Programs that Work
Healthy and Safe Children
Youths not using alcohol, tobacco, or illegal drugs
Age of Child
Middle Childhood (9-12)
Type of Setting
Type of Service
Type of Outcome Addressed
Substance Use and Dependence
Evidence Level (What does this mean?)
Project ALERT is a school-based prevention program for middle or junior high school students that focuses on alcohol, tobacco, marijuana, and inhalant use. The main goals of the program are to prevent adolescent non-users from experimenting with drugs and to prevent youths who are already experimenting from becoming more regular users. The program began in 1984 and is based on an approach that helps motivate young people to avoid using drugs and teaches them the skills they need to understand and resist pro-drug social influences. These influences may come from family, peers, other adults, or the media.
Originally, Project ALERT was organized into a three-month, eight-session curriculum taught during the seventh grade, followed by three "booster" sessions presented in the eighth grade that are designed to reinforce the lessons learned from earlier material. The program uses small-group activities, question-and-answer sessions, role-playing, and the practice of new skills to stimulate students' interest and participation in the ALERT curriculum. Subsequently, Project Alert was revised and strengthened. Parent involvement activities, material on alcohol misuse and a lesson to help smokers quit were added to the curriculum. Today, 18,000 trained Project ALERT classroom teachers present the revised 14-lesson curriculum in more than 3,500 school districts nationwide.
Project ALERT was first used and studied with seventh-grade students from 30 schools in northern California and southern Oregon. Participants were from urban, rural, and suburban areas and represented a variety of racial, ethnic, and socioeconomic backgrounds. Currently, the curriculum is used with students from varied backgrounds around the country.
An evaluation of the revised curriculum was conducted with approximately 5,500 students in 48 school districts in South Dakota. Participants were drawn from schools in urban, small-town, and rural communities. This evaluation also included the ALERT Plus program for high school students, but the results have not been published yet.
The initial Project ALERT evaluation of 6,527 students took place from 1984 to 1986 (Ellickson and Bell, 1990a). Thirty schools participated in the study and were assigned randomly to one of three groups after first being matched on school test scores, language spoken at home, drug use among eighth graders, and ethnicity and income level of students. Twenty schools received the Project ALERT curriculum. Adult health educators taught the curriculum in ten of these schools and adult teachers assisted by teen peer leaders taught the curriculum in the other ten schools. Serving as a comparison group, ten additional schools did not receive the Project ALERT curriculum and continued to implement their school's usual drug education program.
Students in both the program group and comparison group completed a self-report questionnaire before and after the presentation of the seventh-grade curriculum. These same students completed additional self-report questionnaires before and immediately after presentation of the eighth-grade booster sessions. Of the original 6,527 participants, 60 percent completed all three follow-up questionnaires and were included in the final analysis. (Attrition was similar across the experimental conditions, and analytic controls adjusted for the small differences across groups.) Questionnaires assessed alcohol, tobacco, and marijuana use and related behaviors and attitudes. In addition, student saliva samples were collected and analyzed for drug use. A later study (Ellickson, Bell, and McGuigan, 1993) surveyed this same group of students annually in the ninth, tenth, and twelfth grades to assess the long-term impact of Project ALERT.
Students were classified according to their substance use at baseline. For alcohol use, students were non-users, experimenters, or users. The lowest-risk group (non-users) had never used alcohol at baseline survey, students in the moderate-risk group (experimenters) had used alcohol fewer than three times in the past year and not at all in the past month, and the high-risk group (users) was composed of students who had used alcohol three or more times in the past year or in the past month. The same classification was employed for tobacco use. For marijuana use, a student belonged to the low-risk group if he or she had used neither marijuana nor cigarettes by baseline, to the moderate-risk group if he or she had not used marijuana but had tried cigarettes, and to the high-risk group if he or she had used marijuana by the time of the first survey.
A new sample of 5,412 students from South Dakota participated in the Revised Project ALERT curriculum from fall 1997 to spring 1999 (Ellickson et al., 2003). Forty-eight school clusters (high schools and their associated middle school feeders, grouped by geographic region and community size) participated in the study and were randomly assigned to either one of the two treatment groups or to a control group. In the first treatment group, students received the Revised Project ALERT curriculum in seventh and eighth grades; in the second, they also received booster lessons in ninth and tenth grades (ALERT Plus). Students from 34 middle schools received the Revised Project ALERT curriculum, while students from 21 schools were assigned to the control group. To test the effectiveness of the revised middle school curriculum, the two treatment groups were combined hrough eighth grade.
Students in the treatment and comparison groups completed a self-report questionnaire in the fall of seventh grade, before administration of Project ALERT. They completed a follow-up questionnaire after the presentation of the lessons in the spring of eighth grade. Of the original 5,412 participants, 79 percent (4,275) completed the two questionnaires and were included in the final analysis. Students who did not complete both questionnaires included some whose parents refused consent and some who were absent from both the survey and makeup sessions or those who refused to participate. Attrition rates and lost students were similar across the experimental conditions. Similar to the first evaluation, the questionnaires assessed alcohol, tobacco, and marijuana use and related behaviors and attitudes. Also, student saliva samples were collected and analyzed for drug use.
Key Evaluation Findings
Findings are presented chronologically according to the date of the evaluation study. The results from the initial Project ALERT curriculum are presented first, and the results from the Revised Project ALERT curriculum follow.
Initial Project ALERT
The initial Ellickson and Bell Project ALERT study (1990a), which examined outcomes at grade 8, showed the following significant findings:
Marijuana and Cigarettes
Among all students who had not tried either cigarettes or marijuana at the beginning of seventh grade:
- Project ALERT participants were nearly 50 percent less likely than nonparticipants to have become current marijuana users by eighth grade; after delivery of the eighth-grade booster sessions, this figure increased to more than 60 percent.
- Project ALERT participants were 30 percent less likely than nonparticipants to have started using marijuana, both before and after delivery of the eighth-grade booster sessions.
- Project ALERT participants in the teacher-led group were 27 percent less likely than nonparticipants to be current smokers after delivery of the eighth-grade booster sessions and 33 percent less likely to be regular (weekly) smokers.
- Project ALERT participants in the schools using teen leaders were 50 percent less likely than nonparticipants to be regular smokers after delivery of the eighth-grade booster sessions and 55 percent less likely to be daily smokers.
Project ALERT produced modest reductions in drinking among all participants immediately after delivery of the seventh-grade curriculum; however, these early gains had eroded by the time students entered the eighth grade.
Project ALERT produced positive outcomes for participants from a variety of ethnic and economic backgrounds who were at both low risk and high risk for alcohol, tobacco, or marijuana use. It was equally effective with students from schools with low and high numbers of minority students and, where there were differences between the two groups of schools, the results tended to favor those schools with a high number of minority students.
Overall, Project ALERT was equally effective when taught solely by classroom leaders and when teen leaders were included in classroom delivery.
The Ellickson, Bell, and McGuigan (1993) study, which examined outcomes for 9th, 10th, and 12th graders, found:
By the end of high school, Project ALERT no longer had a significant impact on drug use; earlier reductions in cigarette and marijuana use among participants had disappeared.
Revised Project ALERT
The Ellickson et al. (2003) study found that the Revised Project ALERT curriculum improved on the original, including the following significant results:
Among all students, compared with the control group:
- Fewer students from Revised Project ALERT initiated smoking (26 percent of Project ALERT participants were new smokers compared to 32 percent of the control group).
- Students in Revised Project ALERT reduced their current and regular smoking (20 percent versus 26 percent, and 13 percent versus 17 percent, respectively).
- Experimenters were less likely to smoke cigarettes (past-month) in the spring of the eighth grade (29 percent of the program group versus 36 percent for the control group) or to have become regular (weekly) users (18 percent of the program group were regular smokers versus 23.5 percent of the control group).
- Users were less likely to continue smoking (57 percent of the program group were current smokers versus 71 percent of the control group) and to become regular smokers (45 percent of the program group were regular smokers versus 56 percent of the control group).
- Project ALERT participants who had not tried cigarettes before exposure to the program were less likely to be regular smokers by the end of eighth grade than their counterparts in the control schools (4 percent of program participants were regular smokers versus 6.6 percent of non-participants).
Among all students
- The Revised Project ALERT curriculum curbed marijuana initiation (12 percent of the program group initiated marijuana use versus 16 percent of non-participants).
- The revised curriculum reduced initiation rates for non-users (5 percent of the program group initiated marijuana use versus 8 percent of the non-participants). Moderate-risk participants were less likely to initiate marijuana use than non-participants (27 percent versus 37 percent). There were no significant effects for the high-risk group.
Among all students
- Overall misuse was less likely to occur for participants in Revised Project ALERT.
- Participants in Revised Project ALERT were also less likely than those in the control group to suffer alcohol-related consequences such as fighting and getting in trouble at home or school because of drinking.
- High-risk participants in Revised Project ALERT curbed their misuse according to all three measures of alcohol use: overall misuse, alcohol-related consequences and high-risk use (such as binge drinking or use of alcohol with other substances).
Middle and junior high schools (grades 6 through 8)
The National Institute on Drug Abuse supported the evaluation of the revised middle school curriculum.
The Conrad N. Hilton Foundation provided grants in excess of $10 million to the RAND Corporation to develop and test Project ALERT over a ten-year period. Following the development of the program, grants of more than $40 million from the Conrad N. Hilton Foundation to the BEST Foundation have supported the dissemination of Project ALERT.
This grant funding subsidizes the cost of training and program materials and makes it possible for the ALERT curriculum to be offered at a cost of $150 per teacher. This cost includes the required training as well as the curriculum package.
- Program is age-appropriate and easy to use, and includes clear objectives, detailed lesson plans, preparation tips, and stimulating activities for participants.
- Curriculum contains content specifically geared to drug use; it motivates young people not to use drugs and deals with specific social pressures and societal norms that encourage the use of alcohol, tobacco, and other drugs.
- Program materials, both print and video, are updated on a regular basis. Regular updating is particularly important when using videos to teach adolescents about social influences and misperceptions that encourage alcohol consumption and other drug use.
The Project ALERT curriculum is based on the "health-belief model" (that oneís actions are dependent on oneís beliefs), social-learning theory (learning by exposure to the behaviors and attitudes of others), and the "self-efficacy theory" of behavioral change (belief in one's own competencies and self-reliance). Curriculum content includes lessons on learning the consequences of using alcohol, tobacco, or other drugs; identifying both internal and social pressures to use; practicing resistance skills; understanding that most people do not use drugs; recognizing the benefits of not using alcohol, tobacco, and other drugs; and developing positive alternatives to use.
The current Project ALERT program has been strengthened by new sessions on inhalants, smoking cessation, and alcohol that were not part of the original curriculum sequence. It also includes home-learning opportunities designed to foster parental reinforcement of key curriculum messages.
Classroom teachers administer the Project ALERT curriculum. However, schools do have the option of using student peer leaders to assist classroom teachers in presenting the ALERT lessons. A required one-day training (workshop or web-based) prepares the classroom teacher to implement the prevention program.
Issues to Consider
This program received a "proven" rating. The evaluations used an experimental design with more than 6,000 students and followed them from seventh grade through twelfth grade. The first study found that Project ALERT had sizeable positive effects on marijuana and tobacco use and modest effects on alcohol use into the eighth grade, although the program effects faded by the time students entered high school. The second evaluation for middle school students showed that the Revised Project ALERT curriculum replicated and improved on the original programís effectiveness. Furthermore, the program was equally effective for different ethnic and economic groups. While the program developer was involved in all the major studies of Project ALERT, the research was conducted and reported according to high scientific standards.
Wise County Schools, Virginia; Cobb County Schools, Georgia; Round Rock Independent School District, Texas; Houston, Texas; Philadelphia, Pennsylvania; Rapid City Schools, South Dakota; Sioux Falls Schools, South Dakota
Project ALERT is administered by the BEST Foundation for a Drug-Free Tomorrow.
For more information or for training, contact:
725 S. Figueroa St., Suite 1615
Los Angeles, CA 90017
A free introductory video on Project ALERT is available from the BEST Foundation. After completing the required training (workshop or web-based), teachers receive a curriculum package that includes an orientation video, teacher's manual, eight interactive student videos, and 12 full-color classroom posters. An optional teen-leader curriculum component is also available. Teachers continue to receive free print and video curriculum updates on a regular basis and technical assistance in the form of three newsletters per year, a toll-free teacher assistance phone line, and an on-line faculty chat room.
Bell, R., P. Ellickson, and E. Harrison, "Do Drug Prevention Effects Persist into High School? How Project ALERT Did With Ninth Graders,"
Vol. 22, 1993, pp. 463-483.
Ellickson, P., and R. Bell, Prospects for Preventing Drug Use Among Young Adolescents, Santa Monica, Calif.: RAND Corporation, R-3896-CHF, 1990b.
Ellickson, P., and R. Bell, "Drug Prevention in Junior High: A Multi-Site Longitudinal Test," Science, Vol. 247, 1990a, pp. 1299-1305.
Ellickson, P., D. F. McCaffrey, B. Ghosh-Dastidar, and D. L. Longshore, "New Inroads in Preventing Adolescent Drug Use: Results from a Large-Scale Trial of Project ALERT in Middle Schools," American Journal of Public Health, Vol. 93, No. 11, 2003, pp. 1830-1836.
Ellickson, P., R. Bell, and E. Harrison, "Changing Adolescent Propensities to Use Drugs: Results from Project ALERT," Health Education Quarterly, Vol. 20, No. 2, 1993, pp. 227-242.
Ellickson, P., R. Bell, and K. McGuigan, "Preventing Adolescent Drug Use: Long-Term Results of a Junior High Program," American Journal of Public Health, Vol. 83, 1993, pp. 856-861.
Ghosh-Dastidar, B., D. L. Longshore, P. L. Ellickson, and D. F. McCaffrey, "Modifying Pro-Drug Risk Factors in Adolescents: Results From Project ALERT," Health Education and Behavior, Vol. 31, No. 3, 2004, pp. 318-334.