II. Foundation Response: Opportunities And Strategies For Grantmakers In The War On Drugs
1990; Project HOPE; Volume: 9; Issue: 2 Linguagem: Inglês
10.1377/hlthaff.9.2.202
ISSN2694-233X
AutoresJoseph S. Dolan, Chris K. Olander,
Tópico(s)Health and Medical Research Impacts
ResumoGrantWatch Health AffairsVol. 9, No. 2 II. Foundation Response: Opportunities And Strategies For Grantmakers In The War On DrugsJoseph S. Dolan and Chris K. Olander AffiliationsThe J.M Foundation.J.M. Foundation has awarded over $3 million to alcohol and drug abuse projects.PUBLISHED:Summer 1990Free Accesshttps://doi.org/10.1377/hlthaff.9.2.202AboutSectionsView PDFPermissions ShareShare onFacebookTwitterLinked InRedditEmail ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsDownload Exhibits TOPICSPharmaceuticalsDrug useGrantmakersSubstance use disorderEducationMediaAddictionChildren's healthAbstinenceDrug prohibition We believe foundations, corporations, and individuals have both the mandate and the potential to substantially reduce our national dependence on drugs. But first, the philanthropic world must realize there is no simple solution to save us from the ravages of drugs. Neither legalization, control measures, boot camps, nor a host of other politically expedient ideas will have a significant impact on the demand for drugs until we recognize that “we have met the enemy and they is us.” A recent Wall Street Journal editorial succinctly stated, “The truth is that the drug problem begins on American streets, not in Colombia.” 1Community Organization To Meet The ChallengeThe challenge facing grantmakers is how to integrate alcohol and drug issues into current program areas. Grantmakers can become a catalyst for change to help bridge turf issues, coalesce community resources, and empower grass-roots leadership. Due to the multifaceted nature of the drug problem, community leaders and resources must be mobilized through task forces, coordinating councils, or citizens' commissions to foster a winning spirit and sense of mission by diminishing community frustration and paralysis; overcome institutional barriers and encourage comprehensiveness; introduce new models, structures, and strategies; raise funds and build broad-based constituencies from groups that are often fragmented and diverse; and develop thorough data collection and research on a national or regional basis.While few grantmakers have the resources of The Robert Wood Johnson Foundation, its ambitious new $26.4 million Fighting Back program incorporates several important features that can make any grant more effective. The program's grants will support intensive, community-wide initiatives to reduce the demand for illegal drugs and alcohol by consolidating resources and mobilizing a critical mass of local leadership. It involves a broad-based consortium of institutions and organizations, including academia, media, civic and religious groups, schools, businesses, health care providers, human service agencies, insurers, labor, and alcohol and drug treatment providers.Gaps to be filled.As funders, policymakers, and citizens' task forces devise solutions to their communities' particular problems, they should address the following deficits in the alcohol and drug field: (1) forging systemic policy—systemwide structures instead of piecemeal steps, tinkering with current alcohol and drug initiatives, and sporadic funding; (2) building consensus on attitudes to address addiction in our society with a single theme or approach; (3) identifying what works best for whom and under what conditions (National Drug Control Policy Director William J. Bennett has promised a “catalogue” of the most promising models and programs); (4) moving from a curative mode to one of prevention, education, and early intervention, for no epidemic has ever been eradicated simply by treating the casualties; (5) anticipating and intercepting new drug abuse cycles, such as “crack” (smokable cocaine) and “ice” (methamphetamine); and (6) creating multidisciplinary, independent “think tanks” to address the enormous cultural, economic, and social forces that contribute to alcohol and drug problems. We must overcome the historical fragmentation of programs; duplication of efforts; division of the alcohol and drug fields; separation of private and public initiatives; and rival, competing, and contradictory strategies. To focus more resources on prevention, education, and early intervention, J.M. Foundation President Jeremiah Milbank, Jr., has proposed the establishment of a privately financed, billion-dollar Superfund for a Drug-Free America, which would receive tax-deductible contributions from students, citizens, religious groups, foundations, corporations, small businesses, and voluntary organizations. Education And Prevention The authors of a 1984 RAND Corporation report recommended a “social influence approach” to educate young people about substance abuse. This approach addresses the major influences that promote drug use: pressure from others to use drugs and young people's belief that using drugs will yield positive social outcomes. Two other popular approaches showed little success, the authors said, and ought to be avoided by grantmakers in funding education and prevention programs. These are the information approach, which seeks to help young people understand the legal, medical, and dangerous consequences of drug use; and the general skills approach, which helps teenagers acquire a more positive self-image by improving their skills in decision making, communication, and values clarification. 2 The Boys Clubs of America's Smart Moves program has been implemented in approximately 200 Boys and Girls Clubs nationwide, including several facilities in public housing projects. The program is based on the life-skills training concept put forward by Gil Botvin at Cornell University Medical College, which reinforces positive behavior and resists unhealthy peer, social, and media influences. It is designed to target disadvantaged and high-risk youth on their own turf; involve cooperative efforts between youth, parents, and community leaders; and prevent the interrelated problems of drug and alcohol use and teenage pregnancy. A recent evaluation report by Columbia University stated “that Boys and Girls Clubs exert a positive, consistent, and palpable influence on the human and physical environment of public housing projects.” 3Organizations such as The RAND Corporation, the Office of Substance Abuse Prevention (OSAP), National Drug Information Center of Families in Action, and National Association of State Alcohol and Drug Abuse Directors offer guidelines for prevention. Common themes include the following. (1) It is important to prevent or delay the onset of “gateway” drugs such as alcohol, tobacco, and marijuana (significantly, almost everyone who smokes cigarettes or drinks alcoholic beverages starts before age twenty-one). (2) Programs should use strategies such as social influence and personal refusal skills, which emphasize the importance of peers and family and of the ability to say “no.” (3) Effective prevention programming involves the use of multiple strategies implemented in sufficient scope, intensity, and duration. (4) School-based programs appear to be more effective if they have “legs” into the community and involve parents. (5) Messages must be accurate, clear, coherent, consistent, and unambiguous. (6) Parents of young children should be aware of teachable moments to positively instruct on alcohol and drug abuse.Exemplary approaches. Many of these guidelines for prevention can also be applied to publications, public awareness projects, and workplace educational programs. The Harvard Alcohol Project is working with media representatives to portray alcohol and drug issues in a more constructive fashion in popular prime-time television programs. (See William Dejong and Jay Winsten, “The Use of Mass Media in Substance Abuse Prevention,” in this issue of Health Affairs.) The Media-Advertising Partnership for a Drug-Free America is also a noteworthy attempt to “deglamorize” illegal drug use. National voluntary organizations, such as the National Council on Alcoholism and Drug Dependence, Mothers Against Drunk Driving (MADD), and the National Association for Children of Alcoholics, can be catalysts for change. A related trend is the recognition of “codependency” to prevent “enabling” and affect those involved with a chronically dependent person. A flood of workshops, publications, and self-help groups has appeared in recent years.Activities for grantmakers.In addition to seeking out programs that demonstrate new education and prevention strategies, grantmakers should (1) strengthen the family constellation to deal more effectively with children and youth concerning alcohol and drug issues; (2) encourage school-based programs in all middle and senior high schools, with student leadership, peer mentors, and intervention; (3) expand education programs in workplace settings; (4) consider new themes and messages for media and public awareness programs compatible with new approaches and findings; (5) fund and evaluate outreach efforts for high-risk young people in our inner cities, especially those efforts that create positive, reinforcing support systems; (6) foster a counter-drug culture to help reduce illicit drug usage; (7) integrate the benefits and lessons of the antismoking, nutrition, and health fitness movements into efforts to counteract alcohol abuse and illicit drug use; and (8) explore ways of changing community customs, values, and norms that tolerate, support, and reinforce the drug culture.Intervention, Treatment, And Relapse Prevention Research indicates that the less severe an individual's drug problem and, correspondingly, the longer the treatment duration, the more likely it is that drug dependency can be reduced or ended altogether. A recent study of 10,000 drug clients reported that “a variety of analyses confirmed that the time spent in the program was the single most important factor contributing to the improvement observed after treatment.” 4Despite the political appeal of treatment on demand, the sad fact is that most treatment programs have not proved to have a measurable impact on abstinence. This does not mean that a significant number of people do not benefit from current treatment modalities, especially if combined with powerful self-help groups such as Alcoholics or Narcotics Anonymous. However, few chemical dependency programs include dropout rates in their statistics or measure long-term abstinence after discharge. Thus, recovery rates that are generally reported to be 75 percent or more are actually closer to 35 percent, which is the same proportion of alcoholics who stop drinking spontaneously or limit their drinking with or without treatment. While abstinence is surely the most important treatment goal, innovative programs are now beginning to measure other important accomplishments, including reduction in amounts consumed or frequency of abuse, improvement in family and personal relationships, positive changes in work-related behavior, and decreased use of other health or medical care. However, “{N}o single approach is likely to be effective for more than a small minority of individuals,” noted Frederick Glaser of the Addiction Research Foundation. 5New models are needed to compete with the nationally cloned, twelve-step focused approach that currently dominates both inpatient and outpatient programs in this country. However, even the most innovative models will have little impact on recovery rates unless results can be compared against reasonable standards and then used to improve performance and remove incompetent providers. Instead of accountability for services provided, the treatment field must be held—and hold itself— accountable for results achieved.Role of grantmakers. Grantmakers can play a major role in demanding credible data from providers and fostering new cost-effective treatment models, especially in a wide range of nontraditional settings. Given the difficulties involved, funders are understandably reluctant to support evaluation research. 6 Yet, if we fail to act, billions of dollars will be poured into programs of dubious value, and people will not get the help they need. Other opportunities for grantmakers include: (1) devising new conceptual frameworks for treatment (for example, aftercare, case management, and support services in recovery); (2) exploring personal interventions— to ascertain how individuals can effectively intervene and precipitate the recovery process with peers, friends, professional colleagues, and family members; (3) extending employee assistance programs to all nonprofit, community-based agencies, public schools and universities, and small businesses, through consortia, creative insurance plans, or direct formal contractual relationships with intervention and treatment programs; (4) adding an alcohol and drug intervention/treatment referral component to existing health and medical programs, including rehabilitation programs; (5) strengthening relapse prevention, stressing the danger of returning to a drug-prone environment; (6) providing graduate training fellowships in alcohol and drug dependencies; (7) supporting education and training in the allied health fields in early alcohol and drug intervention; and (8) improving treatment assessment to better match clients with the services they actually need.Example.In 1984, The J.M. Foundation launched the Medical Student Program in Alcohol and Other Drug Dependencies, to enable leading educational institutes and summer schools to offer intensive education and training courses in alcohol and drug abuse to medical students across the country. The Scaife Family Foundation became a cosponsor in 1988. This is but one example of how, given the historical participation of philanthropy in medical education, grantmakers can play a major role in the training of medical practitioners to effectively diagnose, refer, and treat patients who abuse alcohol and drugs.Public And Private ResponsibilitiesIn his inaugural address, President Bush reflected national concern about ending the “scourge” of drug abuse. Although heavily weighted toward law enforcement, the administration's Office of National Drug Control Policy also recommends substantial funding increases for education, prevention, and treatment. To address the demand for illicit drugs, an emphasis has been placed on casual users who are generally more responsive than long-term drug abusers to educational initiatives and economic, legal, and social sanctions. During the past eight years, the federal government has spent over $23 billion to combat drug abuse, with mixed results. Since government strategies are largely focused on the “supply side” and on treatment, grantmakers should target their efforts on reducing demand through community organization and prevention. In view of the interrelationship between chemical dependency and family dysfunction, grantmakers can have a major impact by supporting programs that focus on the family. Whatever activity is undertaken, steps must be taken to ensure that reduction of alcohol or drug abuse is likely to be achieved. Knowledge and information, per se, do not often lead to actual changes in individual behavior. However, such information is more likely to be effective if linked to daily living experiences, important individual goals and relationships, positive role models and mentors, or constructive peer reinforcement. 7 Philanthropy has a proud history of concern for those most at risk in our society, yet foundations are just beginning to address the serious challenges of chemical dependency. No other issue has a greater impact on every aspect of American life. Whether individual or institutional grant-making priorities include health, education, economic development, arts and culture, or special populations, they are all adversely affected by alcohol and drug abuse. Given the urgent need for creativity, leadership, and innovation in addressing America's number-one public health problem, grantmakers now have vast opportunities to play a decisive role in winning the war on drugs. 81. “Drugs: Why Not?” The Wall Street Journal, 31 August 1989 , A-14 . Google Scholar 2. Ellickson P.L. , et al. , Strategies for Controlling Adolescent Drug Use ( Santa Monica, Calif. : The RAND Corporation , 1984 ). For an updated discussion of these issues, see Google Scholar Ellickson P.L. , Robyn A.E. , Toward More Effective Drug Prevention Programs ( Santa Monica, Calif. : The RAND Corporation , 1987 ); and Google Scholar Ellickson P.L. , Bell R.M. , Prospects for Preventing Drug Use among Young Adolescents ( Santa Monica, Calif. : The RAND Corporation , March 1990 ). Google Scholar RAND's Project ALERT, funded by the Conrad N. Hilton Foundation, recently advocated middle and junior high school education programs based on the social influence model to prevent or reduce young adolescents’ use of such gateway drugs as cigarettes and marijuana; however, this approach did not help previously confirmed smokers and had short-lived effects on adolescent drinking . Google Scholar 3. Cole K. , Orlandi M. , Schinke S. , Columbia University ( Unpublished evaluation , 1989 ). Google Scholar 4. Hubbard R.L. , et al. , Drug Abuse Treatment: A National Study of Effectiveness ( Chapel Hill, N.C. : University of North Carolina Press , 1989 ). Google Scholar 5. Glaser F. , “Treatment Must Be Carefully Matched to Each Individual,” The Center Magazine 18 , no. 3 ( 1985 ): 38 . Google Scholar 6. The Institute of Medicine of the National Academy of Sciences has released or under way several alcohol and drug studies, some of which were mandated by Congress. These include : Prevention and Treatment of Alcohol Problems: Research Opportunities ( 1989 ); AIDS, Sexual Behavior, and Intravenous Drug Use ( 1989 ); Broadening the Base of Treatment for Alcohol Problems ( 1990 ); Treating Drug Problems (covers financing issues, forthcoming , 1990 ); and a study in progress of drug abuse prevention strategies concerning schools and the mass media (chaired by Lawrence W. Green of The Henry J. Kaiser Family Foundation and directed by Dean Gerstein) . Google Scholar 7. An abundance of both private and government organizations, resources, and publications now focus on various aspects of alcohol and drug problems. The National Clearinghouse for Alcohol and Drug Information, (301) 468-2600, is a significant resource for free database searches and federal publications, particularly from the Alcohol, Drug Abuse, and Mental Health Administration's (ADAMHA's) Office of Substance Abuse Prevention (OSAP), the National Institute on Drug Abuse (NIDA), and the National Institute on Alcohol Abuse and Alcoholism (NIAAA). Each state also has an alcohol and drug authority that can provide a wealth of materials and resources. In addition, any funder can join Grantmakers Concerned About Alcohol and Other Drug Abuse by contacting Constance Marino, The Pew Charitable Trusts, (215) 587-4037. Other funding networks, such as Grantmakers In Health and Grantmakers for Children and Youth, also address alcohol and drug issues . Google Scholar 8. The traditional public health model (agent, host, environment) has not been especially effective in curbing alcohol and drug abuse, homelessness, teenage pregnancy, violence, and the spread of human immunodeficiency virus (HIV) infection, due to the extensive cultural, economic, and social dimensions of these problems . Google Scholar Loading Comments... Please enable JavaScript to view the comments powered by Disqus. DetailsExhibitsReferencesRelated Article MetricsCitations: Crossref 1 History Published online 1 January 1990 InformationCopyright © by Project HOPE: The People-to-People Health Foundation, Inc.PDF downloadCited byTHE ROLE OF CULTURAL AND SOCIAL FACTORS IN THE CAUSE OF ADDICTIVE DISORDERSPsychiatric Clinics of North America, Vol. 22, No. 2
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