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Keywords:

  • Adolescents;
  • drug prevention;
  • drug test;
  • drug use;
  • school;
  • students

DuPont et al. [1] have done researchers and practitioners a favour by examining the key issues involved in mandatory random student drug testing (MRSDT), a controversial drug prevention strategy implemented widely in the United States. DuPont et al. conclude that MRSDT is a promising strategy worthy of continued scientific investigation. This suggestion is welcome, especially if it encourages researchers to move beyond the question of whether MRSDT works to explore the more important question of whether there are any conditions under which MRSDT is more successful than other school drug prevention strategies that are less invasive of students' right to privacy.

In comparing MRSDT to other school drug prevention efforts, it is useful to elucidate the key assumptions underpinning the rationale of MRSDT, and how these compare to those of other prevention strategies. The goals of MRSDT are twofold: (i) deterring student substance use by providing students with a reason to decline peers' drug offers and (ii) identifying individual students with substance use problems for referral to appropriate counselling/treatment services [2]. While the first goal can be placed within universal drug prevention approaches aimed at the general student population, the second goal can be placed within selective prevention approaches that target individual students with increased risk of drug use problems.

As a universal prevention approach, MRSDT shares the basic strategy of traditional universal school drug prevention strategies that aim to encourage students to ‘just say no’, and the underlying assumption that drug use is a function of individual susceptibility to peer pressure. Unfortunately, traditional universal school drug prevention efforts that have been based on this assumption have shown only small, inconsistent and unsustained effects [3-6]. Given that MRSDT shares the underlying assumptions of previously limited universal prevention efforts, one could predict that MRSDT as a universal drug prevention strategy will, at best, be weak.

One reason why traditional universal school-based drug prevention approaches may have had limited success is that they assume optimistically that adolescent drug use is under the control of the individual student: once individuals are informed, they will abstain from drug use. This approach ignores the realization that adolescent drug use is influenced heavily by the individual's social environment [7]. In comparison, holistic approaches that focus upon the school social environment may show more promise. In particular, interventions that improve school social climates rest on the idea that the development of a safe, supportive and inclusive school environment has far-reaching effects on young people's health and wellbeing, including drug problems [8]. Experimental interventions [9, 10] have demonstrated that such school climates can reduce substance use, and national surveys verify that students in schools with positive climates have better mental health and less drug use [11, 12]. Indeed, national surveys indicate that MRSDT may succeed only in schools with positive climates [13].

As a selective prevention intervention, MRSDT aims to identify high-risk adolescents and refer them to targeted interventions. To date, no evaluation of this part of the strategy has been conducted. As DuPont et al. [1] highlight, although MRSDT is intended to be a non-punitive measure, the major focus of testing positive appears to be the threat of removal from extracurricular activities, rather than the drug counselling and treatment that should be implemented. Research shows that motivational interviewing may reduce substance use and related harm, particularly among heavy adolescent substance users [14]. Thus, it may be expected that, in combination with motivational interviewing or other evidence-based interventions, identifying students who use drugs through MRSDT may serve as a valuable selective prevention approach. However, it should be noted that MRSDT may be relatively ineffective as a screening tool for substance use. Due to legal restrictions, MRSDT in the United States is implemented typically only for students in extracurricular activities. Effectively, it targets students who are at low risk for drug use problems [15-17]. Furthermore, MRSDT programmes do not typically test for use of alcohol, which is harder to detect through biological tests than illegal drugs. In effect, MRSDT is likely to miss screening of the drug that is the major source of immediate impairment in youth [18]. As the highest prevalence of drug use occurs among poorer academic performers and adolescents with externalizing and internalizing problems [19], identifying these risk indicators may be a more effective and sensitive way of referring students who could benefit from selective prevention programmes than MRSDT.

DuPont et al. [1] move us in a useful direction. There is no denying that there is a need for better school drug preventive initiatives and MRSDT should be considered carefully. However, MRSDT should be measured against existing evidence-based prevention models, and these should be used as a yardstick of success. From this perspective MRSDT is, at least in theory, a questionable drug prevention strategy.

Declaration of interests

None.

Acknowledgement

  1. Top of page
  2. Acknowledgement
  3. References

This commentary benefited from the thoughtful comments and suggestions by Dr Daniel Romer at the Adolescent Communication and Health Communication Institutes, Annenberg Public Policy Center, University of Pennsylvania.

References

  1. Top of page
  2. Acknowledgement
  3. References
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