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Home > The social norms approach to tackling substance use.

Keane, Martin (2011) The social norms approach to tackling substance use. Drugnet Ireland , Issue 38, Summer 2011 , pp. 16-17.

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 What are the underlying assumptions of the social norms approach?
Numerous surveys have shown that young people tend to overestimate the prevalence (behaviour) and acceptance (attitudes) of substance use among their peers. It is assumed that young people are strongly influenced by what they perceive to be the group norms among their peers (norms = behaviours and attitudes) hence there is a strong likelihood that they will think and behave in similar ways. For example, if they perceive that binge-drinking of alcohol is the norm among their peers, a) they will form the belief/attitude that it is expected of them and b) they will engage in such behaviour. In such cases, they may ignore the information campaigns that tell them the dangers of consuming large amounts of alcohol or the long-term adverse effects of smoking tobacco and/or cannabis.  

Why is this approach gaining favour?
McAlaney and colleagues1 state in a recent paper on the international development of the social norms approach to drug education and prevention: ‘The growth of the social norms approach is perhaps partially explained by growing disenchantment with conventional prevention approaches.’
Such approaches include providing information awareness (drug education) on the adverse consequences of substance use, affective education where interventions seek to improve self-esteem and, to some extent, the life-skills approach, particularly when targeting ‘at-risk’ youth. All these conventional approaches are coming in for criticism and are increasingly viewed as being ineffective in preventing, delaying or reducing substance use among young people.
What are the key components of the social norms approach and how is it delivered?
Reliable data are required on what young people perceive to be the norm in a) peer attitudes towards substance use, and b) peer behaviour in relation to substance use. Reliable data are also required on a) actual attitudes towards substance use and b) actual behaviour in relation to substance use. Data can be collected at baseline with the target group and used to design interventions and for follow-up comparisons. Data from published studies, for example, the ESPAD, HBSC and NACD surveys2 can also be used to challenge misperceptions about the prevalence and attitudes towards substance use among young people.  
How is the social norms approach delivered?
‘Social norms interventions have typically come in one of two forms: social marketing or individual normative feedback. Social marketing approaches rely on universal, mass communication methods for educating students regarding actual [substance use] behaviours... . Individual normative feedback is personalised and may provide a more relevant and powerful intervention.’3 
What is the evidence that the social norms approach can be effective?
According to McAlaney and colleagues,
The goal of [global social norms] campaigns is to disseminate the accurate substance use norms to the target population, such as “Most (73%) students at [college name] have no more than four alcoholic drinks on a night out.” This approach was first implemented in 1989 at Northern Illinois University, which reported a drop in rates of heavy drinking from 43% to 25% over a 9-year period, accompanied by a reduction in the misperception of heavy drinking among peers from 70% to 33%.
Moreira and colleagues undertook a Cochrane systematic review to determine whether social norms feedback reduces alcohol misuse among university or college students. The review included 22 controlled trials involving 7,275 participants randomly assigned to a social norms intervention group or to a control group (no social norms intervention – assessment only, questionnaire used to measure alcohol consumption or alternative educational or psychosocial intervention). The following outcomes were observed:  
·         Alcohol-related problems; significant reduction with web/computer feedback in three studies (278 participants);
·         Peak Blood Alcohol Content (BAC); significant reduction with web/computer feedback in two studies (198 participants);
·         Drinking frequency; significant reduction with web/computer feedback in two studies (243 participants) and individual face-to-face feedback with two studies (217 participants);
·         Drinking quantity; significant reduction with web/computer feedback in five studies (556 participants) and group face-to-face feedback with three studies (173) participants;
·         Binge drinking; significant reduction with web/computer feedback in one study (80 participants), individual face-to-face feedback in three studies (278 participants) and group face-to-face feedback in four studies (264 participants);
·         Drinking norms; significant reduction with web/computer feedback in three studies (312 participants).
In summarising the key findings of the Cochrane review, the authors make the following points:
This systematic review based on 22 trials enrolling 7,275 participants shows that a social norms intervention delivered by web or computer or via individual face-to-face sessions (for some outcomes) is more effective than a control intervention, typically consisting of a leaflet with drinking related advice, for reduction of alcohol misuse in college or university students. Significant effects were more apparent for short term outcomes (up to three months). However, there was some evidence of effect continuing through to medium-term follow-up from four to sixteen months, particularly for web/computer feedback.
Authors’ conclusion on the implications for practice
Overall, this systematic review suggests that individual and personalised normative interventions over the immediate and medium term appear to reduce alcohol use, misuse and related problems amongst university or college students. The use of social norms interventions should also be considered for use and study in other settings since they have the potential to be a very cost-effective intervention for reducing alcohol use and related harms. The use of new technologies, such as computer or web/computer delivered interventions, could be a successful and cost-effective method for providing normative feedback.
Limitations of the Cochrane review
Small sample sizes in many of the studies
Can the social norms approach be transferred to alternative settings and target groups?
The evidence to date suggests that the social norms approach has been mainly delivered to university and college students in the USA. However, this is changing and, as pointed out by McAlaney and colleagues, the approach has been used to change an array of behaviours e.g. sunscreen use, rumour spreading in high-school and towel re-use in hotels. In addition, Moreira and colleagues state that social norms should be considered for other settings.
1.     McAlaney J, Bewick B and Hughes C (2011) The international development of the ‘social norms’ approach to drug education and prevention. Drugs: education, prevention and policy, 18(2): 81–89.
2.     ESPAD (European School Survey Project on Alcohol and other Drugs); HBSC (Health Behaviour in School-aged Children); NACD (National Advisory Committee on Drugs)
3.     Moreira MT, Smith LA and Foxcroft D (2009) Social norms interventions to reduce alcohol misuse in University or College students. Cochrane Database of Systematic Reviews, Issue 3. Art. No.: CD006748. DOI: 10.1002/14651858.CD006748.pub2.

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