Reducing Drug Abuse in America

Chapter III.
United States Efforts to Reduce Demand for Drugs
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 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 cost effective, quickest means of changing drug use behavior through changes in adolescent perceptions of the danger and social disapproval of drugs. It is also the most cost-effective means of reaching baby-boomer parents who may be ambivalent about sending strong anti-drug messages to their children. Although public service messages (PSAs) are part of this campaign, it is impossible to reach the specific audiences at the times and with the frequencies that are required to move drug use attitudes with PSAs alone. The entertainment industry, Internet, and corporate participation and corporate involvement components of their campaigns will support and enhance the impact of advertising. Messages and other activities are linked to existing anti-drug efforts at the community level where possible.
National Youth Anti-Drug Media Campaign

Figure 9

The objectives of ONDCP's campaign are aggressive. Although research indicates that it will take two to three years to achieve measurable changes in youth attitudes and behavior, an ONDCP study of the results of the 12-city test phase of the campaign focused on initial changes in parent and youth awareness of anti-drug messages. Findings resulting from qualitative data, collected through site visits at 12 target and 12 comparison sites at baseline and about 12 weeks after the Campaign was introduced, show that parents are eager to learn more about how to educate their children about the dangers of drug use, and that youth in the target sites have seen and heard the Campaign ads.

12 weeks into the Campaign, youth in target sites had 3 times greater awareness of anti-drug ads than did comparison site youth.
Parents in the target sites reported that the anti-drug ads provided valuable information about the drug problem, including how to obtain more information and the importance of educating their children about the dangers of drug use.
Most parents in the target sites reported that the anti-drug ads had stimulated discussion between them and their children about drugs.
During the Campaign, 3.7 times more of the target audiences in the target sites were exposed to anti-drug ads than in the pre-Campaign period; this demonstrates that the use of paid advertising and the pro bono match requirement has increased the frequency of youth and parent exposure to anti-drug ads.
12 weeks into the Campaign, the number of anti-drug ads appearing in the target sites increased an average of 123 percent. Cities with greatest increases included: Washington, DC (279 percent increase), Houston (246 percent increase), and San Diego (224 percent increase).

Since the campaign expanded in July 1998 to national coverage, the following demonstrated the popularity of the campaign and attested to its ability to mobilize important media groups.

Message frequency and reach: The campaign goal of four message exposures per week seen by 90 percent of the teen audience is being met. For African American teens the rate is 4.3 messages per week and 92 percent of the target audience. When matching contributions from the media are factored in the frequency and reach for the general population is 6.8 per week by 95 percent; for African Americans it is 7.7 per week by 95 percent.
Unprecedented matching contributions by media outlets: An additional 107 percent in public service time and contributions from national and local media has been generated in areas where ads were purchased, more than doubling the benefit derived from public funds.
Outstanding creative support from networks: Network television has been particularly responsive and is becoming more sensitive to depiction of youth drug use issues in their series. Over 20 network episodes, including major series, have been developed and broadcast. Six broadcast and cable networks have produced their own public service messages using the top stars in their programs.
Parent requests for information up 88 percent: Although only 10 percent of current ads show toll free numbers, contacts to the National Clearinghouse for Alcohol and Drug Abuse (NCADI) are sharply higher and will continue to increase further when new ads, which will contain contact numbers,air in early 1999.
Ads being developed in 11 languages: This campaign represents the federal government’s largest ethnic and minority communications effort. When Spanish language ads first aired in late August 1998, Hispanic callers to NCADI jumped from an average of 3-4 per day to 40 per hour.
Web site "hits": ONDCP’s drug prevention Web site for youth and parents launched July 9, 1998, now has an average of 177,000 "hits" per month, and the site is still in its testing phase.

2. Mobilizing Community Anti-Drug Coalitions
The community-based anti-drug movement in this country is strong, with more than 4,300 coalitions already organized. These coalitions are significant partners for local, state, and federal agencies working to reduce drug use, especially among young people. Coalitions typically include schools, businesses, law enforcement agencies, social service organizations, faith communities, medical groups, local and county government, and youth groups. Coalitions develop plans and programs to coordinate anti-drug efforts for the benefit of communities. In many locations, integrating efforts have created comprehensive prevention infrastructures that reduced drug use and its consequences. Such groups have the ability to mobilize community resources; inspire collective action; synchronize complementary prevention, treatment, and enforcement; and engender community pride.
The Drug-Free Communities Program: Congress enacted the Drug-Free Communities Act of 1997 to provide modest grants to community anti-drug coalitions. $20 million is authorized for FY 1999, $30 million for FY 2000, $40 million for FY 2001 and $43.5 million for FY 2002. The program is designed to strengthen community-based coalition efforts to reduce youth substance abuse by bringing together family, school, the faith community, civic and business groups, the law enforcement and criminal justice systems, and the medical community. This systems approach to the reduction of substance abuse is a research-based strategy that has had positive results in many communities.
In October 1998 the President appointed an 11 member Advisory Commission on Drug-Free Communities to advise, consult with, and make recommendations to the ONDCP Director concerning activities carried out under the program The Justice Department’s Office of Juvenile Justice and Delinquency Prevention ( OJJDP ) administers the program through interagency agreements with the Office of National Drug Control Policy (ONDCP). The Substance Abuse and Mental Health Services Administration (SAMHSA) Center for Substance Abuse Prevention (CSAP) is providing training and technical assistance through the Centers for the Application of Prevention Technologies (CAPTs). Additionally, OJJDP is conducting an evaluation of the Drug-Free Communities Support Program, which will determine whether the two major goals of strengthening community coalitions and reducing substance use among youth have been reached.
In 1998, building upon the existing coalition movement, the first grants were awarded to 93 coalitions in 46 states. In 1999 ONDCP and OJJDP will jointly solicit a second round of program applications from communities nationwide to strengthen existing coalitions and expand their number across the nation.
3. Drug-Free Schools and School Coordinator Programs
Prevention in Schools: As the number of "at-risk" children increases in our country over the next five years, resources must be made available to expand school-based drug prevention programs to keep pace with those increases. The Department of Education's Safe and Drug-Free Schools Program (SDFSP) is the only federal drug prevention program intended to reach all school-age children. It provides funds for virtually every school district to support drug and violence-prevention programs and to assist in creating and maintaining safe learning environments. It represents a major investment in our youth and is funded at a level of $531 million in FY 1999 with $441 million for formula grants and $90 million for national programs. Overall, the program has focused on ensuring that SDFSP fund recipients (governors, state education agencies, local education agencies, and community groups) adopt programs, policies, and practices that are based on research and evaluation. In 1998, the Department of Education implemented Principles of Effectiveness for the program. These Principles will help grantees use program funds more effectively. These Principles of Effectiveness state that a SDFSP grant recipient must:

Base its programs on a thorough assessment of objective data about the drug and violence problems in the schools and communities served;
With the assistance of a local or regional advisory council, establish a set of measurable goals and objectives and design its programs to meet them;
Design and implement its programs based on research or evaluation that provides evidence that the programs prevent or reduce drug use, violence, or disruptive behavior among youth; and
Evaluate its programs periodically to assess progress towards achieving its goals and objectives, and use its evaluation results to refine, improve, and strengthen its programs and refine its goals and objectives as appropriate.

The Department of Education is also developing an Expert Review Panel to help identify promising or exemplary drug and violence prevention programs.
In October, 1998 President Clinton announced his plan for the re-authorization of the Safe and Drug-Free School Program to provide more effective prevention programs for the reduction of drugs and violence in schools, more accountability for results, and better targeting to those schools that need the most assistance. These changes include:

Increasing funding for effective plans and strengthening accountability. Under the proposal, federal funds will provide support to school districts with demonstrated need and a commitment to adopt a rigorous, comprehensive approach to drug and violence reduction and prevention.
Creating incentives to develop comprehensive and results-oriented plans. Districts will be expected to use relevant drug and violence data to develop a comprehensive plan -- in consultation with parents, teachers, students, law enforcement officials, mental health providers and other members of the community -- to do the following:

Adopt and enforce, clear and fair discipline policies, such as zero tolerance policies for guns and drugs, and parent notification and involvement.
Provide effective anti-drug and violence prevention programs, including programs that teach responsible decision-making, mentoring, mediation, or other activities aimed at changing behaviors. Funded activities must demonstrate effectiveness in helping to create a drug-free and safe learning environment.
Collect data and report to the public the results by providing annual report cards on the number and type of school-related drug and/or violence incidents.
Assess and intervene for troubled youth through procedures to identify students for evaluation and counseling; training for teachers and staff; and providing linkages between district officials, mental health, and other community professionals where appropriate.
Connect to after-school activities for youth to extend the school day and/or develop links to other after-school programming, and help provide children with meaningful connections to responsible adults in the community.

Develop plans for crisis management, such as drug overdoses. The plan must also address assistance for victims, contacts with parents, law enforcement, counseling, and communication wit the media.

School Coordinator Program: In FY 1999, the Congress provided $35 million to launch the Administration's School Coordinator Program. This program will support the hiring of drug prevention coordinators in middle schools across the country to help improve the quality and effectiveness of drug prevention programs. Drug prevention coordinators will be responsible for developing, conducting and analyzing assessments of their school's drug problems; identifying promising research-based drug prevention programs to address those problems; assisting teachers, coaches, counselors and other school officials in adopting and implementing those programs; working with the community to ensure that the needs of students are linked with available community resources; and identifying alternative funding sources for drug prevention initiatives. The drug program coordinators will assist parents, youth, and school officials to identify community resources and to strengthen the role of parents in school settings. This program will also require coordinators to provide feedback to state educational agencies on programs that have proven to be successful in reducing drug use among school-aged youth.
Post-secondary Education: Illegal drug use and the abuse of alcohol and tobacco also are serious problems on our college and university campuses. In the 1997/1998 academic year, several students died as a direct result of binge drinking, and many more were admitted to hospitals for treatment of alcohol-related injuries and alcohol poisoning. In 1998, the Department of Education has led efforts to identify those programs and activities that have been successful in reducing alcohol and drug use on college campuses. The Department of Education also provides funding and technical assistance to a limited number of colleges and universities so they can adopt those programs that have been identified as successful.
4. Parenting and Mentoring Initiative
Research by the National Institute on Drug Abuse (NIDA) and the Center on Addiction and Substance Abuse at Columbia indicates that if parents would simply talk to their children regularly about the dangers of illicit drugs, alcohol, and tobacco, drug use among youth could be substantially reduced. Data suggests that parents can be the most powerful influence on youth, and we know that children who do not receive adequate supervision and attention are the most likely to engage in anti-social and risky behaviors, including drug use and drug trafficking.
Likewise, effective drug prevention programs require strategies which provide youth with role models and life skills that help to reduce the likelihood of the initiation of alcohol and drug use. This has been demonstrated through studies which reflect the powerful impact a concerned and caring adult can have on a young person's life. For example, a Big Brothers/Big Sisters study of mentoring programs has shown a 46 percent reduction in the initiation of drug use and a 27 percent reduction in the initiation of alcohol use.
Family-Centered Approaches to Keeping Children Drug-Free: A systematic review of current research on the family's role in reducing substance abuse among youth has established that families play the most important role in determining how young people handle the temptations to use alcohol, cigarettes, and illegal drugs. The Substance Abuse and Mental Health Services Administration/Center for Substance Abuse Prevention has produced a compilation of the family-centered approaches which have been proven effective for specific populations. Second in its Prevention Enhancement Protocol System (PEPS), the Preventing Substance Abuse Among Children and Adolescents: Family-Centered Approaches publication includes three specific documents: a comprehensive reference guide; a practitioner's guide; and a community guide.
Raising Awareness of Parents and Mentors: The 1998 National Drug Control Strategy has as its first goal to "Educate and enable America's youth to reject illegal drugs as well as alcohol and tobacco." Objective 5 of this goal seeks to "support parents and adult mentors in encouraging youth to engage in positive, healthy lifestyles and modeling behavior to be emulated by young people." Through an interagency agreement with ONDCP, the Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Prevention, is implementing a number of efforts to organize, train, motivate, and raise the awareness of parents and adult mentors to assist them to help children and youth remain drug-free.
Your Time - Their Future: This campaign was developed by the Substance Abuse and Mental Health Services Administration as part of the Department of Health and Human Services Youth Substance Abuse Prevention Initiative. Your Time - Their Future highlights the importance of structured positive activities, such as playing sports, collecting stamps, or playing a musical instrument, in helping youth resist alcohol, tobacco, and illicit drugs. The Campaign encourages adults to become involved in volunteering, mentoring, and other efforts that help young people ages 7-14 participate in positive activities that build life skills, self-discipline and competence. The four informational guides contained within this Campaign are:

Positive Activities - A Campaign for Youth
Get Involved in Someone's Future - A Guide to Volunteering With Young People
Your Time - Their Future: Membership-Based Groups Provide Positive Activities
Your Time - Their Future: Positive Activities Promote a Productive Workforce

A pilot evaluation study will be conducted to track the Your Time - Their Future Campaign. The purpose of the study is two-fold. Process evaluation will document the implementation of Campaign materials and messages. Outcome evaluation will determine whether there was an increase in public awareness about, knowledge of, and willingness to participate in positive skill-building activities.
"Parenting IS Prevention" Program (PIPP): Under an interagency agreement with the Office of National Drug Control Policy and other federal partners, CSAP has worked to strengthen and mobilize existing anti-drug programs to assist parents and other caregivers to help children and youth remain drug free. Training and technical assistance to motivate and mobilize communities are underway, with more than 200 representatives of large, medium and small-sized communities already trained. In addition to training/technical assistance, PIPP maintains an information referral service, an interactive PIPP Web site and works closely with the media to feature messages that promote parent-focused youth substance abuse prevention efforts.
5. Youth Drug Prevention Research (NIDA)
National Initiative on Drug Abuse Prevention Research: NIDA-supported science research has made significant strides in the past year to further our understanding of drug abuse prevention. The total NIDA funded research portfolio represents a major investment in health research. For FY 1999, NIDA is funded at $634 million, almost one quarter of all Department of Health and Human Services drug-related funding.
Several of these studies illustrate the importance of the collaboration between research-based prevention programs, communities, and families in protecting the future of our youth. The Midwestern Prevention Project in Indianapolis evaluated the effects of a multi-component community-based drug abuse prevention program on 3400 students from 57 junior high schools. Study results showed that participation in the prevention program significantly decreased drug use among users of tobacco, alcohol, and marijuana. The study counters a commonly held belief that primary prevention works only with non-users or occasional users. Parents and families play the major role in drug abuse prevention, however. A study on parental and family risk factors for substance use by inner-city African-American children and adolescents confirmed expectations that positive parental and family characteristics protect children and adolescents against future drug use risk by enhancing negative drug attitudes. Another study enrolled parents in a drug abuse prevention education program and found that participation in the program not only increased communication about drug abuse issues but also increased proactive communications and decreased negative interactions in general between those parents and their children.
NIDA has published the first research-based guide to preventing young people from using drugs. The guide, "Preventing Drug Use Among Children and Adolescents: A Research-Based Guide," is organized around 14 prevention principles distilled from research on effective prevention techniques and notes that every dollar spent for effective prevention programs can save $4 to $5 in the costs of treatment and counseling.
6. Improving State Planning for Prevention
Despite increases in funding for drug control programs over the past decade, the incidence and prevalence of youth drug use has increased. Prevention programs must be responsive to local needs, but also must support proven prevention methods in order to be effective. SAMHSA/CSAP’s State Incentive Grant (SIG) programs help states to implement such programs. These competitive grants support science-based prevention by requiring each grantee state to direct 85 percent of the grant award to community-based substance abuse prevention. The SIG program serves as an incentive for Governors to leverage and/or redirect prevention funding streams and develop and implement comprehensive plans for a more strategic allocation of prevention funds. FY 1999 funding, requested in the President's budget, totaled $65.7 million for 21 Incentive Grants.
7. Civic Alliance: Prevention Through Service
On November 15-18, 1997, the Substance Abuse and Mental Health Services Administration hosted a conference launching the ONDCP Civic Alliance: Prevention Through Service initiative. This meeting was attended by more than 45 national and international civic and service organizations and provided a range of education, training, and networking opportunities addressing all aspects of drug abuse prevention, with a focus on outreach to youth, their parents, and other care givers through parenting and mentoring efforts.
Highlighting the meeting's training function was a media literacy training session for youth. The meeting also included round table discussions and sessions by leading federal partners on the latest developments in drug abuse prevention, including the physiology of addiction and the National Youth Anti-Drug Media Campaign. Training on community and volunteer mobilization was provided, with a focus on parenting and mentoring.
Thirty-three national civic and service organizations, representing more than 55 million volunteers, signed the Prevention Through Service Alliance Resolution Agreement. At the signing, ONDCP Director Barry R. McCaffrey praised the organizations for their promise to volunteer one million hours. He emphasized the importance community groups, which he characterized as "the heart and soul of America," had in reaching out to youth. On April 28, 1998, with the encouragement of Vice President Gore, an additional five groups joined the original 33 national organizations joined as signatories so that the Alliance now includes 38 groups representing over 62 million members.
ONDCP and SAMHSA, as well as the other federal prevention partners, continue to provide support in terms of training opportunities, resource and programmatic materials, and other assistance as needed to the Alliance as it implements its action plans and recruits new Alliance members.
8. Reducing Youth Use of Tobacco and Alcohol and Marijuana
Preventing Alcohol Use and Drunk and Drugged Driving Among Youth: The Strategy recommends educating youth, their mentors, and the public about the dangers of underage drinking. This includes limiting youth access to alcoholic beverages, encouraging communities to support alcohol-free behavior on the part of youth, and creating incentives as well as disincentives that discourage alcohol abuse by young people. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) and SAMHSA/CSAP are examining possible causal relationships between exposure to alcohol advertising and alcohol consumption among youth. The National Highway Traffic Safety Administration (NHTSA) and the Office of Juvenile Justice and Delinquency Programs (OJJDP) are addressing alcohol and drug-related crashes among young people in support of the President's "Youth, Drugs, and Driving" initiative. NHTSA is providing law enforcement, prosecutors, and judges with training and education for detecting, arresting, and imposing sanctions on juvenile alcohol and drug offenders. States are urged to enact zero-tolerance laws to reduce drinking and driving among teens. Civic and service organizations are encouraged to collaborate with organizations like Mothers Against Drunk Driving and Students Against Destructive Decisions.
Preventing Tobacco Use Among Youth: Several federal agencies are working to increase awareness among youth of the dangers of tobacco use. The Food and Drug Administration (FDA) is enforcing regulations that reduce youth access to cigarettes and smokeless tobacco products. The FDA also conducted a publicity campaign in 1998 to encourage compliance by merchants. State enforcement of laws prohibiting sale of tobacco products to minors, as required by the Public Health Services Act, is monitored by SAMHSA/CSAP. CDC supports the "Research to Classrooms" project to identify and expand school-based tobacco-prevention efforts; CDC also will fund initial research on tobacco-cessation programs for youth. The Clinton Administration is calling for tobacco legislation that sets a target of reducing teen smoking by 60 percent in ten years. Arizona, California, Florida, Massachusetts, and other states have ongoing paid anti-tobacco campaigns addressing underage use.
HHS Secretary's Initiative on Youth Substance Abuse Prevention: This initiative, created under the leadership of HHS Secretary Donna Shalala, is guided by the first goal of the President's 1998 National Drug Control Strategy. That goal is to "educate and enable America's youth to reject illegal drugs as well as alcohol and tobacco." There are three major components: 1) Leverage and Mobilize Resources; 2) Raise Public Awareness and Counter Pro-Use Messages; 3) Measure Outcomes. Projects under these headings are conducted in collaboration with other Federal agencies, States, communities, and private partnerships.
Reality Check: To address the dramatic increase in marijuana use by youth, the Substance Abuse and Mental Health Services Administration/Center for Substance Abuse Prevention has developed a nationwide effort to prevent and reduce the growing problems associated with marijuana use among 9 to 14 year-olds. The Campaign addresses the issues of perception and use of marijuana at the community level. Efforts have been made to change community attitudes/practices, to develop credible and effective education programs, and to galvanize support for changing community norms regarding the use of marijuana. To date, the Campaign has placed lighted posters in more than 300 malls throughout the country and 200 regional grocery and department stores.
9. Youth Athletic Initiative Against Drugs
In June of 1998, ONDCP launched the "Athletic Initiative Against Drugs." The purpose of the initiative is twofold: first, to mobilize the athletic world to educate children about the dangers of drugs and provide them with positive opportunities to keep them away from drugs; second, to ensure that the message the athletic world sends our children about drugs is a positive one -- "If you use, you lose. Be a winner."
Mobilize the Athletic World: The first National Coachathon Against Drugs week was held in 1998. Coaches were asked to spend ten minutes or more, at least once during the week, talking about the dangers of drugs to their players and students. With DOJ, ONDCP has published and mailed out 100,000 Coaches Playbooks Against Drugs to coaches across the nation. Events took place all week all across the nation. The kickoff was held with Major League Soccer at their championship in Los Angeles. The anchor event was a basketball clinic in D.C. with leading college coaches.
Public Service Announcements (PSAs) in Stadiums: In the Initiative's first year, 17 major league baseball teams showed anti-drug PSA spots on their "jumbotrons" during the season. NFL teams are now showing PSAs. ONDCP is developing a program with the NHL to show PSAs at all games.
NCAA National Youth Sports Program: Working with Department of Housing and Urban Development (HUD), ONDCP secured additional anti-drug money for this NCAA youth education program, which provides a sports summer camp, tied with anti-drug and pro-learning courses, to over 68,000 at-risk kids across the nation.
Coaching and Youth Programs: ONDCP is working with organizations (e.g., Boys and Girls Clubs) and corporations (e.g., Nike) to help them incorporate anti-drug education into their coach and youth training programs.
Get Drugs Out of Sports: ONDCP has launched a public and private diplomacy effort to ensure that this round of NBA bargaining addresses the problem of drugs in the sport. ONDCP's efforts helped the International Olympic Commission (IOC) to enact a new prohibition on marijuana. ONDCP is participating in the IOC's current effort to strengthen its anti-doping program. In addition to addressing the performance enhancing drug issue, the goal is to make the Olympics drug-free (including non-performance enhancers, such as Ecstasy). ONDCP is working in cooperation with the USOC leadership to help our Olympic program strengthen its domestic anti-doping program.
10. National Guard Drug Demand Reduction Program
The National Guard is uniquely qualified to provide support to the efforts of the community-based anti-drug organizations. Located in over 3,200 communities in all 54 states and territories and working in combination with over 3,900 coalitions, the Guard has provided, since 1989, vital support to a wide variety of demand reduction missions by providing resources and personnel who serve as facilitators, trainers, speakers, mentors, planners, volunteers, and role models. These citizen-soldiers serve on over 2,500 local, state, and national coalitions whose only mission is the prevention of substance abuse.
The National Guard Drug Demand Reduction Program, in partnership with communities, coalitions and organizations, reaches millions of young people in the country to help educate and motivate them to reject illegal drugs. In FY1998, the National Guard spent over $12.5 million to support over 8,600 missions reaching over 11.7 million people. These missions support parents, community coalitions, and law enforcement agencies serving youth prevention programs aimed at youth between the ages of 5-18.
The Guard supports the "Red Ribbon Campaign;" Junior ROTC programs; Adopt-A-School programs; National Youth Sports Program camps; Boys and Girls Clubs; Kids and Cops program; Drug Abuse Resistance Education (DARE); Drug Education For Youth (DEFY); Big Brothers/Big Sisters program; Youth Academies; and Police Athletic League programs.
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