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GAO-03-172R: 

United States General Accounting Office: 
Washington, DC 20548: 

January 15, 2003: 

The Honorable Richard J. Durbin: 
United States Senate: 

Subject: Youth Illicit Drug Use Prevention: DARE Long-Term Evaluations 
and Federal Efforts to Identify Effective Programs: 

Dear Senator Durbin: 

The use of illicit drugs, particularly marijuana, is a problem among 
our nation’s youth. The adverse effects of illicit drug use play a role 
in school failure, violence, and antisocial and self-destructive 
behavior. A recent national survey [Footnote 1] showed that for 1996 
through 2002, more than 30 percent of tenth and twelfth grade students
reported using marijuana in the past year. Further, about 20 percent of 
high school seniors reported using marijuana within the past 30 days. 
In fiscal year 2000, the federal government spent over $2.1 billion on 
illicit drug use prevention activities for youth, according to the 
Office of National Drug Control Policy (ONDCP). 

Many programs are designed to help prevent and reduce illicit drug use 
among youth. Often, these programs also address the use of other 
substances, such as alcohol and tobacco. Youth drug abuse prevention 
programs are implemented in school, family, and community settings. 
School-based prevention programs are the most prevalent because schools 
provide easy access to children and adolescents. The most widely
used school-based substance abuse prevention program in the United 
States is the Drug Abuse Resistance Education (DARE) program, [Footnote 
2] which is funded by a variety of sources, including private, federal, 
and other public entities. DARE’s primary mission is to provide 
children with the information and skills they need to live drug- and
violence-free lives through programs at the elementary school, middle 
school, and high school levels. The DARE program is usually introduced 
to children in the fifth or sixth grade. According to research 
literature, concerns have been raised about the effectiveness of the 
DARE fifth and sixth grade curriculum in preventing illicit drug use 
among youth. As agreed with your staff, this report contains 
information you requested on (1) the results of evaluations on the long-
term effectiveness of the DARE elementary school curriculum in 
preventing illicit drug use among children and (2) federal efforts to 
identify programs that are effective in preventing illicit drug use 
among children. 

To identify evaluations on the effectiveness of DARE at preventing 
illicit drug use among children, we searched social science, business, 
and education databases, which included the Department of Health and 
Human Services’ (HHS) National Institutes of Health’s (NIH) National 
Library of Medicine, for evaluations of DARE published in professional 
journals. We identified articles published in the 1990s on six 
evaluations of the DARE elementary school curriculum that included 
illicit drug use as an outcome measure and that also met key 
methodological criteria for our review, such as a long-term evaluation 
design and the use of intervention and control groups for comparisons. 
The six long-term evaluations that we discuss in this report were 
conducted at different times up to 10 years after student participants 
were initially surveyed. The six evaluations are based on three 
separate studies in three states. We reviewed each of the six 
evaluations and summarized the results of our review. We also held 
discussions with the researchers who conducted the evaluations. We did
not independently validate the research designs or verify the results 
of evaluations on the effectiveness of the DARE program. (Enclosure I 
contains citations for the articles on evaluations of the DARE 
elementary school curriculum that we reviewed and enclosure II 
describes the methodology we used to select the evaluations). 

To determine federal efforts to identify programs that are effective in 
preventing youth illicit drug use, we interviewed federal officials and 
reviewed documentation on efforts by HHS and the Department of 
Education (Education) to recognize programs that demonstrate success in 
reducing illicit drug use among children and adolescents. We did not 
independently verify the results of prevention programs recognized by 
the federal agencies. We conducted our work from January through 
December 2002 in accordance with generally accepted government auditing
standards. 

In brief, the six long-term evaluations of the DARE elementary school 
curriculum that we reviewed found no significant differences in illicit 
drug use between students who received DARE in the fifth or sixth grade 
(the intervention group) and students who did not (the control group). 
Three of the evaluations reported that the control groups of students 
were provided other drug use prevention education. All of the 
evaluations suggested that DARE had no statistically significant long-
term effect on preventing youth illicit drug use. Of the six 
evaluations we reviewed, five also reported on students’ attitudes 
toward illicit drug use and resistance to peer pressure and found no 
significant differences between the intervention and control groups 
over the long term. Two of these evaluations found that the DARE 
students showed stronger negative attitudes about illicit drug use and 
improved social skills about illicit drug use about 1 year after 
receiving the program. These positive effects diminished over time. 

HHS and Education have identified several programs that show evidence of
effectiveness in preventing youth substance abuse and promoted their 
use in schools and communities. The Substance Abuse and Mental Health 
Services Administration (SAMHSA) within HHS and Education use expert 
panels to review program information that the programs’ developers or 
others submit and rank the programs on several criteria, such as the 
scientific rigor of their evaluations and the overall usefulness of 
their findings for preventing substance abuse. Only those programs that
produce a consistent pattern of positive results that have been 
verified scientifically are recognized as effective, according to 
SAMHSA. HHS has also identified other programs supported by HHS-funded 
research, that show evidence of effectiveness in preventing substance 
abuse among youth. Specifically, within NIH, officials from the 
National Institute on Drug Abuse (NIDA) and scientists who conduct NIDA-
funded research identified effective drug use prevention programs that 
were scientifically evaluated and have demonstrated positive results 
over time. HHS and Education disseminate descriptions of effective 
programs to practitioners, schools, and the general public. In addition 
to the effective programs, each of the agencies also has identified 
programs that, based on initial results, show promise in preventing 
substance abuse among youth. However, the outcomes of these programs 
either have not yet been verified scientifically or have not 
consistently demonstrated positive results in preventing or reducing 
substance use, according to the agencies. The agencies also disseminate 
lists of these programs. 

In response to HHS’s comments on a draft of this report, we revised the 
report’s title to better reflect the scope of our work. HHS and 
Education provided additional information about their efforts to 
identify effective substance abuse prevention programs that we 
incorporated as appropriate. 

Background: 

A major goal of drug abuse prevention programs is to prevent the use of 
illicit and nonprescription legal drugs and other substances, such as 
alcohol and tobacco. Two drug prevention approaches show promise in 
reducing drug use and strengthening individuals’ ability to resist 
illicit drugs. The psychosocial approach emphasizes drug resistance 
skills, generic problem solving/decision-making training, and 
modification of attitudes and normative beliefs that encourage drug 
use. The comprehensive approach to prevention focuses on the setting in 
which programs are implemented, which involves the use of schools, 
families, and the community, working together. [Footnote 3] 

Drug abuse prevention programs are categorized by three different 
audiences for which they are designed. Generally, the programs are 
designed for (1) the general population, (2) individuals or subgroups 
that are at risk for drug abuse because of certain conditions such as 
being children of drug users, and (3) those individuals who are already 
experimenting with drugs or who exhibit other risk-related behavior. 

Established in 1983, DARE operates in about 80 percent of all school 
districts across the United States and in numerous foreign countries. 
[Footnote 4] In addition to the DARE elementary school curriculum, the 
DARE program also includes middle school and high school curricula that 
reinforce lessons taught at the elementary school level. 

The elementary school curriculum consists of 17 lessons, taught by DARE-
trained uniformed police officers, that focus on providing students 
with decision-making skills, showing them how to resist peer pressure, 
and teaching alternatives to illicit drug use and violence. The 
majority of studies evaluating DARE focus on the elementary school 
curriculum in effect before 1994. According to researchers, in 1994, 
modest changes were made to the elementary school curriculum, including
revisions to the content and sequencing of the DARE lessons. [Footnote 
5] 

In fiscal year 2000, the Department of Justice’s Bureau of Justice 
Assistance, which supports various substance abuse prevention programs 
for youth, provided about $2 million for DARE regional training centers 
to support the training of new police officers that help deliver the 
DARE program lessons. Also, in fiscal year 2000, Education provided 
states about $439 million in grants for schools and communities under 
the Safe and Drug-Free Schools and Communities Act (SDFSCA) of 1994. 
[Footnote 6] Some of the SDFSCA grant funds could have been used to 
support DARE. However, Education has no estimate of the amount of 
SDFSCA fiscal year 2000 state grant funds that were used for DARE. 

Evaluations of the DARE Elementary School Curriculum Show No 
Significant Differences in Drug Use Between DARE and Non-DARE Students: 

The six evaluations that we reviewed of the long-term effectiveness of 
the DARE elementary school curriculum found no statistically 
significant differences in illicit drug use between students who 
received DARE lessons in the fifth or sixth grade, referred to as 
intervention groups, and students who did not—the control groups. 
[Footnote 7] Three of the six evaluations reported that the control 
groups of students that did not receive DARE were provided other drug 
use prevention education. The six evaluations we reviewed were based on 
three separate studies in three states—Colorado, Kentucky, and 
Illinois. Table 1 summarizes the information on the six evaluations 
that we reviewed. Each of the six evaluations, conducted at intervals
ranging from 2 to 10 years after the fifth or sixth grade students were 
initially surveyed, suggested that DARE had no statistically 
significant long-term effect on preventing illicit drug use. Five 
evaluations also reported on students’ attitudes about illicit drug use 
and other nonbehavioral measures and found no significant differences 
between the DARE and non-DARE students over the long term. 

Table 1: Long-Term Evaluations on the Effectiveness of the DARE 
Elementary School Curriculum in Preventing Illicit Drug Use[A]: 

Kentucky Studies: 

Evaluation/date of article: 1. Sensation Seeking as a Potential 
Mediating Variable for School-Based Prevention Intervention: A Two-
Year Follow-Up of DARE, 1991. Location: Lexington, Kentucky; 
Sample description: The initial sample included a total of 2,071 sixth 
graders from 31 elementary schools. Twenty-three schools and 1,550 
students were assigned to receive the DARE intervention and 8 schools 
and 521 students were designated control groups that received drug use 
prevention education provided under a standard health curriculum. The 
sample size at the 2-year follow-up, when students were in the eighth 
grade, was 1,207,or about 78 percent of the baseline for the 
intervention group and 413,or about 79 percent for the control group; 
Measures: Past year use of marijuana; 
Prevention outcome: No statistically significant differences were 
observed between the intervention and control schools on students’
past year marijuana use 2 years after the intervention. 

Evaluation/date of article: 2. The Effectiveness of Drug Abuse 
Resistance Education (Project DARE): 5-Year Follow-Up, 1996; Location:
Lexington, Kentucky; 
Sample description: In the 5-year follow-up to the 1991 study, students 
were surveyed each year during the sixth through tenth grades. The 
sample size at the 5-year follow-up, when students were in the tenth 
grade, was 858, or about 55 percent of the baseline for the intervention
group and 285, or about 55 percent, for the control group; 
Measures: Past year use of illicit drugs. Nonbehavioral measures 
included attitudes towards drugs, peer pressure resistance, and 
perceived peer substance use; 
Prevention outcome: No statistically significant differences were 
observed between intervention and control groups on marijuana use 1 
year after the intervention and at the 5-year follow-up. Although, 
significant positive DARE effects were observed during the seventh 
grade (about 1 year after the intervention) for measures of students’ 
attitudes towards drugs, capability to resist peer pressure, and
perceived peer drug use, these positive effects diminished over time 
and were not significant at the 5-year follow-up. 

Evaluation/date of article: 3. Project DARE: No Effects at 10-Year 
Follow-Up, 1999; Location: Lexington, Kentucky; 
Sample description: Follow-up to the 1991 and 1996 studies. The final 
sample consisted of 1,002 young adults between the ages of 19 and 
21,who were in the original sixth grade sample of both intervention and 
control groups. Seventy-six percent of the participants had received
DARE lessons; 
Measures: Lifetime, past year, and past month use of marijuana. 
Nonbehavioral measures included peer pressure resistance and self-
esteem; 
Prevention outcome: No statistically significant differences were 
observed between the intervention and control groups for illicit drug
use, peer pressure resistance, and self-esteem at the 10-year follow-
up. 

Colorado Studies: 

Evaluation/date of article: 4. Three-Year Follow-up of Drug Abuse 
Resistance Education (DARE), 1996; Location: Colorado Springs, 
Colorado; 
Sample description: The initial sample included 38 elementary schools in
Colorado Springs, Colorado—21 schools received the DARE intervention 
and 17 control group schools did not. The 3-year follow-up sample 
consisted of 940 ninth grade survey respondents from the initial sample 
of elementary school students. Excluding invalid responses, the final
sample consisted of 849 ninth grade students (497 students in the 
intervention group and 352 in the control group); 
Measures: Use of illicit drugs and the delay of experimentation with 
illicit drugs. Nonbehavioral measures included self-esteem and 
resistance to peer pressure; 
Prevention outcome: No statistically significant differences were found 
between the intervention and control groups with regard to illicit drug
use, delay of experimentation with illicit drugs, self-esteem, or 
resistance to peer pressure after 3 years. 

Evaluation/date of article: 5. Long-Term Impact of Drug Abuse 
Resistance Education (DARE): Results of a 6-Year Follow-Up, 1997; 
Location: Colorado Springs, Colorado; 
Sample description: Follow-up to the 1996 study. The 6-year follow-up 
sample consisted of 676 twelfth grade survey respondents from the 
initial sample of elementary school students. Excluding invalid 
responses, the final sample consisted of 620 twelfth grade students (356
students in the intervention group and 264 students in the control 
group); 
Measures: Use of illicit drugs and the delay of experimentation with
illicit drugs. Nonbehavioral measures included self-esteem and 
attitudes toward drug use; 
Prevention outcome: No statistically significant differences were found 
between the intervention and control groups regarding the use of 
marijuana and the delay of experimentation with illicit drugs, self 
esteem, and attitudes toward drug use, at the 6-year follow-up. 

Illinois Study: 

Evaluation/date of article: 6. Assessing the Effects of School-Based 
Drug Education: A Six-Year MultiLevel Analysis of Project DARE, 1998; 
Location: Chicago, Illinois; 
Sample description: A total of 1,798 students from 36 urban, suburban, 
and rural schools in Illinois were surveyed each year from the sixth 
through twelfth grade. Eighteen elementary schools received the DARE
intervention and the 18 elementary schools in the control group did 
not; 
Measures: The study measured past 30-day and any use of illicit drugs. 
Nonbehavioral measures included attitudes towards drugs, peer pressure
resistance, and self-esteem; 
Prevention outcome: No statistically significant differences were 
observed between the intervention and control groups with regard to 
recent or any use of illicit drugs 1 year after the intervention and
at the 6-year follow-up. The DARE students were more likely to report 
stronger negative attitudes about drug use and improved social 
resistance skills immediately after the intervention. However, these
positive effects eroded over time. 

[A] These evaluations also measured the effects of DARE on other 
behavioral outcomes such as preventing alcohol and tobacco use. 

Source: GAO analysis of six evaluations. 

[End of table] 

Two of the six evaluations (Lexington, Kentucky, 1996 and Chicago, 
Illinois, 1998) also reported information on the short-term effects of 
DARE. These evaluations found no significant differences in illicit 
drug use between the intervention and control groups within a year 
after completing the DARE lessons. They also found that DARE students 
showed stronger negative attitudes about illicit drug use and improved 
peer pressure resistance skills and self-esteem about illicit drug use 
about 1 year after the intervention. These positive effects diminished 
over time. 

Federal Agencies’ Efforts to Identify Effective Substance Abuse 
Prevention Programs: 

HHS and Education have identified several programs that show evidence of
effectiveness in preventing or reducing the use of illicit drugs and 
other substances, such as alcohol and tobacco, among youth. Each agency 
identifies effective programs to recognize their success and promote 
their use in schools and communities in the United States. HHS and 
Education selected many of the effective prevention programs from among 
those submitted by the program developers for review and recognition. 
According to HHS and Education officials, the programs they selected 
through an expert panel process do not include all programs that could 
potentially be effective in preventing substance use among youth. Other 
effective programs that HHS identified were selected from those whose 
development was supported by HHS-funded research. 

Specifically, within HHS, SAMHSA identified substance abuse prevention 
programs that based on rigorous evaluation, consistently demonstrate 
positive results. SAMHSA created the National Registry of Effective 
Prevention Programs (NREPP) [Footnote 8] to recognize many of these 
programs and help policymakers and those working in the field of 
substance abuse prevention learn more about science-based prevention 
programs. Under the NREPP process, teams of scientists who are expert 
in prevention research, review and assess information, such as 
evaluation methodologies and evaluation results, on prevention 
programs. Many of these programs are selected and submitted by the 
program developers. The programs are scored using established criteria 
and ranked on the scientific rigor of their evaluation and the overall 
usefulness of their findings for preventing substance abuse. The 
criteria that programs are evaluated on include factors such as design 
and implementation, data collection and analysis, program outcomes, and 
replication and dissemination capabilities. Only those programs that 
positively affect the majority of the intended populations and produce 
a consistent pattern of results are recognized as effective. HHS 
officials stated that the process of having program developers select
their programs for review tends to encourage the submission of those 
programs that can be tested through conventional, low-cost evaluation 
procedures but discourages the submission of potentially effective 
interventions that result in broad changes in school or community 
activities. As of October 2002, SAMHSA had selected 41 effective 
programs from among 718 submissions. SAMHSA promotes the use of these
programs through dissemination, training, and collaboration activities 
with other substance abuse prevention partners. Table 2 contains 
examples of effective substance abuse prevention programs recently 
identified. 

Table 2: Examples of Effective Substance Abuse Prevention Programs HHS 
and Education Identified: 

1. Life Skills Training Program (LST): 
LST is a school-based substance abuse prevention program for children 
ages 10-14. LST is designed to address a wide range of risk and 
protective factors[A] to reduce illicit drug use by teaching general 
personal and social skills in combination with drug resistance skills 
and normative education. 

2 Child Development Project (CDP): 
CDP is a school improvement initiative designed to reduce the risk of 
alcohol and illicit drug use and bolster protective factors among 
elementary school children. 

3. Project ALERT: 
Project ALERT is a program that is provided to middle school students. 
Its course content focuses on establishing no-drug use norms, 
developing reasons not to use illicit drugs, and resisting pro-drug 
pressures. 

4. Strengthening Families Program (SFP): 
SFP targets families that are at risk for drug abuse. The 
multicomponent, family-focused program provides prevention programming 
for substance-abusing families with 6- to 10-year-old children. 

5. Project STAR, known as the Midwestern Prevention Project (MPP): 
MPP is a comprehensive, community-based drug abuse prevention program 
that uses school, mass media, parent education, community organization, 
and health policy programming to prevent and reduce alcohol, tobacco, 
and illicit drug abuse among adolescents. 

Note: SAMHSA identified all five of the substance abuse prevention 
programs in 1999. In 2001, Education identified all of the programs 
except CDP and MPP. In 2002, NIDA identified all the programs except 
MPP. 

[A] According to NIDA’s research-based guide, risk and protective 
factors encompass psychological, behavioral, family, and social 
characteristics. Risk factors, which include ineffective parenting, 
failure in school performance, affiliations with deviant peers, and 
aggressive behavior in the classroom, are associated with greater 
potential for drug use. Protective factors, such as strong family and 
community bonds, success in school performance, and adoption of 
normative beliefs about drug use, reduce the potential for drug use. 

Source: HHS and Education documents. 

[End of table] 

Also, within HHS, NIDA officials and scientists who conduct NIDA-funded 
research, identify effective drug abuse prevention programs that have 
been studied over time and achieved positive results. The development 
of these programs is supported by NIDA. NIDA publishes a guide on 
preventing drug use among children and adolescents that describes 
research-based concepts for developing and implementing effective drug 
abuse prevention programs and several research-based programs that NIDA 
and the scientists identify. [Footnote 9] 

Education established the Safe, Disciplined, and Drug-Free Schools 
Expert Panel to help identify programs effective in preventing and 
reducing substance abuse and violent behavior among students. The panel 
consisted of teams of experts in research, evaluation, and prevention 
programming. The expert panel used a multilevel review process to 
identify effective programs based on information submitted by entities 
or individuals applying for program recognition. The programs submitted 
for review must show evidence of effectiveness in reducing substance 
use, violent behavior, or other conduct problems for a year or longer 
based on at least one methodologically sound evaluation. Also, the 
programs must obtain a certain rating based on other criteria, such as 
whether the program’s content is appropriate for its target population 
and whether the program provides the necessary information and guidance 
for replication by others. Education officials stated that the programs
identified as effective and designated “exemplary,” showed 
statistically significant differences in outcomes that were sustained 
for at least 1 year beyond the baseline. 

The expert panel makes recommendations to the Secretary of Education, 
who announces those programs recognized as effective. Education began 
making a list of these programs available to schools and others in 
1999. 

Education has also developed guidance, referred to as “Principles of 
Effectiveness,” that identifies standards for state and local 
educational agencies to use in implementing research-based prevention 
programs. According to Education officials, SDFSCA funds can be used 
for programs that meet these standards and the effective programs 
identified by the expert panel process. 

HHS and Education also identify programs that show promise in 
preventing and reducing the use of illicit drugs and other substances 
among youth. These programs have shown positive initial results that 
have not yet been verified scientifically or have not consistently 
demonstrated a positive effect on the prevention or reduction of 
substance use. Each agency also publishes lists of the promising 
programs they identify to recognize the programs’ contributions, based 
on initial results, to preventing and reducing the use of illicit 
drugs, alcohol, and tobacco among youth. 

Comments from HHS and Education And Our Response: 

HHS and Education provided comments on a draft of this report. (See 
enclosure III and enclosure IV, respectively.) Specifically, HHS 
commented that the title of the draft report implied that the scope of 
our work was broader than the report’s discussion. We revised the 
report title to better reflect the content of the report. With regard 
to the DARE elementary school curriculum that we reviewed, HHS 
commented that to evaluate DARE on the basis of a portion of the 
program may be equivalent to arbitrarily evaluating the effects of only 
1 year of multiyear interventions of programs, such as Project STAR and 
Life Skills Training. We limited the scope of our work to reviewing 
published articles on long-term evaluations of the effectiveness of the 
DARE elementary school curriculum that included illicit drug use as an 
outcome measure because of concerns that had been raised about the 
effectiveness of DARE in preventing illicit drug use and because most 
of the research has focused on the DARE elementary school fifth and 
sixth grade curriculum. 

HHS also commented that the conclusions drawn in the draft report 
should not necessarily be applied to the future DARE program and 
suggested that we may want to incorporate more recent findings from the 
ongoing evaluation of DARE that were released by the Robert Wood 
Johnson Foundation. However, information from the ongoing evaluation of 
DARE that was released by the Robert Wood Johnson Foundation did not 
contain any interim findings on the effectiveness of the DARE program 
in preventing illicit drug use among youth. Moreover, according to the
University of Akron researchers who are conducting this work, the focus 
of their study is on revising and evaluating the DARE middle school and 
high school curricula and not the elementary school curriculum that we 
discuss in this report. The researchers expect to have the final 
results of their study in 2006. 

Education questioned the accuracy and source of the statement in our 
draft report that DARE operates in about 80 percent of school districts 
in the United States. We obtained this information from the DARE 
America Web site and information released by the University of Akron 
researchers related to their current evaluation of the DARE middle 
school and high school curricula. We added these sources of the data to 
the report. Education also questioned the basis for the estimate in the 
draft report of SDFSCA funds that the department made available to 
support DARE in fiscal year 2000. The estimate in the draft report was 
obtained from ONDCP. ONDCP and Education staff developed the estimate 
using a formula that assumed a certain percentage of SDFSCA state grant 
funds could be used to support DARE. In response to Education’s 
comment, we contacted officials in Education’s Budget Office and the 
Office of Elementary and Secondary Education Safe and Drug-Free Schools 
Program, to discuss the estimate that Education and ONDCP staff 
developed. According to Education officials, the assumptions that were 
used to estimate the amount of SDFSCA funds that could be used for DARE 
were hypothetical. Therefore, we deleted the estimate from our report. 

HHS and Education provided additional information about their efforts 
to help identify effective substance abuse prevention programs. Where 
appropriate, we made changes to the report to reflect the agencies’ 
comments, including technical changes that HHS provided. 

We are sending copies of this report to the Secretary of HHS, the 
Secretary of Education, the Director of the Office of National Drug 
Control Policy, and others who are interested. We will also make copies 
available to others upon request. In addition, the report is available 
at no charge on GAO’s Web site at [hyperlink, http://www.gao.gov]. 

If you or your staff have questions about this report, please contact 
me at (202) 512-7119 or James O. McClyde at (202) 512-7152. Darryl W. 
Joyce and David W. Bieritz made key contributions to this report. 

Sincerely yours: 

Signed by: 

Marjorie E. Kanof:
Director, Health Care—Clinical and Military Health Care Issues: 

Enclosures - 4: 

Enclosure I: 

Articles on Evaluations of the Effectiveness of the DARE Elementary 
School Curriculum That GAO Reviewed: 

1. Clayton, Richard, R., Anne M. Cattarelo, and Katherine P. Walden. 
“Sensation Seeking as a Potential Mediating Variable for School-Based 
Prevention Intervention: A Two-Year Follow-Up of DARE.” Health 
Communication (1991): 229-239. 

2. Clayton, Richard, R., Anne M. Cattarelo, and Bryan M. Johnstone. “The
Effectiveness of Drug Abuse Resistance Education (Project DARE): 5-Year 
Follow-Up Results.” Preventive Medicine Vol. 25, No. 3 (May 1996): 307-
318. 

3. Dukes, Richard, L., Jodie B. Ullman, and Judith A. Stein. “Three-
Year Follow-Up of Drug Abuse Resistance Education (DARE).” Evaluation 
Review, Vol. 20, No. 1 (February 1996): 49-66. 

4. Dukes, Richard, L., Judith A. Stein, and Jodie B. Ullman. “Long-Term 
Impact of Drug Abuse Resistance Education (DARE): Results of a 6-Year 
Follow-Up.” Evaluation Review, Vol. 21, No. 4 (August 1997): 483-500. 

5. Lynam, Donald, R., Richard Milich and others. “Project DARE: No 
Effects At 10-Year Follow-Up.” Journal of Consulting and Clinical 
Psychology Vol. 67, No. 4 (August 1999): 590-593. 

6. Rosenbaum, Dennis, P. and Gordon S. Hanson. “Assessing the Effects 
of School-Based Drug Education: A Six-Year MultiLevel Analysis of 
Project D.A.R.E.” Journal of Research in Crime and Delinquency, Vol. 
35, No. 4 (November 1998): 381-412. 

[End of Enclosure I] 

Enclosure II: 

Methodology GAO Used to Select Evaluations of the Effectiveness of the
DARE Elementary School Curriculum at Preventing Illicit Drug Use Among
Youth: 

To identify evaluations of the effectiveness of the DARE elementary 
school curriculum at preventing illicit drug use among children, we 
searched social science, business, and education databases, which 
included NIH’s National Library of Medicine, within HHS, for 
evaluations of DARE published in professional journals. The majority of 
the published articles on evaluations of the effectiveness of DARE 
focused on the program’s fifth and sixth grade elementary school 
curriculum. We identified 27 articles on evaluations of the DARE 
elementary school curriculum that included illicit drug use as an 
outcome measure. Of these articles, we selected for review those 
evaluations that used at least three of the following four criteria for
methodological design: (1) long-term study design (study period of 2 
years or longer), (2) intervention and control groups for comparisons, 
(3) random assignment of study groups, and (4) pretest and post-test or 
surveys of study participants. These criteria are among the ones 
suggested by researchers as key components of rigorous experimental 
research design. Six evaluations met at least three of these criteria 
(see table 3). The six evaluations were based on three separate studies 
of the DARE elementary school program in three different 
states—Colorado, Kentucky, and Illinois. 

We reviewed the sample design, research results, and conclusions for 
each of the six evaluations and summarized the results of our review. 
We did not independently validate the research design or verify the 
results of evaluations on the effectiveness of the DARE elementary 
school curriculum. 

Table 3: Six Evaluations of the DARE Elementary School Curriculum GAO 
Selected For Review: 

Evaluation/date of article: Sensation Seeking as a Potential Mediating
Variable for School-Based Prevention Intervention: A Two-Year Follow-Up 
of DARE, 1991; Location: Lexington, Kentucky; 
Period evaluation covered (in years): 2; 
Intervention and control groups: Yes; 
Random assignment of study groups: Yes; 
Pretest and posttest of study participants: Yes. 

Evaluation/date of article: The Effectiveness of Drug Abuse Resistance
Education (Project DARE): 5-Year Follow-Up, 1996; Location: Lexington, 
Kentucky; 
Period evaluation covered (in years): 5
Intervention and control groups: Yes; 
Random assignment of study groups: Yes; 
Pretest and posttest of study participants: Yes. 

Evaluation/date of article: Project DARE: No Effects at 10-Year Follow-
Up, 1999; Location: Lexington, Kentucky; 
Period evaluation covered (in years): 10; 
Intervention and control groups: Yes; 
Random assignment of study groups: Yes; 
Pretest and posttest of study participants: Yes. 

Evaluation/date of article: Three-Year Follow-up of Drug Abuse 
Resistance Education (DARE), 1996; Location: Colorado Springs, 
Colorado; 
Period evaluation covered (in years): 3
Intervention and control groups: Yes; 
Random assignment of study groups: [A]; 
Pretest and posttest of study participants: Yes. 

Evaluation/date of article: Long-Term Impact of Drug Abuse Resistance
Education (DARE): Results of a 6-Year Follow-Up, 1997: Location:
Colorado Springs, Colorado; 
Period evaluation covered (in years): 6
Intervention and control groups: Yes; 
Random assignment of study groups: [A]; 
Pretest and posttest of study participants: Yes. 

Evaluation/date of article: Assessing the Effects of School-Based Drug
Education: A Six Year MultiLevel Analysis of Project DARE, 1998; 
Location: Chicago, Illinois; 
Period evaluation covered (in years): 6
Intervention and control groups: Yes; 
Random assignment of study groups: Yes; 
Pretest and posttest of study participants: Yes. 

[A] Evaluation did not have initial random assignment of intervention 
and control groups. Random assignment allows for the development of 
experimental and control groups that are equivalent on all known and 
unknown variables. Instead of random assignment, the evaluation 
included periodic random tests that included checks of students’ 
demographic characteristics such as, age, gender, and ethnicity and 
students’ attitudes toward alcohol, tobacco, and other drugs to ensure 
equivalency among the groups. No statistically significant differences 
were found between the two study groups on those variables tested. 

Source: GAO analysis of six evaluations. 

[End of table] 

[End of Enclosure II] 

Enclosure III: Comments from the Department of Health and Human 
Services: 

Department of Health & Human Services: 
Office of Inspector General: 
Washington, DC 20201: 

October 30, 2002: 

Ms. Marjorie E. Kanof: 
Director, Health Care - Clinical and Military Health Care Issues: 
United States General Accounting Office: 
Washington, D.C. 20548: 

Dear Ms. Kanof:	 

Enclosed are the department's comments on your draft report entitled, 
"Substance Abuse: Programs to Prevent Illicit Drug Use Among Youth." 
The comments represent the tentative position of the department and are 
subject to reevaluation when the final version of this report is 
received. 

The department also provided several technical comments directly to 
your staff. 

The department appreciates the opportunity to comment on this draft 
report before its publication. 

Sincerely, 

Signed by: 
Janet Rehnquist: 
Inspector General: 

Enclosure: 

The Office of Inspector General (OIG) is transmitting the department's 
response to this draft report in our capacity as the department's 
designated focal point and coordinator for General Accounting Office 
reports. The OIG has not conducted an independent assessment of these 
comments and therefore expresses no opinion on them. 

General Comments of the Department of Health and Human Services on the 
General Accounting Office's Draft Report. "Substance Abuse: Programs to 
Prevent Illicit Drug Use Among Youth" (GAO-03-172R): 

General Comments: 

The Department of Health and Human Services (the department) 
appreciates the opportunity to comment on this draft report. The GAO 
report entitled "Substance Abuse: Programs to Prevent Illicit Drug Use 
Among Youth" presents a detailed discussion of the lack of significant 
findings of the Drug Abuse Resistance Education (DARE) program but only 
a limited discussion of other effective prevention programs. The 
department's Substance Abuse and Mental Health Services Administration 
(SAMHSA) is concerned that the report's title implies that it provides 
an overall assessment of the effectiveness of substance abuse 
prevention programs, when it actually provides a comprehensive 
evaluation of an early iteration of the DARE model and a brief 
reference to federal efforts to identify programs that are effective in 
preventing illicit drug use among children. 

Therefore, we suggest that either separate reports be developed to 
reflect the two objectives ("the results of evaluations on the long-
term effectiveness of the DARE elementary school core curriculum in 
preventing illicit drug use among children" and "federal efforts to 
identify programs that are effective in preventing illicit drug use 
among children") requested by Congress or that the report be retitled 
to clearly indicate its scope. In either case, SAMHSA would urge the 
GAO to expand its discussion of SAMHSA's National Registry of Effective 
Prevention Programs (NREPP). 

The following suggestions to more clearly describe the NRREP program 
build upon the language already in the GAO Report (heading: Federal 
Agencies Identify Effective Substance Abuse Prevention Programs, text 
following Table 2): 

Within the department, SAMHSA created NREPP to identify on an ongoing 
basis substance abuse prevention programs that, based on rigorous 
evaluation, consistently demonstrate positive results. The NREPP is a 
key component of a national system that is accessible to all and 
incorporates not just the work of SAMHSA, but of other federal, state, 
foundation, and private entities, including the National Institute of 
Health (NIH), the Department of Justice, and the Department of 
Education. Teams of scientists who are expert in prevention research 
use a set of 15 scientifically-rigorous criteria to assess various 
programs that may be implemented by states and communities across the 
country. The programs are scored using established criteria and ranked 
on the scientific rigor of their evaluation and the overall usefulness 
of their findings for preventing substance abuse. Only those programs 
that positively affect the majority of the intended populations and 
produce a consistent pattern of results are recognized as effective. To 
date, 41 effective model programs and 32 promising programs have been 
selected from 718 submissions. In addition to enhancing protective 
factors and minimizing risk, these programs have demonstrated a 
significant impact on drug and alcohol use (25% average reduction), and 
may have also demonstrated a positive effective effect on other related 
behaviors including school achievement, prevention and reduction of 
violence, and enhanced family functioning. 

Once programs are identified by NREPP, SAMHSA's National Dissemination 
Initiative is responsible for promoting these programs through the 
active dissemination of written materials, a strong Training of 
Trainers approach, the use of innovative web-based technology, and 
collaboration with a set of national partners, including the National 
Association of Elementary School Principals, the National Mental Health 
Association, and the Community Anti-Drug Coalitions of America. Many of 
these programs are being implemented through the State Incentive Grant 
(SIG) Program (over 1,858 SIG-supported programs are science-based), 
the SAMHSA Substance Abuse Block Grants, and other federal and state 
funding mechanisms, and by a number of agencies including the 
Department of Education, the Department of Justice, etc. 

With regard to the section of the draft report dealing with the 
evaluation of the DARE program, it should be clear that the SAMHSA 
neither supports nor disputes the effectiveness of DARE. SAMHSA's 
prevention scientists are aware that DARE America currently is testing 
the effectiveness of a major revision of the DARE program, conducted 
under the direction of a former official of NIH's National Institute on 
Drug Abuse (NIDA). This revised DARE program has not yet been submitted 
for review to the NREPP, and SAMHSA is not in a position to officially 
comment on the effectiveness of this curriculum. 

Also, we offer the following comments about several questionable 
statements within the draft report on the GAO's assessment of DARE. 

1. "The core of the DARE program is its fifth and sixth grade 
curriculum." 

It is accurate to report that the 5th/6th grade curriculum was the 
first curriculum developed by DARE and that it is the most widely-used 
component. DARE America, however, does not describe this as a "core" 
curriculum and advocates that the most effective use of DARE requires 
sequential use of curricula for elementary school and secondary school. 

More importantly, to evaluate DARE on the basis of a portion of the 
program may be equivalent to arbitrarily evaluating the effects of only 
one year of the multi-year interventions of Project STAR, Life Skills 
Training, or other programs. The department has identified "prevention 
principles" that emphasize the importance of multi year interventions. 
The NIDA publication Preventing Drug Use Among Children and 
Adolescents: A Research-Based Guide (NIH Publication No. 97-4212), for 
example, states: 

"Prevention programs should be long-term, over the school career with 
repeat interventions to reinforce the original prevention goals. For 
example, school-based efforts directed at elementary and middle school 
students should include booster sessions to help with critical 
transitions from middle to high school." 

2. "HHS and Education have identified programs that show evidence of 
effectiveness in preventing or reducing the use of illicit drugs and 
other substances among youth.... HHS and Education select these 
programs based on expert panel reviews of research-based evidence of 
program effectiveness." 

Rather than proactively identifying prevention programs, the department 
and the Department of Education invite the developers of programs to 
submit programs or curricula for review. To the best of this agency's 
knowledge, the Department of Education encouraged DARE to complete and 
test the current revision of the DARE program prior to submission to 
Education's expert review panel. 

The self-selection process generally favors submission of curricula 
with an easily-defined "dosage" that can be tested through 
conventional, low-cost evaluation procedures. It tends to discourage 
consideration of potentially effective interventions involving broad 
changes in the school or community environment (e.g. changes in the 
procedures and policies of law enforcement authorities, increased youth 
participation in structured after school activities, etc.). 

3. "The six evaluations that we reviewed of the long-term effectiveness 
of the DARE elementary school curriculum found no statistically 
significant differences in illicit drug use between students who 
received DARE lessons in the fifth or sixth grade, referred to as 
intervention groups, and students who did not -- the control groups. 
The six evaluations we reviewed were based on three separate studies in 
three states." 

The studies evaluate the DARE program as implemented in the late 1980s 
and early 1990s. The program has since been refined and subsequent 
iterations have been developed. The conclusions that are drawn in the 
GAO report should not necessarily be applied to the future DARE 
program. It is our understanding that a report of the evaluation of the 
revised DARE curriculum is scheduled to be released at the end of 
October by the Robert Wood Johnson Foundation. The GAO report may want 
to incorporate these more recent findings into the report's assessment 
of DARE. 

[End of Enclosure III] 

Enclosure IV: Comments from the Department of Education: 

United States Department Of Education: 
The Under Secretary: 
400 Maryland Ave., S.W., 
WASHINGTON, D.C. 20202
[hyperlink, http://www.ed.gov] 

"Our mission is to ensure equal access to education and to promote 
educational excellence throughout the Nation." 

October 29, 2002 

Ms. Marjorie E. Kanof: 
Director, Health Care - Clinical and Military Health Care Issues: 
General Accounting Office: 
441 G Street, N.W. 
Washington, DC 20548: 

Dear Ms. Kanof: 

Thank you for the opportunity to review your draft report, "Substance 
Abuse Programs to Prevent Illicit Drug Use Among Youth." In the 
introduction of your report to Senator Richard J. Durbin, you state 
that the report contains information on Federal efforts to identify 
programs that are effective in preventing illicit drug use among 
children. We have concerns about the accuracy of some of the 
information included in the report and regret that we did not have the 
opportunity to be formally involved in the development of the report. 

The U.S. Department of Education (Department) established the Safe, 
Disciplined and Drug-Free Schools Expert Panel (Expert Panel) to 
identify exemplary programs that are effective in preventing and 
reducing substance abuse and violent behavior among students. The 
discussion in your report about the Expert Panel does not fully 
describe the Expert Panel process and, we believe, may contribute to 
misunderstanding about the Expert Panel's role. Specifically, the 
discussion on page 11 of the draft report omits important aspects of 
the Expert Panel review process and implies that the programs 
identified by the Expert Panel process are the only prevention programs 
that are effective. 

The Expert Panel used a multilevel review process comprising teams of 
experts in research, evaluation, and prevention programming. 
Submissions were reviewed for evidence of effectiveness based on 
methodologically sound evaluations, and for evidence of high quality 
programming, including educational significance and replicability. 
Programs designated as exemplary showed statistically significant 
differences in outcomes that were sustained at least one year or longer 
beyond baseline. We recommend that you revise your discussion to 
incorporate this information. 

In 1998, the Department developed the Principles of Effectiveness to 
guide State and local educational agencies in their decisions to 
implement prevention programs based on research. Following the 
enactment of the No Child Left Behind Act in 2001, State and local 
educational agencies must use the Principles of Effectiveness to 
design, implement, and evaluate programs funded under the Safe and Drug-
Free Schools and Communities Act (SDFSCA). Because of these 
requirements, there has been some confusion among grantees concerning 
the Expert Panel's "list" of exemplary programs. Some grantees 
mistakenly believe that the programs identified as exemplary are the 
only programs that can be funded under the SDFSCA. In a letter to 
Governors and Chief State Schools Officers dated May 6, 1999, the 
Department provided guidance on the Expert Panel process as it related 
to programs that could be supported with SDFSCA funds. While the 
Department would expect to accept programs identified by this process 
as meeting the standard established by the SDFSCA Principles of 
Effectiveness, the programs identified by this process by no means 
constitute an official or exhaustive list of programs that meet the 
standard established by the Principles of Effectiveness, and grantees 
will continue to have flexibility in selecting prevention programs as 
long as they meet the standard established in the No Child Left Behind 
Act. Therefore, we recommend that you revise your discussion to 
incorporate this information. 

We also are concerned about the accuracy of some of the statements 
about the Drug Abuse Resistance Education (DARE) program contained in 
the draft report. On page 4 of the report, the auditors state that DARE 
operates in 80 percent of all the school districts across the United 
States. You have not provided a source for this information. To our 
knowledge, there has not been any sound survey to determine exactly how 
many schools have implemented DARE programs. Therefore, we recommend 
that you either delete or identify the statistical source of the 
information. 

On page 5 of the report, the auditors state that the Office of National 
Drug Control Policy (ONDCP) estimates that in FY 2000, the Department 
made available about $41 million to support DARE activities in schools. 
We question the basis for this figure. We assume this reference is to 
the Safe and Drug-Free Schools and Communities Act funds spent under 
the Governor's Program, because State and local educational agencies 
are not required to implement DARE activities. For FY 2000, the amount 
of funds awarded, nationally, to the Governor's program was 
approximately $86 million. We do not agree that almost 50 percent of 
the Governor's funds were used to support DARE. Although not required 
in the current authorization of the SDFSCA, in FY 2000 Governors were 
required to use not less than 10 percent of funds for Law Enforcement 
Education Partnership (LEEP) programs. In other words, the SDFSCA only 
required that $8.6 million in FY 2000 SDFSCA funds be used to support 
LEEP programs. Further, under the SDFSCA, allowable LEEP programs 
included, but were not limited to, programs such as Project DARE. We 
recommend that you either delete the $41 million estimate included in 
the draft, or provide supporting documentation about the amount of 
SDFSCA funds spent on DARE activities. 

Again, thank you for providing a copy of this draft report for our 
review. If you have any questions, please feel free to contact William 
Modzeleski, Director, Safe and Drug-Free Schools Program, at (202) 260-
3954. 

Sincerely, 

Signed by: 

Eugene W. Hickok: 

[End of enclosure IV] 

Footnotes: 

[1] Lloyd D. Johnston, Patrick M. O’Malley, and Jerald G. Bachman, 
Monitoring the Future National Results on Adolescent Drug Use: Overview 
of Key Findings, 2001, NIH Publication No. 02-5105 (Bethesda, Md.: 
National Institute on Drug Abuse, 2002). 

[2] The DARE program is administered by DARE America—a nonprofit 
foundation. 

[3] U.S. General Accounting Office, Drug Control: Observations on 
Elements of the Federal Drug Control Strategy, GAO/GGD-97-42 
(Washington, D.C.: Mar. 14, 1997). 

[4] Data obtained from the DARE America Web site at [hyperlink, 
http://www.DARE.com] (as of July 30, 2002) and information released by 
the University of Akron Institute for Health and Social Policy. 

[5] The DARE middle and high school program curricula are being revised 
and will be evaluated, under a Robert Wood Johnson Foundation research 
grant, by researchers from the University of Akron in cooperation with 
DARE America Foundation officials. According to the Akron researchers 
who are conducting the study, the revised middle school curriculum 
places more emphasis on and devotes more time to three prevention 
program areas (1) normative beliefs about drug use, (2) consequences 
of drug and alcohol use, and (3) drug use resistance skills. The 
curriculum also includes more interaction among students through small 
group discussions and role-play. The study is experimenting with using 
police officers as course facilitators rather than as instructors. The 
purpose of these changes is to improve the effectiveness of DARE. 
Revisions to the high school curriculum were not complete at the time 
of our review. The researchers plan to complete their evaluation of the 
revised DARE curricula in 2006. 

[6] Pub. L. No. 103-382, §101, 108 STAT. 3518, 3672-3690 (classified to 
20 U.S.C. §§ 7101-7144 (2000)). 

[7] The studies surveyed individuals about their lifetime, past year, 
and past month marijuana, alcohol, or cigarette use. They were also 
asked about their attitudes towards drugs, peer pressure resistance, and
self-esteem. 

[8] NREPP incorporates the work of SAMHSA, Education, NIH, and the 
Department of Justice, as well as the work of foundations and other 
entities. 

[9] NIDA is having the 2003 edition of its guide reviewed before 
publication. 

[End of section] 

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