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Different interpretations of terms relating to prevention programming by various government agencies at the federal, state and local levels have resulted in inefficient and misguided use of scarce funds for prevention work. The committee therefore finds it necessary to identify and define key terms which are commonly used and misused in discussions of prevention programming.
Prevention Throughout the course of our examination of the prevention aspect of the National Drug Control Strategy, we queried experts on their working definition of the term "prevention." The most practical and comprehensive explanation was forwarded by a witness before the committee, Dr. Allan Y. Cohen, Executive Director of the Pacific Institute for Research and Evaluation, who after decades of involvement with treatment and prevention, has derived a workable definition of the term. Dr. Cohen's use of the word prevention "pertains primarily to a stage of drug involvement by an individual or target population ... and refers to strategies designed at (for) individuals who have never misused illicit drugs, or who are in the very early stages of such misuse, such as experimentation.'
.!” He describes the stage of prevention termed "early intervention" which refers to the time "when identifiable symptoms of the drug experimentation occur, when high risk behavior occurs
." Dr. Cohen also uses the term prevention "as part of the phrase 'prevention programming to define those strategies or programs that use tactics pertinent to the non-user or experimental user."
The issue of defining prevention is not incidental. State offices charged with the distribution of block grants use varying meanings of prevention when allocating funds to an assortment of non-prevention activities. Federal Government agencies are not operating with a reasonable understanding of what prevention means, and therefore can define any strategy to reduce substance abuse as constituting prevention, including interdiction, enforcement, treatment or rehabilitation efforts. A loose definition of prevention has allowed the Federal Government to disperse prevention funds in a manner that has effectively taken resources away from actual prevention strategies or programming. Varying interpretations of prevention, compounded with the lack of coordinated leadership at the federal level and inexperienced program administrators, has caused duplication of effort and reduced efficiency in carrying out prevention strategies.
Substance abuse Recent controversies about the term "substance abuse” have suggested to Dr. Cohen that he offer a working definition that transcends these disputes. Substance abuse is defined as “any use of psychoactive chemicals, licit or not, prescribed or not, where the damage or risk of damage to mind, body or spirit overweighs the medical or physiological benefit.” By utilizing the term in this way, it can be applied to the problem while allowing one to tailor a strategy according to the severity of the problem.
Community development The evidence that promising prevention programming can be carried out by communities, for communities, proves that the local community is able to identify needs and can respond by harnessing resources, energy and creativity inherent to the community.
D.I. Warren in “Helping Networks: How People Cope with Prob lems in the Urban Community," 11 states that community development has traditionally been defined as a process of voluntary cooperation and self-help/mutual aid among residents of a locale aimed at the creation of improved physical, social and economic conditions. This working definition has spurred David M. Chavez and Paul Florin in “Community Development, Community Participation, and Substance Abuse, a manuscript commissioned by the Prevention Office Bureau of Drug Abuse Services, Department of Health, County of Santa Clara to develop four community develop ment goals related to substance abuse prevention.
The objectives assume a process: (1) of citizen action in which citizens initiate and control initiatives; (2) involving voluntary participation, cooperation, and collaborative problem solving; (3) to build the community's capacity to manage and control change in order to influence conditions affecting community residents' lives to achieve empowerment; and, (4) that is holistic, concerned with the development of all of a community's human, economic, and environmental resources.
The ability to achieve strong community development lies in the ability of the Federal Government to provide the necessary resources for communities to take responsibility for preventing drug abuse. Nowhere is this as critical as in the inner cities, where people of color are most disenfranchised and resources are most
Risk factors Discussion of drug prevention and treatment assumes that there are high risk populations-individuals or groups that share some common factors which make them more likely to use drugs. If common threads can be found among people using drugs it should then be easier to develop effective prevention strategies.
Research focusing on risk factors in adolescents conducted over the past 15 years has been spotty; however some studies on substance abuse have been done. While such research is not conclusive, there is some agreement on the usefulness of identifying risk factors for individuals from relatively healthy environments that would place them in danger of substance abuse. Less research has been conducted on environmental risk factors for inner city or ethnically diverse communities. The implications for prevention pro gramming may be that efforts should be concentrated on community systems that embrace a diverse audience rather than focusing on individuals at high risk. While the rate of risk is different in different communities, it is believed that the predictors are similar. Recently, the Federal Government has begun to take these individ
11 D.I. Warren, “Helping Networks: How People Cope with Problems in the Urban Community,” (Notre Dame, IN: Notre Dame Press, 1981).
ual risk factors under consideration in disseminating prevention programming resources.
Richard Catalano and David Hawkins from the University of Washington have been researching the concept of risk factors as they apply to the individual and to a lesser extent the community. Looking at the individual and environmental interactions, they have developed a list of factors in adolescents that put them at risk of substance abuse. The risk factors are: (1) a family history of alcoholism; (2) family management problems, e.g. poor or excessive discipline, abusive or violent behavior, and inconsistent reactions; (3) early anti-social behavior, e.g. aggressive behavior coupled with swings of shyness and withdrawal; (4) parental substance abuse and condoning drug use; (5) academic failure during the fourth to sixth grades due to learning difficulties and problems at home; (6) little commitment to school during grades seventh to ninth; (7) alienation, rebelliousness and lack of social bonding; (8) anti-social behavior in early adolescence, including truancy, fighting, skipping school, early delinquency; (9) initial experience with drugs, usually through friends; (10) favorable attitude toward drugs; and, (11) early first use.
Hawkins and Catalano have also characterized the risk factors of community settings. These include: (1) availability of drugs and alcohol; (2) low neighborhood attachment, community disorganization and low bonding; (3) community laws and norms favorable to use, e.g. increased taxation or price of alcohol; and, (4) economic and social deprivation, where there is a positive relationship between use of a substance and the economic situation surrounding the user.
These researchers and others admit that there is little evidence to determine the relative importance of these risk factors, but prevention strategies should address the risk factors of the individual. By focusing on the various risk factors, communities can target scarce resources more efficiently. Yet the evidence is not conclusive on whether these factors are applicable to ethnically diverse neighborhoods or communities.
Protective factors Protective factors 2 inhibit the development of health compromising behaviors such as drug abuse. Viewed as the opposite of risk factors, protective factors signify a set of variables that in an environment characterized by social and economic chaos with drugs available on street corners and in schools, make it possible for a child to resist drugs. Research in this area is new, but the implications of identifying these protective factors for prevention programming goals are promising. Recognizing elements that strengthen an individual's determination to not use drugs, prevention strategies could reinforce and fortify those factors.
Research on these protective factors is being conducted in inner cities and rural communities around the country, and could, if ap
12 J. David Hawkins and Richard F. Catalano, “Risk and Protective Factors for Alcohol and Other Drug Problems in Adolescence and Early Adulthood: Implications for Substance Abuse Prevention.” Presented at the First Symposium on the Prevention of Alcohol and Other Drug Problems, Rutgers University, 1989.
propriate, be utilized by policy makers in crafting prevention programs in the future.
Community empowerment The ability of a community to manage and control change in order to influence the conditions that affect peoples' lives is key to determining the success of prevention programming, particularly in inner city and ethnically diverse communities.
Community empowerment requires that the neighborhood be given responsibility for disseminating information to create awareness about a particular problem. The community empowerment process allows an appropriate response to develop to solve that problem. In this way the community can become the primary prevention defense against substance abuse. For a community to become empowered to effect positive change, including organizing neighborhoods to rid themselves of drug dealers, they need to control the resources and the decision-making process.
The accessibility and availability of resources are critical to enabling communities to become empowered. According to David Chavez and Paul Florin, the community requires resources for: (1) training programs to develop organizational and leadership skills, resource acquisition and coalition building; (2) telephone and onsite consultation regarding organizational issues, e.g. team building and conflict resolution; (3) information and referral services to appropriate sources of assistance, e.g. city departments, agencies or other technical assistance; (4) mechanisms to create linkages among key community institutions and actors including conferences, networks and coalitions; and, (5) initiatives, e.g. resource directories, "how to" guides and public information materials.
Communities should participate in the programming, planning, and budgeting processes, as well as in directing resources to difficult-to-reach populations. Prevention researchers believe that such an approach holds great promise in organizing communities, enabling them to take control of their own lives and their neighborhoods while promoting a sense of ownership and pride. 2. Target populations
According to the census, there are over 33 million people living below the poverty line, most of whom are white. NIDA's 1989 Household Survey reports that four out of five illegal drug users are white, thereby dispelling the image that people of color comprise the majority of the drug abusing population.
It is true that a disproportionate number of illegal drug abusers are from the inner city, existing below the poverty line. Violent drug-related crime is more prevalent in the inner city, and inner city drug users are more apt to be incarcerated for drug-related crime than their suburban counterparts. Poor African Americans and Hispanics comprise a large proportion of inner city residents in the communities this committee examined in Washington, D.C., Detroit, Los Angeles and Chicago. This fuels the popular media image of inner cities at war over drugs.
Alarming reports of impoverished families entrenched in the drug trade, and hundreds of thousands of cocaine babies born in the inner city, has focused attention and blame on these communi
ties. The implication is that the increasing rates of addiction are somehow the fault of these population groups.
However, according to Dr. Benjamin Bowser, an urban ethnographer and Director of the Multicultural Inquiry and Research on AIDS, Bayview Hunter's Point Foundation, “the vast majority of residents in 'drug infested' (urban) communities are law abiding, opposed to drug use and sales, and wish to exercise control over their immediate public space.” 13 He echoes the concern expressed by other researchers that "blanket stigmatization of whole communities (as drug users] does more damage to drug abuse prevention efforts in the long run than does drug trafficking."
The committee also heard testimony from representatives of the Southwestern Hispanic communities who described settings typical of substance abuse as small towns in rural areas and cities, as opposed to the inner city. The lack of appropriate prevention programming is due to the lack of access to resources, ignorance of planners and a lack of incentive to recognize the diversity of Hispanic communities, language barriers and the unique problems these communities are facing.
According to Mike Watanabe, Chairman of the Asian Pacific Planning Council, Drug and Alcohol Committee, 14 drug and alcohol problems among the 1,500,000 Asian/Pacifics in Los Angeles County parallel those of other ethnic groups. The Asian/Pacific community has increased over 900 percent in the past ten years, but they have not received sufficient assistance from the Federal Government to address the problems unique to their community, such as cultural and language-specific materials.
The evidence indicates, as Watanabe said “that the two areas of concern Congress and the Administration should focus on are the distribution of resources and the control of how that distribution is being implemented." 15
African Americans It has been estimated that the 30 million African Americans in the United States make up less than 12 percent of our nation's drug purchasers. Yet, according to testimony by Dr. Bowser, African Americans are nine times more likely to be incarcerated than whites for drug related crimes. 16 Media and police characterizations of the nation's African American communities being overrun by drug addicts and drug trafficking stigmatize these communities as victims of a drug war. But the war is not of their own making.
Earlier it was pointed out that the drug crisis must not be isolated from other health, social and economic problems. Hearings in Detroit, Chicago and Los Angeles emphasized that a war must be waged on unemployment, inadequate housing and nutrition, and on the lack of health care and health care insurance. To be effec
13 Statement of Benjamin Bowser, Director, Multicultural Inquiry and Research on AIDS, before the Legislation and National Security Subcommittee, July 2, 1990, p. 3.
14 Supplemental information of Mike Watanabe, Chairman, Asian Pacific Planning Council, Drug and Alcohol Committee before the Subcommittee on Legislation and National Security, July 2, 1990, pp. 1-2.
is Statement of Mike Watanabe before the Subcommittee on Legislation and National Security, July 2, 1990, p. 1.
16 Bowser, op. cit., p. 7.