Could school programs based on social-emotional learning prevent substance abuse among adolescents?

Abstract

In this editorial, we comment on the article Adolescent suicide risk factors and the integration of social-emotional skills in school-based prevention programs by Liu et al. While the article focused on the issue of suicide and social-emotional learning programs as a possible intervention, we here discuss evidence of other reported outcomes and if it could be an effective way to prevent substance abuse among adolescents.

Key Words: Social-emotional learning; Substance use; Adolescent; Student; Prevention; Mental health

Core Tip: School programs based on social-emotional learning (SEL) are a powerful, well-established, cost-effective intervention to prevent multiple adverse outcomes. They focus on integrating social and emotional skills in school activities, improving relationships, and creating a better environment that leads to better student development. In the last three decades, they have consistently improved multiple domains that are also shared as risk and protective factors for substance abuse among adolescents. This article will discuss whether SEL-based programs could be an effective way to prevent substance-related outcomes in adolescents.

INTRODUCTION

The background of social-emotional learning (SEL) began in 1968, when Dr. James Comer and his colleagues from the Yale Child Study Center began implementing the Comer School Development Program in the two lowest income and lowest achieving elementary schools in New Haven, Connecticut. The idea of the program was that the school was a place where children could develop not only from an academic perspective, but as a whole[1]. The main idea is that by promoting a healthy and friendly environment, children can learn to develop positive interactions with adults, which serves as a model for adequate child development. The initiative was so successful that, in the 1980s, the two schools had the best attendance record, no serious behavioral problems and their performance rivaled the city’s highest income schools. This program is still ongoing and has been implemented in more than 1000 schools worldwide with excellent results in reducing the achievement gap between different socio-economic contexts[2].

With the success on the first schools, from 1987 to 1992, the project was expanded across K-12 classrooms (kindergarten to high school) and, in 1994, the Collaborative for Academic, Social, and Emotional Learning (CASEL) was created to promote and research SEL nationwide and worldwide. In 1997, the first guideline was published (Promoting Social and Emotional Learning: Guidelines for Educators)[3], defining the framework of SEL that has been used so far.

According to the CASEL program, “Social-emotional learning is the process by which all young people and adults acquire and apply knowledge, skills, and attitudes to develop healthy identities, manage emotions, and achieve personal and collective goals, feel and show empathy for others, establish and maintain supportive relationships, and make responsible and caring decisions”[4]. Similar to the Comer School Development Program, the process of SEL applies not only to the students but also to everyone involved in their care. The main difference between the two programs is that SEL does not encompass academic learning.

SEL is divided into five main areas of competence

Self-awareness: The abilities to understand one’s own emotions, thoughts, and values and how they influence behavior across contexts.

Self-management: The abilities to manage one’s emotions, thoughts, and behaviors effectively in different situations and to achieve goals and aspirations.

Social awareness: The abilities to understand the perspectives of and empathize with others, including those from diverse backgrounds, cultures, and contexts.

Relationship skills: The abilities to establish and maintain healthy and supportive relationships and to effectively navigate settings with diverse individuals and groups.

Responsible decision-making: The abilities to make caring and constructive choices about personal behavior and social interactions across diverse situations.

The process aims to implement values, constant capacitation of education professionals, constant reevaluation of the specific needs of a specific population and using quality evidence-based programs for each situation. It can be used with students from pre-kindergarten to the last year of high school; it involves a systemic implementation with a different approach for each setting, from classroom and school to homes and communities.

OUTCOMES FROM SEL PROGRAMS

Although SEL has been implemented in schools worldwide for 30 years, with thousands of studies conducted in multiple areas of knowledge with many positive findings, there are two major obstacles in proving its efficacy. One derives from the difficulty in evaluating the outcome with the least bias possible in a sample with such heterogeneity of types and quality of interventions, and measurements of outcomes in multiple socioeconomic contexts. The second and equally difficult one to deal with results from the political backstory around it. In an age of such polarization of opinions, when the subject of helping students form their opinion is similar to walking in a minefield, this kind of research is always subject to much criticism.

To help update the evidence around it, there are big meta-analyses that try to come to a universal conclusion[5-7] and the latest one was published in 2023 by Cipriano et al[8] in the Child Development Magazine[8]. 258 studies were statistically analyzed, and despite the huge variability between them, there was a consistent finding that students that received SEL intervention usually fared better than the ones that did not. 1862 outcomes were found and organized in 12 domains. There was a significant improvement in 9 out of 12 of them compared to controls (in order of greatest magnitude): School climate/safety, civic attitudes/behaviors, SEL skills, peer relationships, attitudes/beliefs, prosocial behaviors, externalizing behaviors, emotional distress and school functioning. There was no significant improvement in disciplinary outcomes, family relationships and physical health. Some interesting aspects of the program had an effect on the outcome. Programs delivered by teachers had significant improvement on the effect size compared to those delivered by outside personnel. Programs that teach intrapersonal skills before interpersonal skills had significant greater effect sizes compared to those that did not follow this sequence.

A study from 2023 by Lee et al[9] analyzed the global cost-effectiveness of school-based socio-emotional learning programs to prevent depression, anxiety and suicide among adolescents. It found that the average cost of implementing universal SEL programs is I$0.05 to I$0.20 per head of population and that in low and lower-middle income countries the cost per healthy life year gained is less than 1000 dollars, which confirms it not only as an effective but also as a cost-effective prevention policy.

INTERNATIONAL POLICIES

Due to the consistent research findings in the last 30 years, SEL is recognized and promoted by some of the most important international agencies. The World Health Organization (WHO) describes School-based social and emotional learning programs as among the most effective promotion strategies for countries at all income levels[10]. WHO and UNICEF created the Helping Adolescents Thrive[11] that uses SEL as an integral part to enhance mental health promotion and protection and to reduce risk behaviors among adolescents. The UNESCO Mahatma Gandhi Institute of Education for Peace and Sustainable Development Research Institute focuses on transforming education towards Sustainable Development Goals (SDG 4.7 2030 agenda with programs that promote social and emotional learning)[12].

SUBSTANCE ABUSE AMONG ADOLESCENTS

Adolescence is a critical period for substance experimentation and abuse. The emotional regulation is still under development and the seeking of new experiences creates the ideal scenario for risk-taking behaviors, of which substance use is one[13]. The Health Behavior in School-aged Children international report from the 2021/2022 survey published by the WHO in April 2024[14] measured substance use in more than 50 countries at 11, 13 and 15 years of age and reported that the current use (last 30 days) increases sharply with aging, with the widest gap between 13 and 15 years of age. The study found that at the age of 15, the use in the past 30 days was 15% for tobacco, 20% for e-cigarettes, 40% for alcohol and 12% for cannabis. This data associated with the fact that the earlier the first substance use, the greater the risk of developing substance use disorders[15] puts childhood and adolescence as the prime target for prevention programs.

Substance abuse, as with any other functional or dysfunctional behavior, is the result of the complex interaction between intrinsic (hereditary) and extrinsic (ambient) factors. During development, the interaction between them leads to the development of vulnerability and resilience mechanisms that can lead to or protect against risky behaviors and the development of substance use disorders. Risk and protective factors can be divided into those that influence usage during adolescence and those related to the transition to abusive use in adulthood. A 17-year prospective study made in the United States[16] found that Age of first use, greater popularity with peers, close peer level of substance use, close peer level of substance use, high levels of adolescent and parent-adolescent conflict and proneness to deviant (delinquent) behavior were associated with greater use during adolescence, but not with greater use in adult life. Poor social skills and poor self-concept were related to the transition to usage in adult life and could be identified years before during adolescence.

Another way of understanding substance abuse is considering it as a possible outcome of exposure to stress during childhood and adolescence[17]. Situations of early stress, such as neglect, exposure to violence, physical and emotional abuse in crucial development stages can lead to dysfunction in mechanisms related to impulse control, reward, motivation and increased sensitivity to stressful situations and anhedonia[18]. These lead to reduced cognitive-emotional functions, social competencies and emotional regulation, creating a favorable situation to substance experimentation, abuse, addiction and many other mental disorders[19].

SUBSTANCE ABUSE PREVENTION PROGRAMS IN SCHOOLS

Most prevention programs in schools are specific for substance abuse prevention. Evidence shows that the first prevention programs that focused on only lecturing students about the danger of substance use and on scaring individuals into not using drugs were ineffective[20]. Modern evidence-based approaches not only focus on resisting substance use but also consider the social and emotional factors involved in it and have found more consistent success[20]. One example with consistent results is the Life Skills Training Program that provides skills to resist substance use but also promotes personal self-management and social competence skills[21]. Other programs, such as the Project Toward No Drug Abuse[22], can be used for higher risk populations and also have good results in reducing substance use.

INTERSECTIONS BETWEEN SEL AND SUBSTANCE ABUSE

The importance of SEL in substance abuse prevention is highlighted by common aspect between the interventions with the best outcomes in prevention of substance abuse in adolescence and consequently the transition to abuse in adult life which is the promotion of social emotional skills. The five core areas of SEL are directly related to the mechanisms related to increased risk or resilience to substance abuse. Self-awareness and self-management are related to the ability to understand and manage emotions, thoughts and behaviors and can help improve functioning in the risk factors related to substance abuse such as impulsivity, emotional dysregulation, anhedonia and poor self-concept. Social awareness and relationship skills improve the ability to understand others and make healthy and supportive relationships, which is also an important protective factor. Responsible decision-making is by itself the ability to make constructive choices in different situations. Together, these form a set of skills that improve resilience in stressful situations and can be helpful in reducing substance abuse.

Most studies about substance abuse prevention in schools are about programs focused on substance abuse. There are many prevention programs, such as SEL-based school programs that are not specific for drug abuse, are widely implemented worldwide and have consistent positive findings for multiple outcomes. However, there are few studies that evaluate its impact on substance abuse. A 2022 press release by The United Nations Office on Drugs and Crime puts social and emotional learning-based interventions in schools as crucial for substance use prevention[23]. This points to an important field for future research because there can be effective strategies to prevent substance abuse that are not focused on substance abuse itself.

CONCLUSION

The high burden caused by substance abuse disorders worldwide asks for intervention not only with better diagnosis and treatment, but also with better and widely available prevention programs. SEL school-based programs are a well-established and widely used intervention to promote better relations between students and adults. Creating an optimal environment for a proper development of social-emotional skills leads to improved functioning and, therefore, better outcomes in life. Numerous studies consistently show good results in academic and behavioral aspects, but there is a lack of evidence regarding outcomes related to substance abuse.