significantly lower than those reported just a year before in Vaillant's study with Milofsky. In 1983 Vaillant reported less than a 23% success rate at two years post treatment and less than a 5% success rate at 8 years post treatment. The 1983 Vaillant Study fell within a few percent of previous researchers and was consistent with the Baldwin Research Project, which followed 8 years later.
Regarding the sample size, N, "random-ness" of the sample appears to play a far more important role in the results than does sample size. When sampling is random, or even "pseudo-random," these samples seem to be statistically representative of the total population, even when the sample size is as low as 20 subjects. For example, in 1982 Gottheil and associates studied 20 alcoholics. The Gottheil Study was of particular interest because the result of the 20 alcoholics originally studied by Gottheil and associates were later pooled with a larger study. Gottheil and associates concluded that, of the 20 alcoholics they studied, 81% relapsed within 6 months of treatment. The pooled study consisted of 499 alcoholics, and it concluded that 82% relapsed within 6 months of treatment. In 1981 another independent study, Maddux and Desmond, followed 1651 drug users and concluded 87% relapsed within 6 months of treatment. It is interesting, if not compelling, to note that all three studies delivered consistent results at the 6-month post treatment period despite widely varying sample sizes ranging from 20 to 1651 subjects. And, extrapolating from these results, it is not unreasonable to suggest that although the Baldwin Study sample size was only 38 subjects its results probably would not vary more than Ã‚Â±5% had the study been conducted on a larger population. Of the 38 subjects in the Baldwin Study, one adolescent fatally overdosed early in the study. A deceased category was not accounted for in the study; therefore, all calculations were based on a total population of 37 subjects.
Remarkably, The Baldwin Program as reported in the Baldwin Research Project of 1990 produced significantly better results than conventional treatment at the end of the fifth year. Please consider the following.
The Baldwin Program has shown a 70% success rate at 6 months following participation in the program, where conventional treatment has yielded only an 18% success rate at 6 months post treatment. And, at 5 years following treatment, conventional treatment yields an average success rate of 10%, while the Baldwin Program observed a "worst case" success rate for that same period of 60%. Thus, the Baldwin Program is at least 6 times more successful than conventional treatment in helping persons with drug and alcohol problems.
Throughout history man has sought to improve life. Some efforts produced remarkable results. These results have included such wonders as the lame walking, raising people from the dead and curing the incurable. The medicine of antiquity was deeply interwoven with religious and philosophic dogma, often hindering advances in the necessary knowledge. Once the scientific method was introduced to medical research the pace of advances was staggering, particularly in the latter half of the twentieth century.
Since antiquity there have been stories of miraculous cures cited in many sources including, of course, the Bible, and in particular, the New Testament. Throughout the ages and cultures of man, secular and religious healing coexisted, both with their own claims of miraculous cures. The cult of Asclepius, the Greek god known as the "blameless physician" in the Iliad, were contemporaries of the more "rational" doctor, Hippocrates. But, their followers went to temples where miraculous cures took place, from Athens to Rome for several centuries until Christianity gradually became the dominant religion in the region.
During the Middle Ages, Christianity struggled with some ambivalence toward medicine, pulled between accepting disease as a manifestation of Gods will and healing by miracles against the practice of medicine. Saint Augustine, circa AD 430, wrote of many miraculous cures he had seen in his day. Many miracles involved martyrs and saintly kings. Edward the Confessor was said to have washed the neck of a diseased and infertile woman curing her of her scrofula (a form of tuberculosis) and leading to her giving birth to twins within a year. The diluted blood of St. Thomas of Canterbury was said to have cured blindness, deafness, insanity and leprosy. The patron saints of physicians and pharmacists, the martyred brothers, Cosmas and Damian, were said to have been responsible for many miracles. One involved coming to a physician in a dream to tell him to perform a surgical operation on a woman with breast cancer. The physician on finding this woman at a church praying to these two saints found the operation already performed, and he was left to merely apply the healing ointments.
Despite the church's ambivalence, the monasteries of the Middle Ages were responsible for the preservation of the classical medical writings of Hippocrates and Galen. With the Renaissance and the Age of Reason, medicine began to flourish and anatomical and physiological studies added to the body of knowledge. With the discoveries brought about by the application of the scientific method, medicine has made incredible strides in healing disease with most of the success coming in the twentieth century. True miracles are wrought every day as heart attack victims with deadly arrhythmia's are brought back from the dead by "shocking" them with defibrillators. Children rescued from drowning in cold water and found in coma with a barely detectable heartbeat have been brought back to life. Accident victims close to death from head injury, trauma to internal organs, or massive blood loss are routinely returned to the land of the living with resuscitative techniques, intensive care and emergency surgery.
Modern medicine, along with general improvement in hygienic practices and the standard of living, has formed the miracle of reducing the scourge of infectious diseases such as tuberculosis, plague, smallpox, and polio, some of which have wiped out portions of whole populations as they spread through the land as epidemics. Because of vaccines smallpox is gone from the planet except as a laboratory culture, and polio is predicted to soon depart as well-it is already completely gone from the Western Hemisphere. Antibiotics have provided cures of chronic infections that were deadly in ages past: plague, tuberculosis, leprosy and syphilis.
With the discovery of insulin and the ability to provide it to patients, diabetes, always fatal in the juvenile form, can now be treated and continued progress is being made in preventing the complications that occur due to imperfect control of blood sugar. Many forms of cancer can now be cured with a combination of surgery, radiotherapy, chemotherapy and/or bone marrow transplants; childhood leukemia, for instance, once uniformly fatal, now has cure rates approaching 90 percent for some forms. The lame can clearly be helped to walk if they have rheumatoid arthritis treated by many modern anti-inflammatory drugs or if they have one of several neurological conditions such as myasthenia gravis or post-infectious ascending polyneuropathy that respond to medications with complete return of neuromuscular function. The psychotic patient once put away for life in an institution can be treated with modern psychoactive drugs and live in the community.
Surgery to repair congenital defects of the heart, intestinal and urinary tracts is commonplace today and is performed on younger and smaller infants who 50 years ago would have been left to die. Failing organs such as kidneys, liver and heart are now replaced by transplantation. Arteries clogged with atherosclerotic plaques are opened by catheter-based therapy or bypassed surgically. Artificial joints are replacing knees and hips, which used to leave patients crippled with arthritis in their later years and unable to walk. Clearly the list of "miracles" of modern medicine seems limitless.
From the early successes of the "rational" medicine of the Greek physician Hippocrates to the miracles created by the application of the modern scientific method for healing disease and from the healing arts of the pagan shaman to the modern faith healer, there has been a steady torrent of stories of cures throughout human history. But there have been myths about cures and treatments as well as outright mistakes along the way. Much of the healing arts methods through the ages have been based on unfounded myths and honest mistakes. The traveling "snake oil salesman" may or may not have been honest about the healing powers of his wares, but the idea that a particular product was effective had to come from some prior mythic belief or from anecdotal experience. Even today, in this era of great technological advances in medicine, mistakes have been made and unfounded myths have been exposed through the magnifying lens of the scientific method.
Based on the dogma that disease is caused by humors in the blood that need to be removed, bloodletting as a therapeutic approach was used in the days of Galen (130 -200 AD) up to the early twentieth century. Even Harvey in the 1600s whose scientific studies added much knowledge about the human circulatory system believed that bloodletting was good for diseases caused by plethora, a useless abundance of blood. Whether blood was removed by puncturing blood vessels with a lancet or more slowly with the use of leeches, bloodletting was recommended for treating inflammation, fevers, many different disease states and even hemorrhage (why removing blood helps when you have already lost some escapes the mind of modern man). There were patients who survived this therapy, and who recovered because the natural history of their problem was one of spontaneous recovery. Some actually benefited from bloodletting, for instance, those who had excessive body fluid from congestive heart failure might have had some temporary relief of symptoms. As a scientific approach to medicine began to take hold, a French physician, Louis, in the 1800s did a statistical analysis of the efficacy of bloodletting and showed that bloodletting did not alter the course of pneumonia. Physicians of that era ignored Louis's studies, however, so convinced were they of the prevailing theory of disease causation. It was not until medical science had provided better explanations for disease mechanisms that bloodletting finally fell into disrepute. Medical historians note that bloodletting continued in popularity because doctors, patients and family were all convinced that something important, even heroic, was being done; in addition, the patient, once bled and brought to a state of fainting would appear to be more restful.
Other examples of misdirected therapy based on a myth or mistaken paradigms are the ritual surgeries of the past and present. Through the first three quarters of the twentieth century it was almost a given that children would have their tonsils removed if they had more than a few episodes of sore throat. Even though by the 1950's there were antibiotics to treat strep throat, the only treatable cause of sore throat, the bulk of the remainder being viral, it was thought that removal of the easily infected tonsils would decrease not only sore throat incidence but other respiratory infections, poor appetite, allergic symptoms, etc. Studies were done that showed that only those with quite frequent strep throat would benefit by tonsil removal. Children normally have quite large tonsils relative to adults, but the size has not been related to frequency of infection, and the natural history is one of gradual diminishing size with age. As the medical paradigm shifted, the number of tonsillectomies performed annually in the U.S. peaked at 1.4 million in 1959.
A more current controversy is that of circumcision of the newborn, the surgical removal of the foreskin of male newborns, which is actually a religious ritual for those of some faiths. And, although done on 90 % of American male infants, male circumcision is not the norm in other developed as well as developing nations. The medical myths that circumcision prevents cancer, HIV, urinary tract and other infections have been the reason for this surgery. Recently, after careful review of studies done over the last 40 years, the pediatric professional society has come out with the statement that the medical " benefits are not significant enough for the AAP to recommend circumcision as a routine procedure." Other examples of surgery abandoned or modified because of changing understanding of disease processes or major shifts in thinking would be the trend to remove less breast tissue in breast cancer and the move from total removal of the ruptured or lacerated spleen to partial splenectomy, operative repair and even observation without operation.
Tobacco was brought to Europe from America, and it was hailed by some as having medical virtues and others as a poison; the latter truth took centuries to prove, however. The belief that tobacco had health benefits, no doubt, was derived from its medicinal use by Native Americans. And, in 1571, the Spanish physician Nicolas Monardes claimed that tobacco could cure 36 health problems. It was and is used as a stimulant, appetite suppressant and painkiller by smokers and was recommended by physicians for these uses until information from studies began to mount that smoking was associated with cancer. After World War II cigarette smoking became almost the norm for the U.S. population - in 1965, the peak year, 52 % of men and 32 % of women smoked - and physicians smoked along with their patients and were featured in ads recommending certain brands! There were hints in the medical world of problems with tobacco; for instance, a study from France in 1859 showed that smoking from short clay pipes was associated with oral cancer. It took until the 1950's for good epidemiological studies to reveal the association of tobacco use and lung cancer, and until 1964 for the release of the first of a series of reports from the U.S. Surgeon General documenting that smoking causes lung cancer. It should be noted that the British were quicker to recognize the data, and the Royal College of Physicians of London issued a statement condemning smoking in 1962. Continued efforts to convince the public through the years has led to a great decrease in the rate of smoking, and medicine has been completely opposed to tobacco use for many years.
Nonetheless, myths and honest mistakes about the effectiveness or safety of medications or the mechanism of a drug's operation continue to be exposed even today. Fortunately, the FDA provides the U.S. public with some protection from the modern "snake-oil salesman." But physicians tend to develop routines of using certain medications, often pushed by pharmaceutical company marketing. At times and after widespread use, data becomes available that shows a medicine that was thought safe, is not, or medicine that was thought to be effective is no better than placebo. And, the discovery of more global side effects of popular drugs is not uncommon.
In summary, modern medicine despite or because of its always increasing scientific understanding still finds itself having to endure paradigm shifts as prior "myths " are exposed as untruths or experience reveals mistaken beliefs about effectiveness or safety of a particular treatment, surgery or medication. Sometimes change is slow and medical practitioners tend to hold on to old beliefs due to an inherent conservative attitude, intellectual stubbornness, continued reliance on anecdotal experience and even at times profit motivation.
Such is the case with alcohol and drug addiction treatment providers. There are no verifiable studies that show that treating drug and alcohol problems with group therapy, counseling, or any other psychological based treatment is effective. Nor are there any verifiable studies that support the use of medications such as Antabuse or Methadone. Studies of both psychological and medical based treatments showing 20% to 30% success rates at one year post treatment are observing the same results that kept bloodletting in use as a treatment for disease for nearly two millennia. For a period of 1800+ years treatment providers were convinced that "bloodletting worked." But the truth was bloodletting did not work; in fact, some patients actually died as a result of the therapy. But those who did recover following the bloodletting treatment recovered because the natural history of their problem was one of spontaneous recovery. The recoveries were actually brought about by the human immune system. These people would have recovered with or without bloodletting, and in certain cases, it is likely that the recoveries would have been speedier without the bloodletting treatment. Nonetheless these recoveries became the basis for the claim and the 1800+ years belief that "bloodletting worked." The claim, then, that the bloodletting treatment worked was not based on research or scientific method but on anecdotal experience, which is, more often than not, misleading. Bloodletting, except for a few conditions such as polycythemia and congestive heart failure, did not work. And today, with the one exception being polycythemia, no responsible care provider would employ bloodletting as a treatment for disease.
Reminiscent of bloodletting, the popular treatment for drug and alcohol problems utilizing psychotherapy, psychoanalysis, other psychological methods, counseling, group therapy and medication is equally ineffective. These methods of treatment did not become popular based on convincing research, but rather the methods were implemented based on anecdotal experience. The anecdotal experience originated during the time prior to formalized treatment programs for alcohol and drug problems. At that time, alcoholics and drug addicts who expressed a desire to get treatment or who were forced into treatment by family or society were sent to mental hospitals. In these mental hospitals alcoholics and drug addicts were provided essentially the same treatment as the other patients. This treatment by the mental hospitals became the "de facto standard" treatment for drug and alcohol problems, not because it worked, but because no other hospitals at the time would admit patients with a diagnosis of drug or alcohol problems.
There were also financial considerations that contributed to alcohol and drug problems being declared a form of mental illness. At that time, before the 1960's, many people with drug and alcohol problems were not financially able to pay for treatment. Insurance companies did not cover alcoholism and drug problems. However, people who did have financial capability often had private arrangements with doctors and nurses to provide detoxification services in their own homes or at some secluded cottage. During the late 1950's and early 1960's I was involved with providing these private duty services. It was not unusual to stay with an individual for a period of four or five days at a time. But those who could not afford such services went to state mental institutions where the state picked up the cost of treatment. Many people came out of these institutions worse than when they went in. No one kept statistics on this obviously failed treatment. What's more, there was no need to be concerned about the success rate of these institutions, because there was no other treatment available for the financially disadvantaged.
By the late 1960's a conduit of money from insurance companies and government agencies began to open up, thereby offering a profit motive for treating people with drug and alcohol problems. The experts in the field were mental health professionals, since, up to that time, they were the primary care providers of drug and alcohol treatment. Not unexpectedly, these experts promoted the only thing they knew, psychological treatment. No one from that time to this has questioned the decision of these experts regarding methods of treatment. Like the bloodletting treatment of old, psychological treatment for drug and alcohol problems became firmly implanted as the accepted paradigm, without confirmation by scientific method.
Today (May 1999) psychological treatment remains the preferred method for drug and alcohol problems because care providers, doctors, patients and families are all convinced that drug and alcohol treatment works. Tragically, they remain convinced even in the face of overwhelming scientific evidence to the contrary.
Today, everyone in the industry concedes that conventional treatment offers, at best, only a 30% success rate. While few major independent studies agree the success rate is that high and more than 600 studies have consistently shown the success rate to be substantially lower (18% at 6 months and less than 10% at 5 years), this has not deterred the treatment industry from proclaiming that "treatment works." However, there are many professional alcoholism counselors in the industry that are compelled to tell their clients the truth about the success of treatment.
In 1978 Jerry Brown was a patient at St. Peter's Addiction Recovery Center's detoxification facility located in Albany, New York. As part of my treatment I was told over and over again that only 1 in 30 recover. In 1998 we polled 50 treated alcoholics and/or drug addicts. Forty-two remembered having been quoted success rates for their respective programs and none remembered being told that 3 out of 10 (30%) would recover. The most optimistic quote was that 1 out of 10 "make it." The most pessimistic quoted success rate had not changed since 1978 remaining at 1 in 30 "make it." The most frequently quoted success rate by treatment professionals was 1 out of 20 or about 5%.
These success rates offered by the professional counselors are certainly supported by research. In the previous table in years 4,5 and 8 the measured success rates are 1 in 14, 1 in 33, and 1 in 20, respectively. The average of these three independent findings is 1 in 22, which is within two points of the most frequently quoted success rates by professional counselors.
In 1995 during a public presentation a representative (Source ID# nK01-NSPH) from St. Peter's Alcohol Rehabilitation Center (SPARC) located in Albany, New York said that the success rate at SPARC is 1 in 12. When queried that a 1 in 12 success rate was only an 8% success rate, the representative accused the individual asking about the 8% success rate of having "some sort of an agenda" and was reluctant to answer the question.
In an interview (1997) a counselor from SPARC was asked what she thought SPARC's success rate was. She, without hesitation, responded 1 in 30 (counselor ID # b020-JSPH).
The point is simply this: professionals in the treatment industry know that treatment doesn't work.
While the Baldwin Program results were encouraging, there were, and still are, problems. Little has been reported about recovery rates of adolescents as a group. Schools, courts, parents, counselors and other professionals send thousands of adolescents to conventional treatment every day. Yet, parents, school counselors, physicians, judges, and other professionals rarely, if ever, know the success rate for the conventional treatment program to which they refer adolescents.
To be sure, there are some professionals who do know. In a 1993 interview a high school principal in Upstate New York stated, "I don't have to look at any study to know that treatment [meaning "conventional treatment"] doesn't work; all I have to do is step outside in the hallway and look at all the kids we have sent to treatment only to have them worse than they ever were within a few weeks back at school."
In 1994 a teacher from a city school district in the State of New York wrote to the Baldwin Research Institute, "In my nine years of experience as a high school teacher, I have all too often run up against the tragedy of adolescent drug and alcohol addiction. Many times the cycle of academic and personal failure is solely a function of the use and abuse of alcohol and drugs. Too often our schools fail to address this burgeoning problem with the honesty and compassion it requires. Instead they either turn a blind eye and deny the problem exists or resort to primitive responses that only make matters worse."
This particular high school teacher has during the past 20 years helped hundreds of alcohol and drug addicts recover; many were adolescents.
In 1992 the Baldwin Research Institute began studying the adolescent drug and alcohol problem to quantify the problem, to study current treatment methodologies, and to improve upon existing methodologies or, if necessary, develop entirely new approaches. In 1993 and 1994 the Baldwin Research Institute conducted studies to determine what success rate was achieved by sending adolescents through conventional treatment. The first study was conducted by interviewing counselors and school principals as to the success rates they observed by sending adolescents to conventional treatment. Adolescent subjects of this study were referred to 8 different conventional treatment programs, including hospitalization for a duel diagnosis program, halfway houses, therapeutic communities and outpatient programs. The results were as follows.
All thirty of these adolescents were sent to conventional treatment programs. All thirty adolescents returned to their schools following treatment, and all thirty of the adolescents returned to drinking and drugging. Most of the adolescents returned to drinking and drugging within a week, or two, following treatment. The previous chart shows that one of the thirty remained sober and drug free. This particular study was based on one-year post treatment. Shortly after completing one year of abstinence the 30th subject resumed drinking and drugging. Assuming the average cost of treatment to be $8,500, in this study more than a quarter of a million dollars was spent for treatment, which produced a 0% success rate.
Sadly, these results are, by no means, unusual according to Baldwin Research Institute studies. In 1990 the Baldwin Research Institute conducted a study of an adolescent therapeutic community program for recovery from alcohol problems and drug addiction. This particular therapeutic community is well known in the Capital District of New York State and collects hundreds of thousands of dollars each year from public donations and state funds to support its program. In 1990 two collaborators with the Baldwin Research Program finished the program of recovery at this year-long therapeutic community.
These two collaborators (JC01 & A01) reported that, of the 16 people they came to know during the year, none stayed sober or drug free. In fact, they reported many used drugs while they were in the program. The only two that remained sober and drug free for any period of time were the two collaborators. Then, after about one year, they too returned to drinking and drugging. That year produced a 0% success rate for this therapeutic community's program at a cost to the public of approximately a quarter of a million dollars.
A second study of the same therapeutic community was completed in September 1994 with two new collaborators (J02 & BD02). Again, both completed the program as prescribed by the therapeutic community (although one of the two collaborators reported using illicit drugs while in the therapeutic community). Of the 19 adolescents the two collaborators knew during their 8 months and 10 months participation in the program, only one of the 19 remained sober and drug free. The only one that stayed sober and drug free (for more than a year) upon leaving the therapeutic community began having difficulties at home and at school. But before he started using drugs again he voluntarily came to the Hagaman Guest House and completed the Baldwin Program.
He then became one of the very first students of the Baldwin Academy Project (drug and alcohol free school project of Baldwin Research Institute). His stay at JTA was brief because of family pressures. He returned home within a few months. At age 16 he was not required to go to school, and opted to drop out. As incredible as it may seem, both our research and our personal experience suggest that his chances of staying sober and drug free were actually improved by his not attending public high school.
His remaining sober and drug free, however, could not be contributed to his experience in the therapeutic community, inasmuch as, his last experience was the Baldwin Program at The Hagaman Guest House. In that he was not a pure sample of the therapeutic community program, and in that he stated he intended to use again before entering the Baldwin Program, he must be dropped from the therapeutic community's sample. Thus, the adjusted success rate for this therapeutic community in this second study was 0%. Again, more than a quarter of a million dollars of the public's taxes and donations was spent with no positive results.
In October of 1994 in another rehabilitation program for adolescents in Troy, New York, a collaborator reported results similar to the previous study. Of 18 adolescents in a year-long program, only one stayed sober and drug free for a period of one-year post treatment.
In summary then, of 84 adolescents who received conventional treatment at a cost to New York State taxpayers of more than a million dollars, only two adolescents stayed sober and drug free for more than one year. And of the two only one remained sober and drug free for two years. Pushing this analysis to its absurd and inescapable conclusion, the cost of getting one adolescent sober and drug free using conventional treatment methods is approximately one million dollars.
But even this analysis may be overly optimistic. Only 2.4% of the 84 subjects were sober and drug free one-year post treatment. The adolescent treatment professionals argue that, "the two who got well are worth every penny of what ever the cost." We do not disagree. But such an assessment may be and probably is based on false economies. We know, for example, that 20% to 30% of people with drug and alcohol problems recover as a result of a "brief intervention." A brief intervention is a set of circumstances that causes the individual to be confronted with the problems created as a direct result of their drinking and/or drugging. It is probable, then, that the two who did stop for one year would have stopped whether they were treated or not. This line of reasoning strongly suggests that even more may have recovered in a scenario where none of the subjects received treatment following their respective "brief interventions." Moreover, it is likely that for these 84 adolescents more than one million dollars of donated money and taxpayers' money was spent producing no measurable results. The money was spent for nothing.
Although the adolescents in the Baldwin Research Project of 1990 did far better than those who went to conventional treatment, neither of the results are acceptable. The following table summarizes the success of the adolescents in the Baldwin Study.
Today, however the number of adolescents who have experienced the recovery path first used in the Baldwin Research Project has more than doubled. Nineteen adolescents have completed the Baldwin Program at The Hagaman Guest House. The results are:
Simply stated, the Baldwin Program provides a solution that produces substantially better results with adolescents than conventional treatment programs. Additionally, the Baldwin Program is many times less expensive. The total cost for the nineteen adolescents to attend the Baldwin Program was approximately $30,000. Thirty-seven percent or 7 of the 19 are known to have stayed sober and drug free for more than two years. Getting one adolescent sober by way of the Baldwin Program costs approximately $15,7062; this contrasts so radically with the previous estimate for conventional treatment that to describe the Baldwin Program as more cost effective grossly understates the obvious. (Note2 - In 1999 the price of the six week Baldwin Program is $5750. The total cost for 19 attendees is $109,250. Thus, the 1999 cost of getting one adolescent sober using the Baldwin Program is $15,607 [109,250 / 7 =15,607]. 1999 Baldwin Program--$15,607 versus Conventional Treatment--$1,000,000.)
Schools, courts, social services, government agencies, parents, counselors, physicians, and other professionals need to decide what their motives are with respect to referring adolescents to treatment programs. If their motives are to help the adolescent recover from a drug and/or alcohol problem, clearly the Baldwin Program would be the proper choice. Even without the Baldwin Academy, the Baldwin Program is many times more successful at helping adolescents recover from alcohol and drug addiction than conventional treatment programs. Or, if the motivation for sending an adolescent to a drug and alcohol recovery program is to get rid of a problem, the Baldwin Program would still be preferred over conventional treatment programs based on cost.
Still the Baldwin Program is not the complete answer to helping adolescents out of drug and alcohol problems. Notably the adolescents in the Baldwin study fell into two groups: one group that was heavily involved with the activities at the Baldwin House (where the Baldwin Research Project was conducted) and a second group that was less involved. The group that was more involved did better than the group that was less involved. Preliminary indications are that if an adolescent accepts a peer group whose members have stopped drinking and drugging, then that adolescent's chances of recovery are greatly improved.
The preceding tables suggest a strong correlation between peer group and success rate, not only from an alcohol and drug recovery point of view, but scholastically as well. Those that established a peer group with others who were motivated to not drink and not use drugs were twice as successful in all categories as were those who tried to return to their drinking and drugging peer groups.
Our experience showed that although some adolescents stayed sober after the Baldwin Program, all of them struggled with school. In fact, most that stayed sober left school. The Baldwin Institute remained in close contact (1997) with these youngsters and learned a great deal from them. We learned what should have been obvious: with a teenager "image is everything." Teenagers cannot go back to school because their friends are drug users, and those at school who do not use drugs are, for lack of a better word, "not cool." Some teenagers returned to their old school and used drugs, some switched schools and used drugs again, and some did not return to school. All those who stayed sober went back to school for a short time and found that they could not handle the environment. These teenagers all eventually left school.
The Baldwin Research Institute recognized this problem long ago and tried to help teenagers stay sober by supplying a place where they could live together and go to public school. However, this approach did not work much better than them living at home. What these teenagers needed more than anything else was their own school.
The Baldwin Program could not claim a significant success with a 72% chance of recovery for the total population but at the same time teenagers in that group had no better than a 50% chance of recovery which was largely contingent upon their dropping out of high school. The Baldwin Academy, JTA, was started to study a real solution for the adolescent drinking and drugging problem.
At the time, there were no schools that offered youngsters a drug and alcohol free environment. There were, and are today, such things as drug free school zones, but that does not mean the youngsters at those schools do not use drugs. Designated drug free areas around schools where implemented to provide more severe punishment for students possessing drugs within the designated zone than they would be subjected to if they possessed the same amount and drug outside the zone. Such punitive programs have done nothing to elevate or even lessen drug use in and around schools. In contrast JTA was a drug and alcohol free school. Further, JTA was designed as a high school for youngsters who were afflicted with drug and alcohol addictions, a physical, mental, and emotional malady that handicaps them. These youngsters need a special school much like others who are handicapped and need special facilities.
At JTA the students went through a screening process to make sure that they wanted to stop using drugs. Upon acceptance to JTA, candidates then went through the six-week Baldwin Educational Program, which had already proven its effectiveness. Only after these two requirements were met were the adolescents allowed to enter JTA. They knew that this school consisted of a group of teenagers who all wanted to be sober. They knew that they would not be around those who wanted them to return to drugs. And, more importantly, they were all helping one another to stay sober for life. Thus, the social norm then changed from using drugs to not wanting to use drugs. The student's energies were switched from trying to be cool to wanting to learn.
A curriculum was needed for these handicapped youngsters once the decision was made to establish the prototype school. This was no easy matter, because any proposed curriculum must deal with the monumental task of turning these "problem adolescents" into problem solvers. These teenagers are independent, and for that reason rebel against education and school. But, we found that if they were encouraged to learn through independent study, they were eager to study and educate themselves. It is a very old and simple idea that a person will be happy learning and working on something in which he or she has an interest. Henry David Thoreau observed, "If one advances confidently in the direction of his dreams, and endeavors to live the life which he has imagined, he will meet with a success unexpected in common hours." The goal was not to have the teachers educate the students; rather it was the goal to have the teachers help the students realize their dreams.
As a result JTA used an open curriculum. The students were encouraged to read and write, but were not told what to read and write. We wanted to trigger the lust for knowledge that had been long buried in these students. The students read what they pick out of the library. Then they wrote about what they read and explained it to the rest of the class. The class then had an open discussion about what they had learned from each student's analysis. Rather than an open curriculum, we prefer to say that our curriculum encompassed all subjects. For example, one student wanted to pursue acting, so she was encouraged to join an acting club. Another wanted to learn about automobiles; he was encouraged to work on the school car with a friend. All students were encouraged to play sports and exercise as well as to join us on our biweekly mountain hikes. Mathematics and sciences were presented in the same fashion. Those students who wanted to learn more than the basic life skills were encouraged to do so. Each student was required to pursue something that sincerely interested him or her.
The English and History program was modeled after the reciprocal arrangement that Salinger talks about in Catcher in the Rye. Salinger wrote, "Many, many men have been just as troubled morally and spiritually as you are right now. Happily, some of them kept records of their troubles. You'll learn from them - if you want to. Just as some day, if you have something to offer, someone will learn something from you. It's a beautiful reciprocal arrangement."
The English and History section was mandatory for all students, since the ability to read and understand history is essential in life. This reciprocal arrangement is more than memorization; it is the full understanding of history and poetry. It is the love of knowledge that is the force that drives students to learn, not the grades they receive. For that reason and others, students did not receive grades. Another reason that grades were not recommended was that these special students are already too competitive. Competitiveness and fear of failure are parts of the personality of the addict. If students were graded it would only foster fearful competitive behavior. We were trying to establish a brotherhood among the students. Cooperation rather than competition was the motto.
An overall theme of the school was love and service to others. This was the theme of The Fellowship meetings that all students attended every night. At these meetings they try to help new members. This was as much a part of their education as the regular school hours.
With this curriculum in place, the next problem was how to group the students. Frank Brown, the author of The Non-graded High School and at one time a member of the President's Panel on Research and Education, summed up his thoughts on the class or graded school by saying, "Nothing is so unequal as the equal treatment of unequals." Brown's point is well taken; it is wrong to group people together in the same grade because of their age. In his book he offers the non-graded school as "a place which makes arrangements for the individual student to pursue any course in which he is interested, and has the ability to achieve, without regard either to grade level or sequence." The grade-less school is not an esoteric organization. It is easily implemented and allows education to become the self-discovery it should be.
After learning the basics in mathematics and reading we must allow these handicapped students to uncover their dreams and to discover what they can and can not do. These students, more so than any others, need to learn for the sake of understanding, not for their parent's approval or for a grade, but because they want to. Although this school is somewhat unconventional, we observed that these students enjoyed school. In the past they would have dropped out of school and/or continued using drugs. Nothing was set in stone except our sincere desire to help our students.
The school was located in the same building as the Hagaman Guest House, where the Baldwin Program is offered. The house affords the school the use of two large adjoining rooms for classrooms. One room was a lounge with couches and was used for reading. It also had a large conference table which was used for group discussion and teaching. The other room had the students' desks and computers. This room was used by the students to do their independent assignments. The students lived at the guest house. Besides school and The Fellowship meetings, the students were responsible for two hours of work around the guest house each day which included cleaning the house, cooking meals, doing dishes, and general repair work like plumbing and electrical work. These chores promoted responsibility, work ethic, and some useful skills.
The pilot project for the school was started on November 28, 1994. One of the program youngsters, a 14 year old, was attending the local public school while living at the Hagaman Guest House and was coming home in tears everyday (MS-36). Another was already on home schooling at the guest house (JP-70). A volunteer of the Baldwin Research Institute was sponsoring a 15-year-old in Alcoholics Anonymous. This 15-year-old had spent 10 months in a therapeutic community then returned home and public school (J). Although he was sober, he was getting in trouble at school and was preparing to drop out. The fourth student, a 15 year old, was attending public school and exhibiting severe behavioral problems. She was spending time with older guys and would frequently leave home for two or three days at a time (EB-62).
MS-36 remained sober and drug free for the one year he attended JTA. His work at JTA was so impressive that he was admitted to college at age 16. At college he gravitated to a drinking and drugging social group and within a short time he began drinking and using drugs. Interestingly, at 17 and again at 18, he attempted to get sober and off drugs. His most recent attempt at 18 years old is going well, and he is sober and drug free at this writing (10-Oct-99). JP-70 was sober and drug free for the entire year at JTA. JP-70 returned home-got a job and remained sober and drug free for two years, which is the last information we have received. But at the same time that we heard of his sobriety, we also heard that he was involved in piercing several parts of his body and collecting tattoos. His current status is unknown. J was sober and drug free for the entire year at JTA. J returned home, but did not go back to school. We received information in June 1998 that J had been continuously sober and drug free up to that time. According to the instructor that interviewed him he was happy and doing well. His current status is unknown. EB-62 was sober and drug free for the entire year at JTA. Upon returning home she immediately returned to her social group and began drinking and drugging. She picked up her old behavior right where she had left off the previous year. Two years later she separated from that group of friends-cleaned herself up and made arrangements to enter college. Today she is in college and doing well. She reports drinking socially and with none of the attendant problems of abusive drinking.
Our results (2 out of 4 stayed sober and drug free for more than two years) were certainly better than conventional treatment during the post program period. Moreover, the results during their attendance at JTA were excellent. None of the four drank or used drugs while in a peer group school that was alcohol and drug free. With that said, we are certainly not promoting the JTA Project as conclusive of anything. The sample size is small and the period of time the students attended JTA was too short. However, we do believe, even with the small sample size and the short duration of the project that the project has demonstrated a potential method where adolescents can recover from alcohol and other drug problems.
Even with the limited results present here, this type of program should be made available in every school district throughout the country if adolescents are going to be afforded an opportunity to recover from drug and alcohol problems. Mini-schools within each district with no more than thirty students per facility may be optimum, but much more research is needed in this area. Each facility should be in a non-institution setting with kitchen facilities and home-style living rooms. The staff must be recovered people, in that, no one can teach someone else how to be sober and drug free if they are not. Moreover, the hypocrisy of a teacher, administrator or police office that drinks or uses drugs telling an adolescent not to is judged harshly among the adolescent community-and so it should be.
Even without additional research, the reason this approach should be implemented immediately is that current programs are of no value at all. This is clearly a case where it is better to do something than to do nothing. Trying anything different from the programs that are offered to adolescents today at least gives them a chance to recover.
Nonetheless, the chances of a program such as JTA being implemented into a public school system anytime soon are not likely. Billions of dollars each year are spent on programs like D.A.R.E. and the war-on-drugs and have produced no measurable results. Continuing to pour money into these programs is a public "feel-good" policy, but does nothing to help adolescents out of the drug and alcohol culture. Please consider the following discussion on D.A.R.E.
In March 1998 we issued a public statement regarding D.A.R.E. and its effectiveness in helping to discourage children from using drugs. At that time we wrote:
Recently, the University of Illinois reported that the D.A.R.E. program has been ineffective, and in some instances it may have actually contributed to an increase in the use of illicit drugs among teenagers. D.A.R.E officials and police departments argue that D.A.R.E. really does work, but the problem is that there is not enough of it. They argue that the program needs to be expanded to take in the higher grades for the program to be even more effective.
There are flaws in D.A.R.E.'s pleading for an expansion of their program to improve results. First, D.A.R.E.'s attempt to discredit the University of Illinois research without offering hard evidence to refute the University's findings is at least irresponsible, if not, outright dishonest. Second, there is no research that supports the notion that expanding the D.A.R.E. program to the higher grades would improve upon D.A.R.E.'s current poor results. And, doing more of the same thing that already doesn't work is merely throwing good money after bad.
Nonetheless many parents believe that D.A.R.E. works. These parents are people that do not want to be confused by the facts. They are so myopic they are actually willing to put their own children at risk to protect their misguided views about D.A.R.E. and other programs like S.A.D.D.
The University of Illinois is not the first organization to report poor results by D.A.R.E. Probably the most telling report of the damage that is being done by D.A.R.E. was reported in the National Household Survey on Drug Abuse for the Health and Human Resources Department in 1996. This survey reported that teen (12- to 17-years-old) drug use rose more than 100% from 1992 to 1995. These teenagers would have been exposed to the D.A.R.E. program during the 1980's. The evidence is clear: During the time of D.A.R.E.'s most rapid growth, the results it achieved five, six, and seven years later were the worst in more than a decade. Moreover, it is probable that D.A.R.E. actually contributed to the increase in drug use during that time.
In the final analysis the D.A.R.E. program is a government subsidized public relations program for local police departments and has little to do with drug use prevention. Tragically, parents who support D.A.R.E. are playing Russian Roulette with the lives of their children. And, school administrators and teachers who support D.A.R.E. are abdicating their responsibility to teach as part of the school's curriculum the truth about drug and alcohol use and abuse. The local news media at the time refused to print the report or run a story about these results. We released this information to the local news media and posted it on the Web. Seemingly and as a matter of policy, coverage of research regarding D.A.R.E. by the press has been and continues to be sparse. And, even though the research by the University of Illinois was convincing that D.A.R.E. failed to help kids stay away from drugs, subsequent to the University of Illinois' report there was no measurable decline in the implementation or continued use of D.A.R.E.
Eighteen months ago the information presented by Baldwin Research referred to only two of many studies that had shown that D.A.R.E. failed as a drug and alcohol abuse prevention program. Moreover, new studies continue to definitively show D.A.R.E. is no more effective in helping kids stay away from drugs than the normal drug education presented in the health curriculum of most schools. A study published in August 1999 in the Journal of Consulting and Clinical Psychology (August 1999, Vol. 67, No. 4, 590-593, Ã‚Â©1999 by the American Psychological Association) Project DARE: No Effects at 10-Year Follow-up by Donald R. Lynam and Richard Milich of the Department of Psychology, University of Kentucky, again convincingly reported that there are no significant short-term or long-term effects to be gained by the D.A.R.E. program. The following is a verbatim excerpt entitled Results and Discussion from that report:
Because the school, and not the individual, was the unit of randomization in the present study, we used hierarchical linear modeling, with its ability to model the effect of organizational context on individual outcomes. For each of the substances (cigarettes, alcohol, and marijuana), we constructed three hierarchical linear models (HLMs) that examined amount of use, positive expectancies, and negative expectancies. We conducted additional analyses on peer-pressure resistance, self-esteem, and the variety of past-year illicit drug use. An HLM was used to model the effect of DARE on the school mean of each dependent variable (drug use and expectancies) while controlling for pre-DARE factors. This allowed for the comparison of how each school mean varied with the effect of DARE. We conducted preliminary analyses in which the effect of DARE was also modeled on the relationship between pre-DARE baseline and the substantive outcomes. Significant effects would suggest that DARE affected the relation between pre- and post-DARE outcomes. These effects were not significant and were thus fixed across schools. Respondents' sixth-grade reports of lifetime use served as baseline measures, whereas age-20 reports of past-month use of cigarettes, alcohol, and marijuana served as outcome measures.1 The results of the full HLMs are presented in Table 1 [Table 1 not presented here.].
Pre-DARE levels of use and negative expectancies about cigarette use were significantly related to their counterparts 10 years later. There were no relations between DARE status and cigarette use and expectancies, suggesting that DARE had no effect on either student behavior or expectancies.
Pre-DARE levels of lifetime alcohol use and positive and negative expectancies about alcohol use were significantly related to their counterparts 10 years later. DARE status was unrelated to alcohol use or either kind of alcohol expectancy at age 20.
Pre-DARE levels of past-month marijuana use and negative expectancies about use were significantly related to their counterparts 10 years later. Similar to the findings for cigarettes, respondents' sixth-grade positive expectancies about marijuana use were not significantly related to marijuana expectancies at age 20. DARE status was unrelated to marijuana use or either kind of marijuana expectancy at age 20.
Finally, the number of illicit drugs (except marijuana) used in the past year was examined. Because no measures for these items were obtained during the initial baseline measurement, we estimated a means-as-outcomes HLM using no Level 1 predictors and only DARE status as a predictor at Level 2. The results show that DARE had no statistically significant effect on the variety of illicit drugs used.
The results for peer-pressure resistance were similar to previous results. Pre-DARE levels of peer-pressure resistance were significantly related to peer-pressure resistance levels 10 years later, whereas DARE status was unrelated to peer-pressure resistance levels.
Finally, pre-DARE levels of self-esteem were significantly related to self-esteem levels at age 20. Surprisingly, DARE status in the sixth grade was negatively related to self-esteem at age 20, indicating that individuals who were exposed to DARE in the sixth grade had lower levels of self-esteem 10 years later. This result was clearly unexpected and cannot be accounted for theoretically; as such, it would seem best to regard this as a chance finding that is unlikely to be replicated.
Our results are consistent in documenting the absence of beneficial effects associated with the DARE program. This was true whether the outcome consisted of actual drug use or merely attitudes toward drug use. In addition, we examined processes that are the focus of intervention and purportedly mediate the impact of DARE (e.g., self-esteem and peer resistance), and these also failed to differentiate DARE participants from non-participants. Thus, consistent with the earlier Clayton et al. (1996) study, there appear to be no reliable short-term, long-term, early adolescent, or young adult positive outcomes associated with receiving the DARE intervention.
Although one can never prove the null hypothesis, the present study appears to overcome some troublesome threats to internal validity (i.e., unreliable measures and low power). Specifically, the outcome measures collected exhibited good internal consistencies at each age and significant stability over the 10-year follow-up period. For all but two measures (positive expectancies for cigarettes and marijuana), measurements taken in sixth grade, before the administration of DARE, were significantly related to measurements taken 10 years later, with coefficients ranging from small (b = 0.09 for positive expectancies about alcohol) to moderate (b = 0.24 for cigarette use). Second, it is extremely unlikely that we failed to find effects for DARE that actually existed because of a lack of power. Thus, it appears that one can be fairly confident that DARE created no lasting changes in the outcomes examined here.
Advocates of DARE may argue against our findings. First, they may argue that we have evaluated an out-of-date version of the program and that a newer version would have fared better. Admittedly, we evaluated the original DARE curriculum, which was created 3 years before the beginning of this study. This is an unavoidable difficulty in any long-term follow-up study; the important question becomes, How much change has there been? To the best of our knowledge, the goals (i.e., "to keep kids off drugs") and foci of DARE (e.g., resisting peer pressure) have remained the same across time as has the method of delivery (e.g., police officers). We believe that any changes in DARE have been more cosmetic than substantive, but this is difficult to evaluate until DARE America shares the current content of the curriculum with the broader prevention community.
One could also argue that the officers responsible for delivering DARE in the present study failed to execute the program as intended. This alternative seems unlikely. DARE officers receive a structured, 80-hr training course that covers a number of topics, including specific knowledge about drug use and consequences of drug use, as well as teaching techniques and classroom-management skills. Considerable emphasis is given to practice teaching and to following the lesson plans. Although we did not collect systematic data on treatment fidelity in the present study, a process evaluation by Clayton, Cattarello, Day, and Walden (1991) attested to the fidelity to the curriculum and to the quality of teaching by the DARE officers.
Finally, advocates of DARE might correctly point out that the present study did not compare DARE with a no-intervention condition but rather with a control condition in which health teachers did their usual drug-education programs. Thus, technically, we cannot say that DARE was not efficacious but instead that it was no more efficacious than whatever the teachers had been doing previously. Although this is a valid point, it is unreasonable to argue that a more expensive and longer running treatment (DARE) should be preferred over a less expensive and less time-consuming one (health education) in the absence of differential effectiveness (Kazdin & Wilson, 1978). This report adds to the accumulating literature on DARE's lack of efficacy in preventing or reducing substance use. This lack of efficacy has been noted by other investigators in other samples (e.g., Dukes et al., 1996; Ennett et al., 1994; Wysong, Aniskiewicz, & Wright, 1994). Yet DARE continues to be offered in a majority of the nation's public schools at great cost to the public (Clayton et al., 1996). This raises the obvious question, why does DARE continue to be valued by parents and school personnel (Donnermeyer & Wurschmidt, 1997) despite its lack of demonstrated efficacy? There appear to be at least two possible answers to this question. First, teaching children to refrain from drug use is a widely accepted approach with which few individuals would argue. Thus, similar to other such interventions, such as the "good touch/bad touch" programs to prevent sexual abuse (Reppucci & Haugaard, 1989), these "feel-good" programs are ones that everyone can support, and critical examination of their effectiveness may not be perceived as necessary.
A second possible explanation for the popularity of programs such as DARE is that they appear to work. Parents and supporters of DARE may be engaging in an odd kind of normative comparison (Kendall & Grove, 1988), comparing children who go through DARE with children who do not. The adults rightly perceive that most children who go through DARE do not engage in problematic drug use. Unfortunately, these individuals may not realize that the vast majority of children, even without any intervention, do not engage in problematic drug use. In fact, even given the somewhat alarming rates of marijuana experimentation in high school (e.g., 40%; Johnston, O'Malley, & Bachman, 1996), the majority of students do not engage in any drug use. That is, adults may believe that drug use among adolescents is much more frequent than it actually is. When the children who go through DARE are compared with this "normative" group of drug-using teens, DARE appears effective.
While D.A.R.E. may appear effective to parents, teachers, administrators and law enforcement agencies, these groups are laboring under the same elusion that kept bloodletting a popular method of treating disease for nearly two millennia. That is there is a perception that D.A.R.E. works based on results that would be achieved with or without D.A.R.E. Either way, with or without D.A.R.E., the drug and alcohol problem among the adolescent population is epidemic. The problem with the current educational approach as a prevention method is at best weak, not because education, in and of itself, is a poor approach but because the delivery of the education is hypocritical or is perceived to be hypocritical by adolescents.
The point of this discussion, however, is not confined to demonstrate that the D.A.R.E. program has failed, but to demonstrate that even in the face of convincing evidence that a method has failed the American culture will continue to embrace the method for fear of having to do something different. These fears have made it possible for unnecessary surgical procedures to continue long after research has proven such procedures ineffective or unnecessary, for a failing educational system to continue with little more than cosmetic changes, for ineffective programs like D.A.R.E. to continue to eat into vital resources that could be better used to develop effective programs, and for clinging to failed technologies such as those offered by the drug and alcohol treatment industry. However, in the case of ineffective or unnecessary medical and surgical procedures the result of such practices is rarely death.
Even though our country outspends every other country for an educational system that produces second rate (or less) results, these results are usually not the cause of death among the poorly educated. As for the D.A.R.E. program, while it does take resources away from developing programs that would help and may actually contribute to adolescent drug use, in and of itself, it reportedly has little negative effect. That being true, D.A.R.E. probably contributes little to the death rate associated with adolescent drug use. On the other hand, failed drug and alcohol treatment programs can and should be held directly responsible for the death of its clients who drink and drug following treatment. Moreover, families of such unfortunates should have the right to sue for such loses and the Attorneys Generals of the States should close down all drug and alcohol treatment programs that cannot produce verifiable evidence that the treatment that they provide actually works.