Drug awareness and prevention programs have often relied on shock tactics — graphic stories, fear-based messaging and one-time assemblies meant to scare students into avoiding illicit drugs. But evidence suggests those approaches rarely lead to lasting behavior change.
At Texas A&M University, Joy Alonzo, associate professor of pharmaceutical sciences in the Irma Lerma Rangel College of Pharmacy, along with Marcia Ory, regents and distinguished professor in the School of Public Health, are working to redefine what drug and opioid misuse prevention looks like by shifting the focus from fear to an approach that emphasizes accountability, personal goals and life skills, peer-to-peer influence and behavior change.
Youth have been disproportionately impacted by the national opioid crisis. According to the National Library of Medicine, opioid overdose death rates increased 49% among 15- to 24-year-olds between 2019 and 2020.
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Previous drug prevention education programs have been criticized for failing to produce long-term behavior changes. Through the Texas Opioid Prevention for Students (TOPS) funded by the Texas Opioid Abatement Fund Council, Alonzo serves as principal investigator alongside Ory, working to apply research-based techniques aimed at changing behavior.
There are a variety of reasons that can lead young people to use and misuse opioids. Alonzo said some may develop symptoms of opioid use disorder after being prescribed opioids for injuries, while others may be drawn into misuse to self-treat a mental health crisis, while others may be ensnared in selling illicit substances.
“Kids between the ages of 14 and 18 are most at risk of abusing illicit opioids because that’s also around the age you start having more agency as a person, having a driver’s license or a job that supplies you with your own money, while also not having fully developed the part of their brain that strategizes consequences,” Alonzo said. “These age groups are also targeted specifically by cartels. Youth populations are being infiltrated, and the dealer is not someone unknown to the youth. It’s often a friend in their friend group, someone everyone knows and trusts.”
While overall opioid overdose numbers have flattened due to recent legislation and national efforts to prevent illicit drug trafficking, youth opioid overdoses have tripled year over year since 2019, Alonzo said. TOPS is developing programs and events utilizing youth engagement and peer-to-peer strategies that encourage youth to hold each other accountable. Program components include a graphic novel written by 15-year-olds about their own experiences with opioids and the consequences, and a multiplayer video game called “Trust Hustle” that reflects situations in which friends may pressure others to sell or use opioids.
“Scared straight programs where you see anecdotes and storytelling are great for relatability, but don’t change behavior — and the outcomes of these programs are not assessed either,” Alonzo said. “We want these youth to be able to withstand the pressures that conspire to make them misuse opioids in the first place. That’s a tall order. We want kids to know they have the capability to not use in the first place and to provide the treatment and the resources needed to be able to stop using and live productive lives if they develop substance use disorder.”
The program also works with teachers, coaches and other trusted adults on how to approach conversations about opioids with their students.
“We have Texas A&M Health behavioral scientists and specialists to put this curriculum together, and to continually assess against outcomes. In other words, we are teaching the teachers how to teach,” she said. “The school is provided all the assistance they need from training, material, exercises and wraparound products and games tied up in six modules they can pick and choose from. It’s a very flexible program and written in response to a Texas law called Tucker’s Law that requires a fentanyl specific evidence-based curriculum as well as other state and national standards. We wanted to make sure we could fill that gap.”
Alonzo said the team is also developing programs designed to support at-risk youth and working to expand access to care through existing clinics.
“Overall, we need to make sure that kids don’t feel like they’re victims or there’s only one way to address the challenges they’re facing,” Alonzo said. “They need to be able to empower themselves to make decisions consistent with their goals and they need to empower each other. We hope to exploit the strong bonds they have with each other to help them band together to defeat the pressures of the opioid crisis and the cartels. As a team, we don’t provide presentations in schools to kids. We provide the tools, training, curriculum, activity blueprints and support directly to the local community members to allow them to deliver the interventions to the kids they care about in their own hometowns.”
