Why "Just Say No" Doesn't Work

“Just say no.” In 1982 First Lady Nancy Reagan uttered those three words in response to a schoolgirl who wanted to know what she should say if someone offered her drugs. The first lady's suggestion soon became the clarion call for the adolescent drug prevention movement in the 1980s and beyond. Since then, schools around the country have instituted programs designed to discourage alcohol and drug use among youth—most of them targeting older elementary schoolchildren and a few addressing adolescents.

There is good reason for concern about youth substance abuse. A large U.S. survey conducted in 2012 by psychologist Lloyd D. Johnston and his colleagues at the University of Michigan revealed that fully 24 percent of 12th graders had engaged in binge drinking (defined as five or more drinks on one occasion) in the past two weeks. Moreover, 42 percent had consumed at least some alcohol in the past month, as had 11 percent of eighth graders and 28 percent of high school sophomores. In addition, 1 percent of 12th graders had tried methamphetamine, and almost 3 percent had used cocaine in the past year.

In an attempt to reduce these figures, substance abuse prevention programs often educate pupils regarding the perils of drug use, teach students social skills to resist peer pressure to experiment, and help young people feel that saying no is socially acceptable. All the approaches seem sensible on the surface, so policy makers, teachers and parents typically assume they work. Yet it turns out that approaches involving social interaction work better than the ones emphasizing education. That finding may explain why the most popular prevention program has been found to be ineffective—and may even heighten the use of some substances among teens.

Rehearsing Refusal
The most widely publicized teen substance abuse prevention program is Drug Abuse Resistance Education, better known by the acronym D.A.R.E. Created in 1983 by the Los Angeles Police Department, D.A.R.E. asks uniformed police officers to go into schools to warn students about the dangers of drug use and underscore the pluses of a drug-free way of life. In most cases, the officers do so once a week, typically for 45 to 60 minutes, for several months. D.A.R.E. is immensely popular; according to the program Web site, it has been put in place in 75 percent of U.S. school districts and 43 countries. D.A.R.E. bumper stickers, D.A.R.E. T-shirts, and police cars emblazoned with the word D.A.R.E. are familiar fixtures in many U.S. communities.

Despite this fanfare, data indicate that the program does little or nothing to combat substance use in youth. A meta-analysis (mathematical review) in 2009 of 20 controlled studies by statisticians Wei Pan, then at the University of Cincinnati, and Haiyan Bai of the University of Central Florida revealed that teens enrolled in the program were just as likely to use drugs as were those who received no intervention.

A few clues to D.A.R.E.'s deficiencies come from psychologist Pim Cuijpers of the Netherlands Institute of Mental Health and Addiction in Utrecht. In a review of 30 studies published in 2002, she attempted to pinpoint the common elements of successful programs. Cuijpers reported that the most effective ones involve substantial amounts of interaction between instructors and students. They teach students the social skills they need to refuse drugs and give them opportunities to practice these skills with other students—for example, by asking students to play roles on both sides of a conversation about drugs, while instructors coach them about what to say and do. In addition, programs that work take into account the importance of behavioral norms: they emphasize to students that substance use is not especially common and thereby attempt to counteract the misconception that abstaining from drugs makes a person an oddball.

In a 2011 review of various substance abuse prevention programs, epidemiologist Melissa Stigler of the University of Texas School of Public Health and her colleagues buttressed these conclusions. They further observed that programs that unfold during many sessions—ideally, over several years—garner especially strong results, probably because they provide students with lessons that are reinforced over time, as children mature and encounter different environments.