Youth Alternatives

The results of the small number of research papers published on youth ACE are mixed. Implementation of Alternative activities in the 1990s tended to be piecemeal (ie, after-prom programs once per year) and did not target measurable behavior change over time.

The characteristics of more successful ACE strategies are detailed in bullet points below each paper. Information about the Cohen and Komroe- Toomey articles are borrowed from the 2021 white paper, Evidence of Effectiveness Research (Hope McMickle, 2021, unpublished). The last resource is a guide to hosting alcohol-free events for children and families with the aim to shift community and social norms.

Carmona, M & Stewart, K. (1996). “Review of Alternative Activities and Alternatives Programs in Youth-Oriented Prevention.” SAMHSA CSAP Technical Report. https://www.ojp.gov/ncjrs/virtual-library/abstracts/review-alternative-activities-and-alternatives-programs-youth  Accessed 5/1/2023.

• Alternative events alone unlikely to result in measurable behavior change
• Intensive programs may be more effective
• Programs that engage at-risk youth may be more effective
• Programs should include skill-building components
• Alternatives should be one part of a comprehensive prevention plan

Cohen, A. Y. (1985). Drug treatment in school and alternative school settings. Treatment services for adolescent substance abusers, 178-194.

• This book chapter discusses many different aspects of prevention for adolescents. It does review some previous research that had positive outcomes in using alternative programs (based off the alternatives model) to reduce drug use in adolescents.
• Alternatives were defined as constructive and viable attitudes, values, orientations, and experiences that can diminish drug abuse by providing greater relative satisfaction that can be attained through the use of substances.
• Some of the studies identified alternative activities as religious or service participation, scholastic achievement, reading books, or other extracurricular activities. The section also mentioned that these alternatives are not to be viewed as substitutes for substance use, but they are able to fulfill the adolescent’s goals without a substance aiding in that process.
• Quite an old source, but the base is at least there in determining that these alternative programs have been showed to be effective in the past.

Komro, K.A., Perry, C.L., Murray, D.M., Veblen-Mortenson, S., Williams, C.L. and Anstine, P.S. (1996). Peer-Planned Social Activities for Preventing Alcohol Use Among Young Adolescents. Journal of School Health, 66: 328-334. https://doi.org/10.1111/j.1746-1561.1996.tb03413.x  Accessed 5/3/2023.

• Youth who plan and lead ACE demonstrate lower alcohol use rates
• Effect strongest among those reporting alcohol use at the beginning of the study; SFAE is impacting substance users and not just those who would already abstain

Komro, K. A., & Toomey, T. L. (2002). Strategies to prevent underage drinking. Alcohol Research and Health, 26(1), 5-14.

• The youth programs included sports, recreation, camps, mentoring, and drop-in centers.
• This article examined previous research that found these alternative programs to be associated with better development of life skills, greater communication skills, fewer psychosocial problems, decreased involvement in risky behaviors (drug use), decreased juvenile delinquency and violence, decreased risk of dropping out of school, increased academic achievement, and increased safety.
• In another study that was examined, the difference between peer programs (interventions that included social and life skills training, including refusal skills) and alternative programs (interventions that included the provision of positive activities more appealing than drug use such as sports activities) and found that alternative programs were less effective than peer programs.
• Within the alternative programs, those that involved high-risk youth and that included many hours of activities were most effective.  This article also examined the research from CSAP in 1996 that concluded the alternative approach has no strong research support.

National Crime Prevention Council. (1995). “Strategy: Promoting Drug-Free Social Events for Youth.” From 350 Tested Strategies to Prevent Crime: A Resource for Municipal Agencies and Community Groups. https://www.ojp.gov/pdffiles1/Digitization/159777NCJRS.pdf   Accessed 5/1/2023.

• Case studies include Prom Promise, Project Graduation, Project After Prom
• Several related strategies including Law Enforcement-sponsored community events and Banning drugs from public events.

Vichealth Local Government Partnership. ( ) Increasing Alcohol Harm Prevention at the Local Level. https://www.vichealth.vic.gov.au/sites/default/files/2023-03/Alcohol%20Prevention_VLGP.pdf  Accessed 5/4/2023.

• Promoting and celebrating alcohol-free events influences positive alcohol cultures and changes social norms
• Prevent youth exposure to alcohol industry advertising; risky behavior role modeling
• If there are already alcohol-free events, consider how you can promote and celebrate the alcohol-free element as being suitable for children and families.
• If there are insufficient activities that are alcohol-free and suitable for families, consider if you can offer new and alternative activities, or opportunities to make or support events to be alcohol-free.
• Reducing the consumption and promotion of alcohol products at community festivals and events is a parallel strategy

College Alternatives

There are more studies on Alternatives for college students. The below studies suggest that common alternatives such as Late Nite events may result in measurable decreases in student substance use. These events are almost always layered with other AOD (Alcohol and Other Drugs) resources that campuses are required to offer, including:

• Campus-based, late-night programming for college students as one component of a multi-layered strategy focused on off-campus party enforcement, educational website, neighborhood-based service-learning and conflict resolution programs

• Statistically significant decrease in problem drinking in intervention versus control group

Wei J, Barnett NP, Clark M. Attendance at alcohol-free and alcohol-service parties and alcohol consumption among college students. Addict Behav. 2010 Jun;35(6):572-9. doi: 10.1016/j.addbeh.2010.01.008. Epub 2010 Jan 29. PMID: 20188482; PMCID: PMC2851181.

• Greater availability of and attendance at alcohol-free parties may lead to a decrease in high-risk drinking in the undergraduate population, Controlled experiments needed

College Alternatives, Examples:

• GW Late Nite: https://studentlife.gwu.edu/gw-late-night-0

• GW Late Night Offers Substance Free Entertainment Alternatives. Oct 18 2022. https://gwtoday.gwu.edu/gw-late-night-offers-substance-free-entertainment-alternatives Accessed 5/3/2023.

• Late Nite at Ball State: https://www.bsu.edu/about/administrativeoffices/studentcenter/studentcenterprograms/latenite

• Late Nite at the Indiana Memorial Union: https://imu.indiana.edu/activities-services/late-nite/index.html

• Collegiate Recovery Community at Indiana University-Bloomington: https://blogs.iu.edu/crciub/

• https://specials.idsnews.com/substance-abuse-recovery-bloomington-indiana/

Adult Alternatives

It can be difficult to draw a clear distinction between Alternative and Recovery events. The distinction might be rooted in the perspective of the participant rather than the substance free event itself. (This is true for campus events as well.)

SFAE are created when existing community events, holidays or activities become substance-free through policy changes. A huge number of smoke-free events resulted from state legislation banning all smoking in public spaces. The impacts of this policy change are universal. https://www.in.gov/health/tpc/indianas-state-smoke-free-air-law/

Communications about SFAE for adults and families should be oriented toward prevention. Keep in mind that messaging is a crucial factor in prioritizing attitude and behavioral changes as well as community and social norms. The promotion of substance-free events as events “for everybody” has the potential to reduce stigma impacting the recovery community. Pre-event advertising and messaging during the event itself should be culturally relevant to the intended population(s).

Lockhart J, Knapp MB, Feehan AK, et al. Implementation and Process Evaluation of Alcohol Free for 40: Community-Based Programming to Reduce Alcohol Consumption. Health Promotion Practice. 2023;0(0). doi:10.1177/15248399221142633

• ~400 adults in six Louisiana parishes participated during Mardi Gras in 2021; 74.5% of AF40 (Alcohol Free for 40 days) reported abstaining from alcohol in an exit survey

• Pledge to abstain for 40 days; pre- and post-challenge photographs and physical metrics, end individualized report; Community events and communication campaigns provided reinforcements, support, and opportunities for observational learning and building self-efficacy

• 48.7% participants were moderately engaged in program events: Happy Hour workouts, Mindful Mondays webinars (nutrition, mindfulness, coping with stress), Zero-proof cocktail demo (replacement behaviors). Virtual due to COVID-19

• 14% participants planned to remain sober, 40% planned to be more mindful about drinking, 90% planned to participate next year

1. Meta-Analysis Results:

• Schaps et al. (1981) found alternatives rated second most effective among 10 prevention strategies in 4 drug-related outcome categories.

• Tobler (1986) ranked alternatives as the second most effective strategy after peer programs.

1. Effectiveness for High-Risk Youth:

• Tobler’s analysis showed alternatives were particularly effective for high-risk youth when delivered intensively (more than 21 hours per week).

1. Community Service Programs:

• Channel One: One group showed increased democratic behavior (t = 2.25, p < .05) and increased alternative activities involvement (t = 2.59, p < .05). However, two groups showed increased frequency of drunkenness (t = 1.75, p < .10; t = 1.86, p < .10).

• Community Studies and Service Program (CSSP): Reported statistically significant changes in student attitudes and behavior across all program years, including development of self-esteem, self-efficacy, and community understanding.

1. Adventure-Oriented Programs:

• Outward Bound: Produced short-term changes in self-esteem (p < .001), internal locus of control (p < .001), and expectancy of ability to attain goals (p < .01) among adjudicated youth.

1. Culturally Specific Programs:

• Rhode Island Indian Council (RIIC) Pilot Prevention Program: Showed reduced substance use rates and increased cultural affiliation among Native American participants compared to the control group.

• Project GOLD: None of the participants who were non-users at pretest reported use at posttest, compared to initiation rates of 27.6% for cigarettes, 12.5% for liquor, and 5.9% for marijuana in the control group.

• Greater Alliance Prevention Systems (GAPS): Experimental group showed statistically significant decreases in tobacco use (t = 2.01, p < .05) and alcohol use (t = 2.41, p < .05), increased assertiveness (F(1,86) = 6.50, p < .01), and increased cultural pride (F(1,44) = 2.23, p < .05).

• Everyday Theater Youth Ensemble: Participants categorized as most “at risk” demonstrated the largest decreases in drug and alcohol use.

1. Mixed Evidence on Substance Use Outcomes:

• While some studies (e.g., Project GOLD, GAPS) showed decreased substance use, others (e.g., Channel One) found increased use of some substances among participants.

1. Positive Impacts on Other Outcomes:

• Multiple studies found improvements in self-esteem, social skills, cultural pride, and attitudes toward substance use, even when substance use impacts were unclear.

1. Importance of Program Intensity:

• Both meta-analyses (Schaps et al., 1981; Tobler, 1986) found that more intensive programs produced better outcomes.

1. Combination with Other Strategies:

• Schaps et al. (1981) found that alternatives combined with other prevention strategies (e.g., information plus affective education) were most effective.

Conclusions and Recommendations:

1. Target High-Risk Youth: Evidence suggests alternatives are most effective for youth lacking adequate supervision and opportunities.

1. Emphasize Program Intensity: More intensive programs (21+ hours/week) show greater impacts, especially for high-risk youth.

1. Incorporate Skills-Building: Programs should combine engaging activities with components aimed at developing personal, social, and academic skills.

1. Cultural Tailoring: Culturally specific programs showed promising results for minority youth, warranting further investigation.

1. Comprehensive Approach: Alternatives should be part of broader prevention efforts, not standalone solutions.

1. Realistic Expectations: While some studies show reduced substance use, alternatives alone may not consistently produce measurable changes in use rates.

1. Focus on Multiple Outcomes: Programs should assess impacts on factors like self-esteem, skills, and attitudes, not just substance use.

1. Need for Rigorous Research: More systematic, long-term studies with larger sample sizes and control groups are required to establish effectiveness conclusively.

1. Community Impact: Even without strong individual-level evidence, alternatives may serve as valuable community resources and help establish anti-substance use norms.

Summary of Key Findings:

1. Effectiveness depends on target group: Alternative approaches tend to be more effective with high-risk youth who lack adequate adult supervision, positive activities, and opportunities to develop personal skills. More research is needed on which types of alternatives work best for different groups.

1. Nature of alternatives matters: Programs must offer activities that are enjoyable, attractive, and appropriate for the target youth population to gain participation. Involving youth in program planning and implementation may enhance effectiveness.

1. Intensity is important: More intensive programs providing many hours of involvement and related services tend to be most effective. Brief or one-time events are less likely to have measurable impacts.

1. Skills-building components enhance impact: The most effective alternatives incorporate components aimed at building positive personal, social, and academic skills in addition to providing engaging activities.

1. Alternatives work best as part of comprehensive prevention: Research suggests alternatives are more effective when combined with other proven prevention strategies, especially environmental approaches to reduce substance availability.

1. Culturally-specific programs show promise: Several evaluations of culturally-tailored alternatives programs for minority youth demonstrated positive outcomes, though more rigorous research is needed.

1. Community-wide impact: While individual behavior change may be difficult to measure, alternatives can help establish community norms against substance use and increase support for prevention efforts.

1. Mixed evidence on substance use outcomes: Some studies found alternatives reduced substance use, especially among high-risk youth. However, a few studies found increased use of some substances among participants.

1. Positive impacts on other outcomes: Many studies found alternatives improved outcomes like self-esteem, social skills, cultural pride, and attitudes toward substance use, even when substance use impacts were unclear.

1. More rigorous research needed: While alternatives are popular and align with common sense, there is limited hard evidence on exactly what types of alternatives are effective. More systematic, long-term studies are required.

Conclusions and Recommendations:

• Alternatives should be viewed as one part of comprehensive prevention efforts, not standalone solutions.

• Programs should focus on high-risk youth and incorporate skills-building components.

• Intensive, sustained programming is more likely to show impacts than brief interventions.

• Youth involvement in program planning and culturally-tailored approaches show promise.

• Realistic expectations are needed – alternatives alone may not produce measurable substance use changes.

• Programs should be based on research-supported models of behavior change.

• More rigorous evaluation of alternatives is needed, especially long-term studies.

• Even without strong evidence, alternatives may be valuable community resources for youth.

While more research is needed, alternatives programs appear to have potential as part of comprehensive prevention efforts, especially for high-risk youth. The report recommends continued funding and study of intensive, skills-based alternatives programs targeting those youth most in need of positive opportunities and adult support. Alternatives alone are unlikely to solve substance abuse issues, but can be valuable community investments in youth development when implemented thoughtfully as part of broader prevention strategies.