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broader health, social and economic issues facing our society including crime, inadequate nutritional intake, insufficient housing, unemployment and underemployment, teenage pregnancy, the lack of health care and insurance, academic failure, and family and community disintegration. Successful efforts must involve strong national leadership, mobilization of all sectors of the community, and an increase in funding for state-of-the-art research and prevention programming.
Early prevention efforts consisted primarily of providing information through educational institutions with the hope of changing human behavior, e.g. by simply providing the facts, individuals would make responsible decisions about drug use. While personal motivation is the final determinant in the success or failure of prevention, these endeavors entailed school-based curricula which focused on scare tactics and lacked coordination among the community outside the school system as well as those state and federal entities interested in prevention.
While prevention strategies have since come a long way, scare tactics still exist and can be most notably discerned by the primary techniques implemented by some schools, that of "drug-free school zones”, where punishment of students through suspension and expulsion prevails. While ridding schools of all substance abusers would be ideal, the problem still remains, and has become exacerbated by the growing numbers of disenfranchised youths who are thrust out on the streets and are then at an even higher risk for substance abuse.
Other ill-advised strategies include the dissemination of misinformation on the consequences of illicit substance abuse. Putting forth the idea that all illegal drugs are extremely dangerous and addictive, when young people subsequently learn otherwise through experimentation, discredits the message.
The onslaught of the AIDs crisis and the emergence of the cocaine epidemic in the 1980s has renewed concern that drug abuse is one of our nation's greatest priorities. In response to these growing problems, technology transfer of prevention programming at the community level was established at the federal level with the creation of the Office of Substance Abuse Prevention (OSAP) of the Alcohol, Drug Abuse, and Mental Health Administration (ADAMHA) in 1986, under the U.S. Department of Health and Human Services. Efforts have begun to address the inadequate research and disagreement over strategies that had caused prevention programming to become so fragmented.
Community-based entities benefit from OSAP efforts such as the Community Demonstration Partnerships, the Community Prevention System Framework and the National Training System. However, it is clear from the series of hearings held by the Committee on Government Operations Subcommittee on Legislation and National Security that these efforts are not as effective as they should be to meet the needs of hard-to-reach populations; or to carry out the goals of the communities. Evaluations of the strategies that have been implemented are inadequate and do not reveal what is working in particular communities. In addition, there are not enough ethnically and culturally aware researchers who might better understand the problems and needs of their own communities.
The community must be given the flexibility and authority to better orchestrate comprehensive prevention planning that involves all community sectors in a collaborative partnership to identify and fashion appropriate prevention programming. The community must also be equipped to measurably benefit from prevention programming, regardless of their financial resources. The U.S. Department of Education's Drug Free Schools and Communities monies reach many more segments of our society but prevention strategies disseminated by the department are not necessarily effective. The Department of Education receives, by far, the largest portion of the National Drug Control Strategy's budget allocation for prevention-related activities. Prevention efforts scattered across nineteen departments and agencies in the Federal Government charged with prevention efforts are fragmented and frequently duplicate the efforts of others.
Because national leadership has focused its efforts on finding a "quick fix” or “magic bullet”--the ideal program that would eliminate substance abuse across the United States-local prevention programming has suffered. Local efforts throughout the years have been further undermined by federal budget reductions because of the differing priorities of changing administrations.
Few resources have been made available to comprehensively evaluate prevention programming. The prevailing evidence based on the collective data of prevention programming over the past decade gives reason to encourage the more promising elements of some prevention strategies. Prevention providers hope they can count on the recent increase of funding sources and that the federal bureaucracy will not renege, yet again, on the promise to provide resources to help communities reclaim their neighborhoods from drug dealers and help drug abusers. 3. Principal findings
Sufficient short term research indicates that there are promising prevention approaches which positively impact American society. We have learned that no single measure can provide a "magic bullet” solution in the fight against drugs. Millions of people have been deterred from trying drugs through primary prevention and education, and millions of others have stopped experimenting with drugs before dependency. Casual use of cocaine in particular has decreased significantly. ONDCP Director William Bennett recently pointed to the fact that after a nearly fivefold increase between July 1985 and June 1989, the number of cocaine-related hospital emergencies recorded each quarter by the Drug Abuse Warning Network (DAWN) has declined from 11,096 to 8,135 in the past six months. 4
1. ONDCP has based its data on drug use on National Institute on Drug Abuse (NIDA) statistics. The statistics as measured by NIDA's National Household Survey do not include institutionalized populations, e.g. prisoners, those hospitalized, persons living in military installations, or dormitories and the homeless; and the Annual High School Senior Survey which does not include drop
* Office of National Drug Control Policy. "Leading Drug Indicators." September 1990, pp. 1314.
outs. These omissions represent some of the highest risk populations in the country.
2. The use of drugs, especially crack, in our inner cities has increased. According to the Justice Department, there are as many frequent cocaine users among arrestees as were originally thought to exist in the entire U.S. population,5 because data obtained from the National Household Survey does not include institutionalized populations.
3. Prevention strategies do seem to be working among the educated and middle class. The rate of casual drug use has declined significantly. While welcome news, it is a false measure of success, because the rate of addiction has not decreased. Neither the inner cities, nor communities comprised primarily of poor people and people of color, are being reached-because prevention programming as developed is inappropriate for these communities. The symbolism, the imagery and the language do not correspond to the community.
4. Research indicates that the programs that are most successful involve the local community in their development and implementation. Community empowerment is a critical factor in the development and dissemination of prevention programming at the local level. However, most programs are developed for communities, independent of their input and involvement, then imposed upon them.
5. Prevention policy is more likely to be effective if it includes these criteria: availability, accessibility, acceptability and accountability.
6. Most prevention funding is allocated to the schools. Yet the population that is at the greatest risk for drug use is not in school. They are drop outs, truant or unemployed graduates.
7. Research has identified critical risk factors that place some adolescents and adults at a higher level of substance abuse than others. Using these measures to target individuals who are of high risk would make better use of the meager resources allocated for prevention programming.
8. Two important elements are omitted from the National Drug Control Strategy's prevention efforts. The first is alcohol, the number one drug of choice in American society today, and a “gateway" drug. The other is tobacco. Many states have taken the lead in merging their drug and alcohol prevention and treatment programs and have reported much success in doing so. The Federal Government has not provided the leadership in this vital area and this omission has negatively impacted society by not bringing attention to the need to change attitudes and behaviors regarding alcohol abuse and alcoholism.
9. There is a lack of sufficient funding for the development of new and innovative prevention strategies. This hampers the ability of communities across the country to access information and develop appropriate prevention efforts. Currently, prevention strategies account for less than 12 percent of the total drug strategy budget
5 "Drug Use Forecasting" (Washington, D.C.: Department of Justice, March 1990).
& Statement of Charlene Doria Ortiz, before the Subcommittee on Legislation and National Security, April 3, 1990, pp. 6-9.
and this amounts to approximately $5 per person in the United States that is spent on prevention.
10. ONDCP was created “... to lead a consolidated national campaign against illegal drugs, resolving difficulties that may arise when so many different agencies of the Federal Government must be involved in a unified effort.” ? However, testimony reveals that prevention efforts at the national level remain scattered and are frequently duplicated by other agencies, negatively affecting the efforts of state and local prevention administrators and providers.
11. Representatives of communities of color believe prevention programming efforts and research are not culturally sensitive, nor as effective as they should be. This is primarily because of a lack of sufficient minority representation in agencies of the Federal Government that conduct prevention-related efforts, and a lack of funding for minority researchers who can best identify and articulate the needs of their community.
12. The emergence of a two-tiered drug war has a profound impact on poor and minority populations. 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. They point to the disproportionate number of poor and minorities that are incarcerated, the lack of resources for high risk groups and generally, their lack of participation in, and control of American institutions which they believe are available for the more privileged. 4. Recommendations
The committee does not attempt to recommend any one strategy which would serve as a "model" prevention program. To do so would ignore the fact that communities across the United States are unique, with different strengths and weaknesses, problems and needs. The committee does discuss the factors that help communities to identify their problems, the suitability of available resources, the accessibility and control over appropriate resources, and the ability of communities to fund prevention programming that works for them. The committee heard from community representatives about exciting programs that are working for them. Examples of encouraging prevention programming in communities are detailed in this report. Comprehensive recommendations can be found at the end of the prevention section.
The committee is convinced that Congress and the Administration should revise the National Drug Control Strategy's prevention efforts to reflect the unique problems and needs of communities throughout the United States. Recognizing that no one strategy or program will prevent substance abuse, and that no one community is the same as or perceives their problems in quite the same way as another, will allow us to formulate effective prevention approaches. A strong national commitment to prevention programming will lead to sound investments in research and evaluations which will require a long-term commitment by federal, state and local governments. In this way, we will be addressing related public health and
? Testimony of William Bennett before the Committee on Government Operations, September 13, 1989, p. 1.
social welfare problems while understanding better the root causes of drug abuse.
To better enable the Congress and the Administration to formulate substance abuse prevention policy, the Committee on Government Operations recommends, among other things, that the National Drug Control Strategy:
1. Increase the drug abuse prevention budget to reflect a 5050 split of the National Drug Control Strategy budget allocation of law enforcement/interdiction and treatment and prevention.
2. Provide active national leadership in prevention programming to reflect the importance of prevention at the federal level and to coordinate the many departments and agencies undertaking prevention approaches.
3. Include "gateway drugs" such as alcohol and tobacco in the national drug strategy to reflect a comprehensive understanding and response to substance abuse.
4. Work with communities of color to develop consistent data collection mechanisms which would assist in the formulation of effective federal prevention policy, and in the provision of accountable guidelines for all pass-through (federal and state) funds, and provide essential information on prevention programming that works in these communities.
5. Create technical and training regional centers targeting communities of color to better disseminate material designs, testing, production information, and to provide training in project design, staff development, board training, organizational development, community outreach techniques, administration and management, documentation and evaluation techniques. These should preferably be developed by members of the target communities who have demonstrated that they can best identify and articulate the needs of their community.
6. Include significant community representation to involve people of color in all areas of the Federal Government structure related to substance abuse prevention; e.g., in the Office of Substance Abuse Prevention, Department of Education, Drug Enforcement Administration, National Institute on Drug Abuse, and the Alcohol, Drug Abuse, and Mental Health Administration to assure equal access to, and cultural sensitivity in prevention programming services.
7. Utilize state-of-the-art research which identifies risk factors that are predictive of adolescents and adults who are more prone to substance abuse, thereby allowing better targeting of prevention programming efforts in the community.
8. Better articulate an understanding that drug abuse prevention programming is comprised of multiple complex factors (as opposed to a "magic bullet”) that must work together in the long-term battle against substance abuse. This requires giving constant support and considerable latitude to the community to allow them to identify the best way to solve particular problems based on their needs.
9. ONDCP should convene a panel of prevention experts to assess the efficacy of the Department of Education's (DOE) pre