A Theoretical Framework
for Demand Reduction --
Summary of Presentations
Co-Moderators: Dr. Hoover Adger Jr., and Dr. Roberto Tapla-Conyer
Research and Evaluation
Dr. Karol L. Kumpfer
Director, Center for Substance Abuse Prevention,
Substance Abuse and Mental Health
Services Administration,
Department of Health and Human Services, USA
Dr. Kumpfer stated that the total cost of drug abuse in the U.S. is about $1,000 per person per year, but the total amount the U.S. spends on drug abuse prevention, treatment, and research is only about $3 per capita per year, about the cost of one of our Big Macs. After 20 years of research, she claimed, we now know that a well-coordinated, comprehensive, community-wide approach to prevention, aimed at parents and youth, works. But, as she pointed out, what is needed is a consistent "no use" drug message to youth, coupled with making young people aware that we care about them and that we are determined to achieve a strong, drug-free community in their interest.
Parents are the major factor deterring young people from drug abuse.
While recognizing that peer and other influences play a role, Dr. Kumpfer stated that national and international studies in the Western Hemisphere demonstrated that parents are the major factor deterring young people from drug abuse. Referring to General McCaffrey's comment, she reiterated that the war on drugs will be won around the kitchen table by parents and kids talking about drug abuse and its implications. She expressed regret that there is little overlap between the usual drug prevention activities or programs available in practice in communities or schools and what research has indicated is actually effective.
Dr. Kumpfer pointed out that several phases of research leading to effective methods can be identified:
Phase 1 - Hypothesis development;
Phase 2 - Methods and curriculum development;
Phase 3 - Controlled international trials -- based on the earlier phases, conducting a controlled, demand reduction, drug-abuse prevention program under optimal conditions to see if it works;
Phase 4 - Defined population studies -- testing the techniques found to be effective with a wide range of ethnic populations under real-life field conditions (e.g., in rural and urban areas and in the barrios and colonias);
Phase 5 - Demonstrations and implementations -- conducting large-scale demonstrations with an emphasis on dissemination research to ensure that the methods developed actually work under field conditions and can be readily adopted;
Phase 6 - Full-scale use -- helping schools, communities, and the local funding sources carry out these proven prevention programs on a wide scale.
Dr. Kumpfer explained that part of the function of SAMHSA'S Centers for Substance Abuse Prevention, Treatment, and Mental Health Services is to help build the necessary bridges between research and practice. This enables effective models to be field-tested for wide-scale use and dissemination, she noted. In closing, Dr. Kumpfer stressed that all of the conference participants were equally important in achieving this continuum of research-based practice. She stated that a strong demand reduction strategy is essential and noted that, as long as there is a demand for drugs, there will be producers. By developing effective demand reduction strategies, we can significantly reduce the economic and social problems that the abuse of drugs poses for both our countries.
Ms. Haydée Rosovsky
Director, National Council on Addictions (CONADIC)
Ministry of Health, Mexico
Ms. Rosovsky briefly summarized Mexico's experience with research information systems and outlined its collaborative efforts with the National Institute on Drug Abuse (NIDA), the National Institute on Alcoholism and Alcohol Abuse (NIAAA), and the Centers for Disease Control and Prevention (CDC). As she explained, the Secretariat of Health, the Directorate of Epidemiology , and the Mexican Institute of Psychiatry all play leading roles in conducting her nation's research and addiction programs. For instance, the Institute of Psychiatry has been conducting epidemiological surveys since the mid-1960s, and, under the aegis of the Secretariat of Health, Mexico's Youth Integration Center provides information on adolescent drug-use trends. Ms. Rosovsky said that the Mexican Government is interested in the magnitude of the drug problem, the groups most affected by drug use, and the extent to which studies being conducted can contribute to better decisions on drug prevention, treatment, and social communication. Accurate information on drug-related medical and social problems is essential in order to take appropriate action, she said. Such information also contributes to establishing research goals. Despite limited resources for research in Latin America, Mexico has been a leader in this area.
Ms. Rosovsky noted that two national household drug surveys have been conducted in Mexico with a third planned for 1998. Unfortunately, she explained, national surveys provide little information on the highest drug-risk groups, those who are often no longer in school or who are marginalized. Groups such as "street children," children who live or work on the streets, usually are not included in schools or household surveys. Limited work with such children, she noted, indicates inhalant use is common, second only to that of marijuana. She therefore emphasized the use of ethnographic and focal studies, which permit evaluating both qualitative and quantitative aspects of the drug problem.
Ms. Rosovsky concluded by offering several recommendations with respect to cooperation between Mexico and the United States. She emphasized the importance of the migrant-worker population, which lives in both countries and frequently lacks stabilizing family and community influences while living abroad. In the border region, she noted, it is important to learn more about family and other factors that increase the risk of drug abuse or that have protective significance.
Accurate information on drug-related medical and social problems is essential in order to take appropriate action.
Ms. Rosovsky stated that the U.S. and Mexico also need more basic epidemiological and social research concerning problems linked to drug use such as domestic and other types of violence and crime. It is very important, she said, to compare native population groups in rural and urban settings to determine social, family, community, attitudinal, and normative factors that affect drug use in both countries. She stated that we also need to know who is most likely to succeed in the various drug programs in order to maximize the likelihood of successful treatment outcomes.
