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The purpose of this paper is to describe the topics covered by coaches assisting teachers implementing a research‐based drug prevention program and explore how coaching affects student outcomes.

The All Stars drug prevention curriculum is implemented by 16 urban teachers who received four coaching sessions. Two coaches participated. Coaches are interviewed by investigators to assess topics covered. Students completed pre‐test‐post‐test measures of mediators and substance use behaviours.

The average teacher is coached on 11.7 different topics, out of a total of 23 topics. Coaching topics most heavily emphasized include: introduction and wrap up; time management; general classroom management; teacher's movement around the class; asking open‐ended questions; using students' questions, comments and examples to make desired points; general preparation; engaging high‐risk youth; reading from the curriculum; implementing activities correctly; focusing on objectives and goals; maintaining a focus on the task; and improving depth of understanding. Seven coaching topics are found to relate to changes in student mediators and behaviour.

The current study is exploratory. Future research should explore how teachers develop the particular skills required by prevention programs and how coaches can assist them.

Five levels of skill development are postulated, which coaches may address: fundamental teaching skills, mechanics of program delivery, development of an interactive teaching style, effective response to student input, and effective tailoring and adaptation.

The paper is one of a very few studies that explores how coaching impacts outcomes in substance abuse prevention.

To be effective, evidence‐based programs should be delivered as prescribed. This suggests that adaptations that deviate from intervention goals may limit a program's effectiveness. This study aims to examine the impact that number and quality of adaptations have on substance use outcomes.

The authors examined 306 video recordings of teachers delivering “All Stars”, a middle school drug prevention program. Multiple observers coded each recording, noting the number and type of adaptation each teacher made. Each adaptation was given a valence rating. Adaptations that were deleterious to program goals received negative valence ratings; positive ratings were given for adaptations that were likely to facilitate achievement of program goals; neutral ratings were given to adaptations that were expected to have neither a positive nor negative impact on program goals.

All teachers made adaptations. Teachers were consistent across time in the types of adaptations they made, suggesting each teacher has a personalized style of adapting. Those who made few adaptations, and whose average adaptation was rated as being positive had a higher percentage of students who remained non‐drug users. In contrast, teachers who made many adaptations, whether their average valence rating was positive, neutral or negative, failed to have as many students remain non‐drug users. Measures of fidelity, including quality of delivery and teacher understanding, were related to valence of adaptations, with better performance related to making positive adaptations.

Through training and supervision, teachers should be guided and encouraged to follow programs directions, making few adaptations and ensuring that adaptations that are made advance the goals of intervention. Programs should define acceptable and unacceptable ways they may be adapted.

This study provides significant evidence about the challenges that face disseminated evidence‐based programs.