I teach a trifecta of skills within the context of substance abuse prevention. In New York, our guidance document suggests teaching decision making skills (NHES 5) in combination with analyzing influences (NHES 2) and accessing information & services (NHES 3). So…
I teach my students to analyze what may influence their decisions about drugs & alcohol. We consider the role of risk & protective factors in influencing our decisions. This allows us to look at the impact of:
- our peers,
- our family,
- the community in which we live,
- the cultures to which we belong,
- the media we consume,
- our knowledge and
- our normative beliefs.
Analyzing Influences
One way to introduce this skill is by using fictional characters or scenarios. In my high school classes, I used the characters from Grease to help illustrate what influences our decisions. Why does Zucko decide to clean up his act and try out for sports? Is it because he knows the health benefits of being involved in school activities (a protective factor) or of being physically active?
Nope. His decision is NOT based on his knowledge. Zucko makes this decision to impress the girl he likes. To make a good impression on Sandra-Dee, Zucko consciously (and awkwardly) decides to act more like her. And while Danny Zucko works on his transformation, Sandy simultaneously works on hers.
Why does Sandy ditch the poodle skirt and pick up a cigarette? It’s not because she’s unaware of the dangers of smoking (although in the 50s she may have been), it’s because she wants to fit in with the T-Birds’ fearless leader.
The pull of our own risk and protective factors is on display when students get up out of their seats for a tug of war. In my middle school classes this year, we used scenarios to highlight powerful influences on behavior. Carlos, equipped with a supportive family, goals for his future, a positive adult role model and an activity he loves is less likely to vape than Emma who is pulled in the opposite direction by her low self-esteem, permissive parents, vaping friends, and easy access.
To assess their understanding, I challenge my students to engineer a person who #MakesGoodChoices; metaphorically injecting their profile with as many protective factors as they can while avoiding any risk factors. Students then reflect on their own risk & protective factors by comparing themselves to the profile.
Finding Valid Information
While knowledge is rarely the largest influence on our decisions, being unaware of the consequences of drug & alcohol use can put you at risk. I challenge both my middle school and high school students to learn what’s worth knowing.
- What drugs can kill me the first time I use them?
- Which drugs are illegal for everybody to use?
- Which drugs are legal for people of a certain age?
- How can I help someone who has had too much?
- How can I tell if someone has a substance abuse disorder? (And how can I help?)
- Can I get in trouble for seeking help?
I don’t care if my students can classify drugs as stimulants or depressants – but I do care if they have the basic knowledge necessary to keep themselves safe and healthy.
Rather than answer these questions for my students, I create challenges for them. These challenges require them to find valid & relevant information from sources they can trust and understand. There are many models (STAAR, SIFT, RADAR) that can be used to teach students how to find valid information. I use the CRAAP test with my students, largely because I get a kick out of suggesting that students tell their families, “I learned CRAAP at school today.”
My middle school students use reliable sources to verify that certain facts are related to a particular drug. By doing so they’re able to crack a code and win the challenge. This activity is easy to recreate by simply modifying your existing drug-facts slide show.
Accessing Health Services
My high school students go one step further – creating infographics on a variety of high stakes health topics. In addition to finding relevant information about the topic, students need to find a local service where young people could seek help or treatment. I have students add these resources to the contact list in their phones so they always have access to them.
This project doubles as a quick advocacy project. Those that are completed well are printed and hung in bathroom stalls to educate our larger student body. They also become a student resource when teaching communication skills. Students role play a high stakes health scenario based on the advice given in the infographics about how to help a friend.
The Social Norms Approach
At some point in both my HS and MS curriculum, students use Youth Risk Behavior Survey Data to discover that MOST TEENS MAKE HEALTHY CHOICES. Correcting students’ normative beliefs about drug use (many believe that most teens use drugs) is one of the most effective ways to decrease drug use in our student populations.
My middle school students help to create my “Most Kids Don’t Use Drugs” campaign. They highlight a statistic that proves most kids don’t use alcohol, marijuana or vapes. They also identify their personal reason for being drug free. Their creations are posted throughout school – a constant reminder to the entire student body that most of our students make healthy choices. I often post last year’s creations – banking on the social influence of my students who have advanced to 8th grade – and are now the ones to look up to.
Decisions with A Disadvantage
I often begin lessons on decision making by telling my students that all of them are “mentally challenged.” The comment is intended to get a rise out of them – some laugh, some scowl. I go on to explain that I’m not trying to be mean, I’m just being honest. This is when I tell them about the purpose of their prefrontal cortex and let them know that theirs won’t be fully developed until their mid-twenties.
Despite the disadvantage, students are still held responsible for their decisions and their consequences, intended or not. It’s crucial for teens to consciously pause to think about their decisions; and that’s when I introduce a decision making model.
Groupthink
Students need to identify whether collaborative or individual decision making is appropriate in any given situation. In many health-related situations, collaborative decision making has the same pitfalls of groupthink. People silence their own opinions or values when different from the group to avoid conflict.
Imagine a group of friends, experimenting with drugs or alcohol, when it becomes clear one has had too much. Although someone may feel compelled to get help, if the group thinks they can “sleep it off,” often no one will act.
Timothy Piazza
In my HS classes, I use the tragic death of Penn State student Timothy Piazza to illustrate the importance of individual decision making. Timothy Piazza and fellow pledges consumed large quantities of alcohol, which led to a fall down the stairs. Fraternity brothers administer a sternum rub and get no response. In a disturbing turn of events, the brothers wait over 12 hours to call 911 and never tell the dispatcher about the fall.
The story shows the importance of making one’s own decision in situations like this. That’s why I created the You Be You…I GOT ME decision making model. It uses the same steps as traditional models but emphasizes the need to take personal responsibility for one’s decisions.
Simulations
Authentic skill practice is best, but for obvious reasons, we can’t offer our students drugs and see what they’ll do. The best we can do is offer simulations. I created an online decision-making matrix for my high school students; a virtual choose your own adventure story related to drugs and alcohol. I encourage them to make every choice possible – in this virtual reality – because the consequences aren’t real, so it’s the safest place to see what might happen.
After completing the matrix, students are asked to create one of their own. This allows them to walk through each step in the model, demonstrate their understanding of potential consequences and requires them to identify where they could get additional information on the topic. The best part? I can use assignments that were completed well with my middle school students for their skill practice.
Being Real About Consequences
When predicting consequences, students have a tendency to identify unlikely outcomes of avoiding drug use. For example, my middle school students regularly predict that if they choose not to drink or use drugs, their friends will “unfriend” them. I often ask them what happens when they say no to other offers.
If you’re at a friend’s house and they offer you a Sprite and you say no – do they disown you? Do they pressure you relentlessly to drink the Sprite or threaten to tell others you don’t drink Sprite to ruin your reputation. Probably not.
It’s likely that friends will inquire about why you’re not interested in something and they may ask you more than once, but if you’re not interfering in their decisions, that pressure will likely be short-lived with no other consequence. People are generally more concerned and interested in themselves than in others.
On the flip side, us teachers regularly present the worst possible outcomes from drug use. My online matrix is the perfect example. A character mixes alcohol and opioids at the movie theater and leaves on a stretcher unconscious. I point out to students that this isn’t always the outcome. If it was, fewer people would experiment with drugs.
The truth is, sometimes people have a good time without any consequence. Sharing that reality gives us some credibility in the classroom. The tricky part is you won’t know what will happen when you make the choice. And having experienced something once without consequence, doesn’t guarantee you’ll get the same results the next time.
Evaluating Decisions
The final step in the decision making model is evaluating your choice. I ask students to think about the universal outcomes of good decisions.
None of us are immune to the occasional bad decision. Evaluating our choice gives us the opportunity to avoid repeating our mistakes and to reduce additional harm. If a student makes the choice to drink, they should know how to get home safely to avoid the risk of an accident. If a friend uses an unknown drug and is rendered unconscious, they should know that Good Samaritan laws allow them to seek help for their friend without risking legal consequences to themselves.
Decisions don’t exist in isolation, but rather in sequence. By evaluating our choices along the way, we create opportunities to change our path and to find better outcomes.
An Infinite Number of Choices
When working through the decision making process, students sometimes struggle to see anything more than binary decisions. I help students to recognize that between saying “Yes” and saying “No,” there are an infinite number of options. For example, if offered a beer, I could…
- Say “Yes,” and drink it
- Say “Yes,” and hold it without drinking it
- Say “Yes,” dump it out, fill it with water and pretend to drink
- Say “What else do you have to drink?”
- Say “No,” and leave
- Say “No,” and stay
Each choice will have it’s own unique set of consequences. The more options I identify, the more power I have over the outcomes.
Taking Responsibility
My final lesson for both high school and middle school students asks the question, Who is ultimately responsible for the decisions that we make? In answering the question, we discuss the role our families, peers, school, community and law enforcement play in helping us to make healthy choices, but we conclude that ultimately, each of us will be held responsible for the choice that we make.
Students are asked to complete a “pledge card” in which they identify what they will do to avoid the dangers of drugs and alcohol. Some examples include:
- Avoiding situations where alcohol and drugs are present
- Choosing friends who make healthy choices
- Calling for a ride if impaired by alcohol or drugs
They are asked to discuss this “pledge” with a trusted adult. That adult also identifies what they can do to protect the student from these dangers. They include things like:
- Having a curfew
- Knowing where you are and who you are with
- Providing a safe ride at any hour
“Pledge cards” have been proven ineffective. I share this with my students and hope that they’ll ask, “Then why are we doing this?”
The reason? Research shows that parents who talk to their children about the risks of drugs and alcohol have children who are less likely to start using drugs.
Summing It Up
You can teach decision making skills in a variety of contexts. I choose to pair it with information about substance abuse prevention. My learning experience has more depth, and hopefully more impact, because I teach analyzing influences and accessing information in combination with decision making. Along the way students learn functional health information, I work to shape their beliefs and the group’s norms about drug and alcohol use, and they practice the skill of decision making. These are the qualities of effective health education as identified by the CDC.
When content is the context for teaching skills, our skills-based lessons have greater impact.
