THE CHALLENGE V9 N5THE CHALLENGE V9 N4
he United States’ drug control policyhas historically focused on law en-forcement efforts to control drug traffick-ing and use of illicit drugs. The bulk of the$40 billion budget has been used for pro-grams that control the amount of illicitdrugs that comes into the U.S. to longersentences for drug dealers. But more andmore, the U.S. public is supporting preven-tion as a drug control policy issue. Withthat in mind, RAND’s DrugPolicy Research Center(DPRC) undertook the pow-erful question: “How effec-tive is prevention and at whatprice?”In its new publication, “AnOunce of Prevention, APound of Uncertainty,”DPRC seeks to clarify theissue of prevention pro-grams’ effectiveness. Afterstudying the cost-effective-ness of two drug controlstrategies — law enforce-ment and treatment — DPRCdetermined that it was time toanalyze drug prevention pro-grams as another aspect of drug control spending. Al-though there is little evalua-tion of drug preventionprograms currently in print, DPRC wasable to determine that school-based drugprevention programs are, in fact, cost ef-fective, although the results are filled withdoubts.To begin its research, DPRC chose re-duction in U.S. cocaine consumption as theobjective of the nation’s drug control ef-fort. Cocaine is considered the most prob-lematic illicit drug in our country, andalthough most school-based programs tar-get marijuana, alcohol, and tobacco con-sumption, DPRC was able to calculatefuture consumption of cocaine by drugprevention program participants based onreductions in marijuana use. It is also notedthat DPRC’s previous cost-effective stud-ies on law enforcement and treatment fo-cused on these two strategies’ abilities toreduce cocaine consumption. And there-fore, studying prevention’s ability to re-duce cocaine consumption allowed forcomparison of the various drug controlstrategies.To arrive at its conclusions, DPRC firstconsidered two model school-based pre-vention programs and created a calculationto determine just how effective these pro-grams are in reducing cocaine consump-tion in the programs’ participants. The twoprograms reviewed are Life Skills Trainingand Project ALERT. These programs werechosen because DPRC wanted “best prac-tice programs,” so it could look at whatprevention could do, versus what preven-tion had been doing. The two programshave been recognized as excellent pro-grams and both have clear documentationabout program participants, program con-tent, and evaluations.
DPRC’s calculation is a multiplicationof eight different factors contributing toprevention’s effectiveness at reducing co-caine consumption. These factors are:1.Proportion of persons who would haveever used cocaine, times2.Lifetime cocaine consumption per user,times3.Percentage reduction in cocaine use dueto prevention programs, times4.Discount factor, times5.Social multiplier, times6.Market multiplier, times7.Causation/correlation ratio, times8.Scale-up factor.Throughout the discussion of this calcu-lation, DPRC provides a low, middle, andhigh estimate for each factor. This wasdone because of uncertainties in securing adependable number for each factor. Factornumber one was based on information ob-tained from the National Household Sur-vey of Drug Abuse (NHSDA), whichreports on the numbers of people using co-caine in a given year. Factor number 2 wasmore difficult to determine because thereis no literature on this statistic. The sim-plest way to learn this number is to dividetotal consumption by number of peoplewho initiated cocaine use for a set period.Other methods were described in the re-port, which include variables such asheavy users versus light users, and weretaken into consideration when calculatingthe range of numbers for this factor.Factor number 3 is where the informa-tion from Life Skills Training and ProjectALERT comes into play. Although neitherprogram has data on lifetimecocaine consumption,DPRC took the figures forreduction in marijuana initi-ation. From that it used in-formation from NHSDAwhich shows that delays inmarijuana initiation lowerslikelihood of ever using co-caine and, for those who douse it, lower levels of con-sumption. DPRC then had toconsider the permanence of the prevention program’s ef-fect on reducing cocaineconsumption, and again de-termined a best case sce-nario (100% permanence) toa worst case scenario (0%permanence).The discount factor(number 4 in the calculation) is there toshow that people would rather have bene-fits from a program sooner rather thanlater, and the discount factor accounts forthe benefits of prevention that accumulateover time. Factor number 5 accounts forthe positive influence a prevention pro-gram can have over people not participat-ing in the program — by influencing thosearound the program participant. DPRC ar-rived at this data by relating it to the num-ber of heavy and light users in a givenperiod. The market multiplier relates thefact that reduced consumption by programparticipants creates reduced demand forthe drug, which increases the amount of law enforcement relative to the amount of use.Factor number 7 appears in the calcula-tion because there are ways in which a pro-gram’s effect may be overestimated. Forinstance, if the program only affects mari- juana use, but not whatever drives cocaineuse, future reduction in marijuana initia-tion may imply nothing about future co-caine use. Thus, factor number 7. Factornumber eight is included in this report be-cause DPRC wanted to analyze the possi-bility of national implementation of a
RAND’s Drug Policy Research Center studiesprevention’s effectiveness
An Ounce of Prevention,A Pound of Uncertainty
by Jonathan P. Caulkins,C.Peter Rydell, Susan S.Everingham, James Chiesa,and Shawn Bushway, 1999.Available from RANDDistribution Services(telephone: 310-451-7002;FAX: 310-451-6915).This document may be viewedon-line at www.rand.org/ publications/MR/MR923/.