Substance use prevention in special education: effectiveness of the Dutch 'healthy school and drugs' intervention

Abstract

Introduction. This study assessed the effectiveness of an adaptation of the Dutch evidence-based substance use prevention intervention ‘Healthy School & Drugs’ (HSD), implemented nation-wide in regular secondary education, but now targeted to secondary Special Education. The multimodal program includes a series of 4 lessons supported with written materials and audiovisual tools, teacher training and support, and parental involvement. We also examined whether program effects were moderated by subtypes of SE schools. Methods. In a quasi-experimental study design the HSD program was compared to usual curriculum. A total of 363 students (M = 13.9, SD = 0.82) from 13 Dutch secondary SE schools participated, recruited from several subtypes of schools: intellectual and physical disabilities, learning disabilities and developmental disorders, and behavioral and emotional disorders. Students were administered paper-and-pencil questionnaires at baseline and at 5 months post-treatment follow-up. Outcome measures included cognitive predictors (social influence, refusal self-efficacy, intention to smoke/drink), and behavioral outcomes (self-reported tobacco use and alcohol use). Results. No main effects of the HSD program were found at follow-up on any of the outcome measures. Interaction and within-group analyses revealed small but significant adverse effects in SEB schools on alcohol intention and alcohol use. Conclusion. The HSD program redesigned for use in Special Education was shown to be ineffective, and possibly even counter-effective among the subsample of students with emotional and behavioral disorders. This suggests that applying a universal prevention approach to this target group should be reconsidered.