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SMAD. Revista eletrônica saúde mental álcool e drogas

On-line version ISSN 1806-6976

SMAD, Rev. Eletrônica Saúde Mental Álcool Drog. (Ed. port.) vol.12 no.1 Ribeirão Preto Mar. 2016 



The role of the school in preventive actions related to the use of alcohol and other drugs by Elementary School students


El papel de la escuela en las acciones preventivas relacionadas al uso de alcohol y otras drogas por alumnos de la Educación Básica



Maria da Conceição Aparecida SilvaI

IDoctoral Student, Programa de Estudos Pós-Graduados em Psicologia Clínica, Universidade Católica de São Paulo, São Paulo, SP. Brazil. Professor, Faculdade Sudoeste Paulistano, FASUP, São Paulo, SP, Brazil




This study investigates, in the literature mentioned, the existence of sufficient educational strategies for the prevention of the use of alcohol and drugs by elementary school students in Brazil, in particular between 9 and 11 years of age (students from the third to the fifth grade). The need of this study is shown through scientific data that point to the early use of alcohol and drugs in this age group, called herein as "Preadolescence". After preparing an integrative review of the scientific literature and discovering the lack of research studies specifically aimed at this age group within the school context, our study points to the relevance of the role of the school in multidisciplinary and interdisciplinary programs of prevention against the use of alcohol and drugs.

Descriptors: Drugs; Child; Education; Primary Prevention; Secondary Prevention.


Este estudio investiga, en la literatura citada, la existencia de estrategias educativas suficientes para la prevención del uso de alcohol y drogas por alumnos de la enseñanza básica en Brasil, en particular entre 9 y 11 años de edad (Alumnos del 3º al 5º año). La necesidad de ese estudio se muestra a través de los datos científicos que apuntan para el uso precoz de alcohol y drogas en esa banda etaria aquí denominada "Pre-adolescencia". Después de elaborar una revisión de integración de la literatura científica y hacer el descubrimiento de la inexistencia de investigaciones específicamente dirigidas a esa banda etaria en el ámbito escolar, el trabajo apunta para la relevancia del papel de la escuela en programas multidisciplinares e interdisciplinares de prevención contra el uso de alcohol y drogas.

Descriptores: Drogas; Niño; Educacíon; Prevención Primaria; Prevención Secundaria.




The word ‘drug’, originally from Old Dutch (drogg), means "dry leaf". At the end of the sixteenth century, many drugs used vegetables in their composition(1). However, according to the definition of the World Health Organization (WHO), since 1981, this terminology means "any substance which, not being produced by the body, has the property of acting on one or more of its systems, producing changes in its operation."(2) Any substance that has the ability to act on the brain, resulting in changes in the psyche, is called psychoactive substance or psychotropic drug, as follows: "Psycho: word of Greek derivation meaning psyche (how we feel, think). Tropic: relates to tropism (Be attracted to). Psychotropic: attraction to the psyche. Psychotropic drug: is the one which acts on the brain by altering the psyche somehow"(3).

Drugs: Brazilian research studies

It is worrying the high rate of consumption of alcohol and other drugs in Brazil. Research studies conducted in 2001, in 108 Brazilian cities, with 8,589 participants of both genders between 12 and 65 years old, proved the extent of the use of drugs: marijuana (6.9%), solvents (5.8%), orexigenics (4.3%), benzodiazepines (3.3%) and cocaine (2.3%). In 2005, another research with 7,939 participants presented the following results: marijuana (8.8%), solvents (6.1%), benzodiazepines (5.6%), orexigenics (4.1%) and stimulants (3.2%). That is, "From 2001 to 2005, there was an increase in the estimates for use in life of alcohol, tobacco, marijuana, solvents, benzodiazepines, cocaine, stimulants, barbiturates, steroids, hallucinogens and crack."(4)

Equally worrying are the conditions of the children of these users of alcohol and other drugs who, directly and indirectly, suffer the impacts of family and social vulnerability present in their lives from an early age. The same report presents the results of the "Fifth National Survey on the Consumption of Psychotropic Drugs among Elementary and High School Students of the Public and Private Educational Networks in 27 Brazilian Capitals"(4). Observing 48,155 students, researchers highlighted that, among those who have used psychotropic drugs six or more times during the thirty days preceding the research, the age group that came up most often was that from 13 to 15 years (36.3%)(4). Students who had consumed drugs at some point of their lives had 45.9% of school delay in relation to those who had never used any substance. "The percentages of users tend to increase with age, but, as pointed out in Galduróz (...) the percentage of students in the age group from 10 to 12 years with use in life is expressive (12.7%)."(4)

On this subject, we can consider the results of recent research studies conducted in 2010, in the "Sixth National Survey on the Consumption of Psychotropic Drugs"(5), which involved 50,890 students from the 6th to the 9th grade of elementary school and from the 1st to the 3rd year of high school, from public (31,280 students) and private schools (19,610 students) of 27 Brazilian capitals. This research pointed out that public school students, in relation to private school students, had greater involvement with drugs in general (1.2% x 0.8%, respectively). The same scenario is also repeated for marijuana (0.5% x 0.3%), tobacco (1.7% x 0.7%) and alcohol (1.7% x 1.1%). It is worth mentioning that 24.1% of the students researched in public schools and 31.6% in private schools were aged between 10 to 12 years(5).

Another important point to be emphasized refers to the dissemination of use in life in general (i.e., use of any psychotropic drug at least once in life) in the different age groups. This use was, in fact, reported by 10.4% of students between the ages of 10 and 12 years, 22.5% between 13 and 15 years and 42.8% between 16 and 18 years. At this point, the report about the use in the year (i.e., use of any psychotropic drug at least once during the twelve months preceding the research) showed that 5.4% of students between the ages of 10 and 12 years, 9.6% between 13 and 15 years and 17.0% between 16 and 18 years used drugs. These data show that exposure of students to drugs in general happens very early, and the early use occurs, in fact, in students younger than 10 years(5).

The same result is exposed by the Group for Studies and Research on Alcohol and other Drugs (GEPAD/UERJ), coordinated by Dr. Gertrude Teixeira Lopes(6): in Brazil, drug use among adolescents begins between the 9 and 14 years of age. Among children aged 10 to 12 years, 51.2% consumed alcoholic beverages, 11% used tobacco, 7.8% solvents, 2% anxiolytics and 1.8% amphetamines. In fact, the precocity in the initiation of the use and abuse of psychotropic drugs has been pointed out by the World Health Organization (WHO) as an aggravating factor in this phenomenon.

In Brazil, the Child and Adolescent Statute (ECA), law No. 8,069 of 1990, considers as a "Child" the person up to 12 years of age (incomplete) and defines as "Adolescent" the age group from 12 to 18 years of age(7). Thus, faced with the phenomenon "Precocity in the use and abuse of psychotropic drugs," we emphasize that this study proposes to investigate, in the literature mentioned, the educational strategies for the prevention of the use of alcohol and drugs by Elementary School students in Brazil, in particular, between the age group from 9 to 11 years of age (students from the 3rd to 5th grade) and the relevance of the role of the school in multidisciplinary and interdisciplinary programs in the fight against drugs.



From an integrative review, our study seeks to collect, in an orderly manner, the main results obtained in previous research studies conducted in the area of chemical dependency and that cover the specific subject chosen.

In the context of Evidence-Based Practice (EBP), "Integrative Review" is a research method that allows us the search, the critical assessment and the synthesis of the available evidence on the subject investigated. With this, an integrative review includes the analysis of relevant research studies to support the decision-making and to improve the clinical practice, enabling the synthesis of the state of knowledge of a given subject, in addition to pointing the knowledge gaps that need to be filled with further studies(8).

In particular, the integrative review of our study articulated the following steps presented synthetically:

1st stage (Subject and guiding question): preliminary analysis of the literature and epidemiological data on the use of alcohol and other drugs in Brazil, especially focused on the school stage of preadolescents;

2nd stage (Literature search): review of the scientific evidence, carried out between 14 and 22 of January, 2014 in the databases Lilacs, Scielo and Medline, from articles and research reports in English, Spanish and Portuguese;

3rd stage (Categorization): ordination and subsequent synthesis of information from articles and dissertations, considered as relevant for the objectives of the research, and analysis of the results;

4th stage (Assessment and comparison of studies): critical and comparative analysis of the studies, after fully reading the selected and cataloged publications;

5th and 6th stages (Synthesis of the knowledge and interpretation and discussion): in these last stages, the results of the analyses were subjected to interpretation and final synthesis. Thus, the study culminates as a careful process of assessment of the processed data and comes to the development of a specific proposal in the field of preventive health care in the use of alcohol and other drugs.

In its effective articulation, the research was carried out as follows:

Search development (numbers and data): through a search for keywords, we located 902 publications between articles, dissertations and theses. Approximately 850 did not point to the subject in question — that is, did not specify the age group "preadolescence" correlated to the issue of prevention of use and abuse of alcohol and other drugs in the school. Therefore, 52 studies remained, being them related to the subject of this work. Of them, 22 were duplicates and 18 were unavailable, as the online access was restricted to only the abstract.

In the end, we analyzed 12 scientific papers based on the guiding questions described below:

- In what age group does the early use of drugs begin, in general?

- What are the drugs most consumed by the young audience, and, in particular, by pre-adolescents?

- Does the contact with drugs have significant relationship with family and social vulnerability?

- Does the number of drug users tend to increase with age?

- What are the prevention programs to combat drugs used in elementary school?



Drugs and their psychosocial impact

The various research studies consulted for this study – and that will be presented in the details of the scientific evidence that they carry – show, among several other more specific topics, a preliminary issue that we must highlight: there are multiple factors that lead someone towards drugs. These factors are in some way related to the profound desire of mankind to discover, know and exceed its own knowledge. This movement of expansion is what throws mankind to great discoveries, leading it to face the challenge of the unknown – essential attitude of human nature, as a reflection of its desire to know more and its boldness to break boundaries. Certain experiences can break through these limitations, among them: art, passions and drugs*(9). Or, in the words of Bucher(10), mankind, in order to cure ailments, relieve pain and achieve pleasure, often launches itself towards drugs.

Therefore, since its emergence, civilizations were electing certain substances to aid in the social relationship, to demarcate certain festivities and to favor different rituals, both religious and mystical(11).

Another important factor to be considered is the deprivation of basic rights to humans, which can trigger a transgressive stance able to culminate in the use of drugs. Examples of this are the neglect and scarcity that we can see daily in the current Brazilian public services regarding access to health, housing, security, education and culture – and, therefore, an effective limitation of the daily exercise of freedom of the citizen, which can cause a number of physical, psychological and social damages, not only to the individual but also to society as a whole. Often, what is observed is that, in the face of these experiences of deprivation, the confrontation and transgression of a man is intensified through the use and abuse of drugs(9). Thus, for example, psychoactive drugs such as cocaine and marijuana have the ability to change states of consciousness and, therefore, modify the behavior – a universal phenomenon of mankind. In short: in no period in the history of mankind civilization existed free of the use of any type of drug, in the most different times.

For all these reasons, it seems appropriate to do a survey of the main drugs that humanity knew and used throughout its history, synthesizing historical and epidemiological data organized and published by the National Secretariat of Policies on Drugs (SENAD) and the Brazilian Observatory of Information on Drugs (OBID).** Therefore, this study is an element of openness for a broader dialog in the educational field of the Brazilian Elementary Education.

Drugs: early initiation

Scientific studies on the use and abuse of alcohol and other drugs which were used to carry out this research, say, as described above, that the exposure of students happens, in general, very early: "Approximately 5.0% of Brazilian students must have started experimenting with drugs before the age of 10 years."(5)

We also know, according to research reported by the Federal University of São Paulo, that "The earlier the contact with alcohol and tobacco, the greater the risk of future health problems"(12). Another interesting data pointed out in the research studies corresponds to the high consumption of legal drugs by children and young persons, especially in Brazil. To this end, the World Health Organization (WHO), since 1990, has qualified, for example, smoking as a pediatric disease because of the precocity of consumers in the world. In fact, it states that: "90% of smokers start smoking before the age of 19 years, and 15 years is the average age of initiation. According to the information of the World Bank, approximately 100,000 young individuals start smoking every day in the world"(13).

Drugs: family and social vulnerability

In view of the increased use and abuse of psychoactive substances – especially in the pre-adolescent age group that goes from 9 to 11 years, a period which signals the transition from childhood to adolescence – this work demanded the search for information about the family structure and its means of action as a factor in child welfare.

Some researchers consider preadolescence a crucial phase of discovery, whether social or physical. It is in this phase that hormonal changes begin to occur and there is the consolidation of bodily organs through growing; individuals begin experiencing everyday situations that were not part of their social environment, such as dating, sex, alcohol and drugs, among many other experiences(14). With that, psychiatrist Ronaldo Laranjeira and collaborators (15) have reached the conclusion that we highlight for its relevance: we live in a society that propagates the belief that parents who decide to drink with their child play a "protective role" in relation to the minor, in a possible abuse of alcohol and other drugs.

However, the same authors highlight that to delay the access of young persons to alcohol is an effective use of preventive strategy which should be thought and designed from the childhood and preadolescence. As the family is presented as being fragile, as an important factor in protecting the young, the school inevitably ends up assuming greater responsibility in the context of health promotion and providing adequate information on the use and abuse of alcohol and other drugs. Therefore, the next results achieved in the preparation of this work relates to the school context.

Drugs: exposure and consumption in the school environment

In her master’s thesis, researcher Fabrícia de Freitas Migliari de Sá(16) investigated 225 students aged between 8 and 12 years, students of the  4th and 5th grades in six public schools in Santos, State of São Paulo, Brazil, and did a survey on the knowledge they had about drugs in general. The research found that 96% of respondents stated that they knew some type of drug. She found that, among these, 6% knew only legal drugs (tobacco, alcohol and glue), 38.5% knew only illegal drugs (marijuana, cocaine and crack) against 55.5% who pointed out that they knew both illicit and legal drugs. Marijuana was recognized by 73.8% of the students, cocaine by 56.9%, tobacco by 54.9%, crack by 18.3%, alcohol by 13.8% and glue by 13.8%.

Although most of the students had heard about illegal drugs for the first time through television, 80% could not know describe then correctly regarding color, consistency, forms of use or report at least one effect it would cause in the body. According to the researcher, this scenario demonstrates a worrying mass misinformation on the subject "alcohol and other drugs." The research also showed that few students had information on the subject of "alcohol and other drugs" through preventive school programs.

Another important study to be highlighted was carried out by the United Nations Educational, Scientific and Cultural Organization (UNESCO), having as object of study children and young persons from Elementary and High schools in fourteen Brazilian capitals, and published in: Drogas na escola(17). The research found that 23% of the students interviewed had witnessed the use of psychoactive substances inside the school, and this index increased to 33.5% when they claimed to have witnessed the use around the school environment. The early exposure of students to alcoholic substances explains the magnitude and complexity of this phenomenon, as we can see, for example, in the testimony of a Director of the State Education Network in Salvador, State of Bahia, Brazil: "I was alarmed at the number of young persons who are using alcohol increasingly early. A considerable number began to be use alcohol when they were less than 10 years old. And there are other types of drugs that they have confessed that they use, but alcohol consumption is very high."(18)

This last testimony of a professional in the field of education, along with the scientific evidence presented seem sufficient to highlight how the drug issue focused on the school context is one of the current challenges in the strategies for the prevention of use and abuse.



Drugs: the seriousness of the situation whether in an annual plan or a future perspective

In fact: the research studies analyzed in this study indicate the preadolescent age group as the most vulnerable in the face of the phenomenon of the use of alcohol and other drugs, always in an invasive and provoking manner and therefore leading to greater concerns. This is an alarming situation, which puts into question both the health and educational system of the country. After all, the children, preadolescents and adolescents exposed the most, directly or indirectly, to the consequences of drug use and abuse are mostly students. Therefore, we ask: how can the school contribute to encompass this specificity of the contemporary world, aiming at prevention efforts starting with elementary school students? After all, students from the 3rd to 5th grade generally coincide with the age group from 9 to 11 years — that is, with the preadolescence period.

School and prevention: lack of specific studies on the initial grades

From the picture presented by the literature mentioned, we gathered the prevention policies on the early use of drugs and we found the following result: there is a lack of studies that highlight the educational potential of the school environment regarding the primary prevention specifically designed for the early grades (3rd to 5th grade of Elementary School).

In fact: among the various research studies found, we did not find any approach of the subject "Drugs" exclusively aimed towards the prevention of the use by young preadolescents. Therefore, as our study effectively demonstrates, we know that the phenomenon of the use and abuse always happens earlier among young persons. However, the issue of prevention still remains unclear. Thus, there are two fundamental questions: what is the role that the school has in this process? And what role could it have in the future, following the actions of the field of prevention with a wide operational view?

Unfortunately, it is worth noting that the lack of specific studies aimed at elementary school students regarding the prevention of the use and abuse of alcohol and other drugs does not allows us to have an accurate assessment of the subject.

As highlighted earlier, being childhood a valuable period for building habits and attitudes, school ends up assuming an important role in this process. The values that are expressed in the school context in its different aspects usually can be learned by children in their everyday experience. Therefore, it is up to the teacher to collaborate with the development of the critical thinking of students, in an attempt to encourage them to have favorable health behaviors***(19).

The Ministry of Education, through the National Curricular Parameters (PCNs), states that health must be understood as something transversal, being a key issue for the educational program of any school. However, what is observed is that teachers and schools do not feel responsible for the practice of health in their environments, and generally end up reproducing the "Paradigm of paternalistic character, giving priority to the individual and the disease, to the detriment of society and prevention."(19)

School and prevention: absence of field work for the initial grades

But now what comes into question for the fomentation of our reflections are the results obtained that we highlight in the form of the question: "In the educational strategies outlined by the country’s educational guidelines on health promotion, is there really an operation aimed at providing the proper information regarding the use and abuse of alcohol and other drugs within the school context, especially in the initial grades?"

Unfortunately, in the research conducted for this study, we found that the answer to this question is negative: in the twelve studies analyzed, we did not see the practice of any initiative in the field dedicated to the prevention in this age group, although the same studies highlight its importance.

In this regard, researchers Avila, Ferriani and Nakano(20) suggest that strategies within the school context should be developed with the objective of not only reducing the percentage of potential drinkers, but, essentially, stimulating the quality of life in all children. After all, both the school and teachers improve the protection factors for the development of a communication of intervention and early detection in the fight against the use and abuse of alcohol and other drugs. Therefore, the biggest challenge, according to the authors, is to promote a new conception of public and private policies derived from constitutional rights established for children. After all, preschool students are not only persons who are growing, but they are also individuals that need protection in the exercise of their citizenship.

School: legitimate place for a multidisciplinary and interdisciplinary prevention

In the analysis of the results obtained, we can see that, although there is a lack of specific studies on the subject together with field works, the school stands as a legitimate space for the construction of the recognition, between students and teachers, of the high rates of use and abuse of alcohol and other drugs and their effects. Therefore, the school environment can provide a space for critical reflection in the search of new transformations(21). When we consider the prevention of the use and abuse of drugs in the school context we need to think about multidisciplinary activities – that is, joint actions of different areas of scientific knowledge, in order to allow discussions on the anthropological, sociological, pedagogical, psychological, legal and sanitary character, among others.***(22)

In our research, we found that, between the different professionals who can assist in prevention strategies, the figure of the nurse can be pointed out as of great relevance. This health agent plays an important role in educational practices "for being a dynamic professional, subject to changes and who is continuously incorporating reflections on new subjects, issues and actions, believing that his/her ethical principle is to maintain or restore the dignity of the body in all areas of life."****(16)

Therefore, we consider it essential that the educational strategy should seek to provide continuously to the student of the initial grades direct access to the information, education and training required, so that the student does not give up so easily when faced with drugs to the glimpses of their "pseudo-pleasure"(23).

It is therefore necessary to create effective efforts of prevention within the school context that contribute to the right to a quality education. Namely: that the school should include the growth and development of the individual as a human being, as well as citizens with constitutional rights and obligations(9). This is a preventive planning also open to health professionals, in the development and implementation of common strategies for the prevention of the use of alcohol and other drugs, through games, recreational workshops, involving all school agents, such as administrators, teachers etc.

The researchers Chavez and Andrade(24) point out that the first step to be considered in the context of prevention is "to improve the educational style". If the school does not care about this important phase, which is the adaptation of the newcomer to the school context, it can contribute as a risk factor and not as a protection factor. We explain: the poor adaptation to the school environment can give the student feelings of inadequacy, fear of failure, emotional stress, leading to the difficulty of building relationships with peers and teachers.

Therefore, this type of school will not only deprive itself of the chance of detecting possible risk factors among its students, but it will, fundamentally, be barred from promoting preventive strategies — whether within the primary, secondary or tertiary context. And what would ‘prevention’ be? According to the objective of each stage, according to the World Health Organization (WHO), we would have the "Primary, secondary and tertiary prevention". Each would be thus defined: "Primary Prevention is the set of efforts that seek to prevent the occurrence of new cases of abusive use of psychotropic drugs or even a first use; Secondary Prevention is the set of efforts that seek to avoid the occurrence of complications for persons who occasionally use drugs and who have a relatively low level of problems; Tertiary Prevention is the set of efforts that, from an existing problem, seeks to prevent additional damage and/or reintegrate individuals with serious problems into society. It also seeks to improve the quality of life of users together with the family, work and society in general."*****(25)



An educational strategy can be effective if started early, exactly because the initiation of pre-adolescents on the use and abuse of alcohol and other drugs is happening increasingly prematurely.

The data analysis shows that the school is seen as an institution that needs to provide openness to dialog on the subject of "Alcohol and other drugs". However, being the "Drugs" issue a great problem, it requires an entire specialized system: a work based on the dialog between different agents of the educational institution, involved in a common interdisciplinary horizon.

In this way, the interdisciplinary and intergenerational dialog would be at the center of this process, along with the exchange of information from multiple sources of knowledge within the school context. From that structure, a fundamental, solid and articulated strategy would be presented for the prevention of the use of alcohol and other drugs by young students. For this end, it is essential the continuous training of educators to address qualitatively the different requirements in the field of prevention.

There are many schools that continue to not pay attention to the individual differences of students, thus generating great difficulties, especially for those most socially and economically vulnerable. However, we understand that, from multidisciplinary and interdisciplinary programs of prevention of the use of alcohol and drugs, schools can respond to different individual demands in the field of prevention and, thus, play its effective role contributing to the promotion of health, which is an agreement among researchers(26).

Finally, the precariousness of personal relationships and social and cultural conditions results, to a large extent, in the fragility of the family and school to exercise their roles of protection and prevention in combating drugs. Therefore, it seems to us that the great challenge of a society is to educate its young persons, allowing them to have an appropriate development from a social, emotional and physical point of view. In summary: the concerning results highlighted in this research, in our view, point at the same time to a deep educational deficiency and, therefore, the need to implement multidisciplinary and interdisciplinary programs to prevent the use of alcohol and drugs in schools, from the elementary school, in Brazil.



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Received: 02.10.2014
Accepted: 04.11. 2015

Corresponding Author:
Maria da Conceição Aparecida Silva
Rua Doutor Enéas de Carvalho Aguiar, 419
Cerqueira César
CEP: 05.403-000, São Paulo, SP, Brasil



*Aratangy LR. O desafio da prevenção. In: Aquino JG, organizador. Drogas na escola: alternativas teóricas e práticas. São Paulo: Summus; 1998. p. 9-17 apud  Bertoni LM, Adorni DS. 2010, p.212.
**The following pieces of information were taken from the website of OBID/SENAD. See: [Access 20.Feb.2014].
***Organización Mundial de la Salud-OMS. Departamento de Salud Mental y Abuso de Sustancias. Invertir en salud mental. [on line]. Available:; 2007 apud Lopes GT et al. 2007, p.714.
****Cruz AR. Prevenção do abuso de drogas pela educação formal. In: Cruz AR, organizador. Prevenção do abuso de drogas. Rio de Janeiro: Editora Universitária Santa Úrsula; 1992:29-44 apud Fonseca MS 2002, p.160.
 *****Lima MJ de. O que é enfermagem. 2 ed. São Paulo: Brasiliense; 1994. 277p. apud Sá, FFMF 2001, p.30.

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