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Foreword January 1999

Americans are united in their belief that the drug problem represents a serious threat to
our country. The campaign to reduce drug abuse in America is a comprehensive, concerted
effort by all levels of government -- federal, state, and local -- as well as non-governmental
organizations, the private sector, and individual citizens. The 1999 federal drug control budget
is a record $17.8 billion; of this, over 33 percent, or $5.9 billion, is spent on demand reduction
efforts. This does not include spending by states, local communities, or private organizations.
We have seen positive results from our combined efforts. Current drug use (that is use of an
illicit drug in the previous month) among those 12 or older is now estimated at approximately
13.9 million Americans, or 6.4 percent of the population. This is a decline of over 50 percent
since 1979 when 14.1 percent of Americans were current drug users.

Our goal is to cut today’s drug use in half -- to 3.1 percent of the population -- by the year
2007. We need to bring down the level of drug abuse. Moreover, drug abuse is costly to
Americans. In financial terms, drug abuse costs approximately $110 billion annually. More
serious than that, however, is the cost of drug use to the societal underpinnings of our country.
Drug abuse fuels crime, fills our emergency rooms, means lost productivity to businesses, and
lost futures to teens.

The National Drug Control Strategy is a ten-year plan for reducing drug use in America.
The Strategy proposes international, interdiction, and law enforcement efforts to reduce the
availability of drugs in the United States. But primary among its goals is reducing the demand
for drugs. Research has shown that those addicted to drugs impose greater health costs upon
society and are responsible for more of our crime. Demand reduction’s approach is to treat and
rehabilitate the addicted, convince the occasional user to stop using, and prevent non-uses from
ever starting.

Education, prevention, and treatment are the components of demand reduction. This
booklet highlights the major federal, demand reduction programs and initiatives now underway
which will help bring drug use to historic new lows. These initiatives and programs are not the
only demand reduction efforts in the United States. The solution calls for a coordinated,
nationwide effort that incorporates every level of government, neighborhood organization, and
community structure. Demand reduction is everyone’s business. Together, we can have an
impact on the future of America

Barry R. McCaffrey
Director

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January 1999

Table of Contents

Page
Chapter I C Changing Patterns of Drug Use in America
A. Two Decades of Progress .............................................................1
B. Teen Drug Use Stable for Second Consecutive Year .................. 1
C. Chronic Drug Use Remains a Serious Public Health Problem ...2
D. Emerging Drug Threats ................................................................3
1. Heroin .......................................................................................3
2. Methamphetamine ...................................................................4
E. Drug Use Continues to Take a Toll on American Society............4
F. Drug-Related Medical Emergencies Near Historic Highs ...........5
G. Drug Abuse Affects Business Productivity .................................5
H. Drug Use Closely Linked to Crime and Violence ........................6

Chapter II C Demand Reduction Goals, Objective and


Target Measurement
A. Demand Reduction C Cornerstone of the U. S. Response ...........7
B. Foundations of Strategic Goals and Objectives ...........................7
C. Demand Reduction Goals, Objectives and Rationale .................8
D. Principles of U. S. Demand Reduction Effort ........................... 11
1. Prevention................................................................................ 12
2. Treatment and Rehabilitation Services .................................. 13
3. Focus on the Criminal Justice System ................................... 15
E. Providing Greater Accountability: Performance Measures
of Effectiveness (PME) System................................................... 16
1. Demand Reduction ................................................................. 16
2. Drug Use Consequences ......................................................... 18
F. Federal Government Commitment to Demand Reduction ....... 19
G. Private Sector Involvement Critical to Demand Reduction ...... 19

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Chapter III C United States Efforts to Reduce Demand for Drugs

A. Prevention
1. National Youth Anti-Drug Media Campaign.............................. 21
2. Mobilizing Community Anti-Drug Coalitions ............................ 23
3. Drug-Free Schools and School Coordinator Programs .............. 24
4. Parenting and Mentoring Initiative............................................. 26
5. Youth Drug Prevention Research ............................................... 27
6. Improving State Planning for Prevention ................................... 28
7. Civic Alliance: Prevention Through Service .............................. 28
8. Reducing Youth Use of Tobacco and Alcohol ............................. 29
9. Youth Athletic Initiative Against Drugs ..................................... 30
10. National Guard Drug Demand Reduction Program ................ 31

B. Treatment
1. Close the Public System Treatment Gap..................................... 31
2. Expansion of Treatment in the Criminal Justice System ........... 32
3. Treatment Research Developments and Evaluation.................. 34
4. Reduce Infectious Disease Among Injecting Drug Users ........... 37
5. Training for Substance Abuse Professionals............................... 38

C. Workforce Demand Reduction ............................................................. 39

D. Addressing Emerging Drug Threats


1. Domestic Heroin Initiative ........................................................... 42
2. Countering the Methamphetamine Threat ................................. 42
3. Increasing Awareness of Inhalant Abuse .................................... 43

E. Building International Cooperation in Demand Reduction ................. 43

Bibliography ............................................................................................... 47

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Despite this dramatic drop, 34.8 percent of
I. Changing Patterns of Americans twelve and older have used an
Drug Use in America illegal drug in their lifetime; of these, more
than 90 percent used either marijuana or
A. Two Decades of Progress hashish, and approximately 30 percent tried
cocaine. Fortunately, sixty-one million
During the late 1970s through the mid- Americans who once used illegal drugs have
1980s, the United States experienced an now rejected them.
unprecedented epidemic of illegal drug use.
In 1979, twenty-five million Americans B. Teen Drug Use Stable for
C14.1 percent of the population aged 12 and Second Consecutive Year
over and the highest level ever recorded C
had used an illegal drug at least once in the After five years of increase, drug use by
month prior to being surveyed. Last year, American teens has remained steady—or has
the National Household Survey on Drug decreased—for two consecutive years.
Abuse (NHSDA) estimated that about 13.9 According to the 1998 University of
million Americans, or 6.4 percent of the Michigan Monitoring the Future Survey
population, had used illegal drugs. Since (MTF), nearly all categories of drug use by
1979, the number of Americans who use eighth, tenth, and twelfth graders have either
illegal drugs has dropped by nearly 50 declined or remained unchanged for the
percent, and the percentage of the population second consecutive year. This follows five

Current use of cocaine is down significantly

Millions of Users
6
5
4
3
2
1
0

1985 1988 1990 1991 1992 1993 1994 1995 1996 1997

5.7 3.1 1.7 2.0 1.4 1.4 1.4 1.5 1.8 1.5

Fig 1 Source: 1997 National Household Survey on Drug Abuse

using drugs has years of significantly rising drug use during


fallen by a remarkable 57 percent. Few other the period 1992 through 1996.
chronic societal problems have been reduced
by a comparable magnitude. (Figure 1) From 1992 through 1996 illegal drug use
increased substantially, particularly for

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marijuana but also for such drugs as cocaine a Serious Public Health and
and heroin. For example, marijuana use by
eighth graders nearly tripled. In addition, the
Law Enforcement Problem
period in which teen drug use was increasing
was preceded by erosion of anti-drug Researchers estimate the number of chronic
attitudes among youth. Both the perceived cocaine users at 3.6 million and heroin users
harmfulness of regular illicit drug use as well at 810,000. Yet, estimates of the number of
as the perceived social disapproval of drug chronic users C that is, those who use drugs
use fell significantly among all categories of heavily C are imprecise because many
youth. (Fig 2) individuals who are deeply involved in drugs
are difficult to locate for interviews.
Youth Attitudes and Their Effect on Marijuana Use
Drug use among 12th graders can be linked to changes in
attitudes about risk and social acceptability.

% reporting past month marijuana use


25
90
Percents reference attitudes

80 20

70
15
60
Disapproval of Drug Use
Perception of Risk
First Drug Use
50 10
1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

Source: 1998 Monitoring the Future Study. Fig 2

For example, the Household Survey does not


The results of the 1997 and 1998 MTF survey transients who do not reside in
surveys give cause for optimism that teens shelters, nor those incarcerated in prisons or
are beginning to heed the prevention jails. Learning more about the demographics
message. For example, past-year drug use of chronic users is vital. Chronic users
by tenth graders fell from 38.5 percent to 35 maintain the illegal drug market, commit a
percent, while the percentage of eighth great deal of crime, and contribute to the
graders who viewed marijuana use as risky spread of hepatitis, tuberculosis, HIV/AIDS
increased. Despite these promising signs, the and other sexually transmitted diseases.
levels of teen drug use remain far too high, Without a reasonable estimate of the number
and attitudes toward illicit drugs still far too of chronic users, initiatives responsive to the
lax. Aggressive prevention efforts over the scale of the problem are difficult to develop.
next decade should continue to bring these
levels down. An Office of National Drug Control Policy
(ONDCP)-funded large-scale feasibility
study, conducted in Cook County, Illinois,
C. Chronic Drug Use Remains underscored the difficulty of estimating the

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number of chronic users and the tendency of
survey instruments to undercount. The 1. Heroin
Cook County survey interviewed self-
professed chronic users where they are most Studies estimate that there are 810,000
likely to be found in large numbers: jails, chronic users of heroin (defined as those
drug-treatment programs, and homeless who use heroin 51 or more day per year) in
shelters. Researchers sought to learn about the United States. Injection remains the
the characteristics of heavy drug-users and most common means of administration,
the frequency with which they made contact particularly for low-purity heroin. However,
with institutions. The survey estimated that the increasing availability of high-purity
333,000 chronic drug users were in Cook heroin has made snorting and smoking more
County. The results of this study of drug common, thereby lowering inhibitions to use.
abuse in one county cannot be extrapolated Among lifetime heroin users, the proportion
nationwide. The next step will be applying who had ever smoked, sniffed, or snorted
this approach to an entire region and then, heroin increased from 55 percent in 1994 to
assuming the results are accurate, to the 63 percent in 1995, and 82 percent in 1996.
whole country.
The growing use of heroin by young people
Heroin initiation rates have risen
dramatically since 1992
Heroin Initiates (1000s)
200

150

100

50

0
70 72 74 76 78 80 82 84 86 88 90 92 94 96
Source: 1997 Household Survey
Fig 3

D. Emerging Illegal Drug is an alarming recent trend. (Fig 3)


According to the Monitoring the Future
Threats study, while still low, the rates of heroin use
among teenagers rose in eighth, tenth, and
Cocaine and marijuana have long been twelfth grades during the 1990s. For
America’s most frequent drugs of abuse. In example, for twelfth graders, the prevalence
recent years, however, other substances have increased from 0.9 percent in 1991 to 2.0
become increasingly serious threats to percent in 1998 and this increase was highly
Americans, including young Americans. statistically significant. The 1997 NHSDA
Among these emerging threats are heroin found that the mean age of initiation declined
and methamphetamine. from 26.2 years in 1988 to 18.1 in 1996.

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Communities throughout the country are nation. Between 1992 and 1994, positive
experiencing the results of increased heroin rates for methamphetamine among adult
abuse. Plano, Texas, had eleven heroin- arrestees rose steadily in eight cities (Dallas,
overdose deaths in 1997; many of the victims Denver, Los Angeles, Omaha, Phoenix,
were children. Orlando, Florida saw forty- Portland, San Diego, and San Jose), reaching
eight heroin deaths in 1995 and 1996; ten as high as 44 percent in San Diego and 25
victims were twenty-one years of age or percent in Phoenix in 1994. While the rates
younger. fell significantly for the next two years C to
2. Methamphetamine 30 percent in San Diego and 12 percent in
Phoenix C 1997 data shows that
The 1997 NHSDA estimated that 5.3 million methamphetamine use has returned close to
Americans (2.5 percent of the population) 1994 levels.
tried methamphetamine in their lifetime, up
insignificantly from 1994, when 1.8 percent
of the population had ever used
E. Drug Use Continues to Take
methamphetamine. The National Institute of a Toll on American Society
Justice=s (NIJ) 1997 Arrestee Drug Abuse
Monitoring (ADAM) Annual Report on Illegal drugs cost our society approximately
Adult and Juvenile Arrestees (which 110 billion dollars each year, (Fig 4)
The Economic Costs relating to alcohol and drug abuse
are increasing, adding up to $377 billion in 1995

$300
$110
$250
$98

$200
Billion Dollars

$67 $167
$150
$58 $148

$100 $44
$99
$86
$70
$50

$0
1985 1988 1990 1992 1995

Drugs Alcohol
Sources: Rice et al. 1990; Robert Wood Johnson Foundation, 1993; National Institute on
Drug Abuse & National Institute on Alcohol Abuse and Alcoholism, March 1998.

Fig 4
regularly tests arrestees for drug use in according to the National Institute on Drug
twenty-three metropolitan areas) reports that Abuse (NIDA) and the National Institute on
methamphetamine use continues to be more Alcoholism and Alcohol Abuse (NIAAA).
common in the west, southwest, and Estimates of these costs have risen steadily
midwest United States than in the rest of the since 1985, despite decreases in the number

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of chronic drug use -- create serious problems for hospital Emergency
Departments

Cocaine and Heroin Hospital Emergency


Room Mentions, 1978 - 1996
160,000

140,000

120,000

100,000

80,000

60,000

40,000

20,000

0
78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96

Cocaine
Heroin
Source: HHS Drug Abuse Warning Network
Fig 5

of Americans who use illegal drugs. related emergency room visit in the first half
Accidents, crime, domestic violence, illness, of 1997 was overdose, which comprised 49
lost opportunity, and reduced productivity percent of all episodes. Cocaine-related
are the direct consequences of substance emergency room episodes remained about
abuse. Drug and alcohol use by children the same in 1995 (137,979) and 1996
often leads to other forms of unhealthy, (144,180). The increasing incidence of
unproductive behavior including delinquency cocaine emergencies among persons aged
and premature, unsafe sex. Drug abuse and thirty-five and older continued through 1996,
trafficking hurt families, businesses, and rising 184 percent from the 1990 level.
neighborhoods, impede education, and choke Heroin-related episodes declined slightly
criminal justice, health, and social-service between 1995 and 1996 from 72,229 to
systems. 70,463, yet were 108 percent higher than in
1990. Although the change between 1995
F. Drug-Related Medical and 1996 is not statistically significant, the
decline is the first since 1990. (Figure 5)
Emergencies Remain Near
Historic Highs Methamphetamine/speed-related visits to
emergency rooms increased steadily between
SAMHSA=s Drug Abuse Warning Network the first half of 1988 and the first half of
(DAWN), which studies drug-related 1991 fell by 57 percent during the first half
hospital emergencies, provides a snapshot of of 1996, but are rising again. According to
the health consequences of America=s drug
problem. DAWN reported that drug-related DAWN statistics, they increased 100 percent
episodes increased by 25 percent between between the first half of 1996 and the first
the half of 1997, from 4,200 to 8,400.

first half of 1992 and the first half of 1997,


from 214,600 to 269,000. There was a G. Drug Abuse Affects
seven- percent increase between the first half Business Productivity
of 1996 and the first half of 1997.
According to the 1997 NHSDA, 6.7 million
During this same time, the number of total current illegal drug users were employed
drug episodes increased among those aged full-time; this number represents 6.5% of
18-25 (11%) and 35 and over (10%). The full-time workers aged 18 and older. Drug
most frequently recorded reason for a drug- users are less dependable than other workers

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and decrease workplace productivity. They test positive for more than one drug. About
are more likely to have taken an unexcused half of those charged with violent crimes or
absence in the past month; according to a income-generating crimes such as robbery,
SAMHSA study released in 1997, An burglary or theft test positive for more than
Analysis of Worker Drug Use and one drug. Therefore, it is clear that this
Workplace Policies and Programs, 12.1 population is deeply involved in drug use.
percent did so compared to 6.1 percent of According to a study in Baltimore, the drug
drug-free workers. Illegal drug users get users coming through the court system are
fired more frequently (4.6 percent were highly dependent upon illegal substances as
terminated within the past year compared to measured by traditional addiction severity
1.4 percent of non-users). Drug users also instruments
switch jobs more frequently; 32.1 percent
worked for three or more employers in the Although the ADAM program found little
past year, compared to 17.9 percent of drug- change in overall drug use among arrestees
free workers. One quarter of drug users left between 1996 and 1997, these data do not
a job voluntarily in the past year. reflect changing patterns of drug use such as
an increase in the use of methamphetamine,
H. Drug Use Closely Linked to and the decrease in use of cocaine and
marijuana. Cocaine/crack use seems to be
Crime and Violence declining in most cities, although individual
cities have experienced epidemics. Opiate
Crime in general continues to decline in the use is more often seen in older arrestees; the
U.S. The FBI=s 1997 Preliminary Uniform exceptions to this are New Orleans,
Crime Reports notes that serious crime has Philadelphia, and St. Louis. Marijuana use,
continued its downward trend as indicated by however, is disproportionately concentrated
a 4 percent decline from 1996 figures, the among youthful arrestees.
sixth consecutive annual decrease in reported
crime. Yet arrests for drug-law violations
are at record highs. More than 1.5 million
Americans were arrested for drug-law
violations in 1996. Many crimes (e.g.,
assault, prostitution, and robbery) are
committed under the influence of drugs or
may be motivated by a need to get money for
drugs. In addition, drug trafficking and
violence go hand in hand.

Research conducted at the Arrestee Drug


Abuse Monitoring Program (ADAM)
program shows consistently that between
one-half and three quarters of all arrestees
that were tested in 35 cities around the
country have drugs in their system at the
time of arrest. About a fifth of all arrestees

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involves prevention, treatment, research, law
II. Demand Reduction Goals, enforcement, protection of our borders, and
international cooperation.
Objectives and Target But among these approaches, Demand
Measurement Reduction is the key. The U.S. recognizes
that it will never be able to interdict all drugs
coming across our borders. Even if we
A. Demand Reduction – could, substantial amounts of drugs – for
Cornerstone of the U.S. example, marijuana and methamphetamine –
Response could still be produced domestically. Nor
can we ever arrest our way out of the drug
The National Drug Control Strategy problem. Continuing and expanding demand
proposes a ten-year conceptual framework reduction programs, as well as promoting
to reduce illegal drug use and availability 50 increased participation by the private sector,
percent by the year 2007. If the goal is are paramount objectives of the National
achieved, just three percent of the household Drug Control Strategy.

National Drug Control Strategy


Five Goals

1: Edcuate and enable America's youth to reject illegal drugs as well as alcohol
and tobacco.
2: Increase the safety of America's citizens by substantially reducing
drug-related crime and violence.
3: Reduce health and social costs to the public of illegal drugs.
4: Shield America's air, land and sea frontiers from the drug threat.
5: Break foreign and domestic sources of supply.

Fig 6

Population aged twelve and over would use B. Foundations of Strategic Goals
illegal drugs. This level would be the lowest and Objectives
recorded drug-use rate in American history.
Drug related health, economic, social, and The National Drug Control Strategy outlines
criminal costs would also be reduced five goals (see Figure 6) and thirty-two
commensurately. In order to achieve these objectives. These establish a framework for
goals, the Strategy call for a comprehensive, all national demand and supply reduction
balanced approach to the drug problem that drug-control agencies. These goals and

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objectives are intended to orient a national five goals: Goal 1, Goal 2, and Goal 3.
effort that will reduce illegal drug use and Associated with each of these Goals are a
availability by 50 percent over the next ten number of objectives, targets, and measures.
years. It must be stressed that the Strategy is The relationship is shown in Figure 7 and the
a comprehensive, balanced approach that following section outlines the objectives for
focuses on shrinking America’s demand for each demand reduction goal.
drugs, through treatment and prevention, and Goals and Objectives
attacking the supply of drugs through law
enforcement and international cooperation.
GOAL 1: Educate and enable
The goals and objectives reflect the need for
prevention and education to protect children America’s youth to reject illegal
from the perils of drugs; treatment to help drugs as well as alcohol and
the chemically-dependent; law enforcement tobacco.
to bring traffickers to justice; interdiction to
reduce the flow of drugs into our nation; Objective 1: Educate parents or other
international cooperation to confront drug care givers, teachers, coaches, clergy,
cultivation, production, trafficking, and use; health professionals, and business and
and research to provide a foundation based community leaders to help youth reject
on science. illegal drugs and underage alcohol and
tobacco use.

Performance Measurement
Framework

Measures
Targets
Objectives
Goals
Mission
Targets define desired end-
states with which to compare
Objectives actual performance. Impact
The Mission of the National Measures represent
define Major Targets reflect impact on the
Goals define the means (variables
Drug Control Strategy is to Lines of five Strategy Goals; the
Major Directives and events) for
reduce drug use (demand), Action to remaining Performance tracking progress
drug availability (supply), and or Directions Targets show progress
achieve the towards targets.
the consequences. of the Strategy. towards the 32 Objectives.
desired Goal.

Fig 7

C. Demand Reduction Goals,


Objectives and Rationale

Demand reduction is integral to three of the Rationale: Values, attitudes, and behavior

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are forged by families and communities.
Alcohol, tobacco, and drug-prevention for Objective 4: Provide students in grades
youngsters is most successful when parents K- 12 with alcohol, tobacco, and other
and other concerned adults are involved. drug prevention programs and policies
Information and resources must be provided that are evaluated, tested and are based
to adults who serve as role models for on sound practices and procedures.
children so that young people will learn
about the consequences of drug abuse. Rationale: The federal government is
Objective 2: Pursue a vigorous uniquely equipped to help state and local
advertising and public communications governments and communities gather and
program dealing with the dangers of disseminate information on successful
illegal drugs, including alcohol and approaches to the problem of drug abuse.
tobacco use by youth.
Objective 5: Support parents and adult
Rationale: Anti-drug messages conveyed mentors in encouraging youth to engage
through multiple outlets have proven in positive, healthy lifestyles and modeling
effective in increasing knowledge and behavior to be emulated by young people.
changing attitudes about drugs. The trend
over the past six years of a decreased Rationale: Children listen most to adults
perception of risk connected to drug use they know and love. Providing parents with
among all adolescents correlates with a drop resources to help their children refrain from
in the frequency of anti-drug messages in the using alcohol, tobacco, and other drugs is a
media and an increase in images that wise investment. Mentoring programs also
normalize drug use. Anti-drug publicity by contribute to creating bonds of respect
the private sector and non-profit between youngsters and adults, which can
organizations must be reinforced by a help young people, resist drugs.
federally funded campaign to change young
people=s attitudes about illegal drugs. Objective 6: Encourage and assist the
development of community coalitions and
Objective 3: Promote zero tolerance programs in preventing drug abuse and
policies for youth regarding the use of underage alcohol and tobacco use.
illegal drugs, alcohol, and tobacco within
the family, school, workplace, and Rationale: Communities are logical places
community. to form public-private coalitions that can
influence young people=s attitudes toward
Rationale: Children are less likely to use drugs, alcohol, and tobacco. More than
illegal drugs or illicit substances if such 4,300 groups around the country have
activity is discouraged throughout society. already established broad community-based
Prevention programs in schools, workplaces, anti-drug efforts.
and communities have already demonstrated
effectiveness in reducing drug use. Such Objective 7: Create partnerships with the
success must be increased by concerted media, entertainment industry, and
efforts that involve multiple sectors of a professional sports organizations to avoid
community working together. the glamorization, condoning, or

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normalization of illegal drugs and the use
of alcohol and tobacco by youth. GOAL 2: Increase the safety of
America==s citizens by substantially
Rationale: Discouraging drug abuse reducing drug-related crime and
depends on factual anti-drug messages being violence.
delivered consistently throughout our
society. Celebrities who are positive role Objective 4: Develop, refine, and
models can convey accurate information implement effective rehabilitative
about the benefits of staying drug-free. programs -- including graduated
sanctions, supervised release, and
treatment for drug-abusing offenders and
accused persons -- at all stages within the
Objective 8: Support and disseminate criminal justice system.
scientific research and data on the Rationale: The majority of offenders
consequences of legalizing drugs. arrested each year have substance abuse
problems, and significant percentages are
Rationale: Drug policy should be based on chronic substance abusers. This interface
science, not ideology. We must understand provides an opportunity to motivate addicts
that control of substances that are likely to to stop using drugs.
be abused is based on scientific studies and
intended to protect public health. Objective 5: Break the cycle of drug
abuse and crime.
Objective 9: Develop and implement a set
of principles upon which prevention Rationale: Our nation has an obligation to
programming can be based. assist all who come in contact with the
criminal- justice system to become drug-free.
Rationale: Drug prevention must be Recidivism rates for inmates given treatment
research-based. Prevention programs must declines substantially. The reduction of drug
also take into account the constantly abuse among persons touched by the
evolving drug situation, risk factors students criminal-justice system, crime will decrease.
face, and community-specific problems.
Objective 6: Support and highlight
Objective 10: Support and highlight research, including the development of
research, including the development of scientific information and data, to inform
scientific information, to inform drug, law enforcement, prosecution,
alcohol, and tobacco prevention programs incarceration, and treatment of offenders
targeting young Americans. involved with illegal drugs.
Rationale: Reliable prevention programs Rationale: Law-enforcement programs and
must be based on programs that have been policies must be informed by updated
proven effective. We must influence youth research. When success is attained in one
attitudes and actions positively and share community, it should be analyzed quickly
successful techniques with other concerned and thoroughly so that the lessons learned
organizations.

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can be applied elsewhere. reduce drug use.

GOAL 3: Reduce health and social Objective 4: Support and promote the
costs to the public of illegal drug use. education, training, and credentialing of
professionals who work with substance
Objective 1: Support and promote abusers.
effective, efficient, and accessible drug
treatment, ensuring the development of a Rationale: Many community-based
system that is responsive to emerging treatment providers currently lack
trends in drug abuse. professional certification. The commitment
and on-the-job training of these workers
Rationale: A significant number of should be respected by a flexible
American citizens have been debilitated by credentialing system that recognizes first-
drug abuse. Illness, dysfunctional families, hand experience even as standards are being
and reduced productivity are costly by- developed.
products of drug abuse. Effective treatment
is a sound method of reducing the health and
social costs of illegal drugs.

Objective 2: Reduce drug-related health Objective 5: Support research into the


problems, with an emphasis on infectious development of medications and
diseases. treatment protocols to prevent or reduce
drug dependence and abuse.
Rationale: Drug users, particularly injecting
users, put themselves, their children, and Rationale: The more we understand about
those with whom they are intimate at higher the neurobiology and neurochemistry of
risk of contracting infectious diseases like addiction, the better will be our capability to
HIV/AIDS, hepatitis, syphilis, gonorrhea, design interventions. Pharmacotherapies
and tuberculosis. may be effective against cocaine,
methamphetamine, and other addictive
Objective 3: Promote national adoption of drugs. Research and evaluation may broaden
drug-free workplace programs that treatment options, which currently include
emphasize a comprehensive program that detoxification, counseling, psychotherapy,
includes: drug testing, education, and self-help groups.
prevention, and intervention.
Objective 6: Support and highlight
Rationale: Drug abuse decreases research and technology, including the
productivity. Approximately three-quarters acquisition and analysis of scientific data,
of adult drug users are employed. to reduce the health and social costs of
Workplace policies and programs, such as illegal drug use.
drug testing and Employee Assistance
Programs that include prevention, Rationale: Efforts to reduce the cost of
intervention, and referral to treatment can drug abuse must be based on scientific data.
Therefore, federal, state, and local leaders

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should be given accurate, objective intervention, and treatment programs;
information about treatment modalities. and

♦ The shifting of resource allocation


D. Principles of U.S. Demand decisions and program accountability
Reduction Effort from the federal to the state and local
level.
Once viewed as essentially a moral problem
or character defect, drug use is now more
accurately considered a complex behavioral 1. Prevention
problem with personal, social, and biological
underpinnings. Some individuals are at Progress in prevention will require
greater risk of drug related problems than are significant, long-term change in youth
others. Thus, implementing prevention attitudes toward drug use. Such a change in
strategies requires awareness of factors that attitudes will depend in large part on a
place individuals at increased risk and, consistent "no use" message from American
conversely, factors that protect individuals society, together with predictable negative
from such risk. Similarly, drug treatment consequences for use and affirmation of the
and rehabilitation strategies must address benefits of abstinence.
factors that foster or hinder entry into, and
successful completion of, drug treatment. Principles. Prevention programs must work
America's drug demand reduction strategy at all levels, but especially where they can do
takes into account: the most immediate good -- at the local level.
Local leaders must be given the tools to
♦ Scientific advances in our understanding implement and manage effective programs.
of education, prevention, and treatment,
which must be reflected in practice; ♦ Prevention must be incorporated into the
institutions that are closest to our
♦ Recent setbacks in youth attitudes children and our families. It must start
toward and use of drugs, especially with the informed leadership of parents
marijuana; and remain constant and consistent.

♦ Pro-use messages sent to our young ♦ Numerous scientific investigations have


people by well-organized drug established the fact that families play the
legalization efforts, the media, and other most important role in determining how
manifestations of popular culture; young people handled the temptations to
use alcohol, cigarettes, and illegal drugs.
♦ The cost and service reduction pressures If families are to succeed in preventing
inherent in managed health care substance abuse by children, many
approaches being adopted by private parents and children need to develop new
employers and public programs, which behaviors and skills.
threaten the effectiveness, stability, and ♦ Interrelated, family-focused prevention
continuity of prevention, early programs should be conducted in
schools, health clinics, faith communities,

33
workplaces, and communities. attention to appropriate booster sessions
during critical life transitions (e.g.,

Treatment Reduces Drug Use

Changes in Illicit Drug Use in 12 Months Before


Versus 12 Months After Treatment Exit
80
72.8%
70

Before Treatment
60
50.4% After Treatment
50

37.7% 39.5%
40

30 24.8% 23.6%
17.8%
20
12.6%
10

Primary Drug Crack Cocaine Heroin


Fig 8

♦ No one approach or program is the middle school to high school).


answer, but each is part of the answer.
Individual programs should be structured ♦ reflecting a sensitivity to the specific
to complement one another. They needs of gender, and particular ages and
should be viewed and judged in terms of ethnic and cultural groups.
their contribution to the overall,
cumulative results in the community. ♦ assessing and strengthening social norms
against drug use.
♦ Individual programs should be required
to incorporate the established results of ♦ imparting drug resistance skills, critical
research and evaluation and held thinking skills, social competency skills,
accountable for producing results. and the needed communication skills to
explain and reinforce personal anti-drug
♦ targeting all forms of drug use, including commitments.
underage alcohol and tobacco use.
♦ maintaining a family focus, with
♦ matching activities to the nature of the significant parent involvement.
problem in the community.
For example, school-based programs must:
♦ beginning early in young peoples' lives instill strong social norms against drugs,
and continuing with developmentally evoke a commitment to avoid drugs, provide
appropriate interventions. solid drug resistance skills, provide self-
♦ providing long-term, intensive efforts for management and social skills, recruit peer
children most at risk, with special leaders to work with teachers, and involve

34
parents in a strong leadership role with their society.
children.
Only the most structured interventions can
The federal government is uniquely equipped get chronic users and addicts into treatment,
to help states, local governments, and keep them in treatment, provide the
communities gather and disseminate supervision and support required to start
information on effective family, school, them on recovery, and enable them to
health provider, faith community, workplace, maintain their recovery over the long term.
and community prevention approaches. It is progressively more apparent that long-
Provision of information on proven effective term progress in reducing and managing this
approaches, and support for its application population requires a rehabilitation approach
must be our highest, short-term, domestic that: confronts and exposes thinking errors
priority. Federal government provision of and the addictive lifestyle, provides for
information about state-of-the-art values and character development, matches
approaches to prevention is also critical, and specific services to specific needs, and
must be continuous in response to new continues needed services for a significant
research findings. period of time.

Intensive (often residential) drug treatment


or therapy is essential for many addicts but
2. Treatment and Rehabilitation may be of reasonably short duration. The
Services services that prepare the addict for recovery
and support continuing recovery, while much
less expensive, are of much longer duration.
Reducing the numbers of addicted persons is
also essential to reducing drug demand.
While intervention and treatment are ♦ Vocational skills, social survival skills,
important first steps in accomplishing this relapse prevention skills, social
goal, many addicts also will require supervision and support, medication --
rehabilitation services if they are to achieve most of these will be necessary to some
stable abstinence and recovery. extent, and for a long period of time, to
allow the continuation of the process that
Drug addiction is a chronic relapsing begins with intensive treatment.
condition involving a long-term change in
brain chemistry. Drug seeking and using ♦ During this transitional, or "aftercare,"
behavior also trains the brain. Addicts are period self-help groups, social model
not simply sick people. Rather they are sick programs, faith-based programs, and
people who engage in a web of behaviors other nonprofessional groups can offer
that exacts a toll on the health and safety of the structure, sanctions, and support that
all society's institutions, starting with the are so critically needed.
family. Many drug users cannot, and
sometimes do not want to, control their Principles. Given the chronic relapsing
behavior. They may resist efforts to bring nature of addiction, the consequences of
their actions in line with the requirements of addictive behavior for the individual, the
family and society, and given the condition

35
of existing service systems, our efforts to formal, long-term rehabilitation plan, in
rehabilitate and assist people with addictive accordance with the results of the
disorders are governed by the following assessment; and review and revise it in
principles: accordance with periodic assessments.
This should include the initial intensive
♦ We must take full advantage of any therapy and pharmacology and the
opportunity to get addicts into a formal longer-term recovery plan.
treatment and rehabilitation program.
♦ All formal treatment interventions should
Ø The criminal justice system offers an include specific, realistic relapse
immediate opportunity to engage prevention training and compliance
significant numbers in treatment and motivation training, during the initial
long term rehabilitation; course of treatment and as a continuing
part of recovery.
Ø The child welfare system offers a
similar opportunity C most drug ♦ Consequences for non-compliance
dependent mothers can be motivated should be established clearly; they should
and helped to act in the interest of be graduated and employed swiftly and
their children. Since the children fairly.
who are involved in the child welfare
system are also at high risk for ♦ Treatment programs should be held
substance abuse, such involvement accountable for results in light of the
also offers an opportunity to prevent relative difficulty of the population they
future substance abuse by providing serve, as determined by the initial,
these children with needed comprehensive assessment.
therapeutic and supportive services.
♦ A supervision and support person or
♦ Existing criminal justice and child welfare organization should be designated for
systems of treatment and rehabilitation each person who completes the initial
should be expanded and systematic stage of treatment, to manage and
support and referral systems should be supervise and ensure continuing
developed for workplaces and health care compliance with the recovery plan.
service settings. The federal government plays a leadership
role in assisting the states to establish
♦ All treatment programs should employ a systems of rehabilitation. Federal treatment
comprehensive assessment instrument at programs, such as those in the Department
the point of intake, and to update that of Veterans Affairs and the Federal Bureau
assessment periodically during the course of Prisons, can lead by example. Grant-in-
of treatment and recovery. Programs aid programs, supported by the Departments
should assess progress and respond to of Health and Human Services and Justice,
lack of progress. provide explicit guidance and assistance to
states and localities.
♦ All treatment programs should develop a

36
3. Focus on the Criminal Justice
System ♦ Coerced Treatment Works. Addiction is
a brain disease, but one that often results
The nexus between drug use and the criminal in criminal behavior. Treatment of
justice system is clear. As Arrestee Drug addiction requires management of
Abuse Monitoring (ADAM) statistics show, behavior, and the criminal justice system
between one half and three quarters of all can provide Aincentives@ for an addict to
arrestees tested in the 35 ADAM cities have change behavior, such as rewards and
drugs in their systems at the time of their sanctions. It should be noted that
arrest. Not only are these arrestees deeply coercion also includes the threat of losing
involved in drugs, many are severely a job or a relationship.
addicted, and few have ever been in
treatment. Furthermore, frequent drug users ♦ Length of time in treatment is correlated
who are involved in the criminal justice with success. Drug use for individuals
system are responsible for consuming a who participated in either long-term
significant portion of the illegal drugs residential or outpatient treatment
consumed in this country. programs showed reductions in both
criminal activity and drug use, especially
Reducing drug use among the criminal those who had been in treatment for at
justice population not only contributes least 90 days. Research also shows that
significantly to the overall goal of reducing the presence of criminal justice
drug use by half by 2007, it also goes a long supervision increased the likelihood that
way to reducing crime in America. The the individual would stay beyond the 90-
treatment needs of the population under day mark.
control of the criminal justice system should
be based on four principles: ♦ Post-release supervision is an essential
ingredient to successful prison-based
♦ Treatment works. Not all treatment treatment. Results of an evaluation of
works equally well for all populations, Delaware=s Key-Crest Program, those
and relapse is to be expected. However, prisoners who participated in a
we are striving to be more accurate in transitional work release program after
matching treatment to drug users, and in-prison drug treatment were more than
hope to differentiate treatment settings twice as likely to remain drug free, and
that are appropriate for juveniles, for were one-third more likely to remain
poly-drug users, for those with co- arrest free eighteen months after release.
occurring substance abuse and mental
disorders, and for different, and for E. Providing Greater
different cultural and ethnic groups.
Scarce treatment resources have to be
Accountability: Performance
allocated according to the best match Measures of Effectiveness
between participant and provider, based (PME) System
on scientific evidence of effectiveness
and solid diagnostic profiles of clients. The pursuit of Strategy Goals and their

37
associated Objectives is expected to yield yield a nation-wide drug use rate of 3.1
measurable outputs and outcomes designated percent by 2007. The 3.1 percent rate would
as "performance targets." The be the lowest verified rate since the federal
Administration=s National Drug Control government began systematically tracking
Strategy PME system recognizes that such data. This ambitious undertaking is
performance measures must (1) assess the contingent on a long-term commitment by
Strategy=s overall impact on drug use, federal, state, local, foreign, and private
availability, and consequences, and (2) assess partners in drug control to achieve the Goals
the effectiveness of specific federal, state, and Objectives of the Strategy.
local and private sector programs and
activities that constitute the national drug The Impact Target for overall drug use
control effort. Measures are the means for requires success in the following three key
tracking progress toward the targets. areas: drug use by our nation=s youth; drug
Ultimately, data for the measures will be use in the workplace; and drug use by
provided by the federal, state, and local drug chronic drug users.
control agencies.
♦ Focus on Youth: Two Impact Targets
The Impact Targets, designed to reduce drug are related to current (past month) youth
use, availability, and drug use consequences, drug use. The intent is to delay the onset
establish desirable outcomes or end-states by of drug use, as measured by the mean
defining where the nation should aspire to age of drug use. By 2002, increase the
be, a decade from now. Five Impact Targets average age of first-time drug use by 12
are provided for demand reduction efforts months from the average age of first-
and two are provided for reducing the time use in the 1996 base year. By
adverse health and crime consequences of 2007, increase the average age of first-
drug use. These aggressive targets are time drug use by 36 months from that in
intended to motivate federal, state, local, the 1996 base year. To illustrate the
foreign, and private partners in drug control value of reducing first-time drug use,
to reduce supply and demand to levels that consider the mean age for first- time use
are realistically achievable in the future. of marijuana (16.7 years). If a youth
approaches the age of 20 without having
1. Demand Reduction tried drugs, the chances of becoming a
drug user are much lower. Delaying the
In the area of total demand reduction, we initial use of drugs such as marijuana by
propose a 25 percent reduction by 2002 in 36 months would, in turn, set the mean
the overall rate of illegal drug use in the age of initial use at a high enough level to
United States below that of the 1996 base allow a larger percentage of the
year. By 2007, the target is a 50 percent population to approach the A20 and older
reduction in the rate of overall drug use safety- zone.@ The PME system will use
below that of the 1996 base year. In 1996, average age of first-time use of marijuana
the current (i.e., past month) rate of drug use as a proxy measure to track progress
across the United States was 6.1 percent. toward the target of delaying the onset of
The targeted 50 percent reduction would drug use. Achieving this ambitious
target would clearly demonstrate the

38
nation=s progress toward shutting down drug use rate of 6.2 percent or
the pipeline of youth drug use. approximately 6.1 million drug users.
The rates were 8.6 percent for those
The Strategy also must have an impact employed part-time and 12.5 percent for
on overall youth drug use prevalence. By those actively seeking work. To measure
2002, reduce the prevalence of past progress toward this target, we propose
month use of illegal drugs and alcohol to use the National Household Survey on
among youth by 20 percent as measured Drug Abuse, which reports current use
against that in the 1996 base year and of any illegal drugs for those employed
by 2007, reduce the prevalence by 50 full-time or part-time or who are actively
percent as compared to that in 1996. To seeking work. When the 1996 rates are
measure progress toward this target, we reduced by half, drug use among those
propose to use information collected who are employed full-time will drop to
annually in the National Household 3.1 percent, a reduction of three million
Survey on Drug Abuse on current use of drug users. The rates for those
any illegal drugs by youth aged 12-17. employed part-time or unemployed will
In 1996, the prevalence of drug use in drop to 4.3 percent and 6.3 percent,
the 12-17 age group was 9.0 percent. A respectively. Achieving these targets will
50 percent reduction from the 1996 base substantially enhance productivity and
year incidence rate moves toward a safety in the workplace.
targeted use rate in 2007 of 4.5 percent.
Achieving this critical Impact Target by ♦ Focus on Chronic Drug Use: Chronic
2007 would mean that the nation would drug users consume the vast majority of
have the lowest rate of drug use among available drugs in the United States.
those aged 12-17 since record keeping Unless their demand is substantially
on youth drug use began. reduced, drug traffickers will continue to
enjoy a long-term, stable market in which
♦ Focus on the Workplace: Approximately to provide their products. While
74 percent of drug users are employed. supplying these users, suppliers will
Targeting the workplace with drug entice others to begin using drugs. If the
prevention and education programs will nation=s demand for drugs is to be
reduce overall drug use and protect the broken, chronic drug users must be
health, safety, and productivity of the targeted aggressively. By 2002, reduce
American worker. By 2002, reduce the the number of chronic drug users by 20
prevalence of drug use in the workplace percent compared with that in the 1996
by 25 percent compared with that in the base year and by 2007, reduce the
1996 base year and by 2007, reduce number of chronic drug users by 50
prevalence by 50 percent compared with percent compared with that in 1996.
that in 1996. This target focuses on The Department of Health and Human
users who are not necessarily chronic Services (HHS) estimates that there are
drug users. The workplace offers an at least 3.6 million chronic drug users
opportunity to reach these users. In who could benefit from drug treatment.
1996, the total full-time workforce Though this estimate is subject to
population was 99 million with a current revision as newer and better modeling

39
techniques are developed, meeting this and violence by 30 percent, as compared
Impact Target within 10 years would with the base year. In 1996, the rate of
reduce the number of chronic drug users arrests for drug law violations was 594
to 1.8 million by 2007. A decline of this per 100,000. Reducing this rate by 30
magnitude in the number of chronic drug percent over 10 years to 416 per 100,000
users would result in a significant arrests will significantly increase the
reduction in the overall demand for safety of our nation=s streets.
drugs. In addition, these users place the
greatest burden on society in the form of ♦ Focus on Health: Drug users engage in
health and social costs. high-risk behaviors making them and
their associates susceptible to a range of
2. Drug Use Consequences infectious diseases such as tuberculosis
(TB), HIV/AIDS, and hepatitis. Drug
In the area of drug use consequences, we use also contributes to birth defects and
aim to reduce the substantial damaging infant mortality, undermines workplace
health and social costs stemming from drug safety, and leads to premature death. We
use, including those from drug-related crime. propose by 2002, to reduce health and
These costs are estimated to be $110 billion social costs attributable to illegal drug
annually with a large share being crime- trafficking and use by 10 percent, as
related. We target two principal areas to expressed in constant dollars, as
reduce the health and social costs of drug compared to the 1996 base year, and by
use: crime and violence and health costs. 2007, to reduce such costs by 25 percent
as compared to the base year. To
♦ Focus on Crime and Violence: Reducing illustrate the implication of this Impact
drug use, especially chronic drug use, Target, consider the following example:
can do much to reduce drug-related According to the Centers for Disease
crime. Drug-related crime is not limited Control and Prevention, 1,919 cases of
to highly publicized violent crimes. Drug TB reported in 1996 were related to drug
use also spawns many other types of use (11.5 percent of all cases reported).
crime including corruption, prostitution, Achieving the Impact Target would
domestic violence, money laundering, reduce this figure to 1,727 in 2002 and to
forgery and counterfeiting, 1,439 in 2007.
embezzlement, and weapons violations.
Domestic law enforcement must F. Federal Government
aggressively target traffickers to mitigate Commitment to Demand
the violence that surrounds the drug
trade and decrease the entire range of
Reduction
drug-related crime. We propose by
Many of the approximately fifty federal
2002, to reduce by 15 percent the rate of
agencies involved in the drug control effort
crime and violent acts associated with
are engaged in demand reduction programs.
drug trafficking and drug abuse, as
These include the Department of Health and
compared with the 1996 base year, and
Human Services, the Department of
by 2007, to reduce drug-related crime
Transportation, the Department of Justice,

40
the Department of the Treasury, the the private sector C federal, state, local and
Department of Education, the Department of private entities. These entities, involved in
Labor, the Department of Housing and our national drug control effort, must join
Urban Development, the Department of together to reduce drug abuse if the
Veterans Affairs, the Department of the Strategy=s Goals are to be achieved.
Interior, the Department of Defense, and
numerous sub-cabinet agencies, such as the By providing management objectives, The
Small Business Administration. National Drug Control Strategy provides a
framework by which communication
The President=s FY 1999 budget sought $5.9 between the federal government and its
billion for demand reduction programs and partners in drug control can be improved. It
related research, the largest percentage remains the federal government=s objective
increase in the drug budget. Since 1986, to ensure that resources provided to our
support for demand reduction has increased partners have few strings attached so that
nearly seven-fold. As a percentage of the our partners have maximum flexibility in
overall federal drug budget, demand determining how best to use federal funds in
reduction has increased from 30 percent in achieving Strategy Goals and Objectives. At
1986 to 34 percent in FY 1999. the same time, the requirement for increased
accountability and improved performance
Included are federal resources targeted to means that partners must work cooperatively
state and local governments and private with federal agencies.
organizations that provide demand reduction
and supply reduction programs in our
nation=s communities. Approximately one-
quarter of the federal government=s drug
control resources are for grants-in-aid or
other forms of assistance to state and local
governments and private entities, where they
complement local resources for drug control
programming.

G. Private Sector Involvement


Critical to Demand Reduction
Effort
The National Drug Control Strategy
recognizes that the federal government is not
the sole financier of the national anti-drug
effort. A national-level strategy requires a
national-level effort. To achieve the
Strategy=s Goals, responsibility must be
shared among all levels of government and

41
A. Prevention

1. National Youth Anti-Drug Media


Campaign

Changing Youth Attitudes and Behavior:


Beginning in 1998, ONDCP launched a 5-
year, two billion dollar multi-media
campaign, designed to change the attitudes
of young people toward illegal drug use, as
well as educate parents and other adults
about their roles in preventing drug use. In
fiscal year 1998 the Congress appropriated
$195 million to begin the campaign and has
continued the program with a $185 million
N a tio n a l Y o u th A n ti-D r u g M e d ia C a m p a ig n

C O M M U N IC A T IO N S T R A T E G Y

I n t e g r a t e d C o m m u n i c a t i o n C a m p a ig n

Entertainm ent
Interactive
Industry P a id Public
Inform ation/ Partnerships
Media
C o llaboration
A d v e r t i s in g News Media

Corporate
Participation

Parent Y o u th In flu e n t i a l A d u l t
A u d iences Audiences Audiences

E V A L U A T IO N

F ig 9

appropriation in FY 1999. From its initial


test phase in twelve American cities, the
campaign grew into a full-fledged national
campaign in July.

A targeted, high impact, paid media


campaign emphasizing advertising -- at both
the national and local levels -- is the most
III. United States Efforts to cost effective, quickest means of changing
Reduce Demand for Drugs drug use behavior through changes in

42
adolescent perceptions of the danger and information about the drug problem,
social disapproval of drugs. It is also the including how to obtain more
most cost-effective means of reaching baby- information and the importance of
boomer parents who may be ambivalent educating their children about the
about sending strong anti-drug messages to dangers of drug use.
their children. Although public service
messages (PSAs) are part of this campaign, it ♦ Most parents in the target sites reported
is impossible to reach the specific audiences that the anti-drug ads had stimulated
at the times and with the frequencies that are discussion between them and their
required to move drug use attitudes with children about drugs.
PSAs alone. The entertainment industry,
Internet, and corporate participation and ♦ During the Campaign, 3.7 times more of
corporate involvement components of their the target audiences in the target sites
campaigns will support and enhance the were exposed to anti-drug ads than in the
impact of advertising. Messages and other pre-Campaign period; this demonstrates
activities are linked to existing anti-drug that the use of paid advertising and the
efforts at the community level where pro bono match requirement has
possible. increased the frequency of youth and
parent exposure to anti-drug ads.
The objectives of ONDCP=s campaign are
aggressive. Although research indicates that ♦ 12 weeks into the Campaign, the number
it will take two to three years to achieve of anti-drug ads appearing in the target
measurable changes in youth attitudes and sites increased an average of 123
behavior, an ONDCP study of the results of percent. Cities with greatest increases
the 12-city test phase of the campaign included: Washington, DC (279 percent
focused on initial changes in parent and increase), Houston (246 percent
youth awareness of anti-drug messages. increase), and San Diego (224 percent
Findings resulting from qualitative data, increase).
collected through site visits at 12 target and Since the campaign expanded in July 1998 to
12 comparison sites at baseline and about 12 national coverage, the following
weeks after the Campaign was introduced, demonstrated the popularity of the campaign
show that parents are eager to learn more and attested to its ability to mobilize
about how to educate their children about important media groups.
the dangers of drug use, and that youth in
the target sites have seen and heard the ♦ Message frequency and reach: The
Campaign ads. campaign goal of four message
exposures per week seen by 90 percent
♦ 12 weeks into the Campaign, youth in of the teen audience is being met. For
target sites had 3 times greater awareness African American teens the rate is 4.3
of anti-drug ads than did comparison site messages per week and 92 percent of the
youth. target audience. When matching
contributions from the media are factored
♦ Parents in the target sites reported that in the frequency and reach for the general
the anti-drug ads provided valuable

43
population is 6.8 per week by 95 percent;
for African Americans it is 7.7 per week ♦ Web site “hits”: ONDCP’s drug
by 95 percent. prevention web site for youth and parents
launched July 9, 1998, now has an
♦ Unprecedented matching average of 177,000 “hits” per month, and
contributions by media outlets: An the site is still in its testing phase.
additional 107 percent in public service
time and contributions from national and 2. Mobilizing Community Anti-Drug
local media has been generated in areas
Coalitions
where ads were purchased, more than
doubling the benefit derived from public
funds. The community-based anti-drug movement
in this country is strong, with more than
♦ Outstanding creative support from 4,300 coalitions already organized. These
networks: Network television has been coalitions are significant partners for local,
particularly responsive and is becoming state, and federal agencies working to reduce
more sensitive to depiction of youth drug drug use, especially among young people.
use issues in their series. Over 20 Coalitions typically include schools,
network episodes, including major series, businesses, law enforcement agencies, social
have been developed and broadcast. Six service organizations, faith communities,
broadcast and cable networks have medical groups, local and county
produced their own public service government, and youth groups. Coalitions
messages using the top stars in their develop plans and programs to coordinate
programs. anti-drug efforts for the benefit of
communities. In many locations, integrating
♦ Parent requests for information up 88 efforts have created comprehensive
percent: Although only 10 percent of prevention infrastructures that reduced drug
current ads show toll free numbers, use and its consequences. Such groups have
contacts to the National Clearinghouse the ability to mobilize community resources;
for Alcohol and Drug Abuse (NCADI) inspire collective action; synchronize
are sharply higher and will continue to complementary prevention, treatment, and
increase further when new ads, which enforcement; and engender community pride.
will contain contact numbers,air in early
1999. The Drug-Free Communities Program:
Congress enacted the Drug-Free
Communities Act of 1997 to provide modest
♦ Ads being developed in 11 languages:
grants to community anti-drug coalitions.
This campaign represents the federal
$20 million is authorized for FY 1999, $30
government’s largest ethnic and minority
million for FY 2000, $40 million for FY
communications effort. When Spanish
2001 and $43.5 million for FY 2002. The
language ads first aired in late August
program is designed to strengthen
1998, Hispanic callers to NCADI jumped
community-based coalition efforts to reduce
from an average of 3-4 per day to 40 per
youth substance abuse by bringing together
hour.
family, school, the faith community, civic and

44
business groups, the law enforcement and Aat-risk@ children increases in our country
criminal justice systems, and the medical over the next five years, resources must be
community. This systems approach to the made available to expand school-based drug
reduction of substance abuse is a research- prevention programs to keep pace with those
based strategy that has had positive results in increases. The Department of Education=s
many communities. Safe and Drug-Free Schools Program
(SDFSP) is the only federal drug prevention
In October 1998 the President appointed an program intended to reach all school-age
11 member Advisory Commission on Drug- children. It provides funds for virtually every
Free Communities to advise, consult with, school district to support drug and violence-
and make recommendations to the ONDCP prevention programs and to assist in creating
Director concerning activities carried out and maintaining safe learning environments.
under the program The Justice It represents a major investment in our youth
Department’s Office of Juvenile Justice and and is funded at a level of $531 million in FY
Delinquency Prevention ( OJJDP ) 1999 with $441 million for formula grants
administers the program through interagency and $90 million for national programs.
agreements with the Office of National Drug Overall, the program has focused on
Control Policy (ONDCP). The Substance ensuring that SDFSP fund recipients
Abuse and Mental Health Services (governors, state education agencies, local
Administration (SAMHSA) Center for education agencies, and community groups)
Substance Abuse Prevention (CSAP) is adopt programs, policies, and practices that
providing training and technical assistance are based on research and evaluation. In
through the Centers for the Application of 1998, the Department of Education
Prevention Technologies (CAPTs). implemented Principles of Effectiveness for
Additionally, OJJDP is conducting an the program. These Principles will help
evaluation of the Drug-Free Communities grantees use program funds more effectively.
Support Program, which will determine These Principles of Effectiveness state that a
whether the two major goals of SDFSP grant recipient must:
strengthening community coalitions and
reducing substance use among youth have ♦ Base its programs on a thorough
been reached. assessment of objective data about the
In 1998, building upon the existing coalition drug and violence problems in the
movement, the first grants were awarded to schools and communities served;
93 coalitions in 46 states. In 1999 ONDCP
and OJJDP will jointly solicit a second round ♦ With the assistance of a local or regional
of program applications from communities advisory council, establish a set of
nationwide to strengthen existing coalitions measurable goals and objectives and
and expand their number across the nation. design its programs to meet them;

3. Drug-Free Schools and School ♦ Design and implement its programs


Coordinator Programs based on research or evaluation that
provides evidence that the programs
Prevention in Schools: As the number of prevent or reduce drug use, violence, or

45
disruptive behavior among youth; and following:

♦ Evaluate its programs periodically to ♦ Adopt and enforce, clear and fair
assess progress towards achieving its discipline policies, such as zero tolerance
goals and objectives, and use its policies for guns and drugs, and parent
evaluation results to refine, improve, and notification and involvement.
strengthen its programs and refine its
goals and objectives as appropriate. ♦ Provide effective anti-drug and violence
prevention programs, including programs
The Department of Education is also that teach responsible decision-making,
developing an Expert Review Panel to help mentoring, mediation, or other activities
identify promising or exemplary drug and aimed at changing behaviors. Funded
violence prevention programs. activities must demonstrate effectiveness
in helping to create a drug-free and safe
In October, 1998 President Clinton learning environment.
announced his plan for the re-authorization
of the Safe and Drug-Free School Program ♦ Collect data and report to the public the
to provide more effective prevention results by providing annual report cards
programs for the reduction of drugs and on the number and type of school-related
violence in schools, more accountability for drug and/or violence incidents.
results, and better targeting to those schools
that need the most assistance. These changes ♦ Assess and intervene for troubled youth
include: through procedures to identify students
for evaluation and counseling; training
♦ Increasing funding for effective plans and for teachers and staff; and providing
strengthening accountability. Under the linkages between district officials, mental
proposal, federal funds will provide health, and other community
support to school districts with professionals where appropriate.
demonstrated need and a commitment to
adopt a rigorous, comprehensive ♦ Connect to after-school activities for
approach to drug and violence reduction youth to extend the school day and/or
and prevention. develop links to other after-school
programming, and help provide children
with meaningful connections to
♦ Creating incentives to develop responsible adults in the community.
comprehensive and results-oriented ♦ Develop plans for crisis management,
plans. Districts will be expected to use such as drug overdoses. The plan must
relevant drug and violence data to also address assistance for victims,
develop a comprehensive plan -- in contacts with parents, law enforcement,
consultation with parents, teachers, counseling, and communication wit the
students, law enforcement officials, media.
mental health providers and other
members of the community -- to do the School Coordinator Program: In FY

46
1999, the Congress provided $35 million to technical assistance to a limited number of
launch the Administration=s School colleges and universities so they can adopt
Coordinator Program. This program will those programs that have been identified as
support the hiring of drug prevention successful.
coordinators in middle schools across the
country to help improve the quality and 4. Parenting and Mentoring
effectiveness of drug prevention programs.
Initiative
Drug prevention coordinators will be
responsible for developing, conducting and
analyzing assessments of their school's drug Research by the National Institute on Drug
problems; identifying promising research- Abuse (NIDA) and the Center on Addiction
based drug prevention programs to address and Substance Abuse at Columbia indicates
those problems; assisting teachers, coaches, that if parents would simply talk to their
counselors and other school officials in children regularly about the dangers of illicit
adopting and implementing those programs; drugs, alcohol, and tobacco, drug use among
working with the community to ensure that youth could be substantially reduced. Data
the needs of students are linked with suggests that parents can be the most
available community resources; and powerful influence on youth, and we know
identifying alternative funding sources for that children who do not receive adequate
drug prevention initiatives. The drug supervision and attention are the most likely
program coordinators will assist parents, to engage in anti-social and risky behaviors,
youth, and school officials to identify including drug use and drug trafficking.
community resources and to strengthen the
role of parents in school settings. This Likewise, effective drug prevention
program will also require coordinators to programs require strategies which provide
provide feedback to state educational youth with role models and life skills that
agencies on programs that have proven to be help to reduce the likelihood of the initiation
successful in reducing drug use among of alcohol and drug use. This has been
school-aged youth. demonstrated through studies which reflect
the powerful impact a concerned and caring
Post-secondary Education: Illegal drug adult can have on a young person's life. For
use and the abuse of alcohol and tobacco example, a Big Brothers/Big Sisters study of
also are serious problems on our college and mentoring programs has shown a 46 percent
university campuses. In the 1997/1998 reduction in the initiation of drug use and a
academic year, several students died as a 27 percent reduction in the initiation of
direct result of binge drinking, and many alcohol use.
more were admitted to hospitals for
treatment of alcohol-related injuries and Family-Centered Approaches to Keeping
alcohol poisoning. In 1998, the Department Children Drug-Free: A systematic review
of Education has led efforts to identify those of current research on the family=s role in
programs and activities that have been reducing substance abuse among youth has
successful in reducing alcohol and drug use established that families play the most
on college campuses. The Department of important role in determining how young
Education also provides funding and people handle the temptations to use alcohol,

47
cigarettes, and illegal drugs. The Substance instrument, in helping youth resist alcohol,
Abuse and Mental Health Services tobacco, and illicit drugs. The Campaign
Administration/Center for Substance Abuse encourages adults to become involved in
Prevention has produced a compilation of volunteering, mentoring, and other efforts
the family-centered approaches which have that help young people ages 7-14 participate
been proven effective for specific in positive activities that build life skills, self-
populations. Second in its Prevention discipline and competence. The four
Enhancement Protocol System (PEPS), the informational guides contained within this
Preventing Substance Abuse Among Campaign are:
Children and Adolescents: Family-Centered
Approaches publication includes three ♦ Positive Activities - A Campaign for
specific documents: a comprehensive Youth
reference guide; a practitioner=s guide; and a
community guide. ♦ Get Involved in Someone=s Future - A
Guide to Volunteering With Young
Raising Awareness of Parents and People
Mentors: The 1998 National Drug Control
Strategy has as its first goal to AEducate and ♦ Your Time - Their Future: Membership-
enable America=s youth to reject illegal drugs Based Groups Provide Positive Activities
as well as alcohol and tobacco.@ Objective 5
of this goal seeks to Asupport parents and ♦ Your Time - Their Future: Positive
adult mentors in encouraging youth to Activities Promote a Productive
engage in positive, healthy lifestyles and Workforce
modeling behavior to be emulated by young
people.@ Through an interagency agreement A pilot evaluation study will be conducted to
with ONDCP, the Department of Health and track the Your Time - Their Future
Human Services, Substance Abuse and Campaign. The purpose of the study is two-
Mental Health Services Administration, fold. Process evaluation will document the
Center for Substance Abuse Prevention, is implementation of Campaign materials and
implementing a number of efforts to messages. Outcome evaluation will
organize, train, motivate, and raise the determine whether there was an increase in
awareness of parents and adult mentors to public awareness about, knowledge of, and
assist them to help children and youth remain willingness to participate in positive skill-
drug-free. building activities.

Your Time - Their Future: This campaign


was developed by the Substance Abuse and
Mental Health Services Administration as A Parenting IS Prevention@@ Program
part of the Department of Health and Human (PIPP): Under an interagency agreement
Services Youth Substance Abuse Prevention with the Office of National Drug Control
Initiative. Your Time - Their Future Policy and other federal partners, CSAP has
highlights the importance of structured worked to strengthen and mobilize existing
positive activities, such as playing sports, anti-drug programs to assist parents and
collecting stamps, or playing a musical other caregivers to help children and youth

48
remain drug free. Training and technical the major role in drug abuse prevention,
assistance to motivate and mobilize however. A study on parental and family
communities are underway, with more than risk factors for substance use by inner-city
200 representatives of large, medium and African-American children and adolescents
small-sized communities already trained. In confirmed expectations that positive parental
addition to training/technical assistance, and family characteristics protect children
PIPP maintains an information referral and adolescents against future drug use risk
service, an interactive PIPP website by enhancing negative drug attitudes.
(http://www.emory.edu/NFIA/PIPP/) and Another study enrolled parents in a drug
works closely with the media to feature abuse prevention education program and
messages that promote parent-focused youth found that participation in the program not
substance abuse prevention efforts. only increased communication about drug
abuse issues but also increased proactive
5. Youth Drug Prevention Research communications and decreased negative
(NIDA) interactions in general between those parents
and their children.
National Initiative on Drug Abuse
NIDA has published the first research-based
Prevention Research: NIDA-supported
guide to preventing young people from using
science research has made significant strides
drugs. The guide, "Preventing Drug Use
in the past year to further our understanding
Among Children and Adolescents: A
of drug abuse prevention. The total NIDA
Research-Based Guide," is organized around
funded research portfolio represents a major
14 prevention principles distilled from
investment in health research. For FY 1999,
research on effective prevention techniques
NIDA is funded at $634 million, almost one
and notes that every dollar spent for effective
quarter of all Department of Health and
prevention programs can save $4 to $5 in the
Human Services drug-related funding.
costs of treatment and counseling.
Several of these studies illustrate the
importance of the collaboration between 6. Improving State Planning for
research-based prevention programs, Prevention
communities, and families in protecting the
future of our youth. The Midwestern Despite increases in funding for drug control
Prevention Project in Indianapolis evaluated programs over the past decade, the incidence
the effects of a multi-component community- and prevalence of youth drug use has
based drug abuse prevention program on increased. Prevention programs must be
3400 students from 57 junior high schools. responsive to local needs, but also must
Study results showed that participation in the support proven prevention methods in order
prevention program significantly decreased to be effective. SAMHSA/CSAP’s State
drug use among users of tobacco, alcohol, Incentive Grant (SIG) programs help states
and marijuana. The study counters a to implement such programs. These
commonly held belief that primary competitive grants support science-based
prevention works only with non-users or prevention by requiring each grantee state to
occasional users. Parents and families play direct 85 percent of the grant award to

49
community-based substance abuse Agreement. At the signing, ONDCP
prevention. The SIG program serves as an Director Barry R. McCaffrey praised the
incentive for Governors to leverage and/or organizations for their promise to volunteer
redirect prevention funding streams and one million hours. He emphasized the
develop and implement comprehensive plans importance community groups, which he
for a more strategic allocation of prevention characterized as “the heart and soul of
funds. FY 1999 funding, requested in the America,@ had in reaching out to youth. On
President=s budget, totaled $65.7 million for April 28, 1998, with the encouragement of
21 Incentive Grants. Vice President Gore, an additional five
groups joined the original 33 national
7. Civic Alliance: Prevention organizations joined as signatories so that
the Alliance now includes 38 groups
Through Service
representing over 62 million members.
On November 15-18, 1997, the Substance
ONDCP and SAMHSA, as well as the other
Abuse and Mental Health Services
federal prevention partners, continue to
Administration hosted a conference
provide support in terms of training
launching the ONDCP Civic Alliance:
opportunities, resource and programmatic
Prevention Through Service initiative. This
materials, and other assistance as needed to
meeting was attended by more than 45
the Alliance as it implements its action plans
national and international civic and service
and recruits new Alliance members.
organizations and provided a range of
education, training, and networking
opportunities addressing all aspects of drug 8. Reducing Youth Use of Tobacco
abuse prevention, with a focus on outreach and Alcohol and Marijuana
to youth, their parents, and other care givers
through parenting and mentoring efforts. Preventing Alcohol Use and Drunk and
Drugged Driving Among Youth: The
Highlighting the meeting=s training function Strategy recommends educating youth, their
was a media literacy training session for mentors, and the public about the dangers of
youth. The meeting also included round underage drinking. This includes limiting
table discussions and sessions by leading youth access to alcoholic beverages,
federal partners on the latest developments in encouraging communities to support
drug abuse prevention, including the alcohol-free behavior on the part of youth,
physiology of addiction and the National and creating incentives as well as
Youth Anti-Drug Media Campaign. disincentives that discourage alcohol abuse
Training on community and volunteer by young people. The National Institute on
mobilization was provided, with a focus on Alcohol Abuse and Alcoholism (NIAAA)
parenting and mentoring. and SAMHSA/CSAP are examining possible
causal relationships between exposure to
Thirty-three national civic and service alcohol advertising and alcohol consumption
organizations, representing more than 55 among youth. The National Highway Traffic
million volunteers, signed the Prevention Safety Administration (NHTSA) and the
Through Service Alliance Resolution Office of Juvenile Justice and Delinquency

50
Programs (OJJDP) are addressing alcohol the first goal of the President=s 1998
and drug-related crashes among young National Drug Control Strategy. That goal
people in support of the President=s AYouth, is to “educate and enable America=s youth to
Drugs, and Driving@ initiative. NHTSA is reject illegal drugs as well as alcohol and
providing law enforcement, prosecutors, and tobacco.@ There are three major
judges with training and education for components: 1) Leverage and Mobilize
detecting, arresting, and imposing sanctions Resources; 2) Raise Public Awareness and
on juvenile alcohol and drug offenders. Counter Pro-Use Messages; 3) Measure
States are urged to enact zero-tolerance laws Outcomes. Projects under these headings
to reduce drinking and driving among teens. are conducted in collaboration with other
Civic and service organizations are Federal agencies, States, communities, and
encouraged to collaborate with organizations private partnerships.
like Mothers Against Drunk Driving and
Students Against Destructive Decisions. Reality Check: To address the dramatic
increase in marijuana use by youth, the
Preventing Tobacco Use Among Youth: Substance Abuse and Mental Health Services
Several federal agencies are working to Administration/Center for Substance Abuse
increase awareness among youth of the Prevention has developed a nationwide effort
dangers of tobacco use. The Food and Drug to prevent and reduce the growing problems
Administration (FDA) is enforcing associated with marijuana use among 9 to 14
regulations that reduce youth access to year-olds. The Campaign addresses the
cigarettes and smokeless tobacco products. issues of perception and use of marijuana at
The FDA also conducted a publicity the community level. Efforts have been
campaign in 1998 to encourage compliance made to change community
by merchants. State enforcement of laws attitudes/practices, to develop credible and
prohibiting sale of tobacco products to effective education programs, and to
minors, as required by the Public Health galvanize support for changing community
Services Act, is monitored by norms regarding the use of marijuana. To
SAMHSA/CSAP. CDC supports the date, the Campaign has placed lighted
AResearch to Classrooms@ project to identify posters in more than 300 malls throughout
and expand school-based tobacco-prevention the country and 200 regional grocery and
efforts; CDC also will fund initial research on department stores.
tobacco-cessation programs for youth. The
Clinton Administration is calling for tobacco 9. Youth Athletic Initiative Against
legislation that sets a target of reducing teen Drugs
smoking by 60 percent in ten years. Arizona,
California, Florida, Massachusetts, and other
states have ongoing paid anti-tobacco In June of 1998, ONDCP launched the
campaigns addressing underage use. AAthletic Initiative Against Drugs.@ The
purpose of the initiative is twofold: first, to
HHS Secretary==s Initiative on Youth mobilize the athletic world to educate
Substance Abuse Prevention: This children about the dangers of drugs and
initiative, created under the leadership of provide them with positive opportunities to
HHS Secretary Donna Shalala, is guided by keep them away from drugs; second, to

51
ensure that the message the athletic world launched a public and private diplomacy
sends our children about drugs is a positive effort to ensure that this round of NBA
one -- AIf you use, you lose. Be a winner.@ bargaining addresses the problem of drugs in
the sport. ONDCP=s efforts helped the
Mobilize the Athletic World: The first International Olympic Commission (IOC) to
National Coachathon Against Drugs week enact a new prohibition on marijuana.
was held in 1998. Coaches were asked to ONDCP is participating in the IOC=s current
spend ten minutes or more, at least once effort to strengthen its anti-doping program.
during the week, talking about the dangers In addition to addressing the performance
of drugs to their players and students. With enhancing drug issue, the goal is to make the
DOJ, ONDCP has published and mailed out Olympics drug-free (including non-
100,000 Coaches Playbooks Against Drugs performance enhancers, such as Ecstasy).
to coaches across the nation. Events took ONDCP is working in cooperation with the
place all week all across the nation. The USOC leadership to help our Olympic
kickoff was held with Major League Soccer program strengthen its domestic anti-doping
at their championship in Los Angeles. The program.
anchor event was a basketball clinic in D.C.
with leading college coaches. 10. National Guard Drug Demand
Reduction Program
Public Service Announcements (PSAs) in
Stadiums: In the Initiative=s first year, 17 The National Guard is uniquely qualified to
major league baseball teams showed anti- provide support to the efforts of the
drug PSA spots on their “jumbotrons” community-based anti-drug organizations.
during the season. NFL teams are now Located in over 3,200 communities in all 54
showing PSAs. ONDCP is developing a states and territories and working in
program with the NHL to show PSAs at all combination with over 3,900 coalitions, the
games. Guard has provided, since 1989, vital
support to a wide variety of demand
NCAA National Youth Sports Program: reduction missions by providing resources
Working with Department of Housing and and personnel who serve as facilitators,
Urban Development (HUD), ONDCP trainers, speakers, mentors, planners,
secured additional anti-drug money for this volunteers, and role models. These citizen-
NCAA youth education program, which soldiers serve on over 2,500 local, state, and
provides a sports summer camp, tied with national coalitions whose only mission is the
anti-drug and pro-learning courses, to over prevention of substance abuse.
68,000 at-risk kids across the nation.
The National Guard Drug Demand
Coaching and Youth Programs: ONDCP Reduction Program, in partnership with
is working with organizations (e.g., Boys communities, coalitions and organizations,
and Girls Clubs) and corporations (e.g., reaches millions of young people in the
Nike) to help them incorporate anti-drug country to help educate and motivate them
education into their coach and youth training to reject illegal drugs. In FY1998, the
programs. National Guard spent over $12.5 million to
Get Drugs Out of Sports: ONDCP has

52
support over 8,600 missions reaching over Block Grants to States: For FY 1999, the
11.7 million people. These missions support Substance Abuse Prevention and Treatment
parents, community coalitions, and law (SAPT) Block Grant is funded at over $1.6
enforcement agencies serving youth billion, an increase of $275 million over FY
prevention programs aimed at youth between 1998. Of this increase, $185 million will be
the ages of 5-18. used for the provision of substance abuse
treatment services that will reduce the public
The Guard supports the "Red Ribbon system treatment gap. Additional requests
Campaign;" Junior ROTC programs; Adopt- include funding for the SAPT Block Grant
A-School programs; National Youth Sports and the Targeted Capacity Expansion
Program camps; Boys and Girls Clubs; Kids Program. The Substance Abuse Block Grant
and Cops program; Drug Abuse Resistance provides funding to states and has been a
Education (DARE); Drug Education For cornerstone of federal efforts to close the
Youth (DEFY); Big Brothers/Big Sisters public system treatment gap.
program; Youth Academies; and Police
Athletic League programs. Targeted Capacity Expansion Program:
This program differs from the block grant in
B. Treatment that all of its funds are directed toward
providing treatment services. In addition,
the Targeted Capacity Expansion program
1. Close the Public System makes awards directly to states, localities,
Treatment Gap and service providers based on their ability to
demonstrate an emerging or existing need for
Although treatment services are available to expanded treatment services.
more people today than ever before,
ONDCP and SAMHSA recognize that Parity for Substance Abuse: The Office of
treatment need has expanded more rapidly National Drug Control Policy (ONDCP)
than the service system designed to meet that supports the concept of parity --health
need. Nationwide, there continues to be a insurance coverage for the treatment of drug
great need for additional capacity for dependence that is essentially similar to the
effective drug treatment. The largest coverage for treatment of other medical and
problem in treatment (the Agap@) revolves health problems. The National Drug
around three issues: accessibility, Control Strategy’s goal of reducing drug use
affordability, and availability. These three by 50 percent in the next ten years can only
issues effect both private and public funding. be accomplished with a significant expansion
The efforts of this initiative focus on the of capacity to treat chronic drug users.
federal responsibilities in relation to closing Parity offers an immediate opportunity to
the public system treatment gap. Drug expand capacity. ONDCP has developed a
treatment overall is funded in FY 1999 at position paper and is working with the
over $3 billion. The National Drug Control Federal drug control agencies to establish
Strategy also addresses private sector parity as Federal policy.
treatment issues through its efforts to ensure
parity for substance abuse treatment.

53
consequences, all drug-abusing inmates must
2. Expansion of Treatment in the have access to effective drug treatment
programs. This initiative seeks to build upon
Criminal Justice System
established drug treatment programs targeted
toward the criminal justice system. The
At midyear 1997, more than 1.7 million U.S. Federal Bureau of Prisons (BOP) provides
residents were incarcerated. Of this amount, drug treatment to all eligible inmates, prior
99,175 inmates were in federal prisons and to their release from Bureau custody. The
the remainder in state and local prisons. number of institutions offering residential
Since FY 1990, prisoners sentenced for drug treatment has grown from 32 to 42 since FY
offenses constituted the single largest group 1994. In FY 1997, nearly 31,000 inmates
of federal inmates--approximately 60 participated in Bureau treatment programs
percent. (Note: Similar statistics do not

Treatment Reduces Crime

Changes in Criminal Activity in 12 Months Before


Versus 12 Months After Treatment Exit
80

Before Treatment
70 64% 63.7%
After Treatment
60

49.3% 48.2%
50

40

30

13.9% 17.2% 17.4%


20 11.7% 11.0%
9%
10

0
Selling Shoplifting Beating Arrested for Most
Drugs Someone Up Any Crime Support
Illegal
Fig 10

presently exist for state facilities. However, (education, 12,960; non-residential, 4,733;
the Bureau of Justice Statistics= census of residential, 7,895; community transition,
state and federal correction facilities showed 5,315). This program is funded at over $26
that an estimated 23 percent of state million.
prisoners were serving time for a drug- Provide Drug Testing and Intervention
related offense.) From 1990 to 1996 the Programs: Research has shown that when
increase of nearly 24,000 drug offenders drug testing is combined with effective
accounted for 72 percent of the total growth interventions, such as meaningful, graduated
in federal inmate population. This sanctions, drug use can be curtailed within
population is expected to exceed 168,400 by the criminal justice population. Further,
2004. By 2004, if current trends continue, recent studies demonstrate that drug-
over 104,400 inmates will be serving time for dependent individuals who receive
drug offenses. As the National Drug Control comprehensive treatment decrease their drug
Strategy states Aour nation has an obligation use, decrease their criminal behavior,
to assist all who are in the criminal justice
system to become and remain drug-free.@ In increase their employment, improve their
order to break the cycle of drug abuse and its social and interpersonal functioning, and

54
improve their physical health. Moreover, strong aftercare programs are used to teach
when compared to substance abusers who responsibility and to transition offenders
voluntarily enter treatment, those coerced back into the community.
into treatment through the criminal justice
system are just as likely to succeed. Since The Department of Justice provides $40
the majority of drug users are processed million in grants to localities for Drug
through some part of the criminal justice Courts. This initiative expands the Drug
system during their drug-use careers, it Court program to more sites, expands both
makes sense to consider that system for national and local evaluations of drug courts,
intervention. The Administration’s proposal as well as builds the state and local capacity
for this program would provide drug testing to incorporate drug courts into established
and intervention programs to non- court management systems. It includes the
incarcerated populations. (Note: following components: 1) development of
Incarcerated populations would receive drug state level technical assistance and training
treatment services under the Criminal Justice capacity; 2) provision of drug court
Treatment Priority through Office of Justice management information system
Program=s (OJP) Residential Substance development assistance; 3) national-scope
Abuse Treatment Program and the Federal evaluations, with 1-2 year follow-up periods,
Bureau of Prisons= Residential Treatment of 20 to 30 sites to examine which aspects of
Program.) The President=s Drug Testing drug courts produce the best outcomes; 4)
Program for Federal Probationers is funded provision of assistance to local drug courts
at $4.7 million in the federal courts. so that local evaluations are of high quality;
5) double the current number of drug courts;
Drug Courts: The criminal justice system and 6) target as wide a range of defendants
often fails to subject nonviolent, substance- who are eligible for release as possible. The
abusing adult and juvenile offenders to results of this demonstration will assist in the
intervention measures that provide the modification or development of future
sanctions and services necessary to change criminal justice drug control programs.
their deviant behaviors. Many of these
individuals repeatedly cycle through our Breaking-The-Cycle (BTC): BTC
courts, corrections, and probation systems. combines the coercive power of the criminal
Title V of the Violent Crime Control and justice system with research-based treatment
Law Enforcement Act of 1994 authorizes the for populations under supervision of the
Attorney General to make grants to states criminal justice system. BTC activities
and local units of government to establish include a range of drug testing options, as
drug courts. Statistics collected by recently appropriate, and the use of relapse
established drug courts show a significant prevention and control measures such as
reduction in recidivism among drug court graduated sanctions to bring about
program graduates. This program seeks to behavioral change.
provide alternatives to incarceration through
using the coercive power of the court to On November 10, 1998, ONDCP and NIJ
force abstinence and alter behavior. A announced the three jurisdictions selected to
combination of escalating sanctions, participate with Birmingham, Alabama in the
mandatory drug testing, treatment, and BTC initiative. Jacksonville, Florida and

55
Tacoma, Washington, will introduce BTC shown great promise. In the past several
into their adult criminal justice systems. years, significant strides have been made in
Eugene, Oregon will implement the initiative drug abuse research: we have learned not
in its juvenile justice system. Each only how drugs affect the brain in ways that
jurisdiction received a multi-year, multi- affect behavior, but also that behavioral and
million dollar grant, as well as extensive environmental factors may influence brain
technical assistance and other support function. One of the most significant
coordinated by the National Institute of breakthroughs has been the identification of
Justice. areas of the brain that are specifically
involved in craving, probably the most
BTC programs include: drug testing; important factor that can lead to relapse.
individual and group counseling; academic Working with modern, high resolution,
and vocational instruction; and training. This neuro-imaging equipment, scientists
initiative will increase the capacity of the discovered many underlying causes of
criminal justice system to refer addicts and addiction. Research using positron emission
heavy drug users to treatment and tomography scans shows that when addicts
rehabilitation and monitor their progress. experience cravings for a drug, specific areas
of the brain show high levels of activation.
Although Congress provided no funding in Armed with this knowledge, scientists are
the FY 1999 budget to expand BTC further, now determining pre-addiction physiological
they included a provision that would allow and psychological characteristics so that Aat
up to ten percent of funds going to states for risk@ subjects can be identified before
prison construction (up to $50 million) to be addiction or drug abuse takes place. A major
used for drug testing and treatment during focus of NIDA=s research has been on
and after incarceration. Related initiatives developing new medications. During the
expand the Bureau of Prisons residential past year, several compounds have been
drug treatment program, continue support identified that show promise as long-acting
for prison Residential Substance Abuse cocaine treatment medications.
Treatment at the level of $63 million for
Department of Justice grants to states, and Medications for Cocaine Dependence:
expand the Arrestee Drug Abuse Monitoring Researchers at NIDA have discovered
System (ADAM). compounds that can block the effects of
cocaine without interfering with the normal
3. Treatment Research mood-modulating effects of dopamine.
Development and Evaluation NIDA studies have led to the discovery of
receptors in the brain which act as re-uptake
transporters for dopamine, a chemical that
National Institute on Drug Abuse
causes pleasure responses in the brain, much
(NIDA): Recent intramural and extramural
like cocaine. Also, research has found that
research in the area of pharmacotherapies
there are multiple dopamine receptors that
and behavioral therapies for the treatment of
respond differently to various compounds.
the dependence on and abuse of
For example, one type of dopamine receptor,
cocaine/crack, marijuana, opiates, and
D1, suppresses drug seeking behavior and
stimulants, including methamphetamine, has
relapse, where as activation of the D2,

56
triggers drug-seeking behavior. These this problem, regulatory oversight is
findings have been used for clinical studies. undergoing extensive reform. A pilot test of
accreditation for methadone treatment
Using equipment such as the positron programs is underway. If this test proves
emission tomography (PET), to identify successful the current regulatory approach
brain regions that are particularly responsive will be replaced by an accreditation system.
to cocaine associated-stimuli, researchers In this system, programs will be subjected to
have been able to identify brain activity clinically based performance standards that
associated with drug craving. This could emphasize comprehensive treatment. The
help lead to the development of treatments accreditation system being developed is
that might prevent or reduce craving. consistent with recommendations from
recent reviews conducted by the National
The conclusion of animal studies published in Academy of Sciences, NIDA, and the
August 1998 in the journal Synapse showed General Accounting Office (GAO).
that the epilepsy drug gamma vinyl-GABA,
or GVG, blocked cocaine=s effect in the Behavioral Treatment Initiative:
brains of primates, including the process that Behavioral therapies remain the only
causes Ahigh@ feelings in humans. The GVG available effective treatment approaches to
research was sponsored by the Department many drug problems, including cocaine
of Energy=s Office of Energy Research and addiction, where viable medications do not
the National Institute of Mental Health with yet exist. Behavioral interventions are
the involvement of NIDA. needed, even when pharmacological
treatments are being used. An explosion of
Methadone and Other Opioid Agonists: knowledge in the basic behavioral science
The use of methadone and, more recently, field is ready to be translated into new
other opioid agonists such as bupernorphine behavioral therapies. NIDA is encouraging
is widely accepted in drug treatment. research to develop and establish the efficacy
Methadone treatment, along with counseling of promising behavioral therapies, to
and other interventions, has been used determine how and why a particular
successfully to treat heroin addictions. behavioral intervention is effective; to
Approximately 115,000 Americans are able develop and test behavioral interventions to
to lead stable lives as a result of methadone reduce AIDS risk behaviors, and to
treatment received at the more than 900 disseminate efficacious behavioral
methadone treatment programs. The Drug interventions to practitioners in the field.
Abuse Treatment Outcome Study (DATOS), More specifically, NIDA=s behavioral
conducted by NIDA, found that among research initiative will focus on therapies for
participants in outpatient methadone adolescent drug use, addressing drug
treatment, weekly heroin use decreased 69 addiction treatment as HIV risk reduction,
percent, illegal activity decreased 52 percent, and determining the transportability of
and full time work increased by 24 percent. behavioral therapies to the community.

Unfortunately, regulatory barriers limit National Drug Treatment Clinical Trials


methadone availability and therefore Network: Over the past decade,
methadone treatment capacity. To correct NIDA-supported scientists have made

57
tremendous progress in developing new and with research findings. ONDCP, NIDA and
improved pharmacological and behavioral SAMHSA/CSAT have focused on treatment
treatments for drug addiction. However, in national conferences on marijuana,
most of these newer treatments are not methamphetamine, heroin, cocaine and
widely used in practice, in large part because crack. Additional conferences on treatment
they have been studied only in relatively modalities and treatment in the criminal-
short-term and small-scale studies conducted justice system were held during the spring of
in academic settings on stringently selected 1998. SAMHSA/CSAT continues to
patient populations. To reverse this trend develop Treatment Improvement Protocols
and to dramatically improve treatment (TIPS), which provide research-based
throughout this country, NIDA is guidance for a wide range of programs.
establishing a National Drug Treatment SAMHSA/CSAT also supports thirteen
Clinical Trials Network (CTN) to conduct university-based Addiction Technology
large, rigorous, statistically powerful, Transfer Centers, which cover forty states
controlled multi-site Stage III and Stage IV and Puerto Rico. These centers train
treatment studies in community settings substance-abuse counselors and other health,
using broadly diverse patient populations. social service, and criminal-justice
The National Drug Treatment Clinical Trials professionals. In addition, SAMHSA/CSAT
Network will enable rapid, concurrent testing have several programs in their portfolios that
of a wide range of promising science-based are intended to move research into the field
behavioral therapies, medications, and their and establish an epidemiological
combined use, across a range of patient measurement system.
populations, treatment settings, and
community environments nationwide. 4. Reduce Infectious Disease Among
Science-based behavioral therapies that are
Injecting Drug Users
in queue for testing in the CTN include new
cognitive behavioral therapies, operant
therapies, family therapies, brief motivational Illegal drug users and people with whom
enhancement therapy, and new, manualized they have sexual contact run higher risks of
approaches to individual and group drug contracting gonorrhea, syphilis, hepatitis,
counseling. Medications to be studied and tuberculosis. Chronic users are
include naltrexone, LAAM, buprenorphine particularly susceptible to infectious diseases
for heroin addiction, and those currently and are considered Acore transmitters.@ The
being developed by NIDA for cocaine. prevalence of HIV infection in Injecting
Drug Users (IDUs) and their sexual partners
Center for Substance Abuse Treatment and children is high in the United States, and
(SAMHSA/CSAT) : Effective is on the rise in many other parts of the
rehabilitation programs characteristically world as well. Not only is the AIDS/HIV
differentiate by substances, cause addicts to epidemic a problem in this country, the
change lifestyles, and provide follow-up reemergence of tuberculosis (TB) is also
services. However, all treatment programs something which should be taken notice of
are not equally effective. That is why efforts when working on programs for injecting
are underway to raise the standards of drug users. These populations, especially
practice in treatment to ensure consistency drug users who are dually infected with HIV

58
and TB and who congregate in poorly the CDC; the National Association of State
ventilated areas, are suspected to be the and Territorial AIDS Directors (NASTAD);
source of TB infection for non-HIV infected and the National Association of State
crack smokers. This epidemic has continued Alcohol and Drug Abuse Directors
to grow, especially among women on (NASADAD), has been started to define the
welfare. Many times, these women have barriers to collaboration of state and local
infected their children, further adding to the HIV and substance abuse and mental health
medical costs borne out by society. Both programs in minority communities. In
hepatitis B and hepatitis-C continue to be an addition, SAMHSA/CSAT targets funds to
infectious disease problem associated with support comprehensive treatment for women
drug abuse. and their children, substance abuse treatment
programs that include an HIV component for
Interventions for HIV/AIDS: The National men and youth, and prevention and
Institute on Drug Abuse (NIDA) is substance abuse prevention services for
continuing research programs on the African American and Hispanic youths.
enhancement and further development of
behavioral therapies focusing on AIDS risk The Centers for Disease Control (CDC)
reduction. NIDA research has determined provides funding for AIDS drug counseling
specific factors that should be present in and drug-related HIV prevention activities.
intervention programs aimed at reducing the The Substance Abuse and Mental Health
spread of HIV, especially among youth. It Services Administration (SAMHSA) also
will identify the most effective types of provides HIV/AIDS activities in support of
interventions appropriate for different groups this initiative. The program studies the
and communities, as well as the effect of efficacy, outcomes, recidivism, and HIV risk
abused drugs on the progression of AIDS. behaviors (needle use and sex) among
Drug abuse prevention and treatment injecting drug users.
significantly reduce drug use, improve social
and psychological functioning, decease 5. Training for Substance Abuse
related criminality and violence, and reduce
Professionals
the spread of AIDS, TB and other diseases.

SAMHSA continues to support early The recognition of substance abuse is the


intervention services for HIV through the first step in treatment. Unfortunately,
Substance Abuse Prevention and Treatment although most medical students are required
(SAPT ) Block Grant in 38 States. In to have some background in mental health
addition SAMHSA is developing a strategic training, they receive little education
plan to address HIV/AIDS with an emphasis regarding substance abuse. If physicians and
on minority communities. Planned activities other primary-care managers were more
include funding the National Minority AIDS attuned to drug related problems, abuse
Council (NMAC) for $100,000 to define the could be identified and treated earlier. In
gaps in HIV/AIDS activities and substance 1997, ONDCP and SAMHSA/CSAP
abuse treatment and prevention and mental co-hosted a conference for leaders of health-
health services for women in minority care organizations to address this issue. In
communities. A cooperative project, among addition, SAMHSA/CSAT published a

59
Treatment Improvement Protocol: A Guide for both employees and family members;
to Substance Abuse Services for Primary drug testing; and training so that supervisors
Care Clinicians. can recognize the signs of use reflected in
job performance and refer employees to help.
A related problem is that many competent Workplace anti-drug policies also help
community-based treatment personnel lack prevent drug abuse among millions of young
professional certification. The administration people who have part-time jobs. SAMHSA
supports a flexible system that would respect has awarded nine grants to study the impact
the experience of treatment providers while of comprehensive drug-free workplace
they earn professional credentials. Addiction programs on productivity and health-care
Counseling Competencies: The Knowledge, costs in major U.S. corporations. As the
Skills and Attitudes of Professional Practice, nation=s largest employer, the federal
a SAMHSA/CSAT publication, will help government sets the example. Currently,
provide criteria with which to certify 120 federal agencies have drug-free
practitioners. workplace plans certified by the Department
of Health and Human Services. These
Educational Materials for Substance agencies represent about 1.8 million
Abuse Professionals: This initiative is employees -- the vast majority of the federal
intended to develop educational materials for civilian workforce.
substance abuse professionals using
information such as SAMHSA=s Laboratory Testing of Transportation Employees: The
Certification Program Standards and other Omnibus Transportation Employees Testing
national professional, accreditation, and Act of 1991 requires the Department of
certification organizations materials. It also Transportation (DOT) to prescribe
provides the resources necessary to develop regulations that require drug testing of over
performance and educational materials for eight million safety-sensitive employees in
substance abuse professionals. Funding will the United States who work in businesses
also be used to conduct training for that fall under federal mandatory testing
substance abuse prevention and treatment regulations in the aviation, motor carrier,
professionals, and for employee assistance rail, transit, pipeline, and maritime industries.
professionals employed by programs Consequently, DOT oversees the nation=s
receiving federal funds. largest workplace drug-testing program.
DOT requires workers in safety-sensitive
positions who test positive for drugs to be
C. Workforce Demand referred to substance abuse professionals
Reduction before returning to work. If the employee is
in need of assistance with his/her substance
The Strategy encourages public and private- abuse problem, the employee must receive
sector employers, including eight million treatment or appropriate help before
small businesses, to initiate comprehensive resuming duties. This program -- which also
drug-free workplace programs. Effective requires drug testing for operators of
programs include written anti-drug policies; commercial motor vehicles from Canada and
education; employee-assistance programs Mexico -- has become a model for non-
featuring problem identification and referral regulated employers throughout the United

60
States and in other countries around the
world. It is important to note that there is no Beginning in FY 1999, a new small business
legitimate medical explanation for a safety- initiative, administered by the Small Business
sensitive worker testing positive for Administration and funded initially at $4
marijuana in the DOT and all other federally million, will provide for continuation and
mandated drug-testing programs. expansion of model drug-free workplace
programs. This program is authorized by the
Small Business Drug-Free Workplace Drug-Free Workplace Act of 1998.
Initiatives: Most small and medium-sized
businesses in America have no drug-free
workplace programs in place. According to
the National Household Survey, 69% of
current illicit drug users are employed full-
time. An additional 17% are employed part-
time. The dramatic reduction in substance
abuse in the military and other workforce
settings is an effort that must be replicated in
the small business civilian workforce.

In cooperation with state and local agencies,


the Department of Labor (DOL) and the
Department of Health and Human Services=
Center for Substance Abuse Prevention
(SAMHSA/CSAP=s) assist small and
medium-sized companies to implement drug-
free workplace programs. These programs
may include policy formulation, prevention
education, supervisory training, drug testing
and access to employee assistance programs.
DOL=s Working Partners program enlists
trade associations in encouraging and
assisting small businesses to implement
programs and disseminates helpful
information and materials through its
Internet-based Substance Abuse Information
Database. SAMHSA/CSAP=s Helpline
provides business callers with free technical
assistance and guidance in developing and
evaluating programs and policies that
address substance abuse in the workplace.
Many of the over 1000 telephone calls or
Internet inquiries received every month from
small businesses seek expert assistance about
best practices.

61
Employment Training Programs: The fitness, readiness, mission performance, and
Department of Labor funds a variety of safety of the individual and military unit.
employment training programs for both The program focuses on drug testing and
dislocated and low-income adults, and at- anti-drug education.
risk, disadvantaged youth. Under newly
Drug use reported by military
personnel has declined steadily

Percentage of Military Members


Using Illicit Drugs
40

30

20

10

0
1980 1982 1985 1988 1992 1995

Past 30 days Past 12 mos.


Source: 1995 DoD Surven of Health Related
Fig 11 Behaviors Among Military Personnel

enacted authorizing legislation, these The DoD drug-testing program was begun
programs will include more comprehensive during the Vietnam War era to counter rising
assessments of program participants’ service drug abuse. The program was initiated to
needs. For youth participants, program identify returning veterans in need of
components must include tutoring, study treatment and rehabilitation. In 1980, the
skills training, instruction leading to aircraft carrier Nimitz suffered significant
completion of secondary school, casualties, loss of life, and property damage
occupational skills training, adult mentoring, during aircraft recovery operations. Drug
work experience, leadership training, and presence was detected in several of the
supportive services. Youth will receive casualties of this incident. As a result, the
follow-up services for at least one year, and Department began a concerted effort to deter
will also receive comprehensive guidance and detect drug abuse by military personnel
and counseling which, by the determination
of local workforce investment boards, may The program has been highly successful. In
include drug and alcohol counseling and fiscal year (FY) 1998, total drug positive
referral, as necessary. testing rates for illicit drugs averaged 0.64%
Drug-Testing for Military Readiness: The for active duty military personnel. The
Department of Defense (DoD) drug-testing Triennial Worldwide Survey of Health
program is a military readiness program to Related Behaviors Among Military Personnel
deter and detect drug abuse by military reported self-admitted drug abuse, within the
personnel, thereby ensuring the military past 30 days, of less than 3%. This is a 90%

62
reduction in self-admitted drug abuse since personnel and 100 percent of its new
1980. In FY 1998, approximately 2.5 accessions. The program has been very
million active duty military personnel were successful. The total positive testing rates
tested for drug abuse, or nearly two random for illicit drugs averaged 0.57 percent for
tests per active duty military member per combined active duty and selected reserve
year. The cost of this program approximated personnel. The FY1998 cost for this
$55 million in fiscal year 1998 including the program was approximately $400 thousand,
cost of collection, testing, anti drug including the cost of collection, testing, anti-
education and training, and rehabilitation and drug education and training.
treatment. Fiscal year 1999 expenses are
anticipated to be approximately $54 million.
Drug abuse by military personnel continues D. Addressing Emerging Drug
to decline on an annual basis. The Military Threats
Services implemented several new initiatives
to further reduce drug abuse: 1. Domestic Heroin Initiatives
♦ Beginning in FY 1998, a software
An estimated 810,000 Americans are chronic
package that will randomize the
users of heroin. Between the first half of
frequency of urine collections was
1988 and the first half of 1997, heroin
distributed to the Services. The
medical emergency mentions increased 99
objective is to improve the
percent from 18,100 to 36,000 mentions. As
unpredictability of when a testing event
noted in the July 1997 National Narcotics
will occur. It is believed that increasing
Intelligence Consumers Committee Report
the risk of detection will deter drug
Aheroin remained readily available to addicts
abuse.
in all major metropolitan areas throughout
1996.@ The same report notes that Astable
♦ The Navy, Marine Corps, and Air Force
wholesale process per kilogram and high
have begun drug testing at both the
retail-level purities indicated increasing
military processing center and at the
supplies.@
recruit training center. The purpose is to
prevent the entry of individuals with drug
Heroin Addiction Can Be Treated:
dependency into military service.
Methadone treatment, along with counseling
and other interventions, is being used
♦ To deter abuse of designer amphetamine successfully to treat heroin addiction.
drugs, the military drug testing program Methadone is an agonist agent for opiates.
requires that all specimens that screen In other words, methadone operates by
positive for amphetamines be analyzed in occupying the brain receptor sites that are
confirmation testing for the presence of affected by heroin and blocks the craving
the designer drugs MDA, MDMA and attendant to addiction. Approximately
MDEA. 115,000 Americans are able to lead stable
The United States Coast Guard has a similar lives as a result of methadone treatment
drug-testing program. In FY1998, the Coast received at the more than 900 methadone
Guard tested about 65 percent of its treatment programs.

63
Yet many of the nation’s 810,000 heroin Methamphetamine: Over the past few
addicts do not have access to methadone years methamphetamine trafficking and
treatment or any other effective form of drug abuse in the United States have steadily
abuse treatment. Methadone treatment is increased. According to the 1997 National
not available in Idaho, Mississippi, Montana, Household Survey, an estimated 5.3 million
North Dakota, New Hampshire, South people (2.5 percent of the population) tried
Dakota, Vermont, and West Virginia. The methamphetamine in their lifetime. The
laws governing methadone treatment, the estimate has increased significantly since
Controlled Substances Act (CSA) and 1994, when 1.8 percent of population had
Narcotic Addict Treatment Act (NATA), ever used methamphetamine. In the past,
date from the 1970s and pre-date research methamphetamine was largely produced and
breakthroughs on the nature of addiction. supplied by outlaw motorcycle gangs. More
These laws arbitrarily limit the expansion of recently, however, organized crime poly-
treatment capacity. drug trafficking groups are dominating the
wholesale trafficking in the United States.
SAMHSA/CSAT is developing an These large organized groups have
accreditation system for methadone developed large-scale laboratories C both in
treatment. Regulatory oversight Mexico and the United States C that are
responsibility will be transferred from the capable of producing large quantities of
FDA to SAMHSA/CSAT. The current methamphetamine.
regulatory approach will be replaced by an
accreditation system. In this system, The Attorney General and the Director of
programs will be subjected to clinically based ONDCP are co-chairs of a Federal Task
performance standards that emphasize Force on Methamphetamine. In the past
comprehensive treatment. Law enforcement year, the Demand Reduction component has
(anti-diversion) responsibilities will remain met twice, and is reviewing all federal
with the DEA. programs relating to education, prevention
and treatment as they apply to
Increased Public Awareness: Efforts are methamphetamine.
also underway to increase public awareness
of the dangers of heroin use, especially Funding to implement the demand
among youth. The National Anti-Drug component of the National
Youth Media Campaign is showing heroin Methamphetamine Strategy is included in the
messages on prime-time television, as well as Department of Health and Human Services
in newspapers, magazines and other media. drug control budget. Specifically, the
Areas of the country in which heroin use is National Institutes on Drug Abuse annually
growing are receiving concentrated exposure spends approximately $20 million in research
to anti-heroin programming. to understand the epidemiology of
methamphetamine use, its mechanism of
action and effects on brain functions,
2. Countering the behavioral consequences, and treatment and
prevention implications and approaches.
Methamphetamine Threat

64
Furthermore, the Center for Substance Cooperation in Demand
Abuse Treatment, Substance Abuse and
Mental Health Services Administration, Reduction
allocates funding to investigate the treatment
paradigms that may prove effective to treat Drug abuse is a serious international problem
addiction to methamphetamine. requiring multi-disciplinary prevention. The
United States supports demand reduction
3. Increasing Awareness of Inhalant efforts by the United Nations International
Drug Control Programs, the European
Abuse Union, the Inter-American Drug Abuse
Control Commission of the Organization of
Inhalants are a chemically diverse group of American States, and other multilateral
products commonly found in every institutions.
household. Although they are not illicit
substances, they are often the first substances Expansion of Multilateral Cooperation:
abused. Inhalants are legal, easily obtained, The United States expanded multilateral
commercial products found in most homes. cooperation through participation in summits
They include such products as glue, paint, on drug abuse issues in Central and South
typewriter correction fluid, felt tip markers, America and through collaboration with
gasoline, and many others. When these CARICOM nations, OAS/CICAD, UNDCP,
products are inhaled, however, the and the European Commission. For example,
consequences can be deadly. Death can the United States participated in the United
occur the first time one sniffs, or the tenth, Nations General Assembly Special Session
or the hundredth. Damage can occur to the on Drugs in June. At that meeting, member
liver, kidneys, and bone marrow, even states agreed that reducing demand for drugs
irreversible brain damage. According to the is a key element of the global drug control
National Household Survey on Drug Abuse, strategy, and drafted the first international
there were an estimated 805,000 new agreement to counter drug abuse.
inhalant users in 1996, up from 382,000 in
1991. Approximately 20 percent of The United States hosted anti-drug leaders
adolescents nationwide have used inhalants from 23 nations at the Caribbean Regional
in their lifetime. Drug Control Conference (CRDCC) in
Miami, Florida, from October 12-14. That
In order to raise public awareness of conference fulfilled commitments made at
inhalants, the ONDCP Director has made a the Caribbean/US Summit in Bridgetown,
video in conjunction with SC Johnson Barbados that was held on May 10, 1997,
Corporation and Deloris Jordan, mother of and responded to the document adopted
pro-basketball star Michael Jordan, that has there, the Bridgetown Declaration of
been sent to educators and parents groups Principles. In the spirit of partnership and
around the country warning them of the mutual respect, that document pledged to
dangers of inhalant abuse. strengthen cooperation in responding to the
challenges of the coming millennium and
E. Building International noted the provision of technical assistance
and information exchange on demand

65
reduction and supply reduction issues by the alliance formed between the two countries is
United States. Attendees at the CRDCC expressed in the form of a 16-point
conference included participants from the framework for a U.S.-Mexico Common
Caribbean, observers from Latin America Drug Control Strategy. Alliance Point 1
and Europe, and officials from law seeks to Areduce the demand for illicit drugs
enforcement, criminal justice, drug through the intensification of anti-drug
prevention and treatment communities. The information and educational efforts,
conference focused on regional cooperation particularly those directed at young people,
with anti-drug officials, and assessed and and through rehabilitative programs”. At
promoted further narcotics cooperation present, work is underway to develop
between the US and Caribbean countries. performance measures of effectiveness to
evaluate Alliance Point 1.
Development of a Hemispheric Anti-Drug
Alliance: The U.S. has continued to play a In March 1998, the first U.S.-Mexico Bi-
prominent role in establishing a unified National Demand Reduction Conference was
hemispheric alliance that incorporates a held in El Paso, Texas. More than 300
global and multi-disciplinary perspective. experts in drug prevention, treatment, and
The alliance will strengthen and promote research, as well as government officials,
citizen participation, disseminate information educators and other community leaders from
on the deleterious effects of drug use support both sides of the border met for two and a
and strengthen organizational capacity, and half days to address the root causes of the
create and support a multi disciplinary team drug problem. During the conference,
of experts to assist participating countries in participants from both countries developed
their demand reduction efforts. In April explicit strategies in eight areas to reduce the
1998, the President and other heads of state demand for drugs: research cooperation and
participated in the Second Summit of the the exchange of technical information; public
Americas, which was held in Chile. information and awareness; community
Participants agreed to further meetings in participation; youth; special populations; the
order to forge an alliance against drugs and workplace; HIV/AIDS; and violence and
apply the Hemispheric Anti-Drug Strategy. drug-related problems. Teams of experts
Formal negotiations were begun in May, from the U.S. and Mexico cooperated in
when OAS/CICAD was charged with drafting a Bi-National Strategy for reducing
establishing a procedure for multilateral the demand for drugs in both countries, as
cooperation to prevent and combat all well as performance measures of
aspects of the drug problem and related effectiveness for assessing the outcomes of
crimes based on the principles of the steps taken.
sovereignty, territorial integrity of states, and
shared responsibility, with a comprehensive Development and Expansion of
and balanced approach. Prevention Alliances: Thirty-eight civic,
service, fraternal, womens, and other
U.S.-Mexico Bi-National organizations with national and international
Alliance/Conference: In May 1997, memberships representing more than 62
President Clinton and President Zedillo million volunteers have resolved to work
signed the Joint Alliance Against Drugs. The together as part of the civic alliance

66
APrevention Through Service”. These
organizations have pledged to volunteer one
million hours to prevent drug abuse among
youth. In Lima, Peru, for example, the Lions
International has formed an alliance with the
American Embassy, and the groups are
working together to expand prevention
efforts in Peru. The prevention alliance
continues to conduct outreach to other
international and national organizations to
ensure that all youth have the opportunity to
grow up drug free.

International Cooperation on Drug Abuse


Research and Analysis: In collaboration
with other nations, ONDCP is exploring how
data sets gathered by various countries on
drug abuse can be used in assessing the
effectiveness of regional demand reduction
efforts. It will also be used to analyze
regional drug abuse and trafficking trends,
implications for future research, and the
development and implementation of effective
prevention efforts. Research and
surveillance of drug abuse on an international
basis will be enhanced through extensive
networking with other countries in the
hemisphere and beyond. An important
component will be strengthening the research
and surveillance capacity of participating
countries and sharing the latest research
findings on demand reduction. NIDA is
working with countries in Central America
and the Caribbean to collaborate on drug
research.

67
68
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