EFFECTIVENESS BANK BULLETIN 19 January 2009
EFFECTIVENESS BANK BULLETIN 19 January 2009The entries below are our accounts of documents selected by Drug and Alcohol Findings as particularly relevant to improving outcomes from drug or alcohol interventions in the UK. Entries were drafted after consulting related research, study authors and other experts and are © Drug and Alcohol Findings. Permission is given to distribute these entries or incorporate passages in other documents as long as the source is acknowledged including the web address http://findings.org.uk. However, the original documents were not published by Findings; click on the Titles to obtain copies. Free reprints may also be available from the authors; if displayed, click Request reprint to send or adapt the pre-prepared e-mail message. The Summary is intended to convey the findings and views expressed in the study. Below are comments from Drug and Alcohol Findings. Links to source documents are in blue. Hover mouse over orange text for explanatory notes.
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UK project enables at-risk children of (former) drug using parents to safely live at home ...
Needy clients do as well in day hospital as in residential care ...
Addressing the needs of children of substance using parents: an evaluation of Families First's Intensive Intervention.Woolfall K., Sumnall H., McVeigh J.
Centre for Public Health, Liverpool John Moores University, 2008.
Based in Middlesbrough and winners of the Drug Team of the Year award in 2008, Families First's intensive short-term support meant that children of problem drug users on the verge of being removed from the family were safely able to stay with their parents or other relatives.
Summary Families First is a multi-component support service which provides advice, social work intervention and parenting support for adults and families on substance use related issues. The project was set up with funding from the Neighbourhood Renewal Fund and local authority sources and staff from local authorities and health authorities. Its intensive family support package has been developed from the Intensive Family Preservation (IFP) approach used by the Option 2 project in Cardiff and the Vale of Glamorgan and the Neighbourhood Enabling Team (NET), a Middlesbrough based Family Support Project. The intensive family intervention aims to ensure child welfare. If parents are unable to make necessary lifestyle changes, then alternative care arrangements are made. Upon referral to the project the majority of study participants were heroin and crack cocaine users. Many had previous experience of social welfare involvement which in some cases had resulted in the permanent removal of children from their care. For many of the families involved, the intervention was their last chance to change their lifestyle in order to keep their children in the family home. Research was conducted with 15 project staff, five stakeholders and a cohort of 11 parents from eight families over a 12-month period, and the progress of 18 children over whom there were child protection concerns was monitored. Findings suggest that the Families First model prevents the need for permanent placement of children into care and reduces the time spent in temporary care placements by helping parents provide a safe home environment or by finding an alternative kinship care placement. These findings are limited by a small sample size and no comparison group and therefore implementation in other areas should be accompanied by an imbedded evaluation from the project's inception, based upon the current research model. However, the 12-month follow-up period of this evaluation would suggest that the intervention had a range of positive outcomes, including reduced parental substance use up to 12 months post-intervention. The researchers believe that the Families First model has potential to be used in both social work practice and wider community based family support services.
Across the UK, national targets, service standards and policy statements have recently embodied the perspective that parenting and child welfare are core concerns for services in contact with problem drug users, a contention featuring strongly in new Scottish and English drug strategies. The featured project's recognition in the Drug Team of the Year award for 2008 signifies how high this issue is in government priorities. Areas considering such initiatives can benefit from their experience as documented in the current evaluation and those of similar projects available through the Option 2 web site.
Families First's caseload consists of problem drug and/or alcohol using parents in crisis, whose children risk being removed and/or are subject to child protection measures, or whose families risk breakdown due to parental substance misuse. Parents are, however, sifted to exclude those who see no urgent need to change their parenting practices and lifestyles. In other words, they at least want to return to a degree of normality but have so far been dramatically unable to do so. The injection of a six-week intensive support package and four months follow-on help, sometimes involving the necessary removal of children from the family home, seems in the short term at least to have helped them pull back from the brink. Though all 18 children subject to child protection measures had been at high risk of being taken in to care, Five actually were in care during the 12 months, three before Families First was involved. by the end of the 12-month study 16 were living in the parental home, two with other relatives, and none were in care. None were on the child protection register and 15 were not subject to any form of care order. These successes were almost certainly linked with the fact that most parents stopped using illegal drugs and/or stabilised or reduced methadone dosage.
The longer term success of such projects is highly dependent not just on the calibre of the staff, but also the availability of housing and other community resources and the strong interagency partnerships needed to make these accessible to the families concerned. Possible fragility in the achievements in Middlesbrough is apparent in continuing high levels of parental depression, shortage of social housing, and the lack of progress in education or employment. Wider family relationships had improved, but these other anchors against relapse seemed harder to secure. That this type of intervention is no panacea is also indicated by an earlier evaluation of the similar Option 2 project in Wales. Unlike the featured study, this benefited from a comparison group of families referred to the service, but who could not be accommodated due to staff shortages. In both sets of families, 4 in 10 children entered care, though the intensive intervention delayed and shortened the care period and at the end meant 12% more children (68% v. 56%) were living at home. A similar comparison group in the featured study might also have shown that not all the improvements could be laid at the door of Families First, especially since families were pre-selected for motivation. But at a cost per child of £6555, if the intervention itself saved just 1 in 5 from long-term care, it would have paid for itself. It did so with considerable free support from kinship carers who temporarily provided a safe place for the children while Families First assessed and worked with the parents. Also the projects differed Personal communication from Kerry Woolfall, 7 January 2009. in one possibly important way: Families First had case responsibility for the children, making it a unique adaptation of the Option 2 model.
The evident progress of the Families First parents contrasts with the general lack of progress made by parents in London, presumably largely in the absence of a similar intervention. The study included parents In terms of their long term substance use and social welfare involvement and the fact that their children were at high risk of care entry upon referral, these parents were similar to those in the featured study. However, in London there would have been no filtering for motivation. whose substance misuse was causing concern and who had been referred for long-term social work involvement. Two years later fewer than half the London children were living with their parents, over a quarter were in care, and few parents had significantly curbed their substance use.
The featured intervention is effectively a rescue service attempting to pull families back from the very brink of losing care of their children. Before that point there is a strong case for also offering parenting and child welfare interventions to all problem drug users in contact with treatment and harm reduction or other services. Because these offer positive support without implying parental failure, they often have a good uptake and can reduce the numbers who reach the point reached by the families in the featured study.
Thanks for their comments on this entry in draft to Kerry Woolfall of Liverpool John Moores University and Suzy Kitching of Families First in Middlesbrough. Commentators bear no responsibility for the text including the interpretations and any remaining errors.
Last revised 06 January 2009
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Final report on the evaluation of 'Option 2' STUDY 2008
Home visits reduce risk of 'hidden harm' to children of drug treatment patients STUDY 2008
The family drug and alcohol court (FDAC) evaluation project: final report STUDY 2011
The Drug Treatment Outcomes Research Study (DTORS): final outcomes report STUDY 2009
What works? A 15-year follow-up study of 85 young people with serious behavioral problems STUDY 2010
Motivational arm twisting: contradiction in terms? FINDINGS REVIEW 2006
Doing it together strengthens families and helps prevent substance use STUDY 2004
Early intervention: the next steps. An independent report to Her Majesty's Government REVIEW 2011
Drug Strategy 2010. Reducing Demand, Restricting Supply, Building Recovery: Supporting People to Live a Drug Free Life DOCUMENT 2010
Specialist drug and alcohol services for young people – a cost benefit analysis STUDY 2011
Distinctions without a difference: direct comparisons of psychotherapies for alcohol use disorders.Imel Z.E., Wampold B.E.
Psychology of Addictive Behaviors: 2008, 22(4), p. 533–543.
Request reprint using your default e-mail program or write to Dr Imel at zeimel@wisc.edu
After combining results from studies comparing talking therapies for alcohol problems, this ingenious analysis finds any structured approach grounded in an explicit model as good as any other. We have, it's argued, been looking in the wrong direction for therapy's active ingredients.
Summary To estimate the relative efficacy of alcohol use disorder treatments, the authors used meta-analysis A recognised set of procedures used to summarise quantitative results from several studies of the same or similar interventions. Usually undertaken to allow an intervention's effectiveness to be assessed with greater confidence than on the basis of the studies taken individually. In this case used to assess differences in the effectiveness of different interventions. techniques to aggregate the outcomes of studies which directly compared two bona fide psychological treatments. They faced the problem of how combine a study where for example treatment A was better than B, with another where A was worse than C. To overcome this they randomly assigned a positive or negative sign to an effect size A standard way of expressing the magnitude of a difference (eg, between outcomes in control and experimental groups) applicable to any quantitative data. In this context, a standardised measure of the extent of the difference in drinking outcomes between the treatments compared in each of the studies included in the meta-analysis. expressing the magnitude of the difference between any two treatments. Then they estimated how far the distribution of effect sizes conformed to the shape expected if in reality there were no differences. A highly variable distribution would indicate that there really were differences in the effectiveness of the treatments which were not due simply to sampling error. A smoother, more homogenous distribution would suggest that real differences in effectiveness were at best minor, and that studies which found differences did so largely due to chance variations. For alcohol measures as a whole, and for measures of abstinence in particular, the analysis did indeed find that effects were homogenously distributed, indicating that different treatment comparisons yielded a common effect size which was not significantly different from zero. Further analyses indicated that the researcher's allegiance to the treatment accounted for a significant portion of what variability there was in differences between treatments. The authors argue that the results are consistent with an emphasis on therapeutic processes common across different treatments (such as the relationship between therapist and client) and common mechanisms of change, rather than specific techniques supposedly stimulating specific mechanisms keyed to a specific complaint.
The analysis brings alcohol therapy squarely within the ambit of a fundamental debate across psychotherapy – whether the drive to devise more effective therapeutic programmes is fundamentally misguided because it is not the specific programme which matters, but 'common factors' which cut across these programmes, such as entering a therapeutic setting within which the patient expects to be helped to get better, the credibility of the therapy to both patient and therapist, its ability to (for that patient) make ordered sense of the patient's 'disorder', in doing so to structure a route out of that disorder which generates optimism, its ability to provide a platform for engaging the client in their recovery, and the therapist's ability to create a supportive environment which facilitates these processes. Perhaps the greatest common factor lies in the patients and clients. Typically they have reached the point where they desperately want to get better, have realised they need help to do so, and decided to follow a culturally sanctioned route to gaining that help – formal treatment.
In his influential book, one of the authors of the current analysis exhaustively analysed these issues in respect of psychotherapy in general, concluding that the evidence overwhelmingly supported a common factor model of how therapy works rather than the medical model of a specific treatment for a distinct complaint. The current analysis goes part way to extending that verdict to alcohol therapy in particular. By including only comparisons of 'bona fide' therapies among (presumably) treatment-seeking samples, the analysis effectively evened out many of the presumed common factors. If these truly were the common core responsible for the effectiveness of seemingly distinct therapies, then comparisons between the outcomes of these therapies should find differences no greater and no more often than would be expected by chance. Differences there would be, but they would be smoothly clustered around the zero difference mark, just as random variation in wind and bounce would leave identical apples falling from the same tree smoothly clustered around a point immediately below. On the other hand, if the differences between the therapies were important active ingredients, outcome differences too would be substantial. Rather than clustering around the zero mark, they would often be found in more extreme territory. The results of the analysis were far closer to what would be expected if the common factor model held. They became closer still when one further candidate common factor was accounted for – how committed the researchers (and perhaps also therefore the therapists and through them the patients) were to one of the therapies they were testing compared to the other(s).
The conclusions are similar to those reached by some of the researchers responsible for two of the largest ever alcohol treatment trials, the US Project MATCH study and the British UKATT trial. After pitting deliberately distinct psychosocial therapies against each other, both studies concluded that the outcomes differed little overall, and that there were few indications that certain types of patient benefited more from one therapy than another. Faced with these findings, MATCH researchers argued for a common factor model, and drew the important implication that "If most treatments are similar in their effectiveness, the real value of having an array of treatments available is to promote healthy competition for the wide variety of people who would benefit from any treatment, but who would be more attracted to one because of reputation, convenience, or personal preference". A leading UKATT researcher has argued for attention to be redirected from 'brand name' therapies to "change processes that are common to treatments with different names and theoretical rationales".
Intriguing as it is, the featured analysis restricted itself to impacts on outcomes directly related to drinking as assessed immediately after therapy ended. Sometimes distinctions between the effectiveness of therapies have emerged only in the longer term Persisting effects are particularly noticeable in respect of cognitive-behavioural therapies. On the other hand, it is not unusual for outcomes to converge over the longer term, as happened in the study which registered the greatest outcome difference in the featured analysis (Miller W.R. Behavioral treatment of problem drinkers: a comparative outcome study of three controlled drinking therapies. Journal of Consulting and Clinical Psychology: 1978, 46, p. 74–86). Had the later outcomes from this study been used instead, the analysis would have even more overwhelmingly come down on the side of there being no real differences between therapies. and sometimes a therapy's main advantage over the alternatives lies beyond drinking itself. Such as couples or family based therapies which particularly help improve life for partners and children. See for example http://findings.org.uk/count/downloads/download.php?file=BCT.nug. It is also important to remember that the analysis included only recognised or explicitly structured and theoretically based approaches. Its findings do not mean that an irrational or obviously irrelevant approach would also do as well as any other. Nor can it exclude the possibility that some therapies really are preferable to others; it simply established that generally this has not been the case.
Drug and Alcohol Findings has published a series of articles dedicated to exploring of the impact of some of the common factors which might be important in the treatment of substance use problems.
Thanks for their comments on this entry in draft to Jim Orford of the University of Birmingham. Commentators bear no responsibility for the text including the interpretations and any remaining errors.
Last revised 04 January 2009
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Evidence-based therapy relationships: research conclusions and clinical practices REVIEW 2011
Evidence-based psychotherapy relationships: Alliance in couple and family therapy REVIEW 2011
Evidence-based psychotherapy relationships: Empathy REVIEW 2011
Evidence-based psychotherapy relationships: Alliance in individual psychotherapy REVIEW 2011
Evidence-based psychotherapy relationships: Cohesion in group therapy REVIEW 2011
Evidence-based psychotherapy relationships: Positive regard REVIEW 2011
Adapting psychotherapy to the individual patient: Resistance/reactance level REVIEW 2011
Evidence-based psychotherapy relationships: Goal consensus and collaboration REVIEW 2011
Evidence-based psychotherapy relationships: The alliance in child and adolescent psychotherapy REVIEW 2011
Evidence-based psychotherapy relationships: Psychotherapy relationships that work II REVIEW 2011
Day hospital and residential addiction treatment: randomized and nonrandomized managed care clients.Witbrodt J., Bond J., Kaskutas L.A. et al.
Journal of Consulting and Clinical Psychology: 2007, 75(6), p. 947–959.
Request reprint using your default e-mail program or write to Dr Witbrodt at jwitbrodt@arg.org
By selecting clients at the very edge of ethically requiring referral to residential care, this US study confirms that unless there are pressing contraindications, intensive non-residential options deliver equivalent outcomes. Often of course, there ARE pressing contraindications.
Summary Male and female managed care clients randomised to day hospital (154 clients) or community residential treatment (139) were compared on substance use outcomes at six and 12 months. To address possible bias in naturalistic studies, outcomes were also examined for clients who self-selected day hospital (321) and for clients (82) excluded from randomisation and instead directed to residential treatment because their home environments placed them at high risk of alcohol and/or drug use. American Society of Addiction Medicine criteria for referral to residential care defined whether clients were eligible for the study and for randomisation. More than 50% of followed-up clients reported past-30-day abstinence at follow-ups (unadjusted rates, no significant differences between groups). Despite differing baseline severity, randomised, self-selecting, and directed clients displayed similar abstinence outcomes in multivariate longitudinal models. Number of days spent in the initial treatment episode and 12-step attendance were associated with abstinence. Although 12-step attendance continued to be important for the full 12 months, treatment beyond the initial episode was not, suggesting an advantage for engaging clients in treatment initially and promoting 12-step attendance for at least a year. Other prognostic effects (including gender and ethnicity) were not significant predictors of differences in outcomes for clients in the treatment modalities.
Studies of whether residential care betters non-residential are limited by the ethical requirement that clients assessed as being at high risk in the absence of a protected environment cannot deliberately be denied it. As a result, studies usually only randomly allocate clients who can practically and with reasonable safety be referred to either setting. Not surprisingly, such studies rarely find an advantage for residential/inpatient options. However, some studies have suggested that
high severity
Factors relevant to the decision to provide residential/inpatient care probably include drug problem severity, psychiatric problems and perhaps especially suicidal tendencies, the degree of support for non-use (or non-problem use) in the home environment and among the client's family and social circle, housing, and the client's ability to support themselves in the community. How severe and multiple these problems need to be to justify residential care will depend partly on the intensity and adequacy of the non-residential alternatives. Most studies have compared inpatient versus outpatient settings rather than residential versus non-residential rehabilitation.
clients do differentially benefit from residential/inpatient care.
The featured study went as far as it could to overcome this methodological limitation by including only clients who met at least five of the six standard US criteria Most were to do with not needing to be hospitalised but one criterion also required a history suggesting the potential for relapse if referred to non-residential programmes and another required there to be an unacceptably high risk of substance use due to the home environment. for residential care, but who fell short of criteria for hospitalisation. Clients who also met the optional sixth criterion – an unacceptably high risk of substance use due to the home environment – were directed to residential Generally up to three months with daily group therapy and practical activities. care. The rest were asked to accept randomisation to this or to intensive Clients spent from three to five and a half hours a day in group therapy over an intended two or three weeks. non-residential care, ethically as close as the study could get to randomising clients judged in need of residential care. Despite this profile, most refused randomisation and opted instead for the less disruptive (to their family, social and working lives) non-residential services, a sign of how important it is to maintain both residential and non-residential options.
In line with earlier research, the study confirmed that unless there are pressing reasons for residential care, non-residential alternatives result in equivalent outcomes at lower cost and less disruption to the client's life. It also confirms that at least in the short-term (often the extra benefits dissipate), the protection of a residential setting enables the most needy In this case, those who met all six criteria for residential care. and least promising clients to do as well as more promising clients, perhaps by eliminating the extra environmental risks they face out in the community.
What the balance should be between these options will depend on the population being served. In some areas most of the referred caseload do have a pressing need for residential care; in others (as in the featured study, all of whose subjects were beneficiaries of prepaid health care plan) this will be a minority.
Thanks for their comments on this entry in draft to Jane Witbrodt of the Alcohol Research Group. Commentators bear no responsibility for the text including the interpretations and any remaining errors.
Last revised 05 January 2009
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Aftercare calls suit less relapse-prone patients STUDY 2005
The grand design: lessons from DATOS STUDY 2002
Continuing care research: what we have learned and where we are going REVIEW 2009
Brief 12-step therapy can work for children too STUDY 2000
Self-financing resident-run houses maintain recovery after treatment STUDY 2008
The Drug Treatment Outcomes Research Study (DTORS): final outcomes report STUDY 2009
Alcohol-use disorders: Diagnosis, assessment and management of harmful drinking and alcohol dependence REVIEW 2011
A randomized controlled trial of intensive referral to 12-step self-help groups: one-year outcomes STUDY 2007
Outcomes of a prospective trial of student-athlete drug testing: the Student Athlete Testing Using Random Notification (SATURN) Study.Goldberg L., Elliot D.L., MacKinnon D.P. et al.
Journal of Adolescent Health: 2007, 41, p. 421–429.
First randomised follow-up study offers little support for randomly testing US school pupils for drug or alcohol use, adding to a slim evidence base which has so far found little benefit to justify the risks and the costs.
Summary This US study aimed to assess the effects of random drug and alcohol testing among high school athletes. US supreme court decisions explicitly permit random testing of pupils who participate in extracurricular activities but the legality of going beyond this to all school pupils remains in doubt. Methodology was a two-year prospective randomised controlled study of a single cohort across five intervention high schools with a random testing policy compared to six schools with a deferred policy, serially assessed by voluntary, confidential questionnaires. Athletes at schools with random testing policies were liable to be randomly urine-tested throughout the academic year. Positive test results were reported to parents or guardians and counselling of pupils was mandatory. Indices of illicit drug use, with or without alcohol use, were assessed at the beginning and end of each school year for the past month and past year. These showed that student athletes from intervention and control schools did not differ in past-month use of illicit drugs or a combination of drug and alcohol use at any of the four follow-up periods. At the end of the initial school year and after two full school years, student athletes at random testing schools reported less drug use during the past year compared to athletes at deferred policy schools. Combining past-year drug and alcohol use, student athletes at random testing schools also reported less use at the second and third follow-up assessments. Paradoxically, across all assessments athletes at random testing schools reported less athletic competence, less belief that authorities were opposed to drug use, and indicated greater risk-taking. At the final assessment, athletes at random testing schools believed less in the benefits of testing and less that testing was a reason not to use drugs. The authors concluded that no deterrent effects of random testing were evident for past-month use at any of the four follow-up periods, but self-reports indicated that past-year drug use was reduced at two of the four follow-ups, and at two a combination of drug and alcohol use was also reduced. Overall, drug testing was accompanied by an increase in some risk factors for future substance use. More research is needed before random drug and alcohol testing is considered an effective deterrent for school-based athletes.
The featured study is the first to randomly allocate schools to testing versus no testing and then to follow up the pupils to test the results, making it the most important contributor to a very slim evidence base. To participate in the study, schools had to agree to randomly test pupils involved in extracurricular athletics as provided for in US law. They were then randomly allocated to initiate the policy or to wait until after the study was completed. Confidential pupil surveys suggested that the frequency of illegal drug use had been slightly curbed by the testing. However, trends in none of the other three indices of drug/alcohol use were significantly different across the two sets of schools, including indices of more recent (past month) use, the measures most likely to have been affected by testing. At best the results were inconclusive about impacts on substance use and if anything negative in terms of the students' attitudes to risktaking. Possibly too the relatively lenient response to positive tests led pupils in testing schools to weaken in their beliefs that the authorities were opposed to drug use.
For several reasons the study will not settle the issue of testing. Apart from the mixed outcomes, the fact that seven of the original 18 schools could not complete the study weakens confidence Also the test of whether the two sets of schools differed relied on differences in the trends in survey results from the first assessment through to the last. However, the first assessment was not an uncontaminated baseline. It took place after pupils knew whether they were to be tested so could have been influenced by this knowledge, though there is little indication that this was actually the case. in the findings and it was able to test only a non-punitive Parents were informed of positive tests and pupils referred for counselling. As long as this was accepted there were no further sanctions. If counselling was refused, pupils remained in school but could not participate in extracurricular sports. model; a more severe policy might have had greater deterrent effect but (see below) would also have posed greater risks. On the other hand, no account was taken of the cost of implementing testing, in this case paid for by the research project.
Earlier research included a pilot for the featured study involving just two schools which on some measures found reduced substance use in the school with testing but also a deterioration in attitudes to drugs, testing and school. Also, a survey comparing over 700 US schools with and without a testing policy was consistent with there having been no impact on cannabis use. Echoing the featured study's findings on attitudes, another US survey suggested that severe school drug policies may (along with other harsh disciplinary policies) diminish the degree to which pupils feel affiliated with the school, potentially one of the most important safeguards against unhealthy development, including substance use.
In contrast with the USA, Britain has merely flirted with the idea of testing school pupils for drugs. It was tried in at least two schools and was recently being considered by several others, though a planned large scale trial in Kent fell through when schools were unwilling to divert funds from other activities. Police sniffer dogs are an alternative also tried in the UK. An evaluation commissioned by Bedfordshire police concluded that the costs and the risks (among others, of alienating pupils Many felt the aim was to 'catch them out' and that they should not be made to parade past sniffer dogs. and publicly and potentially falsely stigmatising individuals) were balanced by little in the way of benefits. Pupils in the school where the dogs were used actually became less likely to believe that the experience would deter youngsters from having drugs inside school.
Official guidance for England published in 2004 did not explicitly rule out testing or sniffer dogs but did advise "extreme caution" and raised serious concerns such as whether such measures are consistent with a school's pastoral responsibilities. None of the recent UK national policies (for England, Scotland, Wales and Northern Ireland) mentioned these measures, a sign perhaps that initial governmental interest has receded. If so this would be in line with expert opinion from the government's drug advisers which recommended against sniffer dogs and testing in schools. In the virtual absence of research, their concerns were over ethics, practicality, cost, and the potential impact on relationships with pupils. Overall the slim evidence to date and these other concerns give no reason to subject pupils to drug testing or examination by sniffer dogs at random or without cause.
The same research team has developed prevention programmes for male (ATLAS) and female (ATHENA) students involved in sports activities to be implemented by coaches, aiming to provide healthy sports nutrition and strength-training alternatives to alcohol, illicit and performance-enhancing drugs.
Thanks for their comments on this entry in draft to Linn Goldberg of the Oregon Health & Science University. Commentators bear no responsibility for the text including the interpretations and any remaining errors.
Last revised 15 January 2009
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Drug testing in schools evidence, impacts and alternatives REVIEW 2008
Testing school pupils for drugs does not reduce drug use STUDY 2003
British study queries use of sniffer dogs to detect pupils' drug use STUDY 2004
Drug Strategy 2010. Reducing Demand, Restricting Supply, Building Recovery: Supporting People to Live a Drug Free Life DOCUMENT 2010
UK-style school drug prevention programme helps prevent regular drinking STUDY 2003
Project SUCCESS' effects on the substance use of alternative high school students STUDY 2010
Substance-focused initiatives not only way schools help prevent risky substance use STUDY 2008
Education's uncertain saviour STUDY 2000
Confident kids ... like to party NASTY SURPRISES 2004
