A high school classroom-based drug prevention program that aims to prevent teen drinking, smoking, marijuana, and other hard drug use.
Blueprints: Model
Crime Solutions: Promising
OJJDP Model Programs: Promising
SAMHSA : 2.9-3.4
Leah Meza
USC Institute for Prevention Research
Soto Street Bldg., 302A
201 N. Soto Street
Los Angeles, CA 90032
Phone: (800) 400-8461 for orders
Fax: (323) 442-7254
Email: leahmedi@usc.edu
Website: tnd.usc.edu
Steve Sussman, Ph.D.
University of Southern California
Project Towards No Drug Abuse (TND) is a drug prevention program for high school youth who are at risk for drug use and violence-related behavior. The current version of the Project TND curriculum contains twelve 40-minute interactive sessions taught by teachers or health educators over a 3-week period. Sessions provide instruction in motivation activities to not use drugs; skills in self-control, communication, and resource acquisition; and decision-making strategies. The program is delivered universally and has been used in both traditional and alternative, high-risk high schools.
Project TND is a drug prevention program for high school youth who are at-risk for drug use and violence-related behavior. It originally consisted of nine sessions designed to address issues of substance abuse and violence: 1) Communication and Active Listening, 2) Stereotyping, 3) Myths and Denial, 4) Chemical Dependency, 5) Talk Show, 6) Stress, Health and Goals, 7) Self Control, 8) Perspectives, and 9) Decision Making and Commitment. Three new sessions were added from the third trial on; that is, most trials utilized a 12-session program. These three newer sessions are the 1) Marijuana Panel, 2) Positive and Negative Thought Loops and Subsequent Behavior, and 3) Smoking Cessation. Classes are taught by trained health educators, who administer the curriculum over a 3-week period. Each session lasts 40 minutes and is conducted during the class period. The current version of TND contains twelve 40-minute interactive sessions. The sessions should be taught as written. Those students who are absent on days that a lesson is implemented should be provided with single-page summaries of the material from each lesson that they can utilize as a means to "make-up" learning of missed lesson material.
The Socratic method is used throughout the curriculum. Thus, the emphasis is on interactions between the students and the teacher and the students with each other. The teacher's use of questioning leads students to generate the answers based on the reasoning that information is internalized more readily when it is not imposed from someone else.
Classroom management in Project TND involves development of positive norms of classroom behavior. Although interaction among the youth is encouraged, the course is primarily teacher-directed and highly structured. In Project TND, the teacher's role is to actively develop and maintain peer group support in the class by modeling support, positively reinforcing it among group members, and negatively reinforcing deviant peer bonds and activities. The teacher creates and structures interactions among youth in prosocial directions.
Primary Evidence Base for Certification
Study 1
Simon et al. (2002), Sun et al. (2006), and Sussman et al. (1998) found that students from program schools, relative to students from control schools, exhibited significant reductions in
Study 2
Dent et al. (2001) and Sussman et al. (2002) found that, relative to control classrooms, intervention classrooms exhibited significant reductions in
Study 3
Sussman, Dent, Craig et al. (2002), Sussman, Dent, & Stacy (2002), and Sussman et al. (2003) found that the health educator-led condition, relative to the control condition, significantly reduced
Study 4
Sun et al. (2008) found that, relative to the control group, the two intervention groups significantly reduced
Primary Evidence Base for Certification
Of the eight studies Blueprints has reviewed, four (Studies 1-4) meet Blueprints evidentiary standards (specificity, evaluation quality, impact, dissemination readiness). The four certified studies were done by the developer.
Study 1
Simon et al. (2002), Sun et al. (2006), and Sussman et al. (1998) used a cluster randomized controlled trial that assigned 21 alternative, continuation high schools with 1,578 student participants to an intervention group, an intervention group plus school wide activities, or a control group. Student measures of substance use were obtained over a four-to-five-year period.
Study 2
Dent et al. (2001) and Sussman et al. (2002) used a cluster randomized controlled trial that assigned 26 classrooms with 1,208 students in three regular high schools to the intervention group or a control group. Student measures of substance use were gathered at a one-year follow-up.
Study 3
Sussman, Dent, Craig et al. (2002), Sussman, Dent, & Stacy (2002), and Sussman et al. (2003) used a cluster randomized controlled trial that assigned 18 continuation high schools with 1,018 students to three conditions: the regular intervention, a self-instructional version of the intervention, or a standard-care control condition. Data on student substance use were obtained at one- and two-year follow-ups.
Study 4
Sun et al. (2008) used a cluster randomized controlled trial that assigned 18 continuation and regular high schools with 2,734 students to a cognitive-only intervention, a cognitive plus behavior intervention, or a control group. Student data on substance use were obtained at a one-year follow-up.
Individual: Early initiation of drug use, Favorable attitudes towards antisocial behavior, Favorable attitudes towards drug use, Stress, Substance use
Peer: Interaction with antisocial peers, Peer rewards for antisocial behavior, Peer substance use
Individual: Perceived risk of drug use, Problem solving skills, Prosocial behavior, Prosocial involvement, Skills for social interaction
*
Risk/Protective Factor was significantly impacted by the program
See also: Project Towards No Drug Abuse Logic Model (PDF)
Subgroup differences in program effects by race, ethnicity, or gender (coded in binary terms as male/female) or program effects for a sample of a specific racial, ethnic, or gender group:
Sample demographics including race, ethnicity, and gender for Blueprints-certified studies:
Teacher training consists of 1-2 day workshops, each day lasting 6-7 hours. In 2-day workshops, teachers have much more time to practice delivering session activities and receiving feedback. One-day trainings are more relevant to settings highly familiar with delivery of prevention programming or in settings in which TND has been delivered in the past. We strongly recommend that every teacher who implements Project TND participate in a training workshop, conducted by a certified Project TND trainer, prior to beginning delivery of the program. The objectives of the Project TND training workshop are to provide teachers with an understanding of the theoretical basis, content, instructional techniques, and objectives of the program. In addition, the training is designed to build the skills that teachers need to deliver the lessons with fidelity. Teachers observe and practice the teaching skills crucial to successful implementation. Being able to implement the curriculum with fidelity is quite important. Comfort with engaging in talk shows (psychodramas), using Socratic/interactive dialogue, and how to play the TND game (to motivate student participation, reinforce learning, and aid the teacher with classroom management) are examples of three key skills needed.
At the current time, certification for TND delivery, and certification for some persons to train others (who have much experience with the program), is offered but no TOTs per se. When a TOT is conducted, the person who will be certified does the training and one of the TND-certified trainers will observe the training, provide feedback, and provide a passing-failing score for the training. In general, people are only certified to train others locally on TND.
Program Benefits (per individual):
$469
Program Costs (per individual):
$78
Net Present Value (Benefits minus Costs, per individual):
$392
Measured Risk (odds of a positive Net Present Value):
57%
Source: Washington State Institute for Public Policy
All benefit-cost ratios are the most recent estimates published by The Washington State Institute for Public Policy for Blueprint programs implemented in Washington State. These ratios are based on a) meta-analysis estimates of effect size and b) monetized benefits and calculated costs for programs as delivered in the State of Washington. Caution is recommended in applying these estimates of the benefit-cost ratio to any other state or local area. They are provided as an illustration of the benefit-cost ratio found in one specific state. When feasible, local costs and monetized benefits should be used to calculate expected local benefit-cost ratios. The formula for this calculation can be found on the WSIPP website.
Initial Training & Technical Assistance: $2,100 + trainer travel costs for a two-day training for up to 25 teachers.
$200 per teacher.
Materials Available in Other Language: Student workbooks are available in Spanish at the same price as the English version. The Teacher's Manual has not been translated under the assumption that the program can be taught in English, but Spanish speaking students can follow along with a Spanish Workbook.
None.
None.
$12 per student for student workbooks. Teacher manuals are included in the start-up costs, but if they need to be replaced for new teachers or due to wear and tear, cost is $95 per manual.
Qualifications: No specific requirements, though typically delivered by certified classroom teachers or health specialists.
Ratios: No specific requirements though typically delivered in high school classrooms with ratios of 20 - 30 students per teacher.
Time to Deliver Intervention: Twelve 40 and 50 minute sessions designed to be delivered over 4 weeks (3 sessions per week), but which can be delivered over a six week period.
None.
None.
Fidelity monitoring tools available from developer upon request.
None.
No information is available
None.
To implement TND in two schools with a total of 24 teachers, the following costs can be projected for the first year:
In this example, the cost per student would be $15.65.
Project TND is a very low cost program, with low one-time training costs and inexpensive Student Workbooks. Beyond dedicating teaching time to delivering the intervention, little ongoing funding is required.
Sustaining this program requires the ongoing allocation of existing classroom teaching time to deliver the intervention. Other options include training teachers or youth development professionals to deliver the program, or partnering with public health entities to bring public health professionals into schools to deliver the intervention, affording classroom teachers professional development time. Project TND is delivered, however, in a classroom or classroom-like situation.
State and local funds, most typically from school budgets, are often allocated to purchase the initial training and Student Workbooks. State Tobacco Settlement revenues are also used by some states for substance abuse prevention programs.
Formula Funds:
Discretionary Grants: Federal discretionary grants from the Department of Education or the Office of Juvenile Justice and Delinquency Prevention at the Department of Justice have been used to fund the initial training of teachers. SAMHSA also has relevant federal discretionary grants.
Foundations can be approached for funding for initial teacher training, and curriculum purchases.
School-based prevention programs such as TND can potentially be supported through state or local funding streams dedicated to prevention. Sin taxes, such as those that target alcohol and tobacco use, have been established by some states to support tobacco and substance abuse prevention programs. The program is so low cost that interested schools could potentially consider community fundraising through Parent Teacher Associations, student civic societies, or partnerships with local businesses and civic organizations as a means of raising dollars to support the initial training and curriculum purchases.
All information comes from the responses to a questionnaire submitted by the developer of the program, Steve Sussman, Ph.D., FAAHB, FAPA, Professor of Preventive Medicine and Psychology at the University of Southern California, to the Annie E. Casey Foundation.
Steve Sussman, Ph.D.University of Southern CaliforniaInstitute for Prevention ResearchSoto Street Building, 302ALos Angeles, CA 90032(800) 400-8461 for order(323) 442-8220 Direct(323) 442-7254ssussma@usc.edu tnd.usc.edu
A high school classroom-based drug prevention program that aims to prevent teen drinking, smoking, marijuana, and other hard drug use.
TND is a drug abuse prevention program with a focus on high school youth, ages 14 to 19, who are at risk for drug abuse. It has been tested at traditional and alternative high schools with both racially and ethnically diverse populations.
Subgroup differences in program effects by race, ethnicity, or gender (coded in binary terms as male/female) or program effects for a sample of a specific racial, ethnic, or gender group:
Sample demographics including race, ethnicity, and gender for Blueprints-certified studies:
Individual: Early initiation of drug use, Favorable attitudes towards antisocial behavior, Favorable attitudes towards drug use, Stress, Substance use
Peer: Interaction with antisocial peers, Peer rewards for antisocial behavior, Peer substance use
Individual: Perceived risk of drug use, Problem solving skills, Prosocial behavior, Prosocial involvement, Skills for social interaction
*Risk/Protective Factor was significantly impacted by the program
Project Towards No Drug Abuse (TND) is a drug prevention program for high school youth who are at risk for drug use and violence-related behavior. The current version of the Project TND curriculum contains twelve 40-minute interactive sessions taught by teachers or health educators over a 3-week period. Sessions provide instruction in motivation activities to not use drugs; skills in self-control, communication, and resource acquisition; and decision-making strategies. The program is delivered universally and has been used in both traditional and alternative, high-risk high schools.
Project TND is a drug prevention program for high school youth who are at-risk for drug use and violence-related behavior. It originally consisted of nine sessions designed to address issues of substance abuse and violence: 1) Communication and Active Listening, 2) Stereotyping, 3) Myths and Denial, 4) Chemical Dependency, 5) Talk Show, 6) Stress, Health and Goals, 7) Self Control, 8) Perspectives, and 9) Decision Making and Commitment. Three new sessions were added from the third trial on; that is, most trials utilized a 12-session program. These three newer sessions are the 1) Marijuana Panel, 2) Positive and Negative Thought Loops and Subsequent Behavior, and 3) Smoking Cessation. Classes are taught by trained health educators, who administer the curriculum over a 3-week period. Each session lasts 40 minutes and is conducted during the class period. The current version of TND contains twelve 40-minute interactive sessions. The sessions should be taught as written. Those students who are absent on days that a lesson is implemented should be provided with single-page summaries of the material from each lesson that they can utilize as a means to "make-up" learning of missed lesson material.
The Socratic method is used throughout the curriculum. Thus, the emphasis is on interactions between the students and the teacher and the students with each other. The teacher's use of questioning leads students to generate the answers based on the reasoning that information is internalized more readily when it is not imposed from someone else.
Classroom management in Project TND involves development of positive norms of classroom behavior. Although interaction among the youth is encouraged, the course is primarily teacher-directed and highly structured. In Project TND, the teacher's role is to actively develop and maintain peer group support in the class by modeling support, positively reinforcing it among group members, and negatively reinforcing deviant peer bonds and activities. The teacher creates and structures interactions among youth in prosocial directions.
The development of Project TND's prevention programming was rooted in a variety of theoretical perspectives. These research arenas may be aggregated to include (a) behavioral therapy-related theories (e.g., modern learning theoretical notions of free operants and signal-event connections, self-instructional training notions by Michenbaum (derived from Luria's work), "bonding" notions, and assertiveness notions); (b) social psychological theories such as various ingroup-outgroup stereotyping notions, attitudinal perspective theory, the health as a value notion, the false consensus effect, and stress-coping work; (c) sociological theories pertaining to belief myth creation such as Neutralization Theory, Mystification Theory, and Perceived Effects Theory; (d) recovery or chemical dependency treatment-related literature ideas, such as notions of enabling, family roles, and progression of chemical dependency consequences, and (e) theories of motivation such as classical notions of direction and energy components of motivation, and motivational interviewing.
Primary Evidence Base for Certification
Of the eight studies Blueprints has reviewed, four (Studies 1-4) meet Blueprints evidentiary standards (specificity, evaluation quality, impact, dissemination readiness). The four certified studies were done by the developer.
Study 1
Simon et al. (2002), Sun et al. (2006), and Sussman et al. (1998) used a cluster randomized controlled trial that assigned 21 alternative, continuation high schools with 1,578 student participants to an intervention group, an intervention group plus school wide activities, or a control group. Student measures of substance use were obtained over a four-to-five-year period.
Study 2
Dent et al. (2001) and Sussman et al. (2002) used a cluster randomized controlled trial that assigned 26 classrooms with 1,208 students in three regular high schools to the intervention group or a control group. Student measures of substance use were gathered at a one-year follow-up.
Study 3
Sussman, Dent, Craig et al. (2002), Sussman, Dent, & Stacy (2002), and Sussman et al. (2003) used a cluster randomized controlled trial that assigned 18 continuation high schools with 1,018 students to three conditions: the regular intervention, a self-instructional version of the intervention, or a standard-care control condition. Data on student substance use were obtained at one- and two-year follow-ups.
Study 4
Sun et al. (2008) used a cluster randomized controlled trial that assigned 18 continuation and regular high schools with 2,734 students to a cognitive-only intervention, a cognitive plus behavior intervention, or a control group. Student data on substance use were obtained at a one-year follow-up.
Primary Evidence Base for Certification
Study 1
Simon et al. (2002), Sun et al. (2006), and Sussman et al. (1998) found in the one-year follow-up analyses that students from program schools exhibited a 25% reduction in hard drug use prevalence rates, relative to students from the control schools. In addition, a 7% reduction in alcohol use prevalence was observed for program students relative to controls, but only among those who were using alcohol at baseline. Medium-term (2-3 year) and long-term (4-5 year) follow-up analyses demonstrated maintenance effects for 30-day hard drug use among students in treatment schools.
Study 2
Dent et al. (2001) and Sussman et al. (2002) found in a one-year follow-up analyses reduction of prevalence of hard drug use (25% among baseline non-drug users) and alcohol use (12% among baseline users). Among males only, the study found a reduction of weapon carrying and a 17% reduction of victimization.
Study 3
Sussman, Dent, Craig et al. (2002), Sussman, Dent, & Stacy (2002), and Sussman et al. (2003) found in the one-year follow-up that only the health educator-led condition provided a reduction in problem behavior rates (i.e., hard drug use, alcohol use, weapon carrying, tobacco and marijuana use), relative to each of the other conditions. Similarly, the two-year follow-up indicated that the health educator-led condition significantly lowered the probability of 30-day tobacco and hard drug use, as well as marijuana use among male baseline non-users.
Study 4
Sun et al. (2008) found no significant results for prevalence of any of the four 30-day substance use outcomes for either of the treatment conditions (cognitive perception information with and without a behavioral skills component). The only statistically significant finding was for the frequency of hard drug use, which was reduced in both treatment conditions relative to the control group.
Primary Evidence Base for Certification
Study 1
Simon et al. (2002), Sun et al. (2006), and Sussman et al. (1998) found that students from program schools, relative to students from control schools, exhibited significant reductions in
Study 2
Dent et al. (2001) and Sussman et al. (2002) found that, relative to control classrooms, intervention classrooms exhibited significant reductions in
Study 3
Sussman, Dent, Craig et al. (2002), Sussman, Dent, & Stacy (2002), and Sussman et al. (2003) found that the health educator-led condition, relative to the control condition, significantly reduced
Study 4
Sun et al. (2008) found that, relative to the control group, the two intervention groups significantly reduced
Study 3 (Sussman et al., 2003) reported odds ratios for the program led by health educators relative to the control group. They were .50 for tobacco use (a medium effect size) and .20 for hard drug use (a large effect size). Study 4 (Sun et al., 2008) reported a significant odds ratio of .56 for the frequency of hard drugs (a medium effect size).
Additional Studies (not certified by Blueprints)
Study 5 (Valente et al., 2007)
Valente, T. V., Ritt-Olson, A., Stacy, A., Unger, J. B., Okamoto, J., & Sussman, S. (2007). Peer acceleration: Effects of a social network tailored substance abuse prevention program among high-risk adolescents. Addiction, 102(11), 1804-1815.
Study 6 (Rorhrbach et al., 2010)
Rohrbach, L. A., Sun, P., & Sussman, S. (2010). One-year follow-up evaluation of the Project Towards No Drug Abuse (TND) dissemination trial. Preventive Medicine, 51, 313-319.
Study 7 (Lisha et al., 2012; Sussman et al., 2012; Barnett et al., 2012)
Barnett, E., Spruijt-Metz, D., Unger, J. B., Sun, P., Rohrbach, L. A. & Sussman, S. (2012). Boosting a teen substance use prevention program with motivational interviewing. Substance Use and Misuse, 47,418-428.
Lisha, N. E., Sun, P., Rohrbach, L. A., Spruijt-Metz, D., Unger, J. B., & Sussman, S. (2012). An evaluation of immediate outcomes and fidelity of a drug abuse prevention program in continuation high schools: Project Toward No Drug Abuse (TND). Journal on Drug Education, 42(1), 33-57.
Sussman, S., Sun, P., Rohrbach, L. A., & Spruijt-Metz, D. (2012). One-year outcomes of a drug abuse prevention program for older teens and emerging adults: Evaluating a motivational interviewing booster component. Health Psychology, 31(4), 476-485.
Study 8 (Mohammad et al., 2010)
Mohammad, B. N., Somayeh, B., Mohsen, H., & Kobra, L. (2010). Immediate and six-month outcomes of a school-based substance prevention program (Project TND) for Iranian high school students. Procedia Social and Behavioral Sciences, 5, 1997-2001.
This program is a preventive intervention targeting misuse of illicit drugs including opioids. This program is not a treatment for substance use disorder. As an upstream preventive intervention, this program targets and reduces problem behaviors that are associated with increased risk of developing substance use disorder or opioid use disorder later in life.
Smith-Moncrieffe et al. (2015) examined the school-based Project Towards No Drug Abuse for a sample of students but presented the results in combination with a a sample of non-students that received a community-based adaptation of the program. The combination of programs did not provide a test of the original program.
Smith-Moncrieffe, D. (2015). Final program evaluation: Project Towards No Drug Abuse. Research Report 2015-R010. Ottawa: Public Safety Canada, Research Division.
Gorman (2014) reviewed the evidence of program efficacy from seven evaluations of the program authored by Sussman and colleagues. Table 1 shows 71 tests across the studies for cigarette, alcohol, and marijuana use, with five significant differences using two-tailed tests and three significant differences using one-tailed tests. Table 2 shows more consistent program effects for hard drug use, but many of the results used one-tailed tests, had outcomes that were inconsistent measured across studies, and were likely biased by attrition. Gorman concluded that there was little evidence of program benefits and that the evidence of benefits was subject to threats to internal validity.
Gorman, D. M. (2014). Is Project Towards No Drug Abuse (Project TND) an evidence-based drug and violence prevention program? A review and reappraisal of the evaluation studies. Journal of Primary Prevention, 35, 217-232.
Sussman et al. (2014) responded to Gorman by arguing that one-tailed tests were sometimes appropriate and that most results were significant with two-tailed tests, that changes in outcome measures were minor, and that tests found little evidence of differential attrition.
Sussman, S., Valente, T. W., Rohrbach, L. A., Dent, C. W., & Sun, P. (2014). Commentary-Project Towards No Drug Abuse: An evidence-based drug abuse prevention program. Journal of Primary Prevention, 35, 233-237.
Blueprints: Model
Crime Solutions: Promising
OJJDP Model Programs: Promising
SAMHSA : 2.9-3.4
SITE:
Kern County Superintendent of Schools Office
1300 17th Street - City Centre
Bakersfield, CA 93301
Contact: Kevin Keyes, Prevention Specialist
661-852-5665
kekeyes@kern.org
or
Contact: Daryl Thiesen, Prevention Services Coordinator
661-852-5649
dathiesen@kern.org
SITE:
Eagle River Youth Coalition
P.O. Box 4613
Edwards, CO 81632
Phone: 970.949.9250
info@eagleyouth.org
Contact: Michelle Stecher, Executive Director
Leah Meza
USC Institute for Prevention Research
Soto Street Bldg., 302A
201 N. Soto Street
Los Angeles, CA 90032
Phone: (800) 400-8461 for orders
Fax: (323) 442-7254
Email: leahmedi@usc.edu
Website: tnd.usc.edu