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for, and not available to, the highest risk populations, primarily those who are not in school.
Casual drug use among the educated middle class has declined significantly, while simultaneously inner city addiction has increased. This is not happenstance, but rather reflects education and prevention efforts developed for the educated middle class and the lack of treatment programs for those unable to afford them. The educated middle class is the easier community to reach through both prevention and treatment efforts. Successful prevention and treatment programs that meet the needs of an ethnically and racially diverse urban population beset with a myriad of other socio-economic problems including inadequate housing, education, job skills, and employment opportunities, are far more difficult to develop
The objectives developed to measure success in the war on drugs, the majority of which relate to casual drug use, reflect this bias. By using objectives that virtually ignore the drug use in the inner cities, the Office of National Drug Control Policy does not have to focus its attention on this side of the drug war.
It has become evident that a two-tiered drug war is being waged. Prevention programs primarily target young people in school, effectively eliminating the high risk drug using populations that have dropped out, are truant or unemployed graduates. The communitybased prevention programs available in the inner cities are frequently insensitive to and inappropriate for the needs of a multicultural, ethnically diverse urban population.
Drug use in the primarily poor, ethnic and minority underclass in the United States has become increasingly criminalized. Forty percent of drug-related arrests are African American, whereas only 12 percent of the drug using population are of African Americans. Minority communities have much less access to treatment programs due to a lack of program slots at public facilities, and the lack of insurance which would make them eligible for other available treatment modalities. Drug treatment programs that are partially or wholly subsidized by third-party medical insurance are not readily available to the poor and unemployed.
A successful drug strategy must be framed in broader social and economic problems requiring dramatic reforms in order to attack the root causes of substance abuse. The key to winning the war on drugs lies in the potential of prevention strategies to break the vicious cycle of abuse and addiction, and making treatment programs available to all who need it. Demand reduction strategies must be the cornerstone of successful drug policy.
While increased funding for prevention programming is desperately needed, the continued emphasis on traditional concepts of prevention strategies which stress a school-based orientation and on which the "Just Say No” concept was spawned, will perpetuate the inequities inherent in the current drug policy. Inevitably, inner city residents and communities of color will continue to represent a disproportionate number of abusers and addicts.
The following report addresses the salient issues concerning substance abuse prevention and treatment efforts and the actions that should be taken to provide more responsive, comprehensive demand reduction programming that would reach all segments of the American population.
Union Calendar No. 585
HOUSE OF REPRESENTATIVES
THE ROLE OF DEMAND REDUCTION IN THE NATIONAL
DRUG CONTROL STRATEGY
NOVEMBER 30, 1990.-Ordered to be printed
Mr. CONYERS, from the Committee on Government Operations,
submitted the following
DISSENTING AND ADDITIONAL VIEWS
BASED ON A STUDY BY THE LEGISLATION AND NATIONAL SECURITY
On October 19, 1990, the Committee on Government Operations approved and adopted a report entitled "The Role of Demand Reduction in the National Drug Control Strategy." The chairman was directed to transmit a copy to the Speaker of the House.
I. SUBSTANCE ABUSE PREVENTION
There is nearly universal consensus that a solution to substance abuse can best be accomplished by reducing both the availability of (supply), and the desire to use (demand), illicit drugs. Yet, nearly three-fourths of the Federal Government funds, and thus efforts, for the current war on drugs are directed to stemming the supply of drugs coming into the United States: interdiction, and attempting to deter use through punishment and law enforcement. While interdiction and law enforcement are necessary components of a comprehensive strategy, demand reduction efforts-prevention and treatment, are of equal, if not greater, importance in the war on drugs.
Prevention programs are our most constructive, humane and cost effective defense in the war on drugs. Considered a relatively new field in the work on substance abuse, prevention is the most encouraging new area yet it remains severely underfunded. Research indicates that a successful prevention strategy is comprised of a comprehensive system of promising approaches. The system must address multiple risk factors in the community, be implemented by and across many community agencies and the private sector, begin early in children's lives and be sustained through adolescence.3 Prevention ultimately seeks to shape attitudes about substance abuse, and necessarily pertains to the appropriate stage of drug involvement of an individual or community. Moreover, it should be relevant to those who have never used illicit drugs or who are in the early stages of experimentation. Preventing the onset of use is the cornerstone of a successful drug strategy.
This section of the report examines the National Drug Control Strategy's prevention efforts and recommends appropriate action necessary to strengthen this component of the Nation's substance abuse policy. 2. History
The Anti-Drug Abuse Act of 1988 created the Office of National Drug Control Policy (ONDCP) to lead national efforts against illegal drugs and to coordinate the different agencies of the Federal Government responsible for anti-narcotics efforts including the Department of Education and the Office of Substance Abuse Prevention (OSAP).
The Office of Substance Abuse Prevention was created by the Anti-Drug Abuse Act of 1986 to lead the Federal Government's efforts to prevent alcohol and other drug abuse. The 1988 Act significantly expanded the scope and functions of OSAP, increased its responsibilities and broadened its mandate.
Similarly the Department of Education was given broader responsibilities for prevention programming under the Drug-Free Schools and Communities Act Amendments of 1989 and Title V of the Elementary and Secondary Education Act of 1965 as amended by the Anti-Drug Abuse Act of 1988.
The United States traditionally has invested very little in prevention programming, particularly outside of the school system. Prevention efforts at the federal level have been severely underfunded and have lacked coordination. In Fiscal Year 1989, only 10.7 percent of the total National Drug Control Strategy budget went to prevention efforts; only 11.8 percent in Fiscal Year 1990; and, only 11.7 percent is slated in the President's 1991 budget for preventionrelated efforts.
Prevention in the 1990s is still an emerging discipline, and one that has greatly evolved over the past decade. Early demand reduction efforts centered on various forms of treatment. Increasingly, however, the evidence indicated that in order to wage a successful war against drugs, this problem should not be isolated from the
3 Written response to questions by Allan Y. Cohen, Executive Director, Pacific Institute for Research and Evaluation, before the Legislation and National Security Subcommittee, July 17, 1990, p.1.