Narconon Drug Abuse Prevention Program Evaluation

The California Healthy Kids Resource Center is administered for the California Department of Education (CDE) and the California Department of Health Services (CDHS). This report does not necessarily reflect the position or policies of the CDE or the CDHS. Questions about this report can be sent to Deborah Wood, Ph.D., Executive Director, California Healthy Kids Resource Center, 313 W. Winton Ave., Hayward, CA 94544, 510-670-4581, dwood@acoe.k12.ca.us.

Cover Letter | Summary | Agency Background | Drug Abuse Prevention Program Description | Process of the Evaluation | Medical and Scientific Accuracy | Developmental Appropriateness | Teaching Methods | References | Endnotes | Appendix

Summary

Narconon is a secular program based on the research and writings of L. Ron Hubbard, who also founded the Scientology religion. The Narconon network provides drug rehabilitation, education and prevention services, and professional training. Narconon Drug Abuse Prevention Program (NDAP) consists of one to eight presentations provided in elementary, middle, and high school classrooms. They are designed to supplement schools' core health and drug abuse prevention curricula. The NDAP presentations are usually provided by trained, former drug addicts and graduates of Narconon's rehabilitation program. The NDAP sessions address general drug information, specific information on alcohol, tobacco and marijuana, the negative impact of drug use on the body and mind, media and alcohol use, tobacco and nicotine, drugs and emotions, and goal setting. A subset of NDAP materials requested was provided for review. NDAP was evaluated for accuracy, developmental appropriateness, and teaching methods. Some drug-related information presented in the NDAP and supplementary resources provided to schools—although aligned with the Narconon drug rehabilitation methodology—does not reflect accurate, widely accepted medical and scientific evidence. Some information is misleading because it is overstated or does not distinguish between drug use and abuse. The NDAP elementary, middle, and high school presentation outlines are inadequately differentiated to the developmental characteristics and cognitive levels of student learners. Although the NDAP is ostensibly aligned with research-based practice, the actual presentation outlines, delivery scripts, and additional resources made available to schools are often inconsistent with these standards. NDAP presentations are lecture-oriented sessions that emphasize conveying information to students and provide limited opportunities for students to exchange ideas, interact with concepts, construct personally meaningful understanding, and practice skills. Some NDAP teaching methods may undermine the desired objectives of schools' research-based drug prevention curricula: using ex-addicts to teach drug prevention in schools may tacitly reinforce students' perceptions that drug use really isn't risky and may also contradict efforts to teach students to critically evaluate health information and its sources. Because NDAP presenters are encouraged to be flexible and the presentation materials leave a variety of content and suggested activities with insufficient instructional direction, the standardization and fidelity of implementation may not be high.

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Agency Background

Agency. Narconon is a secular program based on the research and writings of L. Ron Hubbard, who also founded the Scientology religion. The Narconon network provides drug rehabilitation, education and prevention services, and professional training. The Narconon network includes the Association for Better Living and Education International (ABLE), which licenses groups to use L. Ron Hubbard's drug rehabilitation and prevention methods and ensures that the programs delivered under the Narconon trademark are delivered in accordance with Mr. Hubbard's specifications, Narconon International, individual Narconon detoxification centers, Friends of Narconon, and the Foundation for Advancements in Science and Education (FASE).

Narconon drug rehabilitation program. The Narconon treatment program is described as a "social education" model of drug rehabilitation. It is a four-to-six month, drug-free rehabilitation program that includes a detoxification regimen of aerobic exercise, dry-sauna sweating, hydration and nutrition supplements; life skills trainings; and personalized plans for after-graduation living.1-3 As a social education program it does not always require licensing designed for medical, psychiatric or other models of drug rehabilitation. 1 The unique detoxification component of Narconon's drug rehabilitation program is based on the teachings of L. Ron Hubbard. 1 The premise of the detoxification regimen is that the activation of drug residuals stored in the body can elicit drug cravings in the former drug user thus tempting relapse.1,3 The Narconon detoxification regimen is designed to eliminate drug residues from drug users' bodies and thus reduce the cravings that may be caused by these residues. 1,3

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Drug Abuse Prevention Program Description

Narconon drug abuse prevention program (NDAP). Narconon developed the Narconon Drug Abuse Prevention Program (NDAP) as an adjunct to its drug treatment program. 4 NDAP is designed as a supplementary activity to a school's drug abuse prevention education curriculum. 1,4-5 The NDAP lecturers are generally former drug abusers. 4 Over 200 example educator thank you letters and student post-presentation surveys (from 52,000 on file at Narconon) praise the NDAP presentations in California. 6 An unpublished evaluation of a sample of 1,045 middle and high school students who completed a written survey after a one-hour NDAP presentation found positive drug knowledge and attitude results. 4

NDAP, as described in the Narconon Drug Abuse Prevention Specialist Manual, consists of eight 30-45 minute presentations provided in elementary, middle, and high school classrooms. 5 The eight sessions address general drug information, specific information on alcohol, tobacco and marijuana, the negative impact of drug use on the body and mind, media and alcohol use, tobacco-use prevention, and goal setting. (See Appendix A for an overview of the program objectives and content.) The Nacronon network also provides schools with drug abuse prevention videotapes, booklets, student worksheets, peer education program, and training workshops to teachers (http://www.narconon.org, July 2004). 1,5 The NDAP and other drug abuse prevention materials and resources the Narconon network makes available to schools are the focus of this evaluation.

Since 1972 Narconon has delivered 5,772 drug prevention presentations to 447,400 students in California schools (C. Carr, PowerPoint presentation, July 2004). Currently in California there are seven NDAP presenters, of whom "about 50%" are graduates of the Narconon drug rehabilitation program (C. Carr, discussion, July 2004). b

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Process of the Evaluation

Scope of the program evaluation. The California Healthy Kids Resource Center (CHKRC) c evaluated the Narconon Drug Abuse Prevention Program (NDAP) at the request of the California Department of Education (CDE) using research-based evaluation forms (http://www.californiahealthykids.org) and following written procedures discussed with CDE and Narconon (July, 2004). The NDAP and other drug prevention materials made available by the Narconon network to schools were evaluated for medical/scientific accuracy, developmental appropriateness, and teaching methods.

Materials evaluated. Narconon provided a subset of the materials requested for evaluation. Requests were made to Narconon for a complete set of prevention program materials, including curricula, audiovisual materials, student handouts, videotapes of classroom presentations, selection and training of presenters, etc. Follow-up requests were made for these materials and additional drug prevention materials identified as available to schools in Narconon publications (Narconon website, newsletter, and overview of services, July 2004). (See Appendix B for a list of materials requested, received, and reviewed.)

Reviewers. The CHKRC prepared the NDAP evaluation report with input from written independent evaluations from medical, scientific, and health education exerts. The outside evaluations were advisory to the CHKRC. Narconon program materials were independently reviewed by fourteen reviewers and three CHKRC staff. Reviewers included five doctors (M.D.s), four board certified in pediatrics and adolescent medicine and/or with specific expertise in addiction and substance abuse; two doctors (Ph.Ds) with expertise in child and adolescent development; one doctor (Ph.D.) with expertise in prevention research and program evaluation of substance abuse programs. Reviewers also included nine school health education specialists (with teaching credentials and/or masters level health or education degrees) including elementary, middle, and high school teachers, university faculty, and school district/county office of education tobacco, alcohol, and other drug abuse prevention education coordinators.

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Medical and Scientific Accuracy

NDAP instructional materials do not clearly identify authors, their institutional affiliations or qualifications, or whether the materials underwent content or pedagogical review; although one material references L. Ron Hubbard as the source of its information. d Some of the general content presented in the NDAP is accurate, such as the information on media and alcohol, tobacco and nicotine, achieving goals, and possible effects of drug abuse on mental processing (e.g., memory). Some drug-related information presented in the NDAP and supplementary resources—although aligned with the Narconon drug rehabilitation methodology—does not reflect accurate, widely accepted medical and scientific evidence. Some information is misleading because it is overstated or a distinction between drug use and abuse is lacking.

Examples of inaccurate information presented to students in NDAP presentations and supplementary resources include:

• drugs burn up vitamins and nutrients
• drug-activated vitamin deficiency results in pain which prompts relapse
• marijuana-induced, rapid vitamin and nutrient loss causes the "munchies"
• small amounts of drugs stored in fat are released at a later time causing the person to re-experience the drug effect and desire to use again

This information reflects hypothesized processes of drug metabolism, bioavailability, and psychoactive impact, and is the premise for the Narconon detoxification regimen. a This theoretical information does not reflect current evidence that is widely accepted and recognized as medically and scientifically accurate.

Examples of misleading statements and inferences presented to students in NDAP presentations and supplementary resources include:

• drugs are poisons
• the amount of a drug determines if it acts as a stimulant or as a sedative
• anyone who takes drugs does so to avoid problems
• drugs ruin creativity and dull senses

This information is overgeneralized or exaggerated.

Inaccurate and misleading drug-related information is problematic because it can confuse students and be perceived as designed to arouse fear. It may also lead students to discredit the schools' drug prevention program and distrust educators.

Inaccuracies and misleading inferences were not limited to a single material, but were evident in NDAP elementary, middle and high school presentation outlines and delivery scripts and in the supplementary drug prevention materials available to schools that were provided for this review. (See Appendix C for annotated examples of inaccurate and misleading information.)

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Developmental Appropriateness

The NDAP materials lack attention to the developmental characteristics and cognitive levels of student learners. The eight elementary, middle, and high school presentation scripts are undifferentiated. Presentation outlines and delivery scripts for students at different developmental levels comprise the same content, terminology, and presentations verbatim, with limited language and activity differences. Although the introduction of the NDAP manual reviews possible program content for children of different ages, the manual lacks guidance, language, scripts, and examples that translate this content into developmentally appropriate presentations or learning activities. Presenters are directed to "use age-appropriate terminology." However, with the exception of "THC," no examples were found for drug-related vocabulary to be provided to learners of different ages. Nor are presenters provided with definitions of terms to use with students at different developmental levels. Differentiated learning support materials, such as visual and overheads, to help explain concepts to younger students were not evident. Similarly, guidance was not found for the appropriate grade levels for the student videos, worksheets, or booklet. In addition, guidance was not found for presenters regarding what types of personal or observed drug-use anecdotes might be appropriate or inappropriate, effective or ineffective for students of different ages. (See Appendix D for terminology used in NDAP.)

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Teaching Methods

Research-based drug abuse prevention education. School-based drug abuse prevention content areas that have demonstrated effectiveness in the scientific literature include learning activities that enable students to,

• recognize and assess risks and possible consequences of drug use;
• understand and analyze external influences to use drugs (e.g., family, peers, media) and internal pressures to use drugs (e.g., desire for acceptance, perceptions of norms regarding drug use);
• learn and practice personal and social skills (e.g., decision making) and drug-use resistance skills (e.g., refusal skills).

These content areas are most effective when taught using interactive techniques (e.g., role-playing, cooperative learning, discussion, and skills practice) in which students actively construct personally meaningful understanding and learn skills. Ineffective practices include information-only programs about the negative effects of drugs, scare tactics, testimonials of ex-addicts, single-exposure interventions, and non-interactive techniques that emphasize conveying information to students. Non-interactive techniques are most likely ineffective because they fail to accommodate the complex relationship between health knowledge and behavior. The best known non-interactive program is Drug Abuse Resistance Education (DARE), which has been shown to be ineffective. 7-11

The NDAP is designed to supplement the school's core health and drug-abuse prevention curricula. Nonetheless, its content and strategies should be consistent with curriculum standards and research-based practice. e Even though the NDAP manual describes research-based practice, the actual presentation outlines, delivery scripts, and additional resources made available to schools are often inconsistent with these standards, as described in the following sections.

Use of research-based interactive techniques. NDAP presentations do not use research-based interactive techniques. NDAP presentations are lecture-oriented sessions designed to verbally convey information about the risks and dangers of drug use and addiction, using concrete examples, as well as humor, and entertaining moments. Some lectures are interspersed with student participation (mostly in the form of presenter questions and group responses). NDAP presentations offer limited opportunities for students to meaningfully interact with the concepts, construct their own understandings for themselves, and learn and practice skills. With few notable exceptions (e.g., session on media and alcohol), the presenter's questions tend to ask students to confirm the presenter's conclusions rather than critically reflect, exchange ideas and generate their own conclusions. Examples:

1. "'...When a healthy person takes drugs, the drugs can make them sick. . .So if a person is not sick, is there any good reason to take a drug?' (No!)" (1.3)
2. "Tell them: '...who know somebody who smokes cigarettes? (Every hand goes up.) Alright, who knows someone who smokes cigarettes and wishes that they could quit? (Almost all of the same hands go up.) That is a good example of addiction. Do you think those people, when they tried their first cigarette, WANTED to become addicted? ('No!') I don't think so. And, do you think that that person, who ever it might be, started out by using twenty cigarettes per day? ('No!') Probably not. Most people begin by using just a cigarette here, and a cigarette there, and if they don't stop, they can very soon be using 5 or 10 per day. People don't decide to become addicted to a drug. Nobody goes home at the end of a school day and says, 'What am I going to do tonight? Wash my bicycle . . . and become a drug addict.'" (4.1)

Similarly, activities that could provide meaningful student interaction with the concepts often lack sufficient concept development or detail for effective implementation. Examples:

1. "Get students to give examples of varying types of drug use and ask them 'Is this a responsible use of drugs, or is it irresponsible?'" (1.4)

2. "Activity: Role-playing to demonstrate the meaning of addiction." (4.5)

3. "Activity: Students name various commercials they've seen to demonstrate their ability to use critical thinking skills and to identify pro-alcohol messages." (5.4)

4. "Activity: Students give examples they've seen of how powerful the addiction to nicotine can be." (6.4)

Accurate information without the use of scare tactics. Strategies designed to frighten students into avoiding drugs do not work, and can be counterproductive. Statements presented to students in the NDAP are indicative of scare tactics. These include failure to clearly distinguish between drug use and abuse and overstating risks. Example:

1. "...'Even coffee can cause some serious problems if someone takes too much of it. In fact enough coffee in a short period of time could potentially kill a person. Now, I've never heard of anyone dying from an overdose of Starbucks. But I have heard of people dying from an overdose of caffeine. Usually that's from taking caffeine in pills. . . . Other drugs do the same thing. Have you ever seen someone go to a party and the first thing they do is drink beer? . . . if he keeps drinking, he could kill himself.'" (2.1)

Normative perceptions. Most drug education curricula include normative education strategies designed to correct misperceptions that many students are abusing drugs. In contrast, the NDAP delivery scripts suggest presenters ask students about personal experiences and expect shared responses that may reinforce perceptions that drug abuse is common. This questioning strategy may undermine the normative education components of the school's research-based drug prevention curriculum. Examples:

1. "Tell them: 'Raise your hand if you know someone who drinks too much alcohol.' (Most hands will go up.) Ask if they know someone who has trouble with some drug. (Some of the hands.) Ask, 'Who knows someone who smokes cigarettes?' (Every hand will go up.) 'Great. Who knows someone who smokes and wishes they could quit? Alright, you all know someone who has a drug problem then, don't you?'" (0.3)
2. "'Who here has seen someone who just has to have a cup of coffee every morning? (Every hand is up.) . . . Have you ever seen someone go to a party and the first thing they do is drink beer? (Most hands up.) . . . Have you ever seen someone drink so much alcohol that they actually passed out?'" (Almost every hand up.) (2.1)
3. "Discussion: Ask students, 'Have you observed the differences in a person between the time before he started using drugs and the time after he started using drugs?' Get them to discuss this with a partner." (3.2)

In addition, there may be student and family privacy concerns about using this questioning strategy.

Using reformed drug addicts in drug prevention education . NDAP presenters include former drug addicts. As noted above, the use of testimonials of former drug abusers is not a research-based strategy, either as core instruction or as a supplementary activity. Authorizing ex-addicts to teach drug prevention in schools may tacitly reinforce student perceptions that drug use really isn't risky. Similarly, educational institutions may compromise their ability to teach students how to critically evaluate the credibility of health information and its sources 4, f if they afford drug prevention education authority to ex-addicts who do not possess legitimate credentials, degrees, or medical training.

The NDAP materials are equivocal about presenters sharing their personal drug-use experience. The presenter's manual advises that what is most relevant is "your observation of what happens to other people who abuse drugs, not your personal history." If asked, presenters are instructed to be truthful but brief, and "to make it clear that the fact that you are now able to stand in front of a group and deliver an effective presentation is in spite of your experiences," and to practice this with an experienced Narconon presenter. g Despite these cautions, no published scientific evidence was found indicating that either describing the consequences of another's drug use (instead of their own) or cautioning students from drawing inappropriate conclusions is effective or relieves the problems associated with using rehabilitated drug addicts in school-based drug prevention.

In the Marijuana the Myth video— "viewed by over 500,000 students!" (Narconon newsletter, 2004), and which apparently is also used to train NDAP presenters (Narconon Drug Abuse Prevention Specialist Training DVD of 2 Narconon video properties, 2004)—a Narconon presenter voluntarily (not in response to a student question) describes his personal initiation to drug use to a classroom of students, adding, "I almost died four times from drugs." Also in this video, five young adults, each identified as "Former Drug User—Narconon Graduate" describe their personal experiences with drug abuse. (See Attachment E for video statements of former drug users—Narconon graduates.)

Dosage and duration. As noted above, a one-time presentation to students is not a research-based strategy. NDAP includes eight 30-45 minute sessions on different drug prevention topics that could be presented as one-time presentations or sequentially over multiple sessions. Although Narconon has presented hundreds of thousands of NDAP presentations to California students, no evidence was provided that these are typically more than one-time presentations to students. h

Fidelity of implementation. Standardization of NDAP presentations was not reflected in the materials provided for review. First, NDAP presenters are encouraged to be flexible to accommodate the developmental differences, drug experiences and concerns of pre-teens and teenagers. 12 Second, even though delivery scripts are provided for a great deal of content and the NDAP manual directs presenters that "the factual content points are to be adhered to very closely," a significant amount of NDAP content lacks scripts, and activities lack implementation instructions—indicating that many of these elements must be developed by individual presenters. Similarly the NDAP presenter's manual only provides instructional content and delivery scripts for alcohol, tobacco, and marijuana. No instructional content or delivery scripts were found for the seven other drugs listed in the General Developmental Guidelines, suggesting little standardization of content and activities if these drugs are presented. i (See Appendix F for General Developmental Guideline.) No videotapes of live, complete NDAP presentations to California students were provided for assessment of fidelity and standardization of implementation.

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References

1. Narconon Drug Rehabilitation and Prevention Services for Over Three Decades: An Overview of Results. Los Angeles, CA: Narconon International; 2002.
   
   
2. Schare DW, Denk G, Shields M, Brunton S. Evaluation of a detoxification regimen for fat stored xenobiotics. Med Hyp. 1982;9:265-282.
   
   
3. Beckmann S. Narconon: An overview of the drug rehabilitation program. Los Angeles, CA: Narconon International; May 1995. Unpublished manuscript.
   
   
4. Beckmann SL, Chapman SL. Narconon drug education program preliminary analysis. ERIC. 1989. Accession number ED312602.
   
   
5. Narconon Drug Abuse Prevention Specialist Manual. Los Angeles, CA: Narconon International; 2004.
   
   
6. NDAP Examples of educator responses and NDAP Student responses: Elementary, middle and high school. Los Angeles, CA: Narconon International; 2004. Compilation of sample letters and surveys.
   
   
7. Strategies for prevention. In: Getting Results (Part I): California Action Guide to Creating Safe and Drug-Free Schools and Communities. Sacramento, CA: California Department of Education; 1998: chap 4.
   
   
8. Ringwalt CL, Paschall MJ. Substances, Adolescence. In: Gullotta TP, Bloom M, eds. Encyclopedia of primary prevention and health promotion. New York, NY: Kluwer Academic/Plenum Publishers; 2003:1065-1073.
   
   
9. Roona M, Steke A, Marshall D. Substances, Adolescence (Meta-Analysis). In: Gullotta TP, Bloom M, eds. Encyclopedia of primary prevention and health promotion. New York, NY: Kluwer Academic/Plenum Publishers; 2003:1073-1079.
   
   
10. Robertson EB, David SL, Rao SA. Preventing drug use among children and adolescents: A research-based guide for parents, educators, and community leaders. 2 nd ed. Bethesda, MD: National Institute on Drug Abuse; 2003. U.S. Department of Health and Human Services publication NIH 04-4212(A).
    
    
11. Health Framework for California Public Schools: Kindergarten Through Grade Twelve. Sacramento, CA: California Department of Education; 2003.
    
    
12. Carr CRN, Smith GW, Cecchini MA. The Narconon drug abuse prevention program. Los Angeles, CA: Narconon International. Unpublished manuscript.

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Endnotes

1. The theoretical basis of the Narconon detoxification regimen is described as,
   
   The detoxification component of the Narconon program is based on the premise that these adverse consequences of drug abuse arise from small amounts of drugs or their metabolites stored in the fatty tissues of the drug user. When fats are mobilized during times of stress or hunger, the drug residuals are mobilized as well. This may lead to reactivation of drug effects, a 'flashback' type experience or, in the case of the recovering drug abuser, this may lead to reactivation of the craving for his original drug of abuse. This hypothesis is supported by the results from treatment with the detoxification program...3
   
   
2. The majority of the 150 example thank you letters from California educators refer to one presenter: Tony Blysma. One letter each refers to two other presenters: Nathan Johnson and Garry Marshal. Typically the letters praise the presentation and express gratitude for the external funding that made it possible. Some of the letters describe the presenter as a former drug abuser and remark on the personal stories of drug abuse shared during the presentation.
   
   
3. The CHKRC is administered for the California Department of Education and the California Department of Health Services to review research and health instructional materials for use in California schools, provide technical assistance and training in health education, and to provide a library of reviewed resources for loan to California schools, professional development programs, and other youth-serving programs. For more information see the Center's website at http://www.californiahealthykids.org.
   
   
4. The student booklet, "10 Things Your Friends May Not Know About Drugs" (2004) includes the citation,
   
   Narconon centers utilize the drug-free methods of American author and humanitarian L. Ron Hubbard. The information in this booklet is based on the works of L. Ron Hubbard.
   
   
5. Regarding the involvement of other health experts, the California Framework for Health Instruction 11 advises schools,
   
   When planning a health education curriculum, leaders should keep in mind that many professionals with special health-related expertise and interest are available in schools and communities. Potential human resources include health care providers; public health educators in tobacco, alcohol, and drug prevention; public health nurses; juvenile justice staff; environmental health specialists; mental health counselors; and nutritionists... When guests are invited to participate in the classroom, school policies should be considered and adequate precautions taken to ensure student safety and the guests' adherence to curriculum standards and practices. (p. 48)
   
   
6. Some reviewers raised a related question as to whether the display of the Narconon logo, which may also represent rehabilitation centers and services, on the student materials (e.g., worksheets, surveys, videos), created a possible an infringement of social compliance requirements for classroom materials.
   
   
7. The NDAP manual notes that Narconon presenters apprentice under a mentor until the mentor and an experienced presenter attest that the aspiring presenter is qualified to work alone. Full certification is granted when a presenter provides clear evidence of consistent success with students in a variety of educational contexts over a period of several months. Similarly, Narconon reports that NDAP presenters are trained so that they can cogently present material regarding a wide range of drugs. 12 While this attention to training is admirable, no documentation or evidence of presenter training was provided.
   
   
8. Some records on dosage were provided by Narconon New England for the period Aug. 1999— March 2000. Although the records were short term (less than a year) and may be incomplete, they indicate that students at most schools received one Narconon presentation. At some schools presentations were given to more than one grade. If these data are extrapolated, it might be inferred that some students may have received one Narconon presentation per year over several years. Nonetheless, conclusions about dosage for California students cannot be made from New England data.
   
   
9. Similarly, it was noted that the program materials lacked guidance for schools or presenters regarding how to help students who may be living in environments where drugs are abused or chemical dependency exists, or to help students who are using. Given the topics raised by the NDAP presenters, it is likely that students with these troubles might self-identify and be receptive to assistance if it was offered.

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