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The mayors of Chicago and Los Angeles echoed Mayor Goode's contention that major cities should have direct access to federal funds for anti-drug efforts.
Direct access to federal funds is not the only problem. The lack of sufficient funding for prevention strategies is hampering the ability of communities across the country to provide prevention programming. Currently, prevention strategies account for less than 12 percent of the total drug strategy budget and this amounts to approximately $5 per person that is spent on prevention in the United States.
National Drug Control Strategy objectives
The National Drug Control Strategy establishes nine two- and ten-year objectives by which the success of the drug war will be measured. The objectives present statistical measures that indicate the rates of illegal drug use, trends in drug-associated health problems, aspects of drug related crime and evidence of drug availability.4 7.42 Seven of the nine objectives relate to the rate of drug use. Six out of these seven relate to casual drug use as measured by NIDA data. As discussed above, NIDA data reflects the population of better educated middle and upper class drug users because it only surveys households. Only one objective measures frequent drug use which directly relates to the problems of the inner city. Yet NIDA data do not measure key inner city populations.
Progress in the drug war should be measured by objectives, but the committee finds fault with objectives that virtually ignore the poor, urban and communities of color. According to these objectives, the recently announced decline in the casual use of drugs does reflect success. If success is measured by statistics on casual use, this will never reflect success in our inner cities.
National drug policy strategies place greater emphasis on reaching the more educated middle and upper classes. These strategies are clearly working. Yet the poor and communities of color who are disproportionately impacted by the drug crisis have far greater problems which are not being addressed. Prevention programming efforts that are available for this population are not as effective as they should be, because the distribution of resources and the control of how that distribution is implemented excludes them.
Current prevention programming does not address the issues related to the drug problem-employment and underemployment, inadequate housing and nutrition, and the lack of health care and health care insurance. As a result, the root causes of drug use are ignored, and inappropriate strategies are imposed upon poor and minority communities.
Prevention policy is still largely school-based, and does not foster community empowerment efforts. Recent grants awarded directly to community anti-drug programs 43 finally give recognition to the efficacy of grass roots organizations. Such acknowledgement should be the hallmark of prevention efforts, on which all prevention strategies should be based. The current objectives of ONDCP do not
42 ONDCP. "National Drug Control Strategy." January 1990, p. 117.
43 Gabriel Escobar and Dan Beyers, "Community Drug Programs Get $42 Million Infusion from U.S.," the Washington Post, October 5, 1990, p. C5.
address the priorities and key issues relevant to individual communities, therefore success in the drug war cannot be realized.
Race and class
Current statistics from NIDA's National Household Survey and the Annual High School Senior Survey reflect the fact that prevention efforts are effective among certain segments of society-the better educated middle and upper classes where drug use has declined. But drug use among poor inner city residents and in communities of color has increased.
The emergence of a two-tiered drug war is having a profound impact on the poor and on minorities. Community representatives increasingly believe that the war on drugs, in reality, is a war against people of color-the real victims of drug crime and drug use.44 They point to the disproportionate number of poor and minorities that are incarcerated, the lack of resources for high risk groups, and generally, their "increasing marginalization and further exclusion from the center of American culture, its institutions, organizations, and structure of privilege." 45 Dr. Bowser's testimony supports the view that those who have fallen out of the economy are more attracted to drug use and sales, but adds the factor of hopelessness or despair, "the presence or absence of hope that their lives and the condition of their community will be improved in the future." 46
Many lower class drug abusers are inner city, unemployed, high school dropouts who learn at an early age that they are excluded from legitimate avenues to conventional forms of the "good life" and the values that earn status and respect in our society.4 47 Troy Duster's analysis of the poor and underserved "underclass" applies here:
There is nothing new about the long-term consignment of Blacks to the bottom rung of the American economic and political order. What is new is the currently emerging sense of "permanency" of that condition, both in structural terms and in the "sense" of key actors in the society, both white and Black.48
The causes of the two-tiered drug war are complex. Yet the failure of public policy to examine the drug crisis within the context of broader social, economic and health systems avoids looking at the underlying causes of substance abuse impedes the development of an appropriate response to the poor and communities of color in crisis. Instead, emphasis is placed on law enforcement, perpetuating the "vicious cycle of generation after generation being caught up in abusing drugs." 49
44 Thelma Brown, op. cit., p. 3.
45 Troy Duster, "Crime, Youth Unemployment, and the Black Urban Underclass," Crime and Delinquency, Volume 33 Number 2. April 1987, p. 303.
46 Bowser, op. cit., p. 6.
47 William J. Wilson, "The Truly Disadvantaged: The Inner City, the Underclass and Public Policy," (Chicago: University of Chicago Press, 1987).
48 Duster, op. cit.
49 Brown, op. cit.,
The most vocal critics of the Federal Government's prevention programming policy came from the communities of color. As discussed at length in the section on target populations, prevention programming does not meet the needs of the African American, Hispanic and Asian/Pacific communities. The theme which emerged from committee research, hearings and interviews was the issue of resource distribution, and control of that distribution.
Community representatives indicated that successful prevention policy and program development targeting their communities must utilize a conceptual framework which includes: (1) availability of a continuum of substance abuse services; (2) accessibility of resources to all groups to address barriers to participation, including poor public transportation networks, limited hours of service, language and cultural insensitivity, and the lack of child care; (3) acceptability of services which address cultural norms and are appropriate for the community, avoiding the problems of translated materials without culturally appropriate messages and symbols; and (4) accountability where the community works with the service providers to plan and assess needs.
Alcohol and tobacco
There is a glaring absence in national drug policy concerning alcohol and tobacco prevention efforts. As "gateway drugs" which are widely available and negatively affect people, alcohol and tobacco use are linked to more deaths and diseases than other illicit drugs. Witnesses from varied disciplines testified to the need for the Federal Government to integrate these substances into national prevention policy.
Historically, alcohol abuse was considered a moral problem and the alcoholic was the concern of the law and of the clergy. In the 1700s, drinking daily was believed to be necessary for good health. Clinical perspectives on the problem of excessive drinking in the 1800s helped to accelerate the Temperance Movement which advocated total abstinence of most forms of alcohol. This movement fell into disfavor and was replaced by the view that "alcohol was addicting only for those predisposed or vulnerable."50 The medical profession began to focus on excessive use of alcohol, while government concern has reflected indifference. The evolution of current thought on alcohol problems appears to fall somewhere in between. When ONDCP Director Bennett has been subject to increasing complaints on the absence of alcohol in the drug strategy, his response has been that his mandate from Congress is to be "the drug czar, not the health czar."51
The National Centers for Disease Control, which linked 105,095 American deaths in 1987 to injuries or diseases related to alcohol consumption, supported these findings in the "Alcohol and Health: Sixth Special Report to the U.S. Congress (1987)" study that reported that 18 million adults in the U.S. experience problems as a
50 Jerome H. Jaffe, "The Swinging Pendulum: The Treatment of Drug Users in America," "Handbook on Drug Abuse," p. 3.
51 Michael Isikoff, "Alcohol: The 'Worst' Drug Problem: Officials in Midwest Frustrated by Government Priorities," the Washington Post, April 2, 1990, p. 1.
result of their alcohol use. The economic costs of alcohol problems to society were estimated by the National Institute on Alcohol Abuse and Alcoholism to be $117 billion in 1983 alone.
Tobacco is the other "gateway" drug excluded from the federal strategy.
Cigarette smoking, the single most preventable cause of death in our society, continues to decline although it is still responsible for approximately 390,000 deaths per year in the United States The prevalence of smoking remains higher among blacks, blue-collar workers, and less educated persons than in the overall population . . . Smoking is responsible for more than one of every six deaths in the United States. 52
It has been clearly documented by the Federal Government, cabinet secretaries and other officials that tobacco use, which is heavily marketed in African American and Hispanic communities, has not abated. Billboard advertising that is targeted in these communities exacerbates the effects of tobacco use by people of color.
The National Drug Control Strategy does not provide the people of the United States with a comprehensive prevention strategy that includes alcohol and tobacco use, that could then be used in state and local prevention programming efforts. Witnesses testified before the committee who view the exclusion of these "gateway drugs" from the National Drug Control Strategy as a reflection of the Federal Government's ambivalence toward the use of alcohol and tobacco, and the succumbing to industries that spend over $2 million a day to advertise their products.
It was noted that different government agencies use inconsistent definitions of the term prevention. As a result, prevention can refer to almost any strategy to reduce drug abuse and does not always focus on demand reduction, but is utilized to define interdiction, enforcement, treatment and rehabilitation efforts.
State-of-the-art prevention research is sorely lacking. While research budgets have increased during the past several years, it is believed that much more is needed, particularly related to risk factors, protective factors, and ethnic communities. Such research works in tandem with, and reinforces prevention programming efforts. Spokespeople for the African American, Hispanic and Asian/ Pacific communities indicated that there are very few ethnic researchers funded in this discipline, even though such researchers would be most likely to understand the cultural nuances and underlying problems of their communities.
Office of Substance Abuse Prevention
The Office of Substance Abuse Prevention (OSAP) appears to be the more effective prevention programming entity within the Fed
52 U.S. Department of Health and Human Services, Public Health Service. "Reducing the Health Consequences of Smoking: 25 Years of Progress," 1989.
eral Government responding to the needs of communities across the United States. Certainly OSAP received the most accolades from community representatives.
While OSAP may well be the most culturally sensitive government entity, greater numbers of hard-to-reach and ethnically diverse individuals could be reached if OSAP had: the resources to involve greater numbers of communities in the planning and programming process; more regional representation and information services; access to better research on communities of color regarding the underlying problems of those communities; more representation from ethnic communities in positions throughout the agency; and greater oversight and evaluation of the grants awarded to the communities. Researchers in the field concurred that there is a serious lack of program monitoring and evaluation, and believed that prevention programming could be more successful if these weaknesses were addressed. Additionally, prevention practitioners believed that the Federal Government is not committed to long-term prevention programming and research whereby more information could be gathered on what is working in different communities.
The Department of Education
Early prevention policy and programming focused on, and was disseminated through, education institutions. While still an emerging discipline, evidence indicates that successful prevention strategies are composed of a comprehensive system of approaches that addresses multiple risk factors in the community, that are implemented by and across the community, and that are begun early in childhood and sustained through adolescence. Clearly, education has a major role to play in this process, and the Department of Education has the largest budget for school-based prevention activities.
Yet, at a time when the effectiveness and appropriateness of education in America are increasingly evaluated, the disproportionately high resources provided to the Department of Education in comparison to OSAP should be reassessed.
According to the Department of Education, the illiteracy rate for the total American public is 12.5 percent. Looking deeper we find that English-speaking Americans have an illiteracy rate of 8.8 percent, Spanish-speaking Americans have an illiteracy rate of 53.6 percent, and African Americans have a 21.2 percent illiteracy rate. 53
Dropout rates are calculated in a variety of ways, and do not reflect an accurate portrayal of the inner city nor of hard-to-reach ethnic communities. According to October 1988 Census data of 1624 year olds nationally, the rate of dropouts among whites was 12.7 percent, 14.9 percent for African Americans and 36 percent for Hispanics. Witnesses before the committee stated that inner city African Americans and Hispanic communities experienced dropout rates as high as 60 percent. While Census data did not report Asian-American dropout rates, we learned at our Los Angeles hear
53 Statistics on Asian Americans are not available.