Resistance Training

Resistance training programs involve the development of social skills necessary to avoid substance misuse/abuse. Studies of generic resistance training as well as three specific resistance skills training programs are included in the database. Programs are Project ALERT, Social Pressures Resistance Training, and the Adolescent Alcohol Prevention Trial (AAPT). The results of all these programs are mixed. One generic resistance skills training program has been found to decrease alcohol misuse (Dielman, Shope, Leech, & Butchart, 1989), while Project ALERT and Social Pressures Resistance Training have been found to decrease gateway drug use (Ellickson & Bell, 1990; Shope, Copeland, Marcoux, & Kamp, 1996). However, these results have been found to disappear at follow-up (Ellickson, Bell, & McGuigan, 1993; Shope, Copeland, Kamp, & Lang, 1998). Further, a review of 16 outcome studies on resistance skills training programs concluded that these programs "are not universally effective and, while not detrimental, have little or no impact upon participants." (Gorman, 1995; p. 92). Suggested methods to improve resistance skills training programs include booster sessions (Shope et al., 1998), incorporating environmental factors in the youth's life (e.g., parent, peer, and community components; Ross, Richard, & Potvin, 1998), and establishing conservative norms to drug use (Donaldson, Graham, Piccinin, & Hansen, 1995; Hansen & Graham, 1991). In fact, when used alone with youth who already endorse alcohol use, Donaldson et al. (1995) found that resistance skills training seems to reinforce their perception that drug use is more prevalent than it really is.

References with Abstracts for Resistance Training

Author(s): Dielman, T. E., Shope, J. T., Leech, S. L., & Butchart, A. T.
Year: 1989
Title: Differential effectiveness of an elementary school-based alcohol misuse prevention program
Journal: Journal of School Health
Volume: 59
Issue: 6
Pages: 255-263
Keywords: alcohol, social skills training, resistance training
Abstract: An alcohol misuse prevention program was developed, implemented with fifth- and sixth-grade students, and evaluated over a 2-year period postintervention. The protocol involved the development of social skills necessary to avoid alcohol misuse. Students developed and practiced skills in resisting peer pressure. Youth were assigned to intervention and control groups within their respective grade levels. Youth were also categorized as either "abstainers"; "supervised users," youth whose parents sanctioned and supervised their alcohol use; or "supervised plus unsupervised users," youth who used alcohol both with and without parental knowledge and supervision. Results indicate that the sixth-grade control group had a greater rate of increase of alcohol misuse than the sixth-grade intervention group between 2 months and 14 months posttreatment. Further, youth categorized as "supervised plus unsupervised users" who participated in the intervention had a significantly lower rate of increase in alcohol misuse than their control group counterparts.

Author(s): Donaldson, S. I., Graham, J. W., Piccinin, A. M., & Hansen, W. B.
Year: 1995
Title: Resistance-skills training and onset of alcohol use: Evidence for beneficial and potentially harmful effects in public schools and in private Catholic schools.
Journal: Health Psychology
Volume: 14
Issue: 4
Pages: 291-300
Keywords: Adolescent Alcohol Prevention Trial (AAPT), resistance training, normative education, alcohol
Abstract: This study examined the effects of the Adolescent Alcohol Prevention Trial (AAPT) on attitudes toward alcohol and alcohol use. AAPT combines resistance training with normative education. Resistance training consisted of lessons designed to teach adolescents "how to refuse explicit drug offers in a socially acceptable manner" (p. 293). Four lessons dealt with consequences of using substances, and five lessons dealt with refusal skills training. Normative education was designed specifically to "combat the influence of passive social pressures (e.g., social modeling and overestimation of adolescent alcohol and drug use)" (p. 293). Participants in the study were 11,995 fifth- through eighth-grade students. Results indicate a significant inverse relationship between adeptness in use of refusal skills and alcohol use for youth who believed that it was not acceptable to drink. In other words, the more adept these students were in use of refusal skills, the less likely they were to use alcohol. Additionally, results suggest a potential detrimental effect may occur by using resistance skills training alone, particularly with youth who endorse alcohol use. The authors suggest the use of both normative education and resistance skills training to prevent the overestimation of drug use that comes from use of resistance training alone.

Author(s): Ellickson, P. L., & Bell, R. M.
Year: 1990
Title: Drug prevention in junior high: A multi-site longitudinal test
Journal: Science
Volume: 247
Issue: 16
Pages: 1299-1305
Keywords: Project ALERT, cigarettes, alcohol, marijuana
Abstract: This study provides the results from a multisite, longitudinal test of Project ALERT. The program specifically targets cigarette, alcohol, and marijuana use (the "gateway" drugs) using a social influence model of prevention. The social influence model attempts to motivate youth to resist drugs and helps them acquire drug resistance skills. The approach also attempts to teach youth the immediate impact of drugs and helps them to identify prodrug pressures. Thirty schools were randomly assigned to one of three conditions: alternative treatment or no-treatment controls; adult-led groups; and teen-assisted, adult-led groups. Data on 3,852 youth were collected at four points in time: before and after the seventh-grade curriculum and before and after the eighth-grade booster curriculum. The overall results indicate that Project ALERT had positive effects on curbing cigarette, alcohol, and marijuana use, particularly with baseline nonusers or experimenters. For alcohol use, Project ALERT produced significant reductions in drinking for baseline nonusers at the end of seventh grade compared to alternative-treatment/no-treatment controls; however, these gains disappeared at the end of eighth grade. The program significantly decreased cigarette use for experimental users at the end of the eighth-grade booster sessions compared to alternative-treatment/no-treatment controls. For baseline smokers, however, the program produced negative results. Finally, for marijuana baseline nonusers, the program significantly curbed initiation compared to controls. No consistent differences between the adult-led and peer-assisted groups were noted. The authors conclude that the social influence model implemented through Project ALERT is effective in reducing or eliminating gateway drug use.

Author(s): Ellickson, P. L., Bell, R. M., & McGuigan, K.
Year: 1993
Title: Preventing adolescent drug use: Long-term results of a junior high program
Journal: American Journal of Public Health
Volume: 83
Issue: 6
Pages: 856-861
Keywords: Project ALERT, cigarettes, alcohol, marijuana
Abstract: This study examined the long-term effects of a multisite randomized trial of Project ALERT. The 11-lesson curriculum administered in the seventh and eighth grades was designed to build the motivation and skills for effective resistance to prodrug pressures by providing normative education and targeting cognitive beliefs supporting drug use. In addition, strategies are utilized for enhancing skill learning, such as modeling, practicing, and reinforcement. The Project ALERT field trial took place with approximately 4,000 students in 30 middle schools throughout California and Oregon. Schools were randomly assigned to three groups: adult-led groups; adult-led, teen-assisted groups; and alternative treatment controls. Short-term results indicate that Project ALERT had a strong impact on curbing cigarette and marijuana use. The program worked best for children who had limited prior experience with drugs. The long-term results, analyzed in the 10th and 12th grades, indicated that earlier positive effects on cigarette and marijuana use had disappeared by the end of high school. Program effects on cognitive risk factors (consequences of use and normative perceptions of substance use) lasted considerably longer. The authors conclude that teenagers need continued and strong reinforcement to resist drugs throughout high school.

Author(s): Gorman, D. M.
Year: 1995
Title: Are school-based resistance skills training programs effective in preventing alcohol misuse?
Journal: Journal of Alcohol and Drug Education
Volume: 41
Issue: 1
Pages: 74-98
Keywords: resistance skills training
Abstract: Sixteen outcome studies focusing primarily on resistance skills training are reviewed, and conclusions are made by the author as to the overall efficacy of this method of intervention. The author grouped the studies into four major headings: (a) studies reporting negative effects, (b) studies reporting no effect, (c) studies reporting minor effects, and (d) studies reporting positive effects. Half of the research studies reported no significant effects. Studies reporting minor and positive effects often had methodological limitations (e.g., attrition, posttest only design) and did not have significant effects on youth who were already drinking. From reviewing these studies, the author concludes that "resistance skills training programs are not universally effective and, while not detrimental, have little or no impact upon participants" (p. 92). The author reviews suggestions for improving treatment programs, which include involving the wider community beyond the school in delivering the intervention and matching individuals to the most appropriate intervention. The latter suggestion implies abandoning universal primary prevention approaches. The author states that those who support the universal approach to prevention suggest that these approaches be placed in a broader conceptual framework (i.e., normative education and life skills training).

Author(s): Hansen, W. B., & Graham, J. W.
Year: 1991
Title: Preventing alcohol, marijuana, and cigarette use among adolescents: Peer pressure resistance training versus establishing conservative norms
Journal: Preventive Medicine
Volume: 20
Issue: 3
Pages: 414-430
Keywords: resistance training, alcohol, marijuana, cigarette
Abstract: This study examined the differential and combined effects of resistance training and establishing conservative group norms toward substance abuse prevention. Resistance training involved teaching skills to resist peer pressure to use alcohol and other substances. Establishing conservative group norms involved correcting erroneous perceptions about the prevalence and acceptability of alcohol use. Schools were randomly assigned to four conditions: information only, resistance training, normative education, and combined (resistance training plus normative education). Results indicate that the conditions that included normative education significantly reduced alcohol consumption, marijuana use, and cigarette consumption. Further, the combined program was superior to all other programs in decreasing short-term (past 30-days) alcohol and marijuana use. Resistance training alone was the least effective in preventing the onset of marijuana and alcohol use. In fact, data suggest that resistance training, by itself, may have been slightly harmful. The authors conclude that establishing conservative group norms may enhance the efficacy of other programs targeted toward adolescent substance abuse.

Author(s): Ross, C., Richard, L., & Potvin, L.
Year: 1998
Title: One year outcome evaluation of an alcohol and drug abuse prevention program in a Quebec high school
Journal: Canadian Journal of Public Health
Volume: 89
Issue: 3
Pages: 166-170
Keywords: resistance training, alcohol, adolescent
Abstract: This study examined the efficacy of an educational and peer-resistance program in altering the knowledge, beliefs, and self-efficacy regarding alcohol and drug use of adolescents. The intervention consisted of seven 50-minute lessons focusing on information about alcohol and drugs, the role of external influences, decision making, and the role of peer pressure. Youth were taught peer-pressure resistance tactics and decision-making skills through modeling. A total of 491 seventh-grade students from two different schools were evaluated. One school received the intervention, while the other served as a control. Results indicate no significant effects on knowledge or beliefs one year after initiation of the protocol. Further, a significant decrease in self-efficacy was noted in the intervention group. The authors state that these results suggest effective substance abuse programs should involve environmental factors outside the school setting (e.g., parent, peer, and community components) in addition to school prevention efforts.

Author(s): Shope, J. T., Copeland, L. A., Kamp, M. E., & Lang, S. W.
Year: 1998
Title: Twelfth grade follow-up of the effectiveness of a middle school-based substance abuse prevention program
Journal: Journal of Drug Education
Volume: 28
Issue: 3
Pages: 185-197
Keywords: Social Pressures Resistance Training, resistance training, alcohol, cigarettes, marijuana, follow-up
Abstract: This study examined the long-term effects of a substance abuse prevention curriculum (Social Pressures Resistance Training) delivered in the sixth and seventh grades. The curriculum taught students about various pressures to use substances, risks and effects of those substances, and ways to resist pressures to use substances. The 262 students were assessed on four occasions: 6th-grade pretest, 6th-grade posttest, 7th-grade posttest, and 12th-grade posttest. The study examined the curriculum's impact on substance use behavior and knowledge outcomes. The curriculum had a significantly positive impact on alcohol use and misuse, cigarette smoking, and cocaine use at 7th-grade posttest; however, these effects disappeared by the 12th grade for all substances. The authors conclude that, although substance abuse prevention efforts in the school setting are successful, the positive effects of these efforts are "unlikely to be maintained without booster lessons or subsequent intervention" (p. 195).

Author(s): Shope, J. T., Copeland, L. A., Marcoux, B. C., & Kamp, M. E.
Year: 1996
Title: Effectiveness of a school-based substance abuse prevention program
Journal: Journal of Drug Education
Volume: 26
Issue: 4
Pages: 323-337
Keywords: Social Pressures Resistance Training, resistance training, alcohol, cigarettes, marijuana, cocaine
Abstract: This study examined the efficacy of the Social Pressures Resistance Training program on fifth- to eighth-grade students. The program taught about pressures to use substances, the effects of those substances, and ways to resist pressures to use substances. Role-play was used as the primary teaching technique. The study utilized a pretest-posttest, control group design and measured substance use and knowledge acquisition over a 2-year time span. Participants were 1,911 students who were assigned to either the program group or a no-treatment control group. The program group within the youngest cohort (sixth- to seventh-grade) demonstrated a significant increase in knowledge and a significant decrease in alcohol use, cigarette use, marijuana use, and cocaine use over time compared to its respective control group. Within the older cohort (eighth- to ninth-grade), significant increases in knowledge and significant decreases in cigarette and marijuana use were noted, but there were no significant effects on cocaine or other drug use.

Rev July 2000