Department of Psychiatry, Center for Addiction Medicine, Massachusetts General Hospital, Boston, MA, United States.
MassHealth Office of Behavioral Health, Boston, MA, United States.
Front Public Health. 2023 Aug 21;11:1203558. doi: 10.3389/fpubh.2023.1203558. eCollection 2023.
Adolescents who use alcohol and other drugs on school campuses are at heightened risk for adverse consequences to their health and wellbeing. Schools have historically turned to punitive approaches as a first-line response to substance use. However, punishment is an ineffective deterrent for substance use and may cause harm and increase inequities. iDECIDE (Drug Education Curriculum: Intervention, Diversion, and Empowerment) was developed as a scalable and youth-centered drug education and diversion program that can be used as a skills-based alternative to punishment. We aim to evaluate the effectiveness of the iDECIDE curriculum as an alternative to punishment (ATP) for school-based substance use infractions in the context of a large pragmatic clinical effectiveness study.
We will conduct a Type 1, hybrid effectiveness-implementation trial. Using a stepped wedge design with approximately 90 middle and high schools in Massachusetts, we will randomly allocate the timing of implementation of the iDECIDE curriculum compared to standard disciplinary response over approximately 36 months. We will test the overarching hypothesis that student-level outcomes (knowledge of drug effects and attitudes about substance use; frequency of substance use; school connectedness) improve over time as schools transition from a standard disciplinary response to having access to iDECIDE. The secondary aims of this trial are to (1) explore whether change in student-level outcomes vary according to baseline substance use, number of peers who use alcohol or other drugs, age, gender, and school urbanicity, and (2) determine the acceptability and feasibility of the iDECIDE curriculum through qualitative stakeholder interviews.
Substance use continues to be a major and rapidly evolving problem in schools. The importance of moving away from punishment to more restorative approaches is widely accepted; however, scalable alternatives have not yet been identified. This will be the first study to our knowledge to systematically evaluate an ATP for students who violate the school substance use policy and is well poised to have important implications for policy making.
在校园中使用酒精和其他药物的青少年面临着对其健康和幸福产生不利后果的高风险。学校历来采取惩罚措施作为对药物使用的第一反应。然而，惩罚对药物使用是无效的威慑手段，可能会造成伤害并加剧不平等。iDECIDE（药物教育课程：干预、转移和赋权）是作为一种可扩展的以青年为中心的药物教育和转移计划而开发的，可作为惩罚的替代方案。我们旨在评估 iDECIDE 课程作为基于学校的药物使用违规行为的替代惩罚（ATP）的有效性，这是一项大规模的实用临床效果研究的一部分。
我们将进行 1 型混合有效性实施试验。在马萨诸塞州约 90 所中学中采用阶梯楔形设计，我们将随机分配 iDECIDE 课程实施的时间与标准纪律反应相比，在大约 36 个月内完成。我们将测试总体假设，即随着学校从标准纪律反应过渡到能够获得 iDECIDE，学生层面的结果（对药物影响的了解和对药物使用的态度；药物使用频率；学校联系）会随着时间的推移而改善。该试验的次要目标是：（1）探索学生层面的结果是否根据基线药物使用、使用酒精或其他药物的同龄人数、年龄、性别和学校城市性而有所不同，（2）通过利益相关者定性访谈确定 iDECIDE 课程的可接受性和可行性。
药物使用在学校中仍然是一个主要且快速演变的问题。从惩罚转向更具修复性的方法的重要性已被广泛接受；然而，还没有确定可扩展的替代方案。这将是我们所知的第一个系统地评估对违反学校药物使用政策的学生进行 ATP 的研究，这对于决策制定具有重要意义。
