If you have issues viewing or accessing this file contact us at NCJRS.gov. Center for Substance Abuse Prevention A Discussion Paper on Preventing Alcohol, Tobacco, and Other Drug Problems September 1993 U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service Substance Abuse and Mental Health Services Administration Center for Substance Abuse Prevention • • Center for Substance Abuse Prevention • . .. ~PreventionW()'RKS! , - • ~ < !~3' :;:~~~'tt~~ztr(f;..-: 1L'~~:t,'~ .•;rf ';:1fr~"':'~~1{~t~~ .~ • A Discussion Paper on Preventing Alcohol, Tobacco, and Other Drug Problems • • 148094 U.S. Department of Justice National Institute of Justice This document has been repro juced exactly as received from the • p~rson or organization originatin(J it. Points of view or opinions stated In this do.c~ment a~e those of t.he authors and do not necessarily represent the official position or policies of the National Institute of Justice. Permission to reproduce this q j jhll material has been granted by Pllblic Domain/u.s Dept. of Health and Human Services • to the National Criminal Justice Reference Service (NCJRS). Further reproduction outside of the NCJRS system requires permission of the ~ owner. • September 1993 U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES • Public Health Service Substance Abuse and Mental Health Services Administration Center for Substance Abuse Prevention • J • This Discussion Paper was prepared pursuant to a Center for Substance Abuse Prevention (CSAP) contract with • Social & Health Services Ltd. The opinions in this document do not necessarily reflect the opinions, official policy, or position of CSAP, the Substance Abuse and Mental Health Services Administration (SAMHSA), the Public Health Service, or the U.S. Department of Health and Human Services. All material in this paper is in the public domain and may be used or reproduced without permission from CSAP or • the authors. Citation of the source is appreciated. Acknowledgments Judith E. Funkhouser and Robert W. Denniston of CSAP directed the development of this paper. Appreciation also is extended to more than 100 people who provided critical technical and editorial review, including William • Butinsky of the National Association of State Alcohol and Drug Abuse Directors; Michael Stoil of the Washington Area Council on Alcoholism and Drug Abuse; Joseph Gfroerer of the Substance Abuse and Mental Health Services Administration; Nancy Kennedy, Rosalyn Bass, Steve Gardner, Darie Davis, and Cathy Nugent of CSAP; and Nancy Klein, Darcy Otis, Peggy Williams, and George Marcelle of Social & Health Services Ltd. Cathy Crowley and the National Clearinghouse for Alcohol and Drug Infonnation (NCADI) staff were invaluable in providing • research assistance. About the Authors Lewis D. Eigen, Ed.D., is a fonner Associate Professor of Educational Psychology at Temple University and has lectured at dozens of other colleges and universities throughout the country. He fonnerly served as the Project Director of the National Clearinghouse for Alcohol and Drug Infonnation, the Federal Government's leading • infonnation and public education resource for demand reduction and prevention. He currently serves as the Presi­ dent and Chief Executive Officer of Social & Health Services Ltd. He has had management responsibilities for the National School Resource Network, National Drug Abuse Education Center, and the National Center for Alcohol Education. David W. Rowden, Ph.D., is a medical sociologist with 18 years of experience in health promotion, health educa­ • tion, and research. Currently the Project Director of NCADI, he received his advanced training in medical schools. He served on the graduate and medical faculties of the University of Texas Medical Branch in Galveston. Among his graduate faculty duties were teaching courses in the scientific method, philosophy of science, research design, and biostatistics. He also received additional training through the Center for Educational Development in Health while in residence as a fellow in the Department of Preventive and Social Medicine, Harvard Medical School. He has held management positions with the National High Blood Pressure Education Program and National Center for • Alcohol Education and with projects funded by the Rehabilitation Services Administration and the Health Resources and Services Administration. Slides A set of slides illustrating many of the points in this paper has been prepared. For availability of these slides or • additional copies of this document contact CSAP's: National Clearinghouse for Alcohol and Drug Information P.O. Box 2345 Rockville, MD 20847 1-800-729-6686 • TDD 1-800-487-4889 In addition, the appendix contains full-size graphics with which the user may make overhead transparencies. • • From the Acting Director of CSAP. It .. Prevention efforts are largely responsible for a downward trend in the use of alcohol, tobacco, and other drugs over the last decade. However, these efforts need to be sustained, as well as • substantially strengthened if we are to continue to make prevention work better for everyone. As you will see from this Discussion Paper, prevention and treatment efforts have made major gains in reversing the trend toward more and more alcohol, tobacco, and other drug use. The numbers are impressive: Nearly 25 million young adults are not using drugs who might have • been if demand reduction efforts had not reached them. Prevention has been especially effective for adolescents. In 1979, 18 percent of all 12- to 17-year­ olds used illicit drugs and by 1991, only 7 percent were using illicit drugs. This decrease represents more than 2.5 million adolescents who would have been using illicit drugs if the 1979 level of drug • use had continued. The decline holds true for alcohol use among adolescents as well-alcohol use among adolescents dropped from 37 percent in 1979 to under 20 percent in 1991. This news is encouraging. However, there are three major reasons not to become complacent. First, there are always new young people coming into each age group; for example new elemen­ • tary age youth who will be pressured to use alcohol, tobacco, and other drugs at even these very early ages. There could be a rapid reverse in previous prevention gains without continued and sustained efforts to persuade youth to "Be Smart!" Don't Start"; to teach them resistance, social, and other skills; and to provide community support and policies for their non-use choices. • Second, for those who are choosing at an early age to engage in the high-risk behavior of alco­ hol, tobacco, and other drug (ATOD) use, more intensive efforts are required to persuade them that they can make healthier and safer choices for themselves and those around them. They need to know that ATOD use is closely linked to juvenile delinquency, school failure, mY/AIDS transmission, violence, injury, and death. Teens who are making such unhealthy and unsafe • choices, the future employees of American business, jeopardize our future abilities to compete in the global marketplace. And third, we know that some audiences are at less risk than others. These are people who live in communities that have comprehensive prevention programs and norms and practices sanction­ ing non-use of substances by youth; that discourage abuse; and provide treatment for those who • are dependent. As successful as prevention has become, there are still many people who have not yet benefitted from these messages. For instance: • .. There are still over 4 million youngsters who drink illegally. .. There are more than 1.3 million adolescents, 4 million young adults, and 7 million older adults who use illicit drugs. • , Alcohol-related traffic fatalities and Alcohol and Other Drug (AOD)-related violence are still the leading causes of death for America's teenagers. • .1 Therefore, to reach an even larger audience, we must redouble our prevention efforts. For the elementary-age students just beginning to be able to comprehend and integrate no-use mes­ sages and resistance skills, we must provide comprehensive prevention efforts. For the rebel­ lious, high sensation-seeking teenager, we must increase our ability to offer healthy and safe • alternatives to chemicals. And, in our neighborhoods we must enlist families, as well as the business community in helping provide prevention opportunities for all. This is just the begin­ ning of many prevention strategies that can be implemented and sustained through community partnerships, where everyone gets involved with and is committed to preventing alcohol, tobacco, and other drug problems. • Our theme for the 1990's and into the new century must be: Let's Make Prevention Work for Everyone! Vivian L. Smith, M.S.W. • Acting Director Center for Substance Abuse Prevention • • • • • • • • Contents Introduction • What Is Prevention? .......................................................... 9 What Are Prevention Strategies? ................................................ 10 • What Are the Benefits of Prevention? ............................................ 13 Analysis DrugUse .................................................................. 20 • Who Are Prevention Beneficiaries? .............................................. 21 Other Indicators of Success .................................................... 29 • Corroborating Data . .. 35 Discussion Are Prevention Gains Just the Result of Natural Cycles? ............................. 37 • Could the Decade's Prevention Gains Be the Result ofInterdiction? ...................