We Can’t Just Say No

Three decades ago, Nancy Reagan launched her famous anti-drug campaign when she told American citizens, “Say yes to your life. And when it comes to alcohol and drugs, just say no.” 1 Last month, Attorney General Jeff Sessions invoked the former First Lady’s legacy in a speech to Virginia law enforcement when he said, “ I think we have too much tolerance for drug use– psychologically, politically, morally. We need to say, as Nancy Reagan said, ‘Just say no.’”2 As our nation is confronted on a daily basis with the tragic effects of the opioid epidemic, it is important that we understand just how dangerous it is to suggest that we return to the ‘just say no’ approach.

In the 1980s and 1990s, the ‘just say no’ curriculum became the dominant drug education program nationwide in the form of DARE.3 The DARE program– Drug Abuse Resistance Education– was developed in 1983 by the Los Angeles police chief in collaboration with a physician, Dr. Ruth Rich. The pair adapted a drug education curriculum that was in the development process at University of Southern California in order to create a program that would be taught by police officers and would teach students to resist the peer pressure to use alcohol and drugs. With the backdrop of the War on Drugs that had continued from the Nixon presidency into the Reagan era, DARE grew quickly. Communities understandably wanted to prevent their children from using alcohol and drugs. The program was soon being used in 75% of schools nationwide and had a multimillion dollar budget.3 In fact, I would bet that many of you reading this are DARE graduates. I certainly am.

It did not take long for there to be research showing that the ‘just say no’ approach used in DARE was not working. By the early 1990s there were multiple studies showing that DARE had no effect on its graduates choices regarding alcohol and drug use.4 The decision to ignore the research about DARE culminated when the National Institute of Justice evaluated the program in 1994, concluded that it was ineffective, and proceeded to not publish this finding. In the 10 years that followed, DARE was subjected to evaluation by the Department of Education, the U.S Surgeon General’s Office, and the Government Accountability Office.4 The combined effect of these evaluations was the eventual transformation of DARE into an evidence-based curriculum, Keepin’ It REAL, which was released in 2011.5 But this only happened after billions of dollars were spent on a program that did not work and millions of students received inadequate drug education.

And yet, here we are again. The top law enforcement officer in our nation is suggesting that we go back to the days where elementary and middle school students were told that all they needed to do was ‘just say no.’

The current opioid epidemic is resulting in a staggering number of deaths. As of the end of 2016, an estimated 91 people were dying from an opioid-related overdose daily.6 Here in Massachusetts, the numbers seem to only be getting worse as more people are unintentionally overdosing on fentanyl.7 According to state data, fentanyl was involved in 75% of overdoses in 2016.7

We know that drug use in adolescence is a major risk factor for addiction, and therefore, overdose. For adolescents who use illegal drugs before age 13, over two-thirds suffer from a substance use disorder within 7 years of their first use.8 This figure drops to under one third when the age of first use is over 17.8 We also know that teaching adolescents a curriculum based on ‘just say no’ does not work.

A few days ago, I had the chance to visit AHOPE, the Boston needle and syringe exchange program. Upon walking into the needle exchange, I was struck by the pictures of smiling faces and printed obituaries that plaster the walls, memorializing the many people who have recently lost their lives to overdose. Almost all of these faces are young.

Stopping the overdose epidemic in the United States is going to require a massive effort at all different levels. Prevention of substance use disorders is one part of this effort, and educational programs for children and adolescents is a key component of prevention. It is hard to think about how many of the people we have lost to substance use disorder completed DARE or other ‘just say no’ programs. We need to look at the evidence and not allow ourselves to repeat history. We can do better, and Attorney General Sessions should create policies that will help us do better.

  1. Shen, A. “The Disastrous Legacy of Nancy Reagan’s Just Say No Campaign.” ThinkProgress. 6 March 2016.  https://thinkprogress.org/the-disastrous-legacy-of-nancy-reagans-just-say-no-campaign-fd24570bf109. Accessed 7 April 2017.
  2. Schuppe, John. “Just Say No: AG Sessions Cites Old School Anti Drug Motto.” NBC News. 16 March 2017. http://www.nbcnews.com/news/us-news/just-say-no-ag-sessions-cites-old-school-anti-drug-n733961. Accessed 7 April 2017.
  3. Cima, Rosie. “DARE: The anti-drug program that never actually worked.” Priceonomics. 19 Dec. 2016. https://priceonomics.com/dare-the-anti-drug-program-that-never-actually/. Accessed 7 April 2017.
  4. Arkowitz, Hal and Lilienfield, Scott. “Why ‘Just Say No’ Doesn’t Work.” Scientific American. 1 Jan. 2014. https://www.scientificamerican.com/article/why-just-say-no-doesnt-work/. Accessed 7 April 2017.
  5. Nordrum, Amy. “The New D.A.R.E. Program– This one works.” Scientific American. 10 Sep. 2014. https://www.scientificamerican.com/article/the-new-d-a-r-e-program-this-one-works/. Accessed 7 April 2017.
  6. CDC. “Understanding the Epidemic.” CDC: Opioid Overdose. 16 Dec. 2016. https://www.cdc.gov/drugoverdose/epidemic/. Accessed 7 April 2017.
  7. Bebinger, Martha. “Fentanyl Adds a New Terror for People Abusing Opioids.” NPR Shots. 6 April 2017. http://www.npr.org/sections/health-shots/2017/04/06/521248448/fentanyl-adds-a-new-terror-for-people-abusing-opioids. Accessed 7 April 2017.
  8. U.S. Department of Health and Human Services (HHS). Office of the Surgeon General, Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health. Washington, DC: HHS, Nov. 2016. https://addiction.surgeongeneral.gov/executive-summary.pdf. Accessed 7 April 2017.

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