Refuse, Remove, Reasons (RRR)

About the program

RRR is a universal classroom-based substance abuse prevention program for urban and suburban high school students. The main aim of the program is to reduce smoking behaviours, strengthen psychological precursors of behaviour change and improve peer network characteristics.

Who does it work for?

RRR is designed for youth and adolescents in high school with a prior history of substance use. RRR has only been evaluated in the USA. A quasi-experimental design study (Mogro-Wilson et al. 2017) was conducted with 1352 participants (678 in the intervention group and 674 in the comparison group).

Study participants were recruited from non-public high schools serviced by a substance abuse prevention agency. Average participant age was 15. Participants identified as White (37%) Black (22%), Asian (5%) and Other (32%).

RRR has not been evaluated in Australia or with Aboriginal Australians.

What outcomes does it contribute to?

Positive outcomes:

• Perceived Risk: RRR participants were more likely to identify the risks associated with alcohol and substance use
• Social Norms: RRR participants were more less likely to perceive alcohol abuse and substance abuse as normal or acceptable behaviour
• Beliefs & Consequences: RRR participants were more likely to identify the consequences of substance abuse

How effective is it?

Overall, RRR had a positive effect on client outcomes.

How strong is the evidence?

Promising research evidence:

• At least one high-quality randomised controlled trial (RCT)/quasi-experimental design (QED) study reports statistically significant positive effects for at least one outcome, AND
• Fewer RCT/QED studies of similar size and quality show no observed effects than show statistically significant positive effects, AND
• No RCT/QED studies show statistically significant adverse effects.

How is it implemented?

RRR is delivered in 5 face-to-face classroom sessions over a period of 5 weeks. The program is delivered by a trained facilitator who covers the five critical components of the intervention:

1. social resistance skills training
2. normative education,
3. interactive teaching techniques
4. teacher training and support
5. evaluation

RRR encompasses several program components found to deter and combat substance use among adolescents, including addressing all forms of drug use in combination, increasing knowledge of health consequences of substance use, peer teaching in combination with adult facilitator, and emphasizing drug resistance and reinforcement of antidrug attitudes. RRR also incorporates a mutual-aid group approach.

How much does it cost?

The costs for RRR were not reported in the study.

Where does the evidence come from?

1 QED conducted in the USA with a sample of 1352 people (Mogro-Wilson et al. 2017).

Further resources

Mogro-Wilson, C, Allen, E, & Cavallucci, C 2017, ‘A brief high school prevention program to decrease alcohol usage and change social norms’, Social Work Research, vol. 41, pp. 53-62, DOI 10.1093/swr/svw023.