Title: Promising Strategies to Reduce Substance Abuse.

Series: Report

Author: OAAG

Published: September 2000

Subject: Drugs and Crime; Drug Abuse Prevention and Education; Crime Prevention

138 pages

326,000 bytes

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Promising Strategies to Reduce Substance Abuse

An OJP Issues & Practices Report

U.S. Department of Justice
Office of Justice Programs
810 Seventh Street NW.
Washington, DC 20531

Janet Reno
Attorney General

Eric H. Holder, Jr.
Deputy Attorney General

Daniel Marcus
Acting Associate Attorney General

Mary Lou Leary
Acting Assistant Attorney General

Office of Justice Programs
World Wide Web Home Page
www.ojp.usdoj.gov

For grant and funding information contact
U.S. Department of Justice Response Center
1-800-421-6770

NCJ 183152

The research for Promising Strategies to Reduce Substance Abuse was
conducted by Drug Strategies, a nonprofit research institute based in 
Washington, D.C. Drug Strategies' mission is to promote more effective 
approaches to the nation's drug problems and to support private and public 
initiatives that reduce the demand for drugs through prevention, education, 
treatment, and law enforcement (www.drugstrategies.org).

-------------------------------

Promising Strategies to Reduce Substance Abuse


Office of Justice Programs


September 2000

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Contents

Foreword

Executive Summary

Overview

Prevention
I. Teaching Prevention in Schools
II. Reaching Youths Outside School
III. Reaching High-Risk Groups
IV. Building Family Bonds
V. Empowering Communities

Treatment
I. Family-Based Treatment
II. Rehabilitating Criminal Offenders
III. Assessing and Treating Adolescents
IV. Connecting with the Community

Law Enforcement
I. Community Policing
II. Problem-Oriented Policing
III. Reducing Drug Availability
IV. Alternatives to Incarceration
V. Alcohol-Related Approaches

Conclusion

Endnotes

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Foreword

Drug and alcohol abuse, drug trafficking, and related criminal activity
remain serious problems that affect the lives of most Americans. Under the
leadership of President Clinton and in cooperation with the Office of
National Drug Control Policy, the U.S. Department of Justice has
promoted and pursued an approach that combines prevention, treatment,
and enforcement to break the cycle of substance abuse and crime.
Promising Strategies to Reduce Substance Abuse illustrates this approach
through examples of programs that have been adopted successfully by
communities across the country.  We see this volume as a "toolbox" for
elected state and local officials, law enforcement, prosecutors, judges,
community organizers, and other policymakers. It contains practical
information about a range of proven and promising strategies to reduce
substance abuse. 

Several themes emerge from the profiled programs that match the themes
found in the companion volume, Promising Strategies to Reduce Gun
Violence, published in 1999 by the Office of Juvenile Justice and
Delinquency Prevention. One is that the criminal justice system can and
should be used to improve public health as well as public safety. Another
is that providing treatment for drug abuse is a cost-effective means of
reducing the heavy burden that both drug abuse and incarceration impose
on society. If the proximate cause of much criminal activity is the
desperate need to feed a drug habit, if criminal activity is frequently
committed under the influence of drugs and alcohol, if the psychoactive
effects of drug abuse lead people to violent and antisocial conduct, then
using the criminal justice system to hold people accountable for their
deeds but also to enable them to change their behavior can lead to reduced
recidivism, safer communities, and healthier and more productive citizens.

It has long been my goal to develop a continuum of interventions for
substance abuse offenders. Incarceration is just punishment for those who
commit acts of drug trafficking, for those who do violence to innocent
victims, and for those who repeatedly behave in a manner that endangers
our safety. Many times, however, the primary victims of substance abuse
are the defendants themselves who need help turning their lives around.
Drug court programs, for example, are especially effective in dealing with
substance-abusing defendants. The prevention, treatment, and law
enforcement strategies described in the following pages embody this continuum 
of accountability.

These programs also demonstrate how crucial broad collaboration is in
forging sound and effective strategies. This collaboration has different
components: federal, state, and local governments pooling their resources;
education, health, and police officials sharing ideas and data; and
government, business, and nonprofit sectors building coalitions, all in
service of the common goal of combating substance abuse. The problems
touch us all, and we all need to be part of the solutions. I am sure that
every community can find in these pages an example of a program that
will work for it. I hope everyone who reads this will be inspired to
dedicate time and energy to support the appropriate organizations, or to
create new ones, to implement these tested and promising strategies to
reduce substance abuse.

Janet Reno
Attorney General
U.S. Department of Justice

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Executive Summary

Substance abuse is one of the most pervasive problems facing our nation,
costing over $275 billion in health care costs, lost productivity, related
crime, and other social costs, and contributing to over 130,000 deaths each
year. To help communities address the devastating effects of illicit drug
and alcohol abuse, Promising Strategies to Reduce Substance Abuse has
been developed to highlight best practices in prevention, treatment, and
law enforcement.

Prevention, treatment, and law enforcement strategies, discussed in
separate chapters, act in concert with one another, comprehensively
addressing substance abuse in various contexts. Collaboration among law
enforcement, health, and social service agencies can help reduce demand,
which fuels drug trafficking activities, often involving violence and crime.
Treating addicts and preventing the onset of drug use can complement law
enforcement efforts to reduce supply.

Expanded research in drug abuse prevention over the last two decades has
identified key elements of successful programming, discussed in the
Prevention chapter. Recognizing risk and protective factors is an essential
component of successful prevention programs.

Treatment for alcohol and other drug abuse continues to evolve as more is
learned about tailoring treatment to specific populations. Advances have
been made in pharmacological treatments and in treatment for women,
adolescents, and other specific populations. Creating a continuum of care
from prison into the community, incorporating HIV prevention in
treatment, and delivering essential support services, such as job counseling
and child care, are elements of the new approaches to substance abuse.

Criminal justice can have significant impact in reducing illicit drug and
alcohol abuse. Law enforcement initiatives addressing substance abuse and
related crime are now working more intimately with communities to solve
local problems. Local law enforcement also collaborates effectively with
federal anti-drug agencies, forming task forces to combat high rates of
drug-related crime.

Promising Strategies to Reduce Substance Abuse is intended to serve as a
guide to communities by identifying the core elements of promising
strategies and providing examples of programs that are making a
difference locally. 

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Overview

Promising Strategies to Reduce Substance Abuse is an assessment of the
most effective strategies used nationwide to reduce illicit drug and alcohol
abuse and related crime. The report is intended to serve as a guide to
communities by identifying the core elements of promising strategies and
illustrating these strategies with examples of programs that are making a
difference locally. Programs were chosen to represent urban, suburban,
and rural communities.

An important trend evident in many of the effective strategies and
programs is  a close coordination between law enforcement, treatment
providers, and prevention professionals to address substance abuse and
related problems. These partnerships are vital to the success of
programming because they minimize redundancies, help to streamline
service delivery, and improve access to expertise and financial resources.
All types of initiatives in prevention, treatment, and enforcement seem to
work better and have a greater impact if interagency collaboration is
well-developed and well-orchestrated. Such collaborations are vital to
providing a continuum of care that can effectively intervene at all stages of
an individual's life, from birth to adulthood, and in all kinds of community
institutions, from the school to the local jail.

The growing emphasis on "what works" among lawmakers and funders
requires that communities learn from each other and implement program
models with a track record of success. Using programs that are effective in
other communities, tailoring those programs to the needs of the specific
locality, and evaluating their success is critical to creating a sustainable
approach.

Research in drug abuse prevention has flourished for more than two
decades and has identified key elements of successful programming that
are discussed in the Prevention chapter. Identifying risk and protective
factors and focusing on the resiliency and strengths of youths and adults,
for example, have become major focuses of prevention programs. The
report outlines five basic prevention strategies: teaching prevention in
schools, reaching youths outside school, targeting high-risk groups,
building family bonds, and empowering communities.

Treatment for alcohol and other drug abuse continues to evolve as more is
learned about what works with specific populations. Based on research to
date, the National Institute on Drug Abuse recently developed 13
principles of effective treatment (these are discussed later in the report).
Four strategies are discussed in the Treatment chapter: treating the family,
rehabilitating criminal offenders, assessing and treating juveniles, and
connecting with the community.

Criminal justice approaches, which often integrate prevention and
treatment components, are critical in preventing crime and disorder
associated with alcohol and other drug abuse. The changing nature of law
enforcement responses to substance abuse and related crime is
demonstrated in local department efforts to work within their communities
to solve local problems. These trends are evident at the federal level; the
Office of Community Oriented Policing Services (COPS) within the
Department of Justice, for example, directs substantial resources to local
community policing initiatives. In addition, over the past decade
alternatives to incarceration that combine sanctions, accountability, and
treatment for offenders have become increasingly popular. The growth of
drug courts exemplifies this trend. In 1989, the first drug court was
established; in 2000, more than 400 courts exist nationwide, and nearly
300 are in the planning stages. The Law Enforcement chapter discusses
five strategies: community policing, problem-oriented policing, reducing
drug availability, alternatives to incarceration, and alcohol-related
approaches.

Communities looking to implement promising anti-drug approaches
should first assess the areas of greatest need. In some communities
underage drinking may be the most prominent problem, in which case
prevention, treatment, and enforcement activities should be enhanced.
Other communities may face problems of violence linked to illicit drug
trafficking requiring law enforcement activities to target "hot spots" of
heightened drug activity. Determining the gaps in services currently
provided by and for the community is an essential step. The local health
department, police department, and other state and local agencies often
track data and services that will help identify community needs.

Another consideration for communities is cost. The promising programs
highlighted in this report provide information on the cost of implementing
and operating the various activities. In addition to cost, other community
resources, such as personnel and readiness, must be considered. Is there an
existing agency that can incorporate an effective prevention curriculum
into its programming? Does the police department have a strong track
record of collaborating with social service agencies? The degree to which
a community is galvanized around implementing new programs can have a
profound effect on the success of those programs.

Most of the promising programs highlighted in the report have been in
existence for at least three years, demonstrating their durability. All of the
programs have been successful in meeting their goals. For each program
the report provides information vital to community replication, broken
down into the following categories:

o Description--outlines the goals and logistics of the program (i.e., who is
served and program capacity, what services does the program provide to
the community, how are these services provided, etc.);

o Challenges--describes the obstacles to implementing and/or operating
the program, and in most cases how those obstacles were overcome or are
currently being addressed. In doing this, communities can prepare for the
common challenges of implementing the programs and begin to address
them in the development stage;

o Costs--outlines either the annual budget of the program or the cost of
serving an individual over the course of the program. Replication costs are
available for many of the programs, as are various costs that communities
should foresee when designing a similar program; and

o Program Results--details the effectiveness of the program in meeting
goals and objectives. Some programs have been evaluated by external or
internal investigators using rigorous research designs; however, this
standard does not hold true for all of the promising approaches detailed in
this report. Some programs were assessed as promising based on
improvement observed in the community, such as reductions in criminal
activity and/or substance abuse. All programs detailed in the report have
made positive impacts within their communities.

Promising Strategies to Reduce Substance Abuse aims to provide
communities with valuable information on successful efforts to reduce
substance abuse and related problems nationwide, and to assist them in
selecting strategies and programs that will effectively address their specific
needs.

-------------------------------

Prevention

Effective prevention strategies are critically important in community
efforts to combat substance abuse. Virtually everyone is susceptible to
alcohol and other drug problems at different points in their lives. Some
people, however, are at higher risk for developing serious addiction
because of personal, family, or environmental circumstances. The impact
of substance abuse often reaches beyond the abuser to family members,
friends, co-workers, and society at large.

Extensive research during the past two decades has identified a number of
prevention strategies that measurably reduce drug use, including by those
at high risk. These strategies share a common goal: strengthening
"protective factors," such as well-developed social skills, strong family
bonds, attachment to school, and active involvement in the community and
religious organizations, while reducing "risk factors" that increase
vulnerability to drug abuse. Recent research suggests that resilience is also
an important factor; even in high risk, adverse circumstances, many people
are able to resist drugs.[1]

While it is impossible to predict with certainty who will develop alcohol
and other drug problems, research has uncovered a great deal about the
factors which significantly increase risk for millions of children ages 10 to
17. Substance abuse by a parent, lack of parental guidance, or a disruptive,
abusive family are very strong predictors, as are school failure, early
experimentation with drugs, and living in a community where substance
abuse and dealing are pervasive.[2] While these risk factors are all important
predictors, the effect of any single factor can be mitigated by other
circumstances. Research indicates that two risk factors produce four times
the probability of problem behaviors. Children facing multiple risks are
much more likely to move from experimentation to serious substance
abuse by the time they are teenagers.[3,4]

Promising prevention strategies are often designed to address different
levels of risk. Universal prevention efforts, like drug education, target all
youth without identifying those at particularly high levels of risk. Selective
interventions concentrate on those who are particularly vulnerable to drugs
because of personal, family, and community risk factors. Indicated
interventions are intensive efforts aimed at youth who are already
experimenting with alcohol and other drugs or exhibit other risk-related
behavior.[5] Effective prevention promotes the protective factors that reduce
the potential for substance abuse and other closely linked behaviors, such
as truancy, delinquency, and early pregnancy.

Successful prevention strategies also incorporate the cultural, gender, and
age-specific needs of participants. Prevention efforts must address all
stages of life; from infancy to adulthood, prevention can reduce both the
use and abuse of alcohol and other drugs. Although individual programs
differ widely, the federal Center for Substance Abuse Prevention (CSAP)
has identified six basic approaches to prevention which are described in
Understanding Substance Abuse Prevention: Toward the 21st Century: A
Primer on Effective Programs[6]:

o Information dissemination is designed to increase knowledge and alter
attitudes about issues related to alcohol, tobacco, and other drug use and
abuse;

o Prevention education teaches participants critical personal and social
skills that promote health and well-being among youths and help them
avoid substance abuse;

o Alternative approaches assume that youth who participate in drug-free
activities will have important developmental needs met through these
activities rather than through drug-related activities;

o Problem identification and referral involves recognizing youths who
have already tried drugs or developed substance use problems and
referring them to appropriate treatment options. This is particularly
important for high-risk youth;

o Community-based process enhances community resource involvement
in substance abuse prevention, for example, by building interagency
coalitions and training community members and agencies in substance
abuse education and prevention; and

o Environmental approaches attempt to promote policies that reduce risk
factors and/or increase protective factors related to substance abuse, such
as community laws prohibiting alcohol and tobacco advertising in close
proximity to schools.

This chapter discusses a wide range of promising approaches that involve
schools, families, and communities in prevention efforts that use many of
the elements identified by CSAP. The CSAP-identified key elements are
not mutually exclusive, and most of the programs detailed in this report
include more than one key element. Effective strategies include prevention
education; mentoring and other supervised activities for after-school
hours; special interventions for high-risk youth; strengthening families;
and empowering communities. The programs described below are
examples that can help communities tailor strategies to their specific
needs.

I. Teaching Prevention in Schools

Schools can play a powerful role in prevention  as teachers and
administrators often are the first to detect warning signs of possible drug
problems, such as poor school attendance or declining academic 
performance.

Effective school programs teach young people to resist drugs by
developing personal and social skills, such as decision making, stress
management, communication, social interaction, conflict resolution, and
assertiveness. In addition, these programs can enhance awareness and
resistance skills. Students learn that most of their peers do not use drugs,
and they learn to recognize social and peer influences on drug use. With
this new awareness, youths are better able to resist the pressure to use
drugs.[7]

Prevention efforts should begin early and continue through adolescence,
when pressure to drink, smoke, and use other drugs greatly increases.
Without reinforcing skills and anti-drug norms, behavioral results
diminish. Programs enhanced with "booster sessions," activities which
follow up on the initial program, help prevent or delay the initiation of
drinking, smoking, and using other drugs.[8] Delayed initiation is beneficial,
giving children time to develop social competence and resistance skills.
According to the National Institute on Alcohol Abuse and Alcoholism,
each year that children avoid alcohol use significantly decreases their risk
of future dependence.[9] The Department of Health and Human Services
reports that any delay in beginning to smoke during the early teen years
improves the future prognosis for quitting. Delayed onset of smoking is
also associated with a lower incidence of disease and death.[10]

Prevention efforts in schools are designed to serve universal (the general
population), selective (those identified as at risk), or indicated (those
already exhibiting signs of problem behavior) groups of students.
Depending on the targeted population, prevention messages range in
intensity. For example, Life Skills Training, a universal program, teaches
personal, social, and drug resistance skills in weekly 45-minute sessions.
In contrast, Reconnecting Youth, designed for indicated high school
students, involves participants in a daily class focused on reducing or
controlling drug use.

According to Making the Grade: A Guide to School Drug Prevention
Programs[11], successful school-based drug prevention programs
incorporate a variety of key elements:

o help students recognize internal pressures, like anxiety and stress, and
external pressures, like peer attitudes and advertising, that influence them
to use alcohol, tobacco, and other drugs;

o develop personal, social, and refusal skills to resist these pressures;

o teach that using alcohol, tobacco, and other drugs is not the norm
among teenagers, even if students believe that "everyone is doing it";

o provide developmentally-appropriate material and activities, including
information about the short-term effects and long-term consequences of
alcohol, tobacco, and other drugs;

o use interactive teaching techniques, such as role plays, discussions,
brainstorming, and cooperative learning;

o cover necessary prevention elements in at least ten sessions a year (with
a minimum of three to five booster sessions in two succeeding years);

o actively involve the family and the community; and

o include teacher training and support, and contain material that is easy
for teachers to implement and culturally relevant for students.

School prevention efforts should also aim to reduce school disorder and
improve children's attitudes about school. Research over the past two
decades indicates that active involvement in school helps protect young
people from many problem behaviors, including substance abuse.[12] A
positive atmosphere helps engage students in school, giving them a sense
of identity and reducing the likelihood that they will drop out or participate
in delinquent behavior, two factors that can increase risk for later
substance abuse problems.

Although school programs can demonstrate impressive results in
prevention, families and communities shape the larger social context in
which children make decisions about alcohol, tobacco, and other drugs.
According to the 1997 report of the National Longitudinal Study on
Adolescent Health, close relationships with parents and teachers are
powerful protective factors for teens. The closer teens are to their parents
and the more connected they feel to school, the less likely they are to
smoke, drink, or use other drugs.[13]

Prevention is most effective when school lessons are reinforced by a clear,
consistent social message that teen alcohol, tobacco, and other drug use is
harmful and unacceptable.[14] In many communities, police officers work
as school resource officers (SRO) to monitor students, provide advice and
prevention information, and link students to supervised recreational
activities, mentoring, and other services.

The following programs demonstrate the effectiveness of these essential
elements in building comprehensive school-based strategies to prevent
alcohol, tobacco, and other drug use.

Child Development Project, Cupertino, California

Program Type: Teaching Prevention in Schools.

Target Audience: Elementary school students, their parents and teachers.

Years in Operation: 1992-present.

Program Goals: To increase student attachment to school, thereby
reducing risk factors that contribute to substance abuse and other high-risk
behaviors.

Contact Information: Denise Wood, Developmental Studies Center,
Oakland, CA, 800-666-7270.

Description: The Child Development Project (CDP) is a philosophical
approach to interacting with elementary school students, their families,
teachers, and school administrators. The program focuses on an entire
school rather than targeting only high-risk students. Although CDP does
not address substance abuse directly, its character building program is
designed to reduce risk factors for alcohol and other drug use. Since 1992,
CDP has expanded to approximately 100 schools in six states and is
recognized by the Center for Substance Abuse Prevention as a promising
High Risk Youth program and by the National Association of Elementary
School Principals.

D.J. Sedgewick Elementary School in Cupertino, California, was one of
the pilot schools to implement the program in 1992. Teachers at
Sedgewick were unhappy with the school's antagonistic atmosphere and
wanted a more effective way to discipline students. The same children
were repeatedly getting into trouble, and there was no evidence that the
existing forms of punishment were working. The staff chose CDP because
it aims to create a school community in which students feel safe and cared
for and are encouraged to develop their academic and practical skills. The
program increases students' attachment to the school community and
establishes a system of positive reinforcement which reduces risk factors
and promotes protective factors.

CDP has four basic principles: build supportive relationships; attend to the
social and ethical dimensions of learning; honor students' intrinsic
motivation; and teach in ways that support students' learning styles. These
principles are expressed through five program components. The first
component is a reading and language arts curriculum which addresses
social and ethical values. Culturally-appropriate books are selected
according to the student group, and are read aloud to give students a
shared experience. The second component of the program is collaborative
classroom learning, which emphasizes working together and provides
students with meaningful, challenging tasks. Component three,
developmental discipline, is a classroom approach to creating caring
relationships among all members of the classroom. Teachers use
problem-solving techniques rather than reward and punishment to teach
students responsibility and competence. The fourth component gets
parents involved with their children's education by assigning homework
tasks which the family must complete together. The final component is a
school wide activities program that creates a sense of school community.
One activity, the Buddies program, pairs young students with older
partners for academic and social activities.

Challenges: CDP can only work if the principal, teachers, and staff
members all commit to following the program design. The program
requires a change in the overall atmosphere of the school and consistent
implementation. For example, if one teacher continues to discipline
students by sending them to the principal's office while another works with
students to solve problems, the program will not be fully effective.
Sedgewick was fortunate to have the support of the entire school staff, and
the school screens prospective teachers to ensure they are willing to follow
the CDP philosophy.

Costs and Funding Sources: Instructional and curricular materials for the
program cost approximately $550 per classroom teacher. Training by CDP
staff members costs approximately $40,000 per year. Sedgewick receives
approximately $125,000 in grant money annually for initiatives aimed at
improving literacy, including CDP.

Program Results: An internal evaluation of CDP conducted by researchers
from the Developmental Studies Center in Oakland, California, showed
decreased substance use among fifth and sixth graders in schools that fully
implemented the program. The evaluation was conducted in six
communities: Cupertino, Salinas, and San Francisco, California;
Louisville, Kentucky; Dade County, Florida; and White Plains, New York.
In each city, two control schools and two program schools were examined,
and data were collected from classroom observation, student and teacher
questionnaires, and student achievement scores. Over four years the
following changes in drug use were observed:

o Alcohol use among students fell from 48 percent to 37 percent in
program schools while rising from 36 percent to 38 percent in control
schools;

o Cigarette use declined from 25 percent of students to 17 percent in
program schools while declining from 17 percent to 14 percent in control
schools; and

o Marijuana use declined from 7 percent of students to 5 percent in
program schools while rising from 4 percent to 6 percent in control
schools.

Students also reported that after the program was implemented they
enjoyed school more, were more motivated to learn, were better skilled at
resolving conflicts, and felt more socially competent.

Another accomplishment of the Child Development Project is that it
changed the atmosphere at Sedgewick. Students are now more excited
about learning and feel more a part of the school community. Teachers
report that parents have also commented on the change in the school.

Life Skills Training, Garland, Texas

Program Type: Teaching Prevention in Schools.

Target Audience: Middle school students.

Years in Operation: 1997-present.

Program Goals: To teach alcohol and other drug prevention skills to all
middle school students.

Contact Information: Janet Harrison, Chief Executive Officer, Greater
Dallas Council on Alcohol and Drug Abuse, 214-522-8600; research
information, Gilbert Botvin, Institute for Prevention Research, 212-746-
1270; curriculum information, 800-636-3415, www.lifeskillstraining.com.

Description: Life Skills Training (LST) is one of the best-evaluated
substance abuse prevention programs available, having been evaluated in
12 rigorous field trials over the past two decades. LST provides
information on alcohol, tobacco, and marijuana and addresses substance
use risk and protective factors. In 1997, Life Skills Training was
implemented in 13 middle schools in the Garland Independent School
District. In the 1999-2000 school year the program reached approximately
3,968 sixth graders, 3,789 seventh graders, and 3,851 eighth graders.

A universal approach designed for all students, the curriculum targets
middle and junior high school students at the age when substance use
increases most dramatically. The three-year curriculum consists of 15
sessions in the first year (sixth or seventh grade), ten sessions in the
second year, and five to eight sessions in the third year. The curriculum
uses a variety of interactive techniques, including discussions,
brainstorming, role playing, and skill rehearsal. In many schools, teachers
act as facilitators, presenting effective behaviors, coaching students, and
providing positive feedback. In Garland, the Greater Dallas Council on
Alcohol and Drug Abuse (GDCADA) runs LST and employs two full-time
program staff (a Program Manager and LST Specialist) and approximately
eight part-time LST instructors to teach the course to students.

The content of the program falls into three general categories. The first
module contains information about tobacco, alcohol, and marijuana use,
including the immediate effects of these substances on the body, using a
classroom exercise. Students learn, for example, that contrary to myth,
smoking does not help people relax. Nicotine is a stimulant which causes
hands to tremble and the heart to beat faster.

The second module develops personal or self-management skills. LST
provides students with a variety of techniques for effectively managing
anxiety, including deep breathing, mental rehearsal, and muscle relaxation.
LST provides students with a formula for making competent decisions,
provides training in goal setting and planning for the future, and involves
students in semester-long projects that help them achieve individual goals.

The third module of the curriculum hones students' social skills. To help
students feel comfortable in social situations and less vulnerable to peer
pressure, LST provides training in general social techniques, such as
conversational skills and cross-gender communication. In order to help
students effectively resist peer pressure, the curriculum provides students
with training to tactfully resist pressure to use tobacco, alcohol, or other
drugs, as well as how to assert themselves and express their feelings
directly.

Challenges: One of the challenges to implementing Life Skills Training in
Garland and other sites is starting the program at the beginning of the
school year, when class schedules and routines are often in flux. A related
challenge is scheduling LST classes so that they do not interfere with
state-mandated testing. In fact, many schools report that one of the major
challenges to implementing the Life Skills Training Program is
committing the time to complete the program. With many competing
demands on class time, it can be difficult to secure the 15 class sessions
needed to complete the program in the first year. However, studies have
clearly shown that the success of LST depends on implementation of the
program as designed.

Costs and Funding Sources: In Garland, LST is funded through the Texas
Commission on Alcohol and Drug Abuse, which provides $250,000 for
the program in all 13 schools. This amount covers curriculum materials for
program instructors and students, and instructor salaries and trainings.
Schools using teachers to run the program do not have to hire additional
personnel, so costs are limited to curriculum materials and teacher
training. The cost to provide LST to one class of 30 students for one year
is $250. Additional costs for training teachers is $2,000 per day for a
minimum of one to two days of training.

Program Results: The LST program has consistently been shown to reduce
cigarette smoking, problem drinking, and marijuana use, with impact
slightly diminished by the six-year follow-up. Moreover, the size of these
reductions has been significant, with reductions in smoking, drinking, and
marijuana use ranging from 50 percent to 75 percent in the participating
schools, compared with nonparticipating control schools. The program has
also been found to effectively decrease use of inhalants, narcotics, and 
hallucinogens and increase students' knowledge and attitudes about
smoking, drinking, and marijuana use.

These effects have been observed in schools where the program was
implemented by health professionals, older peer leaders, and regular
classroom teachers. Other evaluation studies have demonstrated the
effectiveness of the program in both urban and suburban schools, and
among white, African-American, and Hispanic youth.

LST has received numerous professional awards and endorsements from
professional groups, including the American Medical Association and the
American Psychological Association. Most recently, LST was one of two
programs highlighted by the Centers for Disease Control and Prevention as
"Programs That Work."

Reconnecting Youth, Midland, Texas

Program Type: Teaching Prevention in Schools

Target Audience: High-risk high school students.

Years in Operation: 1997-present.

Program Goals: To increase school performance and decrease drug use and
emotional distress.

Contact Information: National, Nan Macy, Public Information Specialist,
University of Washington School of Nursing, 206-685-4733. Texas, Lyn
White-Giesler, 915-552-7455.

Description: Reconnecting Youth is a school-based drug prevention
program targeting high-risk high school students; the program is designed
to reduce drug use and aggression, as well as academic failure and
dropping out of school. The school districts of Midland and Odessa,
Texas, implemented Reconnecting Youth in four schools in 1997;
approximately 200 students participate each year.

Reconnecting Youth seeks to reduce risk, build resiliency, and provide
training in communication skills, anger management, social problem
solving, social resistance skills, and peace building. Reconnecting Youth
targets students who fall behind their peers in school, have high
absenteeism, experience a drop in grades, or drop out of school.
Reconnecting Youth includes a semester-long course, school bonding
activities, and a school system crisis response plan. The Reconnecting
Youth class is taught for 55 minutes each day and includes four modules:
Decision-Making, Personal Control, Self-Esteem Enhancement, and
Interpersonal Communication. The program is taught by teachers, other
school personnel, or outside specialists. In Texas, Reconnecting Youth is
run by a program specialist rather than school personnel. The program
requires a teacher-to-student ratio of 1:12, a selection process for both
participants and facilitators, and proper facilitator training.

Reconnecting Youth has three primary goals:  (1) increase academic
performance by enhancing school bonding, school attendance, and grades,
and increasing the number of pre-college courses taken; (2) decrease drug
involvement by increasing control over drug use; and (3) decrease
emotional distress by lessening risk factors, such as depression, and
increasing protective factors, such as self-esteem.

Challenges: The most difficult part of implementing the program in Texas
was obtaining the cooperation of the schools. School officials are often
reluctant to release pretest information, including students' attendance
records and grades, which is critical to evaluating. School officials were
more cooperative after the Texas Education Association authorized that a
half credit be given to students taking the course. Texas is the only state
that gives academic credit for the course.

Costs and Funding Sources: Costs vary depending on how the program is
implemented. If school staff teach the program, the only required costs are
training, materials, and student incentives. The initial five-day training for
facilitators costs $500/day for six people, plus trainer travel and expenses.
A recommended one-day follow-up training every six months costs
$750/day plus trainer expenses. The curriculum alone costs $139. In
addition, the Texas program employs specialists to teach the program, four
facilitators, and one director. The Texas Commission on Alcohol and Drug
Abuse provides an annual grant of $235,000 to operate Reconnecting
Youth in four Midland and Odessa schools.

Program Results: Curriculum developers have conducted three studies
using external evaluators that clearly demonstrate that the program results
in improved academic performance; decreases drug use; reduces anger,
depression, aggression, hopelessness, suicidal behaviors, and stress;
decreases bonding to deviant peers; and improves self-esteem, self-control,
bonding to school, and social support. Evaluations of the program have
observed reduced use of cocaine, hallucinogens, opiates, depressants,
tranquilizers, stimulants, and inhalants. Tobacco, alcohol, and marijuana
use were not affected. The program also reduced drug use control
problems (e.g., used more than intended) and adverse drug use
consequences (e.g., feeling guilty or problems with friends or family as a
result of substance use).

Reconnecting Youth received an "A" in Drug Strategies' reports Making
the Grade: A Guide to School Drug Prevention Programs and Safe Schools
Safe Students. The program is also recommended by the U.S. Department
of Education, was recognized by the National Institute on Drug Abuse as
one of the year's top three prevention programs in 1996, and is considered
a model program by the Center for Substance Abuse Prevention.

In Midland and Odessa, students in Reconnecting Youth report improved
communication with their teachers. Teachers report that problem students
have shown improved performance and control on how they behave and
interact with others. At the end of the school year the students participate
in a graduation ceremony attended by the school board and media.

II. Reaching Youths Outside School

After-school hours are high-risk periods for alcohol and illicit drug use,
unprotected sex, and violence among youths. Approximately one-third of
all violent juvenile crimes occur between the hours of 3 p.m. and 7 p.m.,
when many children are unsupervised.[15] Targeted programs during these
vulnerable hours can help prevent, reduce, or delay the onset of alcohol,
tobacco, and other drug use. After-school programs can also reinforce
social skills learned in school and at home.

Many communities are implementing after-school programs that include
substance abuse prevention. Activities range from programs that offer
alternative activities with a drug prevention message to programs for
high-risk youth that involve more intense intervention, specifically
addressing risk and protective factors for substance abuse.

Police departments have taken an active role in developing after-school
programs to keep youths out of trouble. Recently, the police chief of
Mountlake Terrace, Washington, won a National Crime Prevention
Council award for his role in creating the Neutral Zone, a youth center
which provides an array of youth services, including substance abuse
counseling. Five years after creating the Neutral Zone, gang-related crime
dropped more than 90 percent. The program has been replicated in
numerous other cities in Washington state.

Millions of American children participate in elementary, middle, or high
school sports programs, and many others join community teams, providing
prime opportunities to reach large numbers of youth with prevention
messages. Coaches and other supervisors can be trained to recognize
warning signs of substance abuse and deal with at-risk athletes. For
example, the Drug Enforcement Administration's Team Up Anti-Drug
Sports Program trains coaches and school administrators to take active
roles in prevention and education in their schools.

Creating a safe place for youths to gather after school can help protect
them from risk factors in the community, in peer groups, or at home. For
example, the Safe Haven in Madison, Wisconsin, provides educational
opportunities and supervised recreation for 150 at-risk elementary school
children, teaching them conflict resolution and other behavioral skills, and
involving their parents in the program. The program was developed
through a partnership involving the city, the local school district, and a
nonprofit community center.

Mentoring is an increasingly popular prevention/intervention strategy that
helps youths deal with the risks they face in their daily lives. While
informal mentoring occurs naturally for children who have positive adult
influences, many young people have few positive adult role models.
Formal mentoring programs assist these children by structuring one-to-one
relationships with caring adults, that can reduce risk factors for substance
abuse, such as social isolation and insufficient supervision. A positive
adult role model also offers new perspectives to youths living in situations
rife with substance abuse and violence.[16]

Well-developed and executed mentoring programs can effectively reduce
drug use. A 1995 national evaluation of Big Brothers/Big Sisters of
America, which connects middle class adults with disadvantaged youths,
found that young people in the program were almost 50 percent less likely
to begin using drugs than their peers not involved in the program. An even
stronger effect was found for minority Little Brothers and Sisters, who
were 70 percent less likely to initiate drug use than similar minority
youths.[17] In response to the success of mentoring programs, the Office of
Juvenile Justice and Delinquency Prevention (OJJDP) developed the
Juvenile Mentoring Project (JUMP) in 1994 to support mentoring
programs for at-risk youths in communities across the country. OJJDP
highlights several elements of effective mentoring programs:

o Creating collaboration between community-based providers and local
education agencies to improve school performance and reduce school drop
out rates and juvenile delinquency;

o Performing thorough background checks for all volunteer mentors to
establish a safe environment for participating children;

o Assessing young participants carefully so appropriate matches can be
established that maximize opportunities for success;

o Designing mentor and project activities that enrich and enhance youth
opportunities and experiences; and

o Gathering and routinely reporting program data for evaluation purposes.

The U.S. Navy's Drug Demand Reduction Task Force (DDRTF)
developed the Drug Education for Youth initiative (DEFY), a mentoring
program that works with Weed and Seed neighborhoods. DEFY, targeting
youths ages 9-12, improves youths' self-image, communication skills, and
awareness of the dangers of alcohol and other drug use through weekend
camping and continued mentoring. The first two DEFY programs began in
1993 in Pensacola, Florida, and Oakland, California, and there are now 65
DEFY/Weed and Seed sites.

Providing constructive and healthy activities for youths--coupled with
substance abuse prevention--can offset the attraction to alcohol, tobacco, or
other drugs. Community youth development programs, such as Boys and
Girls Clubs, can integrate prevention education into traditional activities.
A 1992 evaluation of such programs offered in public housing
developments found greater reductions in drug use among participating
youngsters than among youths not involved.[18]

The following programs are examples of how communities have used
mentoring initiatives and youth development programs to prevent
substance abuse by reaching youths after school.

Big Brothers & Sisters of Wichita, Kansas

Program Type: Reaching Youths Outside School.

Target Audience: Children ages 5-17 at risk for substance abuse.

Years in Operation: 1969-present.

Program Goals: To prevent destructive behavior and promote positive
attitudes and habits among youths.

Contact Information: In Wichita, Mike Keller, 316-263-3300; National
office, Jerry Lapham, 215-567-7000; national@bbbsa.org;
www.bbbsa.org.


Description: For nearly a century, Big Brothers and Big Sisters of America
(BBBSA) has been providing adult support and friendship to children.
Through a careful matching process, volunteers interact regularly with
youngsters in one-to-one relationships. Of the 514 local BBBSA agencies
nationwide, the Big Brothers & Sisters program in Wichita, Kansas, is the
largest, with over 1,300 matches of adult mentors with area youths in
1999. Wichita, like the other local agencies, uses a case management
approach developed by the national organization. Case managers screen
children and volunteers, make and supervise matches, and handle match
closures. In Wichita, each case manager handles 65 cases; monthly
contacts with volunteers, children, and parents are made to ensure success.

Little Brothers and Sisters are referred by educators, social workers,
counselors, parents, and others, and are considered at risk of substance
abuse and other destructive behavior. The goal of the program is to prevent
such problems and promote positive habits and attitudes through support,
role-modeling, and exposure to healthy activities. Volunteers make a
year-long, once-a-week commitment to their matches. Youngsters in the
program range in age from 5-17; 83 percent of them come from single
parent homes, 76 percent live at or below the poverty level, 54 percent
have been abused or neglected, and 52 percent come from alcoholic and/or
drug addicted families. Serving children of substance-abusing parents is
crucial, since they are at high risk; children of alcoholics, for example, are
four times more likely to develop alcoholism than other youths.

In addition to growing its core mentor numbers, the organization is
expanding its programming to provide on-site mentoring in schools and at
Boys and Girls Clubs. The agency is also planning to implement outreach
programs targeting Hispanic mentors and youths, senior citizen mentors,
and a program in collaboration with community organizations and the
police department aimed specifically at alcohol, tobacco, and other drug
prevention.

The success and popularity of Big Brothers and Big Sisters of America can
be attributed to its rigorous published standards and required procedures,
including mandatory volunteer orientation; volunteer screening, involving
a background check, extensive interview, and home assessment; youth
assessment, which involves parent and child interviews and a home
assessment; carefully considered matches; and ongoing supervision. The
program was named a Model Program in Blueprints for Violence
Prevention by the Center for the Study and Prevention of Violence at the
University of Colorado.

Challenges: The biggest challenge in Wichita is recruiting volunteers.
Currently, there are approximately 700 boys and girls awaiting matches.
While the organization needs both male and female volunteers to meet
demand, male volunteers are especially hard to get. Little Brothers wait an
average of two years, while African American Little Brothers wait an
average of three years. To address this challenge, the program has made
strides in finding volunteers by working with local companies and
universities to recruit mentors. Advertisements are also posted on
billboard space donated to the organization. While the waiting list is still
long, it has decreased significantly from previous years.

Costs and Funding Sources: The national average cost within the BBBSA
system of making and supporting one adult and child match is $1,000 a
year, and includes recruitment and training of volunteers, administrative
costs, employee salaries, and various activities. The annual budget in
Wichita is $2.5 million. Funding comes from three main sources: the
United Way; in-kind and cash donations, including grants from private
foundations and state, city, and county government; and revenue from an
annual fundraiser, Bowl For Kids Sake, which raised over $600,000 in
1999.

Program Results: An evaluation of eight local BBBSA agencies, including
the one in Wichita, found volunteer mentors had the greatest impact
preventing alcohol and other drug abuse when comparing participating
youths with similar nonparticipating youths. In 1992 and 1993, nearly
1,000 boys and girls in eight cities (including Wichita), ages 10 through
16, entered into an evaluation study to determine the effectiveness of
BBBSA. Half of the children were matched with a mentor, while the other
half were assigned to a waiting list or control group. On average, the
matched children met with their mentors about three times a month for at
least one year. Researchers found that 18 months later, the Little Brothers
and Little Sisters were:

o 46 percent less likely to begin using illicit drugs;

o 27 percent less likely to begin using alcohol; and

o 53 percent less likely to skip school.

o Minority youths were 70 percent less likely than their peers to initiate
illicit drug use.

The evaluation was conducted by Public/Private Ventures, a national
research organization based in Philadelphia. In addition to Wichita,
evaluated programs were located in Phoenix, Arizona; Minneapolis,
Minnesota; Rochester, New York; Columbus, Ohio; Philadelphia,
Pennsylvania; and Houston and San Antonio, Texas.

A major accomplishment in Wichita was meeting the goal of 1,000 active
matches by the year 2000, making the Wichita program (which was
already the largest per capita BBBSA site) the largest overall site
nationwide. The success of the program has prompted a state-funded
initiative to create satellite Big Brothers and Sisters facilities in all 105
Kansas counties. According to local Wichita data:

o 0.5 percent of Little Sisters become pregnant, compared to 5.5 percent
of area girls;

o 1 percent of participants are arrested, compared to 7.6 percent of local
youths; and

o 60 percent of participants show improvement in grades, 57 percent in
school attendance, and 61 percent in relationships with teachers.

Self-Expression Teen Theater, Toledo, Ohio

Program Type: Reaching Youths Outside School.

Target Audience: High-risk minority adolescents.

Years in Operation: 1986-present.

Program Goals: To provide teenagers with information on substance use
so they can make healthy decisions.

Contact Information: Charles Muhammad, Executive Director,
419-242-2255.

Description: Self-Expression Teen Theater (SETT) trains young people to
educate their peers about the dangers of alcohol and other drug use,
premature sexual activity, and other risky behaviors, and helps youths
explore positive alternative activities. The program was begun in 1986 in
response to a needs assessment which revealed that Hispanics and African
Americans in Toledo had high rates of alcohol and other drug use. Since it
began, SETT has trained over 1,200 peer educators, given more than 500
performances, and conducted over 200 youth-led workshops focusing on
substance abuse and its relation to violence.

SETT targets primarily Hispanic and African American youths ages 11-18
to be peer educators. Peer educators conceive, write, and perform skits on
topics including substance abuse, teen pregnancy, suicide, violence, and
academic failure. Performances illustrate the importance of
communication between young people and adults, and provide youths in
the audience with information on treatment and prevention services in
their community where they can seek help. The troupe performs in
schools, churches, public housing projects, and malls.

SETT performers receive 80 hours of training covering substance abuse,
violence prevention, health education, community resources,
communication, and performing arts. Ten hours of training are dedicated
to culturally specific information. Peer educators are trained by experts in
the community, such as certified alcohol, tobacco, and other drug abuse
counselors.

Parents of SETT members are highly involved in the program. The Parent
Advisory Board meets monthly to review group training and activities and
explore ideas for further programming and development. Representatives
from community organizations providing services for youths are often
present at the board meetings, which allows parents to remain up-to-date
on available community resources.

SETT's How-To-Training Manual and consultation services are available
to communities and organizations interested in replicating the program.

Challenges: One of the implementation challenges for SETT was finding
the most efficient and effective way to involve local agencies in the
program and to take advantage of their expertise and knowledge. Local
and state agencies and organizations were invited to make presentations
during the 80 hour youth peer training, and now 14 organizations,
including the police department and children's services agencies are
regularly present at training sessions. An additional 73 organizations are
involved in the program in various ways. Another problem, which is
ongoing, is the struggle to find and retain qualified employees willing to
work in the inner city. As SETT's positive effects on the community
become better known, more people have become interested in working in
the program.

Costs and Funding Sources: The average annual program budget of
$138,472 covers all expenses, including a full-time project director, a
full-time office manager, a part-time project coordinator, contract workers
such as coaches and training assistants, evaluation, rent, and program
materials, such as costumes. SETT receives funding from the Ohio Department 
of Alcohol and Drug Addiction Services ($100,000), City of Toledo Department of
Neighborhoods ($30,000), and the Marshall Field Foundation ($2,000).
Additional funding comes from general donations received from performances.

Program Results: In the program's target area of Toledo, 60 percent of all
students graduate from public high schools. However, 93 percent of SETT
peer educators graduate from high school, and 87 percent are attending or
have graduated from college.

The program is currently being evaluated by researchers at the Wright
State University School of Medicine in Dayton, Ohio. Results of the
evaluation should be available in fall 2000.

SETT won Most Outstanding Exemplary Program Award for Prevention
from the Ohio Department of Alcohol and Drug Addiction Services in
1993 and 1999, and the Exemplary Program Award from the Center for
Substance Abuse Prevention in 1993. The program has been replicated in
Lima, Ohio, and Atlanta, Georgia.

III. Reaching High-Risk Groups

Targeted prevention services can effectively reach people at high risk for
drug problems who may be impervious to universal prevention efforts
offered in schools and other community settings. High-risk populations
include children of substance abusers, pregnant teens, and juvenile
offenders. These efforts, which often involve home visits, counseling, and
parent training, enhance resilience and promote individual strengths.[19]
The federal Center for Substance Abuse Prevention (CSAP) has identified
seven factors contributing to resilience. These factors, described in
Understanding Substance Abuse Prevention: Toward the 21st century: A
Primer on Effective Programs[20], include:

o A strong relationship with a parent or caring adult who provides a
consistent nurturing environment;

o Feelings of success and self-respect;

o Strong internal and external resources, such as good physical health,
self-esteem, a sense of humor, and a supportive network that includes
family, school, and community;

o Social skills, including good communication and networking skills, and
the ability to make good decisions;

o Problem-solving skills that help children overcome obstacles;

o Hope that adverse circumstances can be overcome with perseverance
and hard work; and

o Surviving previous stressful situations.

Parental substance abuse is one of the strongest predictors for alcohol and
other drug problems among youth. Children of alcoholics, for example, are
four times more likely than others to develop alcoholism later in life.[21]
Targeting prevention services to particularly vulnerable young people is
crucial. Kids Connection, a prevention program in Cincinnati, Ohio, has
won national awards for its programs that target children of alcoholics and
other drug abusers. The program helps children understand addiction,
teaches skills, and encourages youths to cope without alcohol or other
drugs. Kids Connection works with local treatment facilities, teachers, and
mental health professionals to identify children in need.

Some groups, such as juvenile offenders, are at greater risk to become
substance abusers. Interventions designed for this population can work in
various settings, including correctional facilities and residential treatment
centers. Children with emotional and behavioral problems are also
considered at high risk, as they are significantly more likely to have
alcohol and other drug abuse problems than youths in general.[22]
Youngsters involved in the foster care system are another target population
for prevention services, since their families often have histories of
substance abuse.[23] Initiatives to assist foster families can be integrated
into programs for abused, neglected, orphaned, or troubled adolescents.

As substance abuse and sexual activity often overlap, targeting
prevention/intervention services to pregnant teens and young women can
benefit both the women and their children. Home visits by nurses to teach
young mothers healthy lifestyles is one effective approach. The national
Prenatal and Infancy Home Visitation by Nurses Program conducts
intensive and comprehensive home visits during a woman's pregnancy and
during the first two years after childbirth. An evaluation of the program
found significantly reduced substance abuse among mothers and children
in the program compared with similar nonparticipants.[24] In-home visits
are designed to ensure women's prenatal health and pregnancy outcomes;
improve the care provided to infants and toddlers; and facilitate women's
own personal development by helping them plan future pregnancies,
continue their education, and participate in the work force.

The following examples demonstrate successful prevention programs that
target high-risk individuals.

Prenatal and Infancy Home Visitation by Nurses, Oakland, California

Program Type: Targeting High-risk Groups.

Target Audience: Low-income first-time mothers and their children under
age two.

Years in Operation: 1997-present.

Program Goals: Improve the health of pregnant women and their babies.

Contact Information: Peggy Hill, of the Center for the Study and
Prevention of Violence at the University of Colorado, 303-864-5207.

Description: The Prenatal and Infancy Home Visitation by Nurses program
assists low-income, first-time mothers by helping them improve their
prenatal health, and after childbirth provides care to infants and toddlers to
ensure the children's health and development. The program also helps
women plan future pregnancies, continue their education, and participate
in the work force. Originally piloted in the early 1970s in Elmira, New
York, the program is currently being replicated in 19 states. In Oakland,
California, the program began in November 1997, and the first group of
100 mothers will soon graduate. Prenatal and Infancy Home Visitation by
Nurses has been identified as a Model Program in Blueprints for Violence
Prevention by the Center for the Study and Prevention of Violence at the
University of Colorado.

The program hires and trains registered nurses to conduct home visits with
pregnant women before delivery and to continue visiting once or twice a
week until the child is two. One reason for the program's success is that
nurses have a caseload limited to 25 families, allowing them to bond with
the mothers and children and give them individual attention. The program
focuses on five aspects of development: health, parenting skills,
environmental health (living conditions), life skills, and the creation of
solid support networks. Women are encouraged to seek higher education,
reduce their alcohol, tobacco, and other drug use, and cultivate other
positive behaviors. Nurses involve family and friends in the program and
refer mothers to other community health services when necessary. Detailed
records are kept on each family--their needs, services provided, and the
family's progress and outcomes. Mothers are referred mainly through area
health organizations; much of the recruitment in Oakland is done through
the Women, Infant and Child (WIC) program and through the county's
health maintenance organization.

The program was evaluated at three sites with three different population
groups: Elmira, New York, in the 1970s (primarily white women);
Memphis, Tennessee, in the 1990s (primarily African American women);
and Denver in 1994 (primarily Mexican-American women). While the
three programs have ended, results in all of the studies were promising.
Based on the success of the earlier programs, the Department of Justice
began funding new program sites three years ago.

Challenges: The city of Oakland had no centralized tracking system for
at-risk mothers, which made recruiting mothers a challenge. Program staff
had to contact each agency working with the target population, inform
them about the program, and set up a recruitment system. Recruiting is
complicated because many mothers are not willing to let nurses into their
homes on a weekly basis for two years. Although Oakland originally
targeted 200 mothers for the program, only 112 agreed to participate. Staff
have taken these lessons into account, and today there is better
coordination among agencies providing services to young mothers.

Costs: Program costs vary depending on local nurses' salaries. In Oakland
the average salary of a registered nurse is $65,000 plus benefits; the site
employs four nurses. Other program costs include the salary for a part-time
program coordinator, training, rent, computers, and medical supplies.
Total cost for the first year of the program in Oakland was approximately
$400,000 (100 mothers) and about $350,000 in the second year. The
program costs approximately $3,200 per family per year during the
start-up phase and $2,800 per family per year after the nurses have been
trained and are working to full capacity.

Program Results: Studies have demonstrated that the program reduces
neurological impairment in children by helping mothers improve their diet
and reduce alcohol, tobacco, and other drug use, and also minimizes
childhood abuse and neglect. A 15 year follow-up study of the program in
Elmira, New York, by researchers from the University of Colorado,
Cornell University, the University of Rochester, and the University of
Denver compared participating mothers and infants with a control group
receiving basic prenatal care. Mothers were randomly assigned to either
the program or control group. The evaluation found that program
participants had:

o 79 percent fewer reported cases of child abuse and neglect;

o fewer subsequent children (1.1 versus 1.6);

o longer intervals between the births of their first and second children (67
months versus 37 months);

o 30 fewer months on welfare (60 months versus 90 months);

o 44 percent fewer alcohol and other drug-related behavioral problems
and 69 percent fewer arrests among mothers; and

o 56 percent fewer arrests and days of alcohol consumption among the 15
year old children.

Furthermore, the evaluation data showed that, given the fewer number of
subsequent pregnancies and reduced dependence on government welfare
programs, the costs of the program were recovered in four years. A report
from the RAND Corporation estimated that by the time the children
reached the age of 15, the cost savings were four times greater than the
original investment when reductions in welfare expenditures, crime, and
health care costs are taken into account.

The Oakland program has produced some impressive changes among
women in the program. Although it is too early for site-specific evaluation
data, program staff say that there have been no reported incidents of child
abuse, many women have reduced tobacco use, few premature babies were
born, and approximately 95 percent of the women have received their
GED, job training, or have entered college.

Residential Student Assistance Program, Westchester County, New York

Program Type: Targeting High-risk Groups.

Target Audience: Adolescents in the juvenile justice system.

Years in Operation: 1988-present.

Program Goals: Delay the onset and reduce the use of alcohol and other
drugs and improve youths' self-esteem and communication skills.

Contact Information: Ellen Morehouse, Student Assistance Services,
914-332-1300, sascorp@aol.com.

Description: The Residential Student Assistance Program (RSAP) is a
substance abuse prevention/intervention program serving adolescents in
the juvenile justice system in Westchester County, New York. Started in
1988 with a five-year demonstration grant from the Center for Substance
Abuse Prevention, the program is based on successful Employee
Assistance Programs (EAPs) used by business and industry to identify and
aid employees affected by substance abuse. Goals of the program are to
delay the onset of, or reduce, alcohol and other drug use; develop peer
resistance skills; improve self-image and sense of self-worth; and enhance
communication and interpersonal skills. In 1999, RSAP was selected as a
national high-risk youth replication model by the Center for Substance
Abuse Prevention.

RSAP targets youths between the ages of 14 and 17, most of whom are
African American or Hispanic. The program is implemented in six
Westchester County locations: a locked county correctional 
facility; a nonsecure residential facility for juvenile offenders; a facility for
adolescents with severe psychiatric problems; and three foster care
facilities for abused, neglected, orphaned, and troubled youths. Highly
trained Student Assistance Counselors (SACs) work with youths in the
facilities. The SACs assess all new residents for substance abuse and
provide drug users and children of drug users with individual and group
counseling. The SACs also implement small (6-8 residents) discussion
groups in which adolescents talk about their own substance abuse or that
of a family member, other family problems, and stress. The discussion
groups help the youths and counselors get acquainted and begin changing
the participants' attitudes about alcohol and other drugs. The facility also
hosts 12-Step meetings, and residents are referred for treatment outside the
residential facility when necessary. The SACs assist residents in
developing an Adolescent Resident Task Force which meets regularly and
works to increase self-referral for prevention and treatment activities.

The Student Assistance Counselors also work with the staff of the
residential facilities. They coordinate a Residential Facility Staff Task
Force which includes employees of the youth residential facility. The
group meets weekly to discuss policy and program issues that affect
prevention. SACs train residential staff to implement drug prevention
strategies, and an EAP is available to help those experiencing personal
problems. The Westchester County program employs five full-time
counselors (four work full-time in individual facilities and one splits time
between two facilities) and one supervisor. Together, they serve
approximately 600 adolescents per year.

RSAP is currently being replicated in Massachusetts, and similar
programs in Alaska, Arizona, Connecticut, and Florida are in the planning
stages of implementation.

Challenges: One of the major obstacles to implementing RSAP was
recruiting, hiring, and retaining project staff qualified to work with
program participants. Initially, staff were hired based solely on their
experience in working with adolescents, but program developers soon
learned staff also needed to be trained and experienced in substance abuse
prevention to be successful. Changing the qualifications of the counseling
staff helped ensure success. Another obstacle was building support among
all staff working in the residential facilities where the program was being 
implemented. RSAP encouraged facilities to implement EAPs for their staff 
members, offered staff training at all levels, and formed a staff task force 
representing personnel from clinical to maintenance staff.

Working program activities into the adolescents' already busy schedules
presented difficulties. As a result, the staff decided to present the program
in the school setting, where most prevention programs are traditionally
offered. Staff had to help school personnel understand that while the
program might require children to miss a class or two, the benefits would
significantly improve their schooling. Realizing that their students would
learn more if they were not using drugs or distracted by family issues,
most teachers acknowledged RSAP's importance.

Costs and Funding Sources: The RSAP program in Westchester County
was initially funded by a five-year demonstration grant from the Center for
Substance Abuse Prevention. When federal funds ran out, all six of the
facilities where the program was being implemented picked up the costs of
the program. The program budget consists only of the salary of the
full-time or part-time student assistance counselor working in the facility
and some supervision by the agency implementing the program. For
communities looking to replicate the program, expenses would include
hiring on-site counselors, staff supervision, and training. RSAP offers a
five-day training which costs $375, and on-site training costs range from
$500 to $1,000 per day, depending on the location. Training fees include
the implementation manual, which can also be purchased separately for
$125. A $20 informational video is also available.

Program Results: An independent evaluation of RSAP conducted by
Dobler Research Associates of Sand Lake, New York, showed promising
results. The evaluation, which compared 125 adolescents who took part in
the program with 201 youths who did not, yielded the following
information:

o 82 percent of youth who did not drink, 83 percent who did not use
marijuana, and 78 percent who did not smoke before entering the program
remained nonusers;

o 72 percent of youth who drank, 59 percent who used marijuana, and 27
percent who smoked before entering the program reported discontinued
use at post-test;

o past month alcohol use fell 46 percent (versus a 2 percent drop among
the control group);

o marijuana use dropped 45 percent (versus a 12 percent increase in the
control group); and

o tobacco use fell 16 percent (versus an 8 percent increase in the control
group).


A major accomplishment of RSAP is that it achieved such significant
prevention results with adolescents who are considered at highest risk
because of multiple risk factors. The combination of a sound theoretical
basis for the program and quality staff helped ensure success. While
program staff believe in involving parents in prevention, the target
audience for the program did not have the parental resources available to
most children. For young people without parental support, RSAP proved
effective prevention can be achieved.

IV. Building Family Bonds

Parents are powerful influences in the lives of their children. Through
words and actions they   can provide key guidance on alcohol, tobacco,
and other drug use. Parents have a critical role to play in prevention-not
only within the family, but also in collaboration with schools and
community groups. Research shows that the more often parents talk with
their children about the dangers of alcohol and other drugs, the less likely
it is that their children will experiment with them.[25] Increasingly,
prevention  programs are being designed to enhance parent-child
communication and improve other family skills. Parental disapproval of
delinquency and drug use can counteract the peer pressure youngsters
experience to engage in these activities.

Substance abuse prevention programs have traditionally been part of
school and community efforts, but a new trend is toward family-based
prevention programs. School and community programs, while essential,
are not sufficient because many schools do not begin to address the
problem of substance abuse until adolescence; substance abuse often
begins earlier. According to the 1999 Monitoring the Future study, by the
time children are in eighth grade, more than 50 percent of them have tried
alcohol, 44 percent have tried cigarettes, 22 percent have tried marijuana,
and 20 percent have tried inhalants.[26] Family-centered approaches train
and support families who are trying to keep their children free from
alcohol and other drugs.

Family programs employ a variety of tools, including homework
assignments, brochures, home study guides, workshops, and audio and video-
cassettes. Recent research suggests that the most effective programs
promote positive relationships between parents and children.[27] They
provide training in communication, especially as young people move into
adolescence, and they work to reduce conflict, which can damage bonds
between parents and children.

The National Institute on Drug Abuse (NIDA) recommends that
family-based prevention programs incorporate the following principles[28]:

o Reach families of children at each stage of development;

o Train parents in behavioral skills to reduce conduct problems in
children, improve parent-child relationships, provide consistent discipline
and rulemaking, and monitor children's activities during adolescence;

o Include an educational component for parents with drug information for
them and their children;

o Direct services to families with children in kindergarten through 12th
grade to enhance protective factors; and

o Provide access to counseling services to families at risk.

Family-based programs serve families based on the child's stage of
development, ranging from birth to young adulthood. The federal Center
for Substance Abuse Prevention recommends three family-centered
approaches that show great potential. The first, parent and family skills
training, teaches parents how to build protective factors and reduce risk
factors linked to substance abuse. These risk factors include
communication problems, too lax or too stringent discipline, parental
substance use, and child abuse or neglect. Family protective factors
include close-knit familial relationships, consistent discipline, and parental
supervision of children's daily activities. These programs can improve
poor parent-child communication, child behavior, and parenting skills, and
reduce family conflict. Such interventions are directed at families with
children who have no apparent risk factors for substance abuse as well as
those at moderate and high risk.[29]

Programming differs depending on the target population. For example,
Preparing for the Drug Free Years is a program that aims to improve
parents' child-rearing techniques, parent-child bonding, and children's peer
resistance skills in five weekly sessions, four of which are parent-only.
Treatment Foster Care, however, trains foster families to care for teenagers
with histories of chronic, severe criminal behavior. Both programs have
been found to reduce drug use among participants.

The second approach, family in-home support, provides crisis intervention
(such as food, shelter, clothing) and long-range training that addresses the
root causes of the crisis. These programs aim to decrease domestic
violence, child abuse and neglect, and child placement in foster care, and
are most effective with high-risk children. In-home services can also
reduce youth crime rates by helping youngsters improve their social skills,
anger management, school attendance, and attitudes toward authority.[30]

Family therapy, the third approach, helps family members improve the
way they communicate, manage family life, and solve problems. Programs
are aimed at families with children at high risk and are designed to
improve family functioning and reduce antisocial behavior among both
parents and children. Family therapy is often integrated with other
prevention efforts, such as in-home support and school-based
counseling.[31]

Media campaigns aimed at educating youths and their parents about the
dangers of substance abuse are also used to develop family prevention
skills. The Office of National Drug Control Policy (ONDCP) launched the
National Youth Anti-Drug Media Campaign in 1998, which aims to teach
youths about drugs, educate parents about the dangers of drugs, and
encourage adults to communicate with their children. Anti-drug
advertisements will run through 2002.

Preventing substance abuse by building family bonds is a growing trend
among the nation's communities; the following programs are noteworthy
examples of the different approaches.

Dare to be You, Ute Indian Reservation, Colorado

Program Type: Building Family Bonds.

Target Audience: Preschoolers and their families.

Years in Operation: 1989-present.

Program Goals: Improve communication between parents and their
children and train teachers and community members to provide services to
target families.

Contact Information: Jan Miller-Heyl, Colorado State University,
970-565-3606.

Description: Dare to be You is a substance abuse prevention program for
families with preschoolers. Developed by researchers at the University of
Colorado, the program was inspired by the need for family-based
prevention efforts on the Ute reservation, which was experiencing high
rates of substance abuse, unemployment, and teenage pregnancy. The
program began in 1989, has served approximately 180 families (the entire
population of the reservation is 1,400), and remains popular among
residents.

There are three components of the Dare to be You program. The family
component provides training in communication, parenting skills, and
social skills for children and parents. The school component trains and
supports child care providers and teachers, and the community component
trains community members who will provide ongoing support to the target
children and their families. Goals of the program include improving
parents' sense of competence, helping parents understand appropriate child
management strategies, improving children's and parents' relationships
with their peers, and boosting children's developmental levels. Parents are
given incentives to complete the program: they receive a free meal each
session, child care is provided, and each family receives $200 at the end of
the program.

The Ute program is run through the reservation's Head Start program, and
classes are held in the Head Start building. Sessions run concurrently, so
while parents are learning skills in one room, their children are receiving
developmentally appropriate information in the same building. Teenagers
from the community (sometimes older siblings of preschoolers in the
program) are trained and paid to be helpers. Some of the children who
entered the program as preschoolers have returned as teen workers. There
is a strong emphasis on hiring multicultural teen workers, since Ute youths
typically have poor relationships with youths outside their community.

Dare to be You was selected as an Exemplary Prevention Program by the
National Association of State Alcohol and Drug Abuse Directors, chosen
as a High Risk Youth replication model by the Center for Substance Abuse
Prevention, and is a winner of the Colorado Governor's Award for
Excellence in Substance Abuse Prevention.

Challenges: The major obstacle to implementing Dare to be You on the
Ute reservation was securing adequate meeting space. Head Start has
donated use of its classrooms; however, it continues to be logistically
difficult to share work space. Dare to be You can be implemented through
any community organization in contact with the target audience.

Costs and Funding Sources: The estimated cost of putting 25-30 families
through the program is $25,000. This amount varies depending on the
local cost of living. Program expenses include staffing (including teen
worker salaries), parent incentive money, rent (if necessary), and supplies.
Training costs approximately $3,000 for 35 people; everyone involved in
the program, including teen workers and agency supervisors, receives the
training. The Ute program was originally funded as a demonstration
project by the Center for Substance Abuse Prevention. Current funding to
support the program's $11,000 annual budget is provided by a local
foundation.

Program Results: Researchers at the University of Colorado evaluated the
program at four sites in Colorado; Montezuma County, Colorado Springs,
San Luis Valley, and the Ute reservation. The program was implemented
in community centers, day care, and Head Start facilities, and included
Hispanic, African-American, and White parents and their preschool
children. The evaluation involved 780 parents, 498 in the intervention
group and 282 in the control group.

Parents in the experimental group reported multiple positive benefits
which reduce substance abuse risk factors for their children:

o increased satisfaction with their parenting role (15.5 percent more than
control group);

o increased sense of personal worth (13.5 percent more than control
families);

o a more positive relationship with their children (6.5 percent more than
control families); and

o a 13.7 percent decrease in the use of harsh punishment to discipline
their children (use of harsh punishment decreased less than one percent
among control families).

Children in the program experienced a 6 percent increase in their
developmental level compared to their peers in the control group.

Dare to be You has had a positive impact on the Ute reservation and is
now a household name in the community. One of the major
accomplishments of the program is that it has been institutionalized in the
community; all Head Start teachers on the reservation are now trained
Dare to be You providers, and they reinforce the themes of the program to
preschoolers on a daily basis. Moreover, teen workers who assist with the
program have become role models in their community.

Functional Family Therapy, Las Vegas, Nevada

Program Type: Building Family Bonds.

Target Audience: Youths ages 11-18 in the juvenile justice system and
their families.

Years in Operation: 1996-present.

Program Goals: Change negative family behavior patterns and assist
families in accessing community resources.

Contact Information: Kathie Shafer, Project Coordinator, University of
Utah, 801-585-1807.

Description: Functional Family Therapy (FFT) is a prevention/intervention
program for at-risk children (ages 11-18) and their families. The program
mainly targets youths in the juvenile justice system, aiming to reduce
delinquency and substance use. The family focus of the program has
evolved from the hypothesis that the family setting is the entry point to
addressing problem behavior among adolescents. FFT has been identified
as a Model Program in Blueprints for Violence Prevention by the Center
for the Study and Prevention of Violence at the University of Colorado.

In Las Vegas, the fastest growing city in the country, FFT is the sole
source of counseling services for all youths in the juvenile justice system.
The program is provided by the Family Project-a collaborative effort
between the University of Nevada, Las Vegas (UNLV) and the Clark
County Family and Youth Services Division. The juveniles entering the
system range from relatively low-risk children to youths with multiple
antisocial behaviors and related syndromes. To address the diverse needs
of these children and their families, FFT is designed as a phased program,
with modules that complement one another. Each phase has special
intervention and assessment activities aimed at accomplishing specific
goals of individual families. The phases include:

o Engage and motivate youths and their families by decreasing the intense
negativity so often characteristic of these families;

o Reduce and eliminate problem behaviors and patterns by improving
family communication and parenting and problem-solving skills; and

o Generalize changes across problem situations by increasing the
families' knowledge of and ability to avail themselves of community
resources.

In Las Vegas, four full-time counselors, two from UNLV and two
provided by the county, work with families. FFT is a short-term
intervention that, on average, conducts eight to 12 one-hour sessions for
mild cases and up to 26-30 hours of direct service for more intensive
cases. Often, counselors handle 15 cases at a time, and cases average three
months in length. Upon completion, participants are assessed at
one-month, six-month, and one-year follow-ups. In the last two years, 480
families have been referred to the Las Vegas program.

In addition to the Las Vegas site, FFT is being implemented in 25
locations nationwide. One major innovation is that all sites enter
individual case data into a national network called the Clinical Services
System that enables researchers to monitor and compare data.

Challenges: One of the challenges program providers faced in Las Vegas
was creating a partnership with the juvenile justice system. The goal was
to formally integrate FFT into the system in order to create a continuum of
care for juveniles and their families. Program developers dedicated a great
deal of time to developing effective communication with justice personnel.
Probation officers were taught to make appropriate referrals to the
program and to respect the confidentiality of therapy.

A potential obstacle for communities looking to implement FFT is the
year-long training process, which includes basic training, on-going
supervision, and use of the Clinical Services System. Program developers
insist on strict adherence to the program model.

Costs and Funding Sources: In Las Vegas the cost of serving one family
ranges from $500 to $1,300. The year-long process of training and
supervision required to become an FFT-certified site costs $20,500. A
community can expect to pay, on average, $2,000 per family served.

Program Results: Thirteen evaluations of Functional Family Therapy have
been conducted over the past 30 years, including studies by the University
of Utah and the University of Nevada. The studies indicate that FFT can
reduce criminal recidivism among high-risk youths between 25 and 60
percent. A cost-effectiveness study of the program estimated that spending
$2,000 on one family resulted in $14,000 in cost savings by:

o Deterring adolescents from moving into higher cost treatment services;

o Preventing younger children in the families from entering the system of
care;

o Preventing juveniles from entering the adult criminal system; and

o Avoiding future crime victim costs.

Since siblings of the adolescents being served in Nevada generally
experience lower arrest rates and minimal contact with the juvenile justice
system, it appears that FFT creates systemic change within the families it
serves. Another study found that counselors were able to get 86 percent of
referred families into at least two program sessions, indicating that FFT
providers are successfully engaging families.

Strengthening Families Program: For Parents and Youth 10-14, Pella,
Iowa

Program Type: Building Family Bonds.

Target Audience: Youths ages 10-14 and their parents.

Years in Operation: 1992-present.

Program Goals: Prevent teen substance abuse by increasing family bonds.

Contact Information: Sherry Maakestad, Crossroads of Pella,
515-628-1212; for replication information, Virginia Molgaard, Ph.D.,
Institute for Social and Behavioral Research, Iowa State University,
515-294-4518.

Description: Youths and families in more than 80 Iowa communities
participate in the Strengthening Families Program: For Parents and Youth
10-14 (SFP 10-14), a parent, youth, and family skills-building curriculum
designed to prevent teen substance abuse and other problem behaviors,
strengthen parenting skills, and build family strengths. Developed in 1992
by the Institute for Social and Behavioral Research at Iowa State
University, the program is based on the Strengthening Families Program
developed at the University of Utah.

For the past six years, Crossroads, a private social service agency in Pella,
Iowa (population 15,000), has run two SFP 10-14 programs annually for
fifth to eighth graders and their parents, one in the local public school and
one in a private school. The programs typically average 15 families
annually in seven two-hour weekly sessions. In addition, four two-hour
booster sessions are provided between three and 12 months following
conclusion of the original sessions. During the sessions, parents and
youths meet separately for the first hour, and then during the second hour
practice what they have learned together. The seven parent-oriented
sessions focus on making house rules, encouraging good behavior,
employing discipline, building bridges, protecting against substance abuse,
and using community resources. The child-oriented sessions focus on
building personal goals, appreciating parents, dealing with stress, handling
peer pressure, and reaching out to others. Family sessions involve
supporting and attaining goals, appreciating family members,
understanding family values, and building family communication. The
booster sessions generally include handling stress and conflict, and
improving family communication.


In addition to schools, other possible venues for SFP 10-14 include
religious facilities and community centers. While the program can involve
12 families at once, group size should be reduced in special situations,
such as court-ordered treatment. Three group leaders are required to
implement the program: one to lead the parent session, and two to lead
youth sessions. All three leaders facilitate the family sessions.

Over 600 SFP 10-14 facilitators have been trained in Iowa, and
programming has reached more than 1,000 families in the state, including
those in inner-city settings. Increasingly, the program is expanding outside
of Iowa, and is currently being replicated in nearly 40 states. SFP 10-14
has been identified as a Promising Program by the Center for the Study
and Prevention of Violence at the University of Colorado and as a Model
Family Program for Delinquency Prevention by the Office of Juvenile
Justice and Delinquency Prevention.

Challenges: A major obstacle to program success is recruiting and
retaining families. Schools, social services agencies, and other community
agencies are relied upon to recruit families by hosting informational
meetings for parent leaders who in turn also assist in recruitment.
Advertisements promote the program as help for parents during the teen
years, as opposed to a support program for at-risk families. In Pella the
program offers on-site child care to help retain families. SFP 10-14
program sites have demonstrated a 94 percent retention rate of families
who attend the first meeting.

Costs and Funding Sources: To replicate SFP 10-14, curricula for the 11
sessions including a one-day training session, plus manuals and
videotapes, costs $535. The manuals contain instructions for 33 hours of
activities, such as learning games, discussions, skill-building activities,
and family projects. Training consists of a lesson on program background
and research results, discussion of techniques and teaching philosophy, an
overview of program logistics and recruitment, and hands-on practice of
selected activities. Agencies at various sites have implemented the
program without hiring new staff, keeping costs at a minimum.

The two programs in Pella cost about $4,500 annually. Child care is
provided on-site, and Crossroads conducts publicity campaigns to recruit
families.

Program Results: Evaluation studies of SFP  10-14 conducted by the
Institute for Social and Behavioral Research at Iowa State University have
found lowered alcohol, tobacco, and marijuana use among participating
youngsters when compared with similar children in a control group. Four
years following baseline assessment:

o 31 percent of program youths had ever been drunk, compared to 46.5
percent of the control group;

o 13 percent of program youths had smoked cigarettes in the past month,
compared to 24.5 percent of the control group; and

o 8.3 percent of program youths had used marijuana, compared to 17.6
percent of the control group.

Two major accomplishments of the Pella program are successfully
involving parents in prevention activities, often a difficult task, and
forming a partnership with the schools, facilitating recruiting and
publicity.

V. Empowering Communities

Communities can find solutions to many of their own problems.
Community-led initiatives addressing the problems of substance abuse and
related crime have proliferated throughout the last decade. Community
coalitions aimed at underage drinking, Weed and Seed initiatives, and
other programs have sprung up in cities and towns nationwide, supported
by foundations, individual donors, and the federal government.

A community coalition is comprised of community stakeholders--service
providers, residents, community and business leaders, educators,
government officials, law enforcement officers, and others--who combine human 
and financial resources to address a particular issue or set of issues within the
community. The emergence of crack cocaine in the 1980s prompted many
communities to form anti-drug coalitions, a number of which still exist
today. Coalitions, by mobilizing the community, have helped to change
public policy and have empowered residents by giving them a sense of
ownership and investment.

The federal government and private foundations recognize the value of
building community coalitions to address substance abuse and have spent
hundreds of millions of dollars to support these efforts. The Robert Wood
Johnson Foundation, for example, created Fighting Back coalitions to help
communities reduce the demand for alcohol and other drugs. The Center
for Substance Abuse Prevention has spent over $300 million on its
Community Partnership program, which has supported nearly 500
coalitions nationwide. The Drug-Free Communities Act, signed into law in
June 1997, provides financial support and technical assistance to
community coalitions seeking to reduce adolescent substance abuse. The
Office of Juvenile Justice and Delinquency Prevention manages the
Drug-Free Communities Support Program, which provides annual grants
of up to $100,000 to community coalitions for youth substance abuse
prevention efforts. Funding for the program, which was $10 million in FY
1998, has increased annually and will be $43.5 million in FY 2002. There
are currently 213 grantees from 45 states and the U.S. Virgin Islands and
Puerto Rico.

While most coalitions are established for the same purpose--bringing the
community together to address substance abuse--the structure and activities
of coalitions can differ markedly, making it difficult to offer one blueprint
of how coalitions work. However, studies conducted in 1999 by the Center
for Substance Abuse Prevention and the Community Anti-Drug Coalitions
of America identified some key elements of successful coalitions[32,33]:

o Understanding the community's needs and resources;

o Widely shared and comprehensive vision;

o Clear and focused strategic plan;

o Diverse membership (including key community leaders, local
government officials, and volunteers);

o Strong leadership and committed partners;

o Diversified and relevant funding (coalitions should not accept funding
that may compromise their mission); and

o Well-managed structure (including organized administration, effective
communication among members/volunteers/staff, and a comprehensive
evaluation plan).

The growth of coalitions has also spurred the creation of national
organizations to support them. The Community Anti-Drug Coalitions of
America and Join Together are two major organizations that provide
technical assistance to new and existing coalitions.

Some communities have developed coalitions focused specifically on
curbing youth alcohol use. These coalitions have demonstrated an impact
by effecting environmental changes that reduce youth access to alcohol,
through legislation and public awareness. For example, the Coalition to
Reduce Underage Drinking in North Carolina helped pass legislation that
sets penalties for adults who supply alcohol to minors and limits the
amount of revenue that stores in certain low-income neighborhoods can
generate from alcohol sales. In addition, the Coalition worked with
retailers to create a media campaign designed to change adult attitudes
about youth drinking. Recognizing the devastating effects of underage
drinking on communities, the Office of Juvenile Justice and Delinquency
Prevention supports coalition efforts through its Combating Underage
Drinking Program.

Another Department of Justice program, Weed and Seed, targets the
relationship between substance abuse and crime in America's cities. Weed
and Seed is a community-based, multiagency initiative designed to control,
reduce, and prevent violent crime and drug abuse. Law enforcement
agencies and prosecutors cooperate in "weeding out" criminals who
participate in violent crime and drug abuse to prevent their return to the
target area; "seeding" brings human services to the area, encompassing
prevention, intervention, treatment, and neighborhood revitalization. A
community-oriented policing component connects weeding and seeding
efforts. An important feature of Weed and Seed is that each site must form
a local steering committee, made up of all key community stakeholders
and chaired by the U.S. Attorney for that district. The committee is then
responsible for establishing goals and objectives, developing programs,
providing guidance, and assessing achievement.

The inclusion of local residents, services, and institutions contributes to
community ownership of programs, which is important for finding local
funding. In Fort Wayne, Indiana, for example, funding for the anti-drug
coalition comes from money collected from individuals arrested for
driving under the influence or some other drug offense. In Kansas City,
Missouri, residents approved a 0.25 percent increase in the sales tax to
support community anti-drug efforts. Nonprofit community organizations
also offer win-win partnerships with local business and industries looking
to support a good cause and garner local publicity.

Evaluation of community coalitions is providing data about what makes
coalitions successful. The following programs exemplify how
communities can combine grassroots efforts with research-based theories
of intervention to address illicit drug and alcohol problems.

Midwestern Prevention Project, Marion County (Indianapolis), Indiana

Program Type: Empowering Communities.

Target Audience: Pre-middle school youths, their parents, and
communities.

Years in Operation: 1987-present.

Program Goals: To reduce youth drug use by coordinating anti-drug efforts
among schools, parents, and communities.

Contact Information: Karen Bernstein, University of Southern California,
323-865-0325.

Description: The Midwestern Prevention Project (MPP) delivers anti-drug
messages to youths through schools, parents, and communities. The
program aims to reduce drug supply and demand by combining prevention
activities with policy changes. The program began in 1984 and is now
being used in five states. The Midwestern Prevention Project was named a
Model Program in Blueprints for Violence Prevention by the Center for
the Study and Prevention of Violence at the University of Colorado. In
1987, the MPP was implemented in all 133 public schools in Marion
County, Indiana.

The MPP consists of five components: school program, mass media,
parent program, community organization, and health policy. The program
is introduced in sixth or seventh grade, before youths make the transition
into middle or junior high school. The program is administered by teachers
and student leaders elected by the class and trained by the teacher. During
the first year there are between ten and 13 classroom sessions discussing
resistance skills, promoting a nondrug use environment, and creating an
anti-drug climate in the school. The second year of the program provides
five follow-up sessions which reinforce the skills learned in the previous
year. Throughout high school, peer counseling and support activities are
available.

The mass media component begins the same year as the school component
and continues for five years. Each year there are approximately 30 reports
about the program on television, radio, and in newspapers. The reports are
designed to keep community members involved by keeping them informed
of new program components and what students are learning in the
program.

The parent component, taking place during years two and three, gets
parents involved in supporting a drug-free environment in their homes and
in middle school. A group consisting of the principal, four to six parents,
and two students meets throughout the school year to institutionalize drug
prevention in the school, monitors the school grounds to ensure a drug-free
environment, and plans and implements parent skills training twice each
year. Each of the schools in Indianapolis has a parent committee led by a
parent involved in the Parent Teacher Association.

During years three through five, community leaders are trained and form a
community organization to implement drug abuse prevention services.
These services complement what is being done in the schools and with the
parents. During the fourth and fifth year, members of the community
organization form a health policy subcommittee to implement policy
changes designed to reduce the supply of and the demand for drugs. Policy
changes might include ordinances restricting cigarette smoking in public
areas or mandating drug-free zones. Indianapolis has had eight
committees, including a medical action committee which produced a
resources list of all local substance abuse treatment facilities serving
youth. The list was distributed to area schools and hospitals. The
government committee produced a brochure detailing parents' legal
responsibilities concerning youth and alcohol, such as the possible
repercussions of allowing alcohol to be served at a graduation party in the
home. Over 150,000 of these brochures were distributed to parents.

Challenges: One of the challenges to implementing the MPP in Marion
County was coordinating program development among the key players,
including teachers, the school superintendent, local officials in law
enforcement, and the business community. In order to address this
problem, the Lilly Endowment, the project funder, required that all schools
in the district commit to participating in the program before awarding the
grant.

Costs and Funding Sources: The program was funded by a $6 million
grant from the Lilly Endowment. Additional funding was provided by the
University of Southern California for evaluation of the program. It costs
approximately $175,000 over a three-year period for a school to
implement the MPP, which includes providing curriculum materials for
1,000 students and training 20 teachers and 20 members of the parent
group.

Outcome Measures: The University of Southern California and the
Kaufman Foundation are conducting an ongoing evaluation of the
Midwestern Prevention Project in Kansas City, Missouri, which was the
first city to implement the program. Results from the evaluation show that
the positive effects of the program endure over time.

By the end of high school, the program youth showed the following net
reductions* in drug use:

o 4.9 percent daily cigarette use;

o 7.2 percent monthly drunkenness; and

o 2.9 percent marijuana use more than twice a week.

*Percent increase in control group minus percent increase in program
group.

By early adulthood (age 23), program youths continued to show less drug
use than the control group:

o 1.9 percent less cigarette use;

o 1.5 percent less marijuana use more than twice a week;

o 6.2 percent less lifetime amphetamine use; and

o 8.1 percent less lifetime inhalant use.

Project Northland, Ten Minnesota Communities

Program Type: Empowering Communities.

Target Audience: Youths, their parents, and communities.

Years in Operation: First phase: 1991-1994; second phase: 1996-1999.

Program Goals: To prevent underage drinking through community and
family supported alcohol education.

Contact Information: Project Northland curriculum materials,
800-328-9000; in Minnesota, 612-624- 0057.

Description: Project Northland is a communitywide intervention designed
to reduce adolescent  alcohol use. The program was developed at the
University of Minnesota and piloted in ten Minnesota communities to help
prevent underage drinking. The program is a multilevel program involving
students, parents, businesses, and community residents and organizations.
The Minnesota program served 2,400 students from 24 school districts,
including schools on seven Native American reservations with high rates
of death and disability from alcohol abuse. Each community site had a
part-time field coordinator to assist in implementation.

Through Project Northland, community strategies, action-based curricula,
and peer leadership activities all encourage positive individual behavior
and environmental change. The first phase of the intervention includes
eight sessions each year for sixth, seventh, and eighth grade students that
focus on the risks of drinking. These sessions are designed to prevent
alcohol use through normative education, social resistance skills training,
and decision making. Each of the middle-school years revolves around a
specific theme and incorporates individual, parent, and community
training.

o sixth grade--a strong family component targets student and parent
communication by requiring parents and children to complete homework
assignments together that describe adolescent alcohol use. Group
discussions on family communication are held in schools. Also in the first
year, a communitywide task force is created to address teen alcohol use.

o seventh grade--a student- and teacher-led classroom curriculum focuses
on resistance skills and normative expectations regarding teen alcohol use.
Discussions, games, problem-solving, and role plays are all components of
this curriculum. A peer participant program creates alternative alcohol-free
activities, and parents continue to be involved. The task force focuses on
alcohol-related environmental policies, and businesses get involved by
providing discounts for children who pledge to be alcohol- and drug-free.

o eighth grade--students work on becoming active citizens by interviewing
community leaders about adolescent drinking and conduct town meetings
to make recommendations for the community's help in preventing alcohol
use.

The second phase, delivered during the students' last two years of high
school, incorporates five major components to reduce alcohol availability
and reinforce no-use norms: community organizing, parent education,
youth participation, media campaigns, and school curriculum. Program
staff work with youth in more sophisticated ways for example, developing
community action projects focused on teen alcohol issues, creating
original videos that focus on alternatives to drinking, community response
to teen drinking, and dramatizations of the negative consequences of
drinking; and learning about the state legislative process.

Challenges: One challenge in implementing the program is creating a
community partnership that embraces the program's goals. In Minnesota,
staff used media messages to help create a partnership within the
community; articles in newspapers and school newsletters helped publicize
the program. Minnesota staff conducted a community leader survey to
assess what changes the community would support. Another obstacle can
be obtaining agreement from the schools to participate, particularly
considering potential shifts in school leadership and administration. A
nonlegal binding agreement was used in Minnesota communities to keep
schools on board.

Costs and Funding Sources: The complete Project Northland curriculum
for one school costs $549, plus $150 for each set of sixth grade workbooks
(one set includes 30 workbooks; individual books can also be purchased).
Training sessions (which last two to three days) are held in various sites
throughout the country and cost $1,500 per day. Additional costs include
salaries for part-time program coordinators. Project Northland was
developed, implemented, and evaluated in Minnesota through a five-year
grant from the National Institute on Alcohol Abuse and Alcoholism.

Program Results: Project Northland successfully prevents youth substance
abuse. While the primary focus of the program is on alcohol, it has
impacted tobacco and marijuana use as well. A study comparing Project
Northland youths with similar noninvolved youngsters found that
participating youths were:

o 30 percent less likely to drink in the past week;

o 20 percent less likely to drink in the past month;

o 20 percent less likely to smoke regularly; and

o 15 percent less likely to use marijuana.

The second phase of the program was completed in 1999, and evaluation
of its effectiveness in preventing teen alcohol use is currently underway.

The program has also indirectly contributed to the passage of five
alcohol-related city ordinances, including the establishment of responsible
beverage server training, stricter requirements for the renewal and granting
of liquor licenses, and limitations on liquor establishment operating hours.
Project Northland received an "A" in Making the Grade: A Guide to
School Drug Prevention Programs and has been identified as a Promising
Program by the Center for the Study and Prevention of Violence at the
University of Colorado.

Troy Community Coalition for the Prevention of Drug and Alcohol Abuse,
Troy, Michigan

Program Type: Empowering Communities.

Target Audience: Youths, their families, and communities.

Years in Operation: 1985-present.

Program Goals: To reduce underage drinking by educating youths, their
parents, and the community.

Contact Information: Mary Ann Solberg, Director, 248-740-0431.

Description: The Troy Community Coalition formed when the town began
to experience an increase in youth alcohol abuse in the mid-1980s. To
address the problem, the school district created a three-pronged approach:
implement a new health and peer pressure resistance program, develop a
parent group, and create a community program. This community program
developed into the Troy Community Coalition for the Prevention of Drug
and Alcohol Abuse. After operating on a small budget for about one year,
the coalition won a $1.3 million grant from the Center for Substance
Abuse Prevention.

The coalition follows a cradle-to-grave strategy, implementing programs
for all sectors of the community ranging from pre-schoolers to senior
citizens. The coalition works with schools, parent groups, the police
department, the court system, and the city commission, among others. For
example, the coalition offers a parenting class to help parents talk with
their children about alcohol, encourages the police to make sure bars and
store do not sell alcohol to minors, and successfully advocated legislation
requiring alcohol to be safeguarded, because youths were stealing alcohol
from grocery store shelves. In addition, the coalition trains pediatricians to
work with parents to help them understand the problems associated with
underage drinking.

Through a decade of programming, the coalition has identified several key
elements of success:

o Public officials are vital to the work of  coalitions;

o Coalition programs must match or exceed community perceptions of
quality;

o Creative methods must be used to recruit, retain, and recognize
volunteers; and

o Coalitions must be funded, at least in part, locally. Creative use of data
and outcomes attracts this funding.

Challenges: A major obstacle to the coalition's work in Troy is denial
among residents that there are alcohol and other drug problems in the
community. The coalition conducts public awareness campaigns to
educate the public and demonstrate existing problems. Data collection is a
vital activity for informing the creation of programs. The coalition
monitors adult and school surveys, emergency room data, police data, etc.,
to make sure the community's needs are being addressed and met. For
example, the coalition observed an increase in alcohol abuse among newly
retired senior citizens and created a senior volunteer bureau to address this
problem.

Another challenge is maintaining vital relationships with partners in public
and private sectors despite constantly changing leadership. Continued
public education is needed to explain the mission of the coalition, the
problems in the community, and how partnerships can help solve these
problems. The coalition must constantly educate new leaders and
volunteers to maintain and enhance these linkages, which are vital to the
success of the coalition. For example, the linkage with the police
department alerts the coalition to emerging drug problems so it can
develop appropriate programming.

Costs and Funding Sources: The coalition operates on a $300,000 annual
budget, which includes four full-time staff and one part-time employee,
and receives funding from the city government (it is a lineitem in the
annual city budget). The school   district supplies office space and other
services, while corporate donations, small foundation grants, individual
donors, and fundraisers make up the remaining budget. Troy staff believe
that all fundraisers, in addition to collecting money, should send
significant prevention messages as well. For example, an annual celebrity
dinner sponsored by local corporations and attended by adults and children
is alcohol-free.

Program Results: The coalition's efforts to reduce teenage drinking
resulted in significant reductions between 1991 and 1998:

o 12th-grade students who reported consuming alcohol in the past month
decreased from 62.1 percent to 53.3 percent; and

o eighth-grade students who reported consuming alcohol during the past
month decreased from 26.3 percent to 17.4 percent.

In addition, the coalition has been successful in changing community
norms. For example, when the National Football League wanted to host a
youth competition in Troy sponsored by Budweiser, the county
commission (which works closely with the community coalition) declined
the offer unless a new sponsor was found. The next year, the NFL
resubmitted a proposal with a new sponsor. Another coalition
accomplishment is receiving significant community funding. Since its
inception, the coalition has worked to establish win-win relationships with
businesses and organizations who in turn support the coalition. For
example, the coalition assisted one of its corporate sponsors in the
development of an anti-drunk driving promotion. The coalition's work has
also prompted various public policy changes that have strengthened the
community's resistance to alcohol and other drug abuse.


---------------------------------


Treatment

Substance abuse treatment is the most cost-effective way to reduce
addiction, improve the health of drug abusers, and relieve the growing
burden of drug-related health care costs. With treatment, addicts can get
off drugs, get jobs, and become productive members of society. Addiction
to alcohol and other drugs is similar to other chronic illnesses, such as
diabetes and hypertension, in that successful treatment requires permanent
behavior change. As with all chronic illnesses, relapse is a possibility, and
failure to comply with treatment weakens the chances for successful
recovery.

An untreated addict can cost society an estimated $43,200 annually,
compared with an average $16,000 for a year of residential care or $1,500
for an outpatient program.[34] A 1994 California study (CALDATA) found
that $1 invested in alcohol and other drug treatment saved taxpayers $7 in
future costs.[35] The federal government's 1997 National Treatment
Improvement Evaluation Study evaluated the effectiveness of treatment
services for 5,000 clients in publicly funded programs. Treating these
low-income clients saved society an average of $9,000 per client,
compared to $3,000 spent on treatment. The study found a 3 to 1 ratio of
benefits to costs.[36]

Services offered by substance abuse treatment programs vary, as do the
modalities, staff, and target populations. The four most common types of
substance abuse treatment are[37]:

o Outpatient methadone programs--provide methadone to reduce cravings
for heroin. Counseling, vocational training, and case management are
often used to stabilize patient functioning;

o Long-term residential programs--offer drug-free treatment in a
residential community of counselors and recovering addicts. Patients
generally stay in the programs a year or more;

o Short-term inpatient programs--keep patients up to 30 days. Most of
these programs focus on medical stabilization, abstinence, and lifestyle
changes. Staff are primarily medical professionals and trained counselors;
and

o Outpatient drug-free programs--use a wide range of approaches,
including problem-solving groups, specialized therapies,
cognitive-behavioral therapy, and 12-step programs.

Studies of successful drug treatment programs have identified certain
elements that enhance effectiveness. Length of time in treatment, intensity
of treatment, and aftercare are key factors in helping addicts stay clean.
According to extensive national studies of tens of thousands of addicts,
one-third of those who stay in treatment longer than three months are still
drug-free one year later. The recovery rate jumps to two-thirds when
treatment lasts a year or longer.[38]

The National Institute on Drug Abuse has identified 13 principles of
effective treatment that are described in Principles of Drug Addiction
Treatment: A Research-Based Guide (1999). These principles are as
follows:

o No single treatment is appropriate for all individuals;

o Treatment needs to be readily available;

o Effective treatment attends to multiple needs of the individual (such as
medical, psychological, social, vocational, and legal problems);

o Treatment and services plans must be assessed continually and
modified as necessary to ensure that the plan meets the individual's
changing needs;

o Remaining in treatment for an adequate period of time is critical for
treatment effectiveness;

o Counseling (individual and/or group) and other behavioral therapies are
critical components of effective treatment;

o Medications are an important element of treatment for many patients,
especially when combined with counseling and other behavioral therapies;

o Addicted or drug-abusing individuals with coexisting mental disorders
should have both disorders treated in an integrated way;

o Medical detoxification is merely the first stage of addiction treatment
and by itself does little to change long-term drug use;

o Treatment does not need to be voluntary to be effective;

o Possible drug use during treatment must be monitored continuously;

o Treatment programs should provide assessments for HIV/AIDS and
other infectious diseases, and counseling to help patients modify or change
behaviors that place them or others at risk of infection; and

o Recovery from drug addiction is a long-term process and frequently
requires multiple episodes of treatment.

Although treatment has proven effective, programs are still scarce. The
National Academy of Sciences' Institute of Medicine estimates that
programs are available for only one quarter of the almost six million 
people needing treatment.[39] The federal government estimates that the
need for substance abuse treatment in the United States will grow 57
percent over the next 20 years.[40] The shift to managed health care among
both public and privately funded treatment providers has reduced the
availability of long-term substance abuse treatment. Instead, coverage is
provided only for short-term interventions. Failure to provide adequate,
appropriate treatment services reduces success rates and contributes to
public skepticism about investing in treatment programs.

This chapter discusses various promising treatment approaches involving
families, communities, and the criminal justice system. Effective strategies
include treating parents with their children, rehabilitating criminal
offenders, addressing the unique needs of adolescents, and connecting with
the community to serve hard-to-reach clients. The programs described
below may serve as examples to other communities trying to develop
strategies to meet their own needs.

I. Family-Based Treatment

Treatment for a parent means prevention for a child. Children whose
parents receive substance abuse treatment have lower health care costs
than children of parents who do not receive treatment.[41] In addition,
children of untreated addicts are at significantly higher risk of abusing
substances themselves. Providing treatment services to addicts and their 
children helps break the inter-generational cycle of substance abuse.
However, treatment has historically been largely inaccessible to pregnant
addicts and parents without access to transportation, child care, and
affordable services.

Pregnant addicts have a particularly difficult time getting treatment, in
large part because most treatment models were originally designed for
male addicts. The 1997 Uniform Facility Data Set found that only 20
percent of treatment facilities surveyed offered programs for pregnant or
postpartum women; 7.2 percent provided prenatal care, 4.8 percent offered
perinatal care, and 10.2 percent offered  child care.[42] Lack of specialized
treatment options translates into greatly increased health and social costs.
According to a 1995 study in Washington state, Medicaid expenses during
the first two years of life for an infant born to an untreated
substance-abusing woman were 1.4 times higher than those incurred for
infants born to treated substance-abusing women.[43] The difference in
dollar terms amounted to $1,800 per infant.

Other deterrents for pregnant addicts are the risks of prosecution and of
losing their children. An increasing number of states are prosecuting
women under criminal laws for using drugs during pregnancy. For
example, several women have been jailed under South Carolina's
child-endangerment law, which targets women who use illegal drugs while
pregnant. The U.S. Supreme Court, which upheld the state's right to
prosecute these women in 1998, is now considering whether a South
Carolina public hospital is violating pregnant women's constitutional
rights by testing them for crack cocaine use. Public clinics are generally
required to report a pregnant woman to child welfare agencies if her urine
tests are drug-positive.[44] As a result, many pregnant drug users regard
prenatal care as a potential legal trap and choose to forgo it. Recent studies
show that prenatal care substantially improves a baby's health, even if the
mother continues to use drugs during pregnancy.[45]

Women account for almost one-third of the total number of substance
abusers in treatment.[46] The Substance Abuse and Mental Health Services
Administration's 1998 Services Research Outcomes Study, which
surveyed several thousand addicts five years after their discharge from
treatment, found that women responded better to treatment than men.
Women reported almost twice as great a reduction in illicit drug use after
treatment than men did.[47] The 1997 National Treatment Improvement
Evaluation Study also found that women addicts showed marked
improvement in the year following treatment.[48] Among women in the
treated group, arrests declined by two-thirds, while drug use dropped by
almost half.[49]

Certain aspects of women's lives are particularly important in addressing
their treatment needs. Children are a central reality in the lives of most
women. Unless programs provide help with children, women often cannot
participate. Several treatment outcome studies have found that women
who have their children with them during residential treatment are less
likely to drop out and are more successful after treatment than women
whose children are not with them during treatment.[50,51,52] Moreover,
having children accompany mothers in both nonresidential and residential
treatment provides an opportunity to teach women parenting skills in a
safe therapeutic setting.

Sexual abuse, domestic violence, and depression are widespread among
women addicts; these problems must be addressed in order to prevent
relapse. Research indicates that women-only programs tend to be more
effective than coed, primarily because women feel more comfortable
talking to other women about their experiences.[53] Programs should offer
access to comprehensive services, such as family planning, physical and
mental health care, job training, parenting, and family building skills. This
model departs from traditional drug treatment, which concentrates almost
exclusively on addressing addictive behavior rather than the constellation
of other problems that often contribute to addiction in women.

Despite the challenges, new treatment programs for pregnant, postpartum,
and parenting substance abusers have begun to target high-risk families,
providing treatment as well as parent training and job readiness skills. An
emerging trend is to combine prenatal care with drug treatment to protect
unborn babies from exposure to drugs and to prepare pregnant women for
parenthood. The Center for Addiction and Pregnancy in Baltimore found
that infants of untreated women were more than twice as likely (26
percent) to require neonatal intensive care unit (NICU) hospitalization
than infants of treatment patients (10 percent). Taxpayers save nearly
$5,000 per child in NICU costs.[54]

Families in crisis often lack the ability to support each other. Some
treatment programs are working with addicts and their families to enhance
chances for recovery and family stability. For example, La Bodega de la
Familia, a treatment facility in New York City serving families with a
relative in the criminal justice system, incorporates family members and
in-home visits into the treatment process. La Bodega requires that
substance abusers have a family member willing to participate in the
treatment program to assist case managers in developing an action plan for
the addict and the family. Since children often suffer because of the
substance abuse or incarceration of a parent or sibling, family-based
interventions are an effective way to integrate prevention and treatment.

By involving the family in the treatment process, addicts need not be
distracted by the risks of losing their children, and at the same time their
families serve as support networks in treatment and recovery.
Consequently, strengthening family relationships is a major objective for
the following family-based treatment programs.

Center for Addiction and Pregnancy, Baltimore, Maryland

Program Type: Family-Based Treatment.

Target Audience: Substance-abusing women and their families.

Years in Operation: 1991-present.

Program Goals: To provide multiple types of medical services to
substance-abusing women and their families.

Contact Information: Center for Addiction and Pregnancy, 410-550-3020;
Dr. Lauren Jansson, 410-550-3415.

Description: The Center for Addiction and Pregnancy (CAP) offers a
comprehensive, multidisciplinary treatment program for substance-abusing
women and their families. The program, established in 1991, is housed in
one wing of the Johns Hopkins Bayview Medical Center. The CAP
program combines substance abuse/mental health treatment, pediatrics,
obstetrics/gynecology, family planning, and nursing.

CAP's main goals are to reduce the number and severity of obstetric
complications, including HIV infection; to deliver healthier infants to
mothers who no longer abuse drugs or alcohol; to provide effective family
planning services acceptable to the patient; and to ensure initial and
long-term pediatric assessments and care to the infants and siblings of
program patients. Upon admission, women are placed into residential care
for seven days, during which they receive eight hours of interdisciplinary,
individual, and group counseling per day. After this one-week residential
stay, the women are transferred to an outpatient  program, where they
attend six and a half hours of programming each day. As women progress,
they go through three levels of treatment that lessen in intensity in
accordance with their progress. Ancillary services, including methadone
maintenance, psychiatric therapy, and specialized services for
HIV-positive women are offered when necessary.

Prenatal assessment and care are provided by nurse midwives and an
obstetrician, and infants are delivered on the medical center campus.
Pediatric care consists of routine child health care maintenance, as well as
developmental screenings every three months and formal psychological
assessments at six, 12, and 24 months. A structured parenting program
provides individual and group training to all mothers, especially those
identified as having exceptional parenting needs. A children's service
coordinator conducts pediatric outreach and in-home assessments as well
as overall case management for CAP children and their siblings.


Participants, primarily from Baltimore, are predominantly African
American. The majority of women have less than a high school education,
live in poverty, are single, and have an average of three children. CAP
admits between 35 and 40 women per month and performs approximately
200 deliveries annually.

Challenges: A challenge to implementing the CAP program was
integrating the many disciplines involved. Having all staff members work
together without a particular hierarchy encouraged effective working
relationships and facilitated the free flow of information, allowing staff to
learn about disciplines outside of their expertise.

One of the major obstacles currently facing the CAP program is the cost
restrictions of managed care. Although the program historically could
provide long-term intensive services, women are now much more limited
in their time in the program and access to special services. To address this
problem, the program is seeking to provide longer-term services through
foundation grants and state funds. In addition, the program is working with
managed care companies to address the lack of services.

Another programmatic challenge is retaining women in treatment. A
significant number of women entering the program drop out quickly. CAP
is working on ways to make treatment more user-friendly, such as offering
vouchers and hiring treatment advocates. The program also provides
transportation and child care to help reduce barriers to treatment.

Costs and Funding Sources: The total expenditures of the program are $3.7
million annually, including salaries for CAP's 37 full-time employees.
Funding for the program comes from managed care companies and
Medicaid.

Program Results: A cost-effectiveness study of CAP conducted by
researchers at Johns Hopkins University, the National Institute on Drug
Abuse, and the Maryland State Alcohol and Drug Abuse Administration
found that providing treatment ser- vices to pregnant women significantly
reduced the costs of medical care for their infants. The evaluation
compared two groups of pregnant drug-abusing women-100 who received
treatment, and 46 who did not. Drug use of mothers at time of delivery
was measured using urinalysis. The outcomes were as follows:

o The total neonatal intensive care unit (NICU) costs for infants born to
mothers who did not receive substance abuse treatment totaled $12,183,
significantly more than the $900 in NICU costs for the treated women's
infants;

o Factoring in the $6,639 in costs to provide addiction treatment services
to mothers, total cost savings of the program were $4,644 per
mother-infant pair;

o Infants born to treated women averaged less than one day in NICU,
compared with more than ten days for control group infants;

o Women in treatment were significantly less likely to use illicit drugs at
the time of delivery than women who did not participate in treatment (37
percent and 63 percent, respectively).

o Infants of treated women had a mean birth weight approximately 400
grams heavier and a gestational period approximately three weeks longer
than the infants whose mothers did not get treatment for drug abuse.

The cost-effectiveness study won the 1999 Hazelden Foundation Dan
Anderson award, which honors clinical research endeavors seeking to
improve treatment services.

La Bodega de la Familia, New York, New York

Program Type: Family-Based Treatment.

Target Audience: Families of drug users.

Years in Operation: 1996-present.

Program Goals: Provide services to families of drug users to increase the
likelihood of drug users remaining in treatment.

Contact Information: Carol Shapiro, Program Director, 212-982-2335.

Description: La Bodega de la Familia, begun in 1996, is an alcohol and
other drug treatment program focusing on families of drug users. The
theory behind La Bodega is that a substance abuser will be more
successful in treatment if supported by their family. La Bodega serves a
population of 60,000 in a 56-block area of Manhattan's Lower East Side,
referred to by locals as Loisaida. Loisaida was chosen as the program site
by the Vera Institute of Justice because the community has high levels of
drug use and related crime (the building housing La Bodega was formerly
the site of a drug market), but also has many churches and health clinics
providing crucial support to drug users and their families. The Lower East
Side is 33 percent Hispanic (largely Puerto Rican), 30 percent Asian, 29
percent white, and 8 percent African American. Forty-four percent of the
children live in poverty.

At La Bodega, case managers help family members of addicts develop a
plan to keep their relatives in treatment. Field counselors offer 24-hour
support to families in drug-related emergencies, such as encounters with
police or relapse; follow-up on client referrals; and act as advocates in law
enforcement settings. The program also provides walk-in support and
prevention services for all neighborhood residents, including clients who
no longer need intensive family case management. Ongoing prevention
services include support groups for young mothers, victims  of family
violence, and community members returning home after incarceration. The
bilingual staff at La Bodega helps families deal with substance abuse-
related problems, such as domestic violence, child abuse, and neglect,
HIV/AIDS, and truancy. Programs designed to end the generational cycle
of drug abuse and criminal activity among youths include mural painting
projects, back-to-school nights, and poetry, writing, and photography
workshops.

On average, La Bodega maintains a caseload of 90 families. To date, La
Bodega has served over 1,400 individuals. Sixty percent of the families
required crisis intervention support, 50 percent reported multigenerational
substance abuse, 35 percent reported multigenerational involvement with
the criminal justice system, and 28 percent had histories of domestic
violence.

La Bodega is led by two advisory boards, one national and one local. The
Community Advisory Board, consisting of service providers, government
partners, and community residents, provides expertise on treatment, helps
facilitate referrals, and helps clients resolve medical, financial, and legal
problems. The National Advisory Board consists of family therapists,
judges, academics, doctors, and law enforcement officials who help guide
the staff of La Bodega and put them in touch with other experts across the
country.

Challenges: One of the greatest obstacles in starting La Bodega was
getting law enforcement and health organizations to shift their focus from
the individual to the family. Treatment programs often focus exclusively
on the drug user, and law enforcement agencies on the offender. But as La
Bodega developed, local agencies saw the wisdom in utilizing the family
as a natural resource. Law enforcement officials realized that the program
increases public safety because the family is the first to know when one of
its members relapses into drug abuse and becomes a possible danger to the
community. In addition, clients of La Bodega are more likely to contact
police when danger, such as domestic violence, arises because they have a
healthy relationship with authorities. As an example of confidence in La
Bodega's services, the New York Division of Parole has assigned four
parole officers to work full-time with caseloads comprised solely of La
Bodega participants.

Costs and Funding Sources: The annual budget of La Bodega de la Familia
is $1.2 million, which includes staff salaries, walk-in support services, and
24-hour support services. Funding comes from both city and state
organizations, including the New York City Department of Mental Health
and the New York State Department of Parole.

For communities interested in implementing a similar program, La Bodega
staff recommend adding a family component to an already existing
organization. In New York clients are already receiving treatment services
funded by the New York Division of Parole; La Bodega incorporates
families into the treatment to make it more successful. Other program
necessities include a local advisory board consisting of criminal justice
and health officials and program participants, a neutral program space
within the community being served, a project coordinator, and one family
case manager for every 25 families.

Program Results: The Vera Institute is currently conducting an evaluation
of La Bodega which will be completed in the spring of 2001. The
evaluation will collect quantitative data from 100 families served by La
Bodega and 100 control families. Funding for the evaluation is being
provided by the National Institute of Justice and the Fan Fox and Leslie R.
Samuels, Robert Wood Johnson, and Jacob and Vealeria Langeloth
foundations.

Preliminary results on the qualitative aspect of the evaluation are
promising. Parole officers involved with the program are pleased that their
relationship with La Bodega allows them to follow up on parolees'
treatment progress and say they enjoy the opportunity to focus on the
social service aspects of their job. Addicts report that they are more
motivated to succeed in treatment when family members are involved
because they do not want to disappoint them. Treatment clients say it is
easier to deceive a parole officer, whom they might see only once a week,
about their drug use than family members they see every day.

In 2000, La Bodega plans to incorporate under the umbrella of Family
Justice Inc. to provide training and technical assistance to criminal justice
and treatment agencies nationwide. The training will focus on
incorporating families into all aspects of substance abuse treatment. La
Bodega is already offering training and technical assistance to national
drug courts and to New York State parole and probation staff.

PAR Village: Integrated Addiction and Mental Health Delivery Systems,
Largo, Florida

Program Type: Family-Based Treatment.

Target Audience: Substance-abusing women and their children.

Years in Operation: 1989-present.

Program Goals: Provide gender-specific treatment for women.

Contact Information: Debra Dahl, Clinical Director, 727-538-7245.

Description: PAR Village is a fully integrated substance abuse and mental
health treatment facility near Tampa, Florida, that has been providing
gender-focused rehabilitation and treatment to chemically dependent
women and their children since 1989. Although PAR Village accepts a
wide variety of women and children, its three target populations are
women who are pregnant, injection drug users, or HIV positive. While
some women voluntarily enter the program, most are referred by the
Florida Department of Corrections or the Department of Children and
Families.

Women at PAR Village receive a customized treatment regimen that
includes substance abuse classes, physical rehabilitation, spirituality
courses, educational and vocational training, anger management
workshops, life skills and parenting classes, and career counseling. Unlike
most family-based programs, PAR Village also provides comprehensive
services to the children of addicted mothers from birth to age 10, including
physical therapy, pediatric counseling, speech pathology, Head Start, and
occupational counseling, among others.

A staff of 30 provides services to about 100 women and 60 children each
year. Each PAR Village case manager, or "primary counselor," is assigned
an average caseload of ten clients. Primary counselors coordinate
treatment individually for their clients, manage customized treatment
regimens, and coordinate activities with outside treatment specialists,
doctors, foster care and social workers, and corrections department
officials. Staff also collaborate with local social service agencies and
referral sources to ensure that clients without health insurance can receive
needed medication.

During the course of treatment, women must pass through four stages
tailored to their capabilities. Each level has distinct goals, and
advancement is marked by an increase in the level of client responsibility.
Before a client graduates to the next treatment stage, progress is evaluated
by the professional staff and by the client's peers at PAR Village. Families
in the program reside in ten on-site homes for 16-18 months. This home
environment, as opposed to dormitory style living, provides a more natural
atmosphere for treatment and allows the professional staff to work around
the clock with the families.

Challenges: PAR Village's family-based strategy was challenged at the
outset by foster care workers who thought that a drug treatment facility
was an inappropriate living environment for young children. PAR's good
track record persuaded opponents to permit the strategy to be tested.
Family-based treatment has proved to be a successful method of attracting
women to the program by alleviating the fear of being separated from their
children and eliminating the need to find interim child care during the
rehabilitation process. PAR Village also works with an association of
judges and child welfare officials in Tampa to ensure that recovering
mothers are not separated from their children as long as they are receiving
treatment.

Funding has been a persistent problem for PAR Village. After initial
grants from the National Institute on Drug Abuse (NIDA) and the Center
for Substance Abuse Treatment (CSAT), funding declined significantly.
While enough funding was secured to maintain quality services, the
diversity of new funding sources has led to increased paperwork for the
program's counselors. As a result, staff turnover is relatively high.
Consequently, PAR Village is attempting to streamline its administrative
procedures to reduce the amount of paperwork assigned to its primary
counselors.

Costs and Funding Sources: PAR Village's annual budget is $1.6 million.
This includes staff salaries, operational costs of the facilities, and
administrative costs. Funding comes from several sources, including the
Florida Departments of Corrections and Children and Families, and the
federal Department of Housing and Urban Development. In addition,
support comes from Head Start, the United Way, Medicaid, and
Temporary Assistance for Needy Families.

PAR Village benefits from some special advantages that would ordinarily
increase overhead costs for any community looking to replicate the
program. The ten houses at the facility were donated, as were the vehicles
used to transport clients. The 16-acre tract of land where the facility is
situated was provided by a local resident. Furthermore, many of PAR
Village's therapists and counselors volunteer their services.

Program Results: A five-year evaluation of PAR Village, conducted by the
University of Southern Florida and PAR's own in-house research center,
found that six months after completing treatment:

o Nearly two-thirds (64.7 percent) of clients are drug-free, and 88 percent
are arrest-free;

o 95 percent of clients attain the educational/vocational skills necessary
for employment, and more than one-third (35 percent) are employed; and

o 73 percent of clients attain custody of their children.

PAR Village has been recognized by CSAT and NIDA as a model
treatment program.

II. Rehabilitating Criminal Offenders

Alcohol and other drug problems are the common denominator for most
offenders in the criminal justice system. Drug offenders constitute a rising
proportion of offenders in U.S. prisons. According to the Bureau of Justice
Statistics (BJS), between 1980 and 1996 the number of drug offenders in
state prisons skyrocketed from 19,000 to nearly 240,000. In federal prisons
during this time, the number grew from 4,900 to over 55,000.[55,56]
According to the National Institute of Justice's Arrestee Drug Abuse
Monitoring Program (ADAM), which tracks drug use among arrestees in
34 cities, the percentage of men testing positive for drugs ranges from 42.5
in Anchorage to 78.7 in Philadelphia. Among women, percentages range
from 33.3 in Laredo to 82.1 in New York City.[57] According to BJS, four
in ten violent offenders were under the influence of alcohol when they
committed their crimes.[58]

Despite the growing numbers of substance abusers in the criminal justice
system, treatment remains scarce. The percentage of inmates who reported
being treated for drug abuse dropped significantly between 1991 and 1997.
One in ten state prisoners reported receiving treatment in 1997, down from
one in four in 1991, according to BJS data.[59] Without treatment, three in
four offenders are rearrested within three years, continuing the costly cycle
of addiction and crime. Providing treatment to offenders is a less
expensive alternative than incarcerating them for future illicit drug and
alcohol-related crimes. The most expensive drug treatment programs cost
about $10,430 per year for each offender, compared to $20,142 per year
for incarceration.[60]

The major contributors to relapse among addiction treatment patients are
low socioeconomic status, co-occurring psychiatric conditions, and lack of
family or other social supports. Often, criminal offenders have multiple
risk factors for relapse, making long-term abstinence even more difficult to
achieve. However, treatment even for this population has resulted in
maintained abstinence for some, and significantly reduced drug use for
others, which in turn lead to reduced crime and social costs.

According to the National Institute on Drug Abuse, the therapeutic
community treatment model has been found to be quite effective in
reducing drug use and criminal recidivism.[61] Therapeutic communities
are intensive, long-term, residential treatment programs. Program
participants are segregated from the general prison population so that the
"prison  culture" does not overwhelm progress toward recovery. Treatment
gains can be lost if inmates are returned to the general prison population
after treatment. Moreover, relapse and criminal recidivism are significantly
lower if the offender continues treatment after returning to the community.
A 1996 18-month follow-up study of prisoners in Delaware State Prison
found that inmates who participated in a therapeutic community and
continued treatment in a work-release program and aftercare were
significantly more likely to remain drug free than those not treated (76
percent versus 19 percent).[62] The effects were still visible after three
years, with one-third of treated offenders remaining drug-free, compared to
5 percent of the comparison group.[63]

Women are the fastest-growing population in jails and prisons, largely due
to drug offenses and crimes committed to support addiction, like theft and
prostitution. Increased use of mandatory minimum sentencing laws for
drug offenses has contributed to the explosive growth of the nation's
prison population. According to the Center for Substance Abuse
Treatment, mandated sentencing without the parallel development of
treatment services has had a particularly devastating impact on women in
prisons.[64] In 1997, 79,600 women were serving sentences in federal and
state prisons, six times the number incarcerated in 1980.[65] More than
two-thirds of the women inmates in federal prisons have been incarcerated
for drug offenses.[66]

The criminal justice system is an important treatment entry point which
can interrupt and shorten a career of drug use. The criminal justice system
refers drug offenders into treatment in a variety of ways, such as diverting
nonviolent offenders and stipulating treatment as a condition of probation
or pretrial release. There are also specialized courts (to be discussed in
greater detail under Alternatives to Incarceration) that handle drug cases
and mandate treatment for participants. According to the National Institute
on Drug Abuse, individuals in court-mandated treatment stay longer and
perform as well as or better than those who participate in treatment
voluntarily.[67] The threat of criminal sanctions can be a strong motivator to
stay in treatment.

Providing treatment to addicted offenders requires collaboration between
criminal justice and treatment systems, which have traditionally operated
with different goals. Criminal justice and treatment personnel must work
together to develop services that respond to offenders' overlapping
criminal and drug problems. Such collaborations include client screening,
placement, testing, monitoring, and supervision, and the systematic use of
sanctions and rewards. Cross-training helps familiarize staff from both systems 
with each other's philosophy, approach, language, goals, and objectives, and fosters 
an environment of mutual respect.

The following examples highlight the kinds of programs that show
promise for wide replication.

Delaware KEY/CREST, Wilmington, Delaware

Program Type: Rehabilitating Criminal Offenders.

Target Audience: Substance-abusing offenders in Delaware prisons.

Years in Operation: 1988-present.

Program Goals: Reduce drug use and criminal recidivism.

Contact Information: Sandra Buell, Regional Director for KEY/CREST,
Spectrum Behavioral Services, 302- 325-9500. Kathy English, Delaware
Department of Corrections, 302-739-5601.

Description: Alcohol- and other drug-addicted offenders in four Delaware
prisons have access to the KEY/CREST program, where they receive
substance abuse treatment in a therapeutic community setting while in
prison, followed by work-release and aftercare services in the community.

The KEY program, developed in 1988, provides treatment to inmates in
the last 12 to 18 months of their incarceration. Offenders learn to change
the behaviors that led them to drug use. Clients are housed in the
therapeutic community setting, separate from other inmates, and they
spend seven days a week focusing on treatment. To avoid distraction,
participants do not have access to television or telephones during the day.
Treatment includes individual counseling, group therapy, educational
seminars, HIV education, family and parenting education, and 12-step
programs. Clients are also encouraged to participate in GED and
vocational programs offered by the prison. KEY counselors work with 20
clients at any given time. Other staff include a program director, a clinical
supervisor, and an administrative assistant.

Upon leaving the correctional facilities, KEY participants enter one of three 
CREST Outreach Centers, which operate work-release programs based 
on a therapeutic community model.Developed in 1992 as a National Institute 
on Drug Abuse demonstration project, CREST is designed to help inmates 
make a smooth transition into society. Residents of CREST receive six months 
of intensive substance abuse treatment presented in two phases. During the first 
three-month phase, clients adapt to life outside of prison by learning job skills, 
visiting their families and communities, attending AA meetings, and continuing
their substance abuse treatment with a strong focus on relapse prevention.
During the next phase, clients work full time in the community but return
to the facility in the evenings. They also take part in community service
activities as a form of restitution to the community.

After completing CREST, clients go through a six-month aftercare
program during which they return to CREST weekly for group sessions,
drug testing, and counseling. At any given time there are approximately
572 clients in the four KEY programs, 328 in the three CREST programs,
and an additional 350 clients in aftercare. The Delaware Department of
Corrections contracts with Spectrum Behavioral Services to run all three
components of the program.

Challenges: One of the challenges to implementing KEY/CREST was
convincing those in the corrections field that it was beneficial and cost
effective to treat substance-abusing criminal offenders. Many people in the
criminal justice field did not believe that it was possible to change an
offender into a law-abiding citizen. Changing people's perceptions so that
they would not view the treatment program as merely an "easy way out"
for offenders required extensive training of the correctional staff. Soon
after the program began, correctional officers observed that offenders in
the therapeutic communities were less violent than offenders in the general
prison population.

Getting offenders into treatment is an ongoing challenge for KEY/CREST.
Some offenders do not believe they need treatment and are unwilling to
take part in the rigorous therapeutic community. Delaware prisons have
increased the number of participants in treatment by sanctioning offenders
who choose not to participate and offering incentives to those who do.
Offenders who are identified as needing treatment, but are unwilling to
participate, are not considered for early release (early release is a result of
good time credits and other behavioral incentives).

Costs and Funding Sources: KEY/CREST programs are funded through
the Delaware Department of Corrections. The programs receive
approximately $4 million per year from the state, funding treatment for
approximately 13,000 inmates yearly. It is estimated that treatment costs
are $7.50-$8.00 per day for each offender in the program (this is for
treatment only and does not include food and other services that all
inmates receive).

Program Results: An evaluation of the CREST program by researchers at
the University of Delaware showed promising results. The evaluation
included 279 people divided into four groups: CREST dropouts, CREST
graduates without aftercare, CREST graduates with aftercare, and a control
group of offenders with substance abuse problems assigned to a traditional
work-release program with little alcohol and other drug treatment. Three
years after release from prison:

o 69 percent of inmates completing CREST and aftercare remained
arrest-free, compared to 55 percent of those completing CREST only, 28
percent of CREST dropouts, and 29 percent of the control group.

o 35 percent of inmates completing CREST and aftercare remained
drug-free, compared to 27 percent who completed CREST, 17 percent who
dropped out, and 5 percent of the comparison group.

Forever Free, Frontera, California

Program Type: Rehabilitating Criminal Offenders.

Target Audience: Substance-abusing women in California prisons.

Years in Operation: 1991-present.

Program Goals: Provide alcohol and other drug treatment to incarcerated
women and encourage them to continue treatment after their release.

Contact Information: The Department of Corrections Office of Substance
Abuse Programs, Contract Manager, 916-327-3707, or David Conn at
Mental Health Systems Inc., 619-689-2633.

Description: Since 1991, Forever Free has been providing substance abuse
treatment to inmates at the California Institute for Women (CIW) in
Frontera. Developed through a partnership between the California
Department of Corrections and the Department of Alcohol and Drug
Programs, Forever Free has provided approximately 4,000 female inmates
with substance abuse treatment.

Most women who participate in Forever Free do so voluntarily. When
offenders enter the prison system, they are screened for substance abuse. If
they are found to have an alcohol or other drug problem and meet the
criteria for entering the program (such as adequate length of stay in prison
and no violent history), prison officials suggest they volunteer. Some
women are involuntarily placed in the program by prison officials.

Participants in Forever Free are housed separately from other inmates in a
240-bed facility. They spend four hours a day at prison work assignments,
such as cooking or grounds work, and four hours a day in treatment. There
are two treatment tracks, one lasting four months and the other six. Track
placement depends on length of incarceration. Women who are sentenced
to more than six months may remain in Forever Free for the duration of
their sentence.

The State Department of Corrections contracts with Mental Health
Systems Inc. to run the treatment program. Forever Free utilizes a
behavioral change approach, and treatment includes counseling, relapse
prevention, problem solving, re-socialization, 12-step groups, and case
management. Women's issues, such as dependency, physical and sexual
abuse, and coping with the stress of motherhood are also addressed. Prior
to parole, transition plans are developed for program participants which
detail their arrangements for employment, housing, and further treatment.
Clients are encouraged to voluntarily enter community residential
substance abuse treatment, funded by the state, upon parole. The State
Department of Corrections contracts with community treatment providers,
who reserve a number of beds for Forever Free clients at a reasonable cost.

Thirty percent of program participants are African American, 23 percent
are Hispanic, and 44 percent are white. The average age of clients is 35.
Forever Free serves approximately 720 clients per year and has a staff of
17, including 13 counselors, one supervising counselor, one transition
counselor, an administrative assistant, and a project director.

Challenges: The biggest obstacle for Forever Free is finding qualified
inmates. Because most inmates in CIW are serving short terms for lesser
offenses such as parole violation, they often do not remain in prison long
enough to receive successful treatment. To solve this problem, CIW tries
to engage women in the program as soon as they enter prison. Women
who are serving only a few months in prison are also allowed into the
program if they agree to enter a residential treatment facility upon their
release.

Costs and Funding Sources: The total budget for the program during FY
1999/2000 was approximately $1.6 million. Nearly half of the budget,
$739,000, is for post-release community treatment services. The remaining
amount includes program staff, staff training, and in-prison treatment. The
Department of Alcohol and Drug Programs also sets aside community
treatment beds for Forever Free participants at no cost.

Program Results: The California Department of Corrections contracted
with an evaluator to examine the impact of Forever Free on program
participants who left prison in 1995 and 1996. The evaluation compared
four groups of women: all women who entered the program, women who
dropped out of the program, women who received only the in-prison
program, and women who continued to receive treatment after being
paroled. Program retention during these years was high; 94.8 percent of
women completed the program. Women who completed the in-prison
program and at least three months of community treatment fared the best.

Twelve months after parole:

o Only 9 percent of women receiving 120 days or more of community
treatment were re-incarcerated; and

o 38 percent of women who dropped out of the program and 39 percent of
the in-prison only group had returned to custody versus 32 percent of
women receiving continuing care.

Twenty-four months after parole:

o Only 25 percent of women receiving more than 120 days of treatment
after being paroled were returned to custody after two years; and

o 60 percent of program drop-outs were reincarcerated, compared to 48
percent of the continuing care group.

Despite changes in staff and prison management, Forever Free has
sustained effective programming for almost ten years. A major
accomplishment of the program is that 50 percent of participants agree to
enter a residential treatment program upon release from prison.

New Vision Therapeutic Community, Kyle, Texas

Program Type: Rehabilitating Criminal Offenders.

Target Audience: Substance-abusing prison inmates in Texas.

Years in Operation: 1992-present.

Program Goals: Provide substance abuse treatment and other services to
inmates to help them succeed after prison.

Contact Information: Shirlee Livingston, Program Director, 512-268-0264.

Description: New Vision, begun in 1992, was the first in-prison
therapeutic community in Texas. Currently, the program is offered in four
Texas prisons and has been replicated in Oklahoma and New Mexico. The
primary goal of the program is to provide residents with the skills
necessary to live as productive members of society after their release from
prison. In order to be considered for the treatment program, offenders must
be assessed as having a substance abuse problem, be in the last nine to 12
months of their sentence, and need only medium or less security. New
Vision serves 520 clients in its program (approximately 750 offenders per
year).

New Vision provides clients with educational seminars and lectures,
therapeutic groups, individual and group counseling, and 12-step
meetings. Counseling is also offered to offenders and their families on
Saturdays and Sundays. The program consists of three phases: orientation,
main treatment, and re-entry. During orientation, offenders are introduced
to the therapeutic community and learn the rules and policies of the
program. They also become familiar with the concepts of substance abuse,
the addiction process, and relapse.

During the main treatment phase of the program, participants begin to
identify the problems contributing to their addiction, accept responsibility
for their addiction, and formulate long- and short-term recovery goals.
During the last phase, re-entry, clients and counselors design relapse
prevention and continuum of care plans which include employment,
housing, and peer support groups. Movement through the phases depends
on the individual client's progress; there is no specified duration for any
phase. After completion of the program, some offenders serve as role
models for program participants and assist in facilitating group activities.

Upon prison release, New Vision participants enter a community aftercare
program that helps them reintegrate into society. Offenders are paroled to a
three-month residential work-release program, which is followed by up to
12 months of outpatient counseling. Participants meet with their parole
officers regularly, undergo monthly urine tests, and have frequent contact
with case managers to review progress and any problems.

New Vision staff consist of a program director, two administrative staff, a
family therapist, a training coordinator, and 26 counselors. There is one
counselor for every 20 clients. The program also utilizes volunteer interns
from local colleges and universities.

Challenges: The biggest obstacle to creating New Vision was convincing
therapists, who had been trained to work within a different model of
treatment, to try the therapeutic community model. To convince them,
program developers used evidence of other successful in-prison
therapeutic communities. Another problem was achieving cooperation
between the treatment and correctional staff, which was addressed through
cross-training, allowing staff to learn more about the treatment model and
to appreciate the various roles in the in-prison treatment design.

Costs and Funding Sources: The annual budget for New Vision is $1.4
million. Program funding is provided by the Texas Department of
Criminal Justice and the Texas Department of Substance Abuse
Treatment. In order to replicate the program, qualified staff would be
required, including a program director, administrative staff, and a
counselor to client ratio of 1:20. Staff training would also be a significant
cost.

Program Results: A 1997 three-year follow-up study of 394 New Vision
participants was conducted by researchers at Texas Christian University.
Recidivism rates were examined for three groups of offenders: prison
treatment and aftercare, aftercare dropout, and an untreated comparison
group. One of the major findings of the evaluation was that completion
of the New Vision aftercare component is a critical factor in maintaining
treatment success. The recidivism rates were as follows:

o prison treatment and aftercare--25 percent

o aftercare dropout--64 percent

o untreated--42 percent

The study further divided the subjects by severity. High-severity offenders
had more serious criminal and drug-related problems and were viewed as
more likely to be reincarcerated. However, offenders completing treatment
and aftercare had significantly lower recidivism rates than dropouts and
untreated offenders. Recidivism rates for the high- and low-severity
offenders were as follows:

High-severity

o prison treatment and aftercare--26 percent

o aftercare dropout--66 percent

o untreated--52 percent



Low-severity

o prison treatment and aftercare--22 percent

o aftercare dropout--52 percent

o untreated--29 percent

III. Assessing and Treating Adolescents

The number of adolescents in alcohol and other drug abuse treatment
programs increased by more than a third between 1992 and 1997;
however, young people continue to be greatly underserved.[68] According
to the National Household Survey on Drug Abuse (1999), of an estimated
one million youths ages 12 to 17 assessed as drug dependent, only 175,000
had received treatment.[69] Since most substance abuse treatment is
designed for adult addicts, appropriate services for adolescents can be hard
to find. According to the federal Center for Substance Abuse Treatment
(CSAT), less than one percent of the more than 6,700 publicly funded
treatment programs nationwide are designed exclusively for
adolescents.[70]

Adolescent users differ from adult users in many ways. Young teens begin
with experimentation and occasional use, while adults have often
experienced a decade or more of addiction and have developed severe
problems, such as job loss, criminal histories, and medical complications.
The types of drugs abused also tend to vary with age. Marijuana and
alcohol are the most prevalent among treatment clients under age 18, while
opiates and cocaine are associated with older clients. Adolescents also
have unique treatment needs. Teen treatment models tend to be less
confrontational than treatment for adults. Concurrent mental illness, legal
problems, educational needs, family and community environment, and
emotional, intellectual, and physical development must all be considered
in planning effective youth treatment.

Treatment for adolescents should incorporate a wide range of social
services, provide aftercare services to reinforce progress, and encourage
family involvement. Teaching parents the skills to support their children
through treatment can enhance family stability and increase chances for
success. Learning to appropriately monitor their children and identify
warning signs of relapse enables parents to participate in their children's
recovery.

Teen treatment programs should consider youths' ethnicity and gender
when designing services. Norms, values, and health beliefs may differ
across cultures, and these factors can have a significant impact on
treatment. Gender-related factors also affect an adolescent's involvement
in treatment. For example, adolescent females may require more attention
with regard to problems such as sexual abuse.

Most adolescent treatment that does exist is aimed at youths with serious
drug habits; relatively few are designed to help teens who are just
beginning to develop problems. As a result, these teens are often referred
to programs focused on severely troubled addicts, which may exacerbate
rather than reduce their drug use. Different levels of pathology require
different treatment environments; not all programs are equally effective for
young people. Early intervention offered through a school-based student
assistance program, for example, can substantially reduce drinking and
marijuana use before more intensive services are needed and is far less
costly than making treatment available only after teens develop an
addiction, drop out of school, or commit crimes.

In addition to developing more youth-specific treatment approaches, it is
important to screen young people to identify those most likely to need
treatment, such as teens who exhibit warning signs of abuse, including
substantial behavioral changes, significant changes in academic
performance, trauma injuries, and contact with the juvenile justice or child
welfare systems. Homeless and runaway teens in shelters and all teens who
receive mental health assessments should be screened for addiction
treatment needs. According to the Substance Abuse and Mental Health
Services Administration, adolescents with severe emotional and
behavioral problems are significantly more likely to have substance abuse
problems than other adolescents.

Involvement in the juvenile justice system is an important consideration
when developing appropriate substance abuse treatment for teens.
According to CSAT, programs designed for this population should be
holistic and include juvenile justice, substance abuse treatment, schools,
community-based organizations, and other providers of health and social
services in one plan. Case management is critical to coordinate services for
these children and to act as the central monitoring and tracking source for
each child.

CSAT identifies essential elements to treating juvenile offenders in
Strategies for Integrating Substance Abuse Treatment and the Juvenile
Justice System (1999).[71] They include:

o Focusing treatment on risk factors associated with criminal behavior,
such as antisocial attitudes and peers, rather than on risk factors that are
not particularly associated with criminal behavior, such as self-esteem;

o Concentrating more intensive services on those who are at risk of
re-offending; and

o Offering comprehensive treatment that addresses all related behaviors,
especially the need for academic and vocational education and work skills
training.

Since juveniles placed in detention facilities are unlikely to receive the
special programs necessary for treatment or reintegration into society,
alternative placements have increased dramatically in recent years. Options
include intensive community supervision, day treatment, evening and
weekend programs, and tutoring.

While programs designed for adolescents are still scarce, the following
examples highlight how communities are utilizing successful approaches
to treat young people.

The Bridge, Columbia, South Carolina

Program Type: Assessing and Treating Juveniles.

Target Audience: Juveniles recently released from prison or inpatient
substance abuse treatment.

Years in Operation: 1994-present.

Program Goals: Provide aftercare services to youths to assist them in
making the transition from institutionalization to the community.

Contact Information: Katherine Yandle Thornton, Coordinator of Juvenile
Justice Services, South Carolina Department of Alcohol and Other Drug
Abuse Services, 803-734-4184.

Description: The Bridge, begun in 1994 as a Center for Substance Abuse
Treatment demonstration project, is a family-centered program designed to
prevent juveniles from returning to prison or inpatient substance abuse
treatment. The program is sponsored by the South Carolina Department of
Alcohol and Other Drug Services and is recognized as a promising
approach to juvenile alcohol and other drug treatment by the American
Probation and Parole Association and the Office of Juvenile Justice and
Delinquency Prevention. The program is offered in seven counties in the
state.

The goal of The Bridge is to improve alcohol and other drug treatment
outcomes for adolescents leaving, or in danger of entering, residential
treatment or juvenile justice facilities. The program strives to reduce
alcohol and other drug use, juvenile offending, dropping out of school,
high-risk sexual activity, and violent behavior. Clients are 80 percent male
and 48 percent African American. Participants, on average, are between 15
and 16 years old, have more than three delinquency referrals, and a family
income under $15,000. Criminal behavior has occurred in more than half
the families, and the majority of clients' households are headed by a single
mother. Nearly three-quarters of the clients are referred by the Department
of Juvenile Justice (DJJ), with most of the remainder being referred by
inpatient alcohol and other drug treatment facilities. The program serves
approximately 240 clients annually.

Since making the transition from institutional settings into the community
can be difficult for youths and their families, The Bridge offers gradual
"step-down" services. The program consists of three phases: intensive
assessment, intensive care management, and continuing care. First,
program staff assess the youngsters through interviews, home visits, and
interagency communication about the family's history and needs. Based on
the four- to six-week assessment period, a treatment plan is developed.
Next, the client receives four to six weeks of intensive case management
during which the case manager maintains daily contact with the
adolescent, the family, and any agencies involved in the case. Clients
receive intensive services, including alcohol and other drug treatment and
home-based support. Services are also available for family members to
help them improve their parenting skills and to create a healthy home
environment for their child. Once clients achieve abstinence and improve
areas, such as school performance and family relations, they are moved to
continuing care. Continuing care lasts up to seven months and provides
clients with less intensive treatment and services. At the culmination of
continuing care, a formal graduation is held.

Challenges: The greatest obstacle to implementing The Bridge was
convincing the DJJ that youth alcohol and other drug use is a major
problem. The Bridge staff succeeded in doing this by providing
background information and education about the scope of the problem. In
the past two years The Bridge has seen a decline in the educational success
of the clients they serve, due in part to new zero tolerance policies at
schools which often target youths with substance abuse problems. Another
factor is that The Bridge serves more older clients (17 years old) than
when the program began, who are at higher risk for dropping out of
school. Program staff are working with school officials to help keep The
Bridge clients enrolled in school.

Costs and Funding Sources: The annual budget of The Bridge is $714,845,
which includes costs of personnel, evaluation, wrap-around services such
as drug testing and transportation, staff training, and client incentives. The
program receives $300,000 from the South Carolina Department of
Alcohol and Other Drug Services and $418,845 from matching federal
block grant funds.

Minimum program start-up expenses include staff development and
salaries, wrap-around services, and client incentives. Program staff include
one case manager for every 22 to 25 youths, a part-time administrator, and
a project director to supervise the program. In South Carolina, the
Department of Alcohol and Other Drug Services assigns one of its staff as
program director in each county to The Bridge at no cost. Wrap-around
services cost approximately $1,100 per youth annually. In South Carolina,
The Bridge staff from across the state meet once a month for training and
meetings, which helps boost staff morale. Client incentives can include
tee-shirts, hats, or any other items which might encourage youth to
continue in the program.

Program Results: The Bridge contracts with an independent evaluator who
monitors the progress of clients and reports on trends. Results of the
ongoing evaluation are promising:

o Reduced Recidivism: One year after program discharge, only 19
percent of program participants (including those who did not complete the
program) have been reincarcerated, and only 16 percent have been
readmitted to inpatient treatment programs. Only 10 percent of youths
completing the program have been reincarcerated.

o Increased Abstinence: At time of graduation, 78 percent of the clients
are abstinent and an additional 11 percent have reduced their level of use.
Among program drop-outs, 27 percent are abstinent and another 22
percent have reduced their level of use.

o Improved Vocational and Educational Performance: Since the program
began, 85 percent of program graduates versus 64 percent of program
drop-outs have completed high school; 71 percent of graduates are
successfully employed versus 30 percent of drop-outs.

o Reduced Costs to State: Since 1994, the program has saved the state
$800,000 in incarceration costs alone. (This number was derived by
comparing one-year recidivism rates of The Bridge clients, 18.7 percent,
versus average juvenile recidivism rates, 40 percent.)

The Denver Juvenile Justice Integrated Treatment Network, Denver,
Colorado

Program Type: Assessing and Treating Juveniles.

Target Audience: Juvenile offenders with substance abuse problems.

Years in Operation: 1995-present.

Program Goals: Coordinate alcohol and other drug treatment agencies
serving juveniles.

Contact Information: Jennifer Mankey, Project Director, 303-893-6898.

Description: A major obstacle to treating youths in the juvenile justice
system is the fragmented systems designed for these children. To address
this problem, the Denver Juvenile Justice Integrated Treatment Network
was created to provide seamless and comprehensive substance abuse
services to juvenile offenders from initial contact through parole. The
Network coordinates services among more than 100 participating agencies,
including state and local juvenile justice and law enforcement agencies,
welfare and social services providers, substance abuse and mental health
organizations, public schools and universities, and community coalitions.
With funds from the Center for Substance Abuse Treatment (CSAT), the
Denver Juvenile Court created the Network in 1995.

Network services include screening, assessment, referral, case
management, treatment and rehabilitation, family advocacy, and health
services for offenders ages 10 to 21. In the five years since its development, 
the Network has helped to standardize services among its participating member 
organizations. A management information system(MIS) facilitates the sharing 
of information between agencies. A streamlined network of providers enables 
more comprehensive assessment and screening procedures, which helps ensure 
that a juvenile's multiple needs are met. As a result, issues of gender and culture 
are being regularlyaddressed in treatment, as is family advocacy.

Each point of entry in the juvenile justice system performs a preliminary
substance use screen to identify the degree of substance abuse. Referrals
from both the juvenile justice system and social services are sent to one
central point for referral. Case managers, who are certified alcohol and
other drug abuse counselors, and staff from some participating agencies
conduct assessments, develop treatment plans, link juveniles with Network
services, and conduct ongoing monitoring and follow-up. Services are
provided based on specific needs of each juvenile and family.


The Network employs seven full-time staff and coordinates services for
approximately 600 juvenile offenders per year. The Network is directed by
a local coordinating committee composed of 40 representatives of member
organizations.

Challenges: Because the Network is the creation of many established
organizations, it was a challenge to create an appropriate forum for
discussion and collaborative problem solving. The Network's lead agency, 
the Denver Juvenile Court, linked it to a smaller, previously existing network 
to help guide the process during the start-up phase.

A second challenge was the need to integrate progressive, results-oriented
thinking into established systems. The Network responded by analyzing
each organization and system, identifying similar philosophies and ideals,
and building linkages based on these common elements. The Network then
coordinated a series of staff training sessions to familiarize the member
organizations with new methodologies.

Cost and Funding Sources: The Network's original 1995 CSAT grant was
$1 million. The annual budget for the Network is $676,000 and includes
staff, facilities, equipment, evaluation costs, MIS development, and
administrative costs. The average cost per client is $2,126, which covers
the services they receive from assessment through program termination. In
addition to the CSAT grant, the Network receives financial support from
federal block grants, the City and County of Denver, various state alcohol
and other drug abuse programs, the Denver Public School System, and the
Rose Foundation.

Program Results: In 1999 the Network contracted with Human Resources
Consortium, a private consulting firm, to evaluate the effectiveness of the
program. Outcome data indicate that among juveniles that received
Network services: 

o Abstinence increased from 20 percent to 52 percent;

o Ability to remain alcohol- and drug-free went from 19 percent to 49
percent;

o Positive family relationships improved from 24 percent to 40 percent;
and

o Ability to respect and follow the law grew from 20 percent to 47
percent.

A 1998 survey of key decision makers in participating member agencies
involved in the Network found an overwhelming majority surveyed (95
percent) reported the Network had a positive impact on information
sharing; 84 percent reported the Network improved services to juveniles.

The Denver Juvenile Justice Integrated Treatment Network has been
recognized by Harvard's John F. Kennedy School of Government as "an
outstanding innovation in government." The Robert Wood Johnson
Foundation is funding replication projects based on the Denver model in
communities nationwide.

IV. Connecting with the Community

Substance abuse treatment often encompasses more than treating
addiction; it also involves helping clients prevent relapse when treatment
ends. Vocational and educational training, and access to health care and
other social services, are provided by many treatment programs to help
prepare their clients for life in the community when the structure and
supervision of treatment are no longer there to support them. In addition to
helping treatment participants re-enter society, some programs serve
another vital function in the community by reaching out to the underserved
(such as homeless addicts and those at high-risk for HIV) to engage them
in treatment.

During the past decade the gap between treatment clients' needs for
support services and the availability of those services has grown.
According to a 1995 analysis of outpatient treatment conducted by the
Research Triangle Institute in Raleigh, North Carolina, 60 percent of the
clients did not receive support services in 1993, compared with 18 percent
in 1981.[72] This decline reflected a substantial reduction in federal support
for treatment-related services nationwide. Such support services address
medical, psychological, family, legal, vocational, and financial problems
which must be resolved to keep drug addicts in treatment, reduce
substance abuse, and improve other areas of social functioning.

For substance abusers with multiple needs, case managers help link clients
with appropriate services. According to the Center for Substance Abuse
Treatment (CSAT), case management enhances treatment success by
retaining clients in treatment and ensuring their needs are met. CSAT
identifies the functions of a case manager in Comprehensive Case
Management for Substance Abuse Treatment: Treatment Improvement
Protocol 27 (1998)[73]:

o Provide the client a single point of contact for multiple health and
social services systems;

o Advocate for the client;

o Be flexible, community-based, and client-oriented; and

o Assist the client with needs generally thought to be outside the realm of
substance abuse treatment.

Addiction, as science has revealed, is a chronic, recurring disease that
requires lifelong management. Clients often need help remaining abstinent
following treatment, particularly when a recovering addict re-enters the
community and faces old temptations. Providing aftercare services, such as
group or individual counseling, 12-step meetings, relapse prevention,
vocational training and employment, primary and mental health care, and
parenting/family skills training can prevent or delay relapse. Case
management is often used to coordinate services.

Attempts to treat homeless substance abusers tend to be ineffective due to
the multiple risk factors that often accompany homelessness, such as
co-occurring mental disorders. Recruitment of these addicts into treatment
programs also poses a challenge, and for those who do enter treatment,
dropout rates are high. There are a few innovative approaches however,
showing promise for treating this group. National Institute on Drug
Abuse-sponsored programs in New York City and Birmingham, Alabama,
address patient recruitment and retention problems by coordinating efforts
with homeless shelters and social service agencies. They move patients
from highly structured interventions to more flexible treatment as patients
progress toward self-sufficiency by living with peers, paying rent, and
working. In Birmingham clients participate in "contingency management"
programs that make access to housing and employment contingent on
staying clean. Program evaluation found participants in the contingency
management program remained abstinent from drugs substantially longer
than other patients.

HIV prevention is an increasingly critical part of drug treatment. Drug use
is now the major risk factor in new cases of AIDS, hepatitis C, and
tuberculosis in the United States.[74] Alcohol abuse may also increase an
individual's risk of exposure to HIV by decreasing the likelihood of
condom use.[75] Drug injectors who do not enter treatment are up to six
times more likely to become infected with HIV than injectors who
participate in treatment.[76] Treatment presents disease prevention
opportunities, including screening, counseling, and referral for additional
services.

Needle exchange programs designed to stop the transmission of HIV and
hepatitis among injection drug users are controversial. Critics believe they
promote illegal drug use. However, the U.S. General Accounting Office
and the Centers for Disease Control and Prevention have found that needle
exchange programs do not increase drug use and are effective in reducing
the spread of HIV and hepatitis B.[77] According to the National Institute
on Drug Abuse's Sixth Triennial Report to Congress (1999),
comprehensive programs that include needle exchange, community-based
outreach, and drug treatment remain the most cost-effective approaches to
averting new HIV infections.[78]

Alcoholics and other drug addicts often have significant difficulty staying
clean when they re-enter the same community that fostered their substance
abuse. Programs that help train people for jobs, help them find
employment and housing, and link them with other social services can
facilitate the transition. In addition, some people in the community are in
need of treatment services but, due to a lack of access or motivation, are
not receiving them. Community outreach is critically important in
engaging these individuals in treatment. The following examples highlight
how treatment programs are connecting with communities.

University of Alabama at Birmingham School of Medicine and
Birmingham Healthcare for the Homeless, Birmingham, Alabama

Program Type: Connecting with the Community.

Target Audience: Homeless alcohol and other drug addicts.

Years in Operation: 1991-present.

Program Goals: Provide services to the homeless and help them design
long-term goals.

Contact Information: Dr. Cecelia McNamara, Project
Director/Investigator, 205-934-8960.

Description: In 1991 the National Institute on Alcohol Abuse and
Alcoholism and the National Institute on Drug Abuse (NIDA) jointly
funded a project in Birmingham to study effective addiction treatments for
people who are homeless. Since then, researchers from the University of
Alabama at Birmingham in partnership with Birmingham Healthcare for
the Homeless have been developing and testing successful treatment
models for homeless crack cocaine abusers through NIDA grants.

The Birmingham program involves homeless clients in six hours of
treatment a day, five days a week, over a two-month period. Clients
receive psycho-educational and behavioral group therapy, individual
counseling, and assessment by a psychologist or post-doctoral fellow.
Clients set long-term goals to address their problems with drug abuse,
housing, employment, mental illness, and social/recreational activity.
Clients meet with counselors weekly to set short-term objectives which are
designed to help achieve the long-term goals. Weekly sessions are held in
which clients rate their own progress as well as that of other clients.

Transportation to and from treatment and lunch are provided. Day
treatment is followed by ten months of aftercare (once-a-week group
sessions) and individual counseling as needed. The program employs a
tracker who assists with follow-up and goes to shelters, crack houses, and
abandoned buildings to bring clients back to treatment.

A unique treatment component of Healthcare for the Homeless is the use
of contingency rules, which make housing and work dependent on
drug-free living. Housing is provided after clients have several consecutive
negative drug screens. To remain in housing, participants must remain
drug-free. Upon testing positive, participants are immediately placed in a
shelter until they again demonstrate abstinence through two consecutive
clean tests. Clients can participate in four months of a work program,
where they receive vocational training in construction (refurbishing
housing for other homeless people in the program) or educational training.

The program has 2.5 full-time substance abuse counselors, a housing
manager, a recreation therapist, a vocational counselor, and various
personnel involved in job training, administration, transportation, or other
aspects of the program. Counselors have approximately seven to ten
individual clients in day treatment at any given time and up to 60 clients in
aftercare.

Challenges: The first major obstacle was arranging to cooperate with the
housing authority administration in time to meet deadlines and provide
necessary documentation for a collaborative study. In the second phase of
the program, a challenge was getting psychiatrists to prescribe medications
for cocaine-abusing clients. Most of these clients are now sent to a clinic
run by the Salvation Army. Staff turnover and the problem of finding
homes suitable for rehabilitation are also pressing issues. Obstacles have
been overcome through perseverance by the clinical and research teams
who have forged alliances within the local community.

Costs and Funding Sources: The annual budget has not been calculated
because research-specific costs comprise such a substantial part of the
budget. However, treatment costs have been calculated. In the first phase
of treatment (including enhanced day treatment for two months), cost per
client was $3,177; during the second phase (which included abstinent
contingent work and housing for four months), cost per client was $3,476;
during the third phase (including counseling as needed, weekly aftercare
groups, and drug testing for six months), cost per client was $599. Total
program cost for one year was $7,212 per client.

Major costs to implement the program include administration, facility fees,
salaries, cost of day treatment (counseling, food, transportation), urine
monitoring ($684/client), housing purchases, materials and tools (a total of
$80,000 for two houses annually), and stipends for clients in the
vocational program ($2,307/client).

Program Results: Outcomes have been measured in two different studies
conducted by researchers at the University of Alabama at Birmingham. In
the first study, the enhanced homeless treatment package (DT+) was
compared with usual care (UC), which consisted of weekly individual and
group counseling sessions and case management for work and housing
referrals. Overall, greater reductions were found in DT+ than UC for
alcohol use (self-report), cocaine use (measured by urine toxicology), and
days homeless at two, six, and 12 month follow-ups.

In the second study the enhanced treatment package (DT+) was compared
to day treatment alone (DT). Consecutive weeks of abstinence as measured
by urine toxicology were significantly greater for DT+ during the first six
months of treatment (at six months, DT+ averaged 9.1 consecutive weeks
clean versus DT at 3.99 weeks). Days housed were also significantly
higher in DT+. In addition, the second study demonstrated reductions in
AIDS risk behaviors as a result of day treatment (number of different sex
partners decreased from 7.5 at baseline to 2.3 post day treatment, and the
number of times trading sex for crack decreased from 6.6 at baseline to
0.11 post day treatment).

Pioneer Human Services, Seattle, Washington

Program Type: Connecting with the Community.

Target Audience: High-risk populations, including ex-criminal offenders
and substance abusers.

Years in Operation: 1962-present.

Program Goals: Provide treatment, job training, and other social services
through a self sufficient program.

Contact Information: Larry Fehr, Senior Vice President, 206-322-6645,
ext. 211.

Description: Pioneer Human Services (PHS) has provided job training to
ex-offenders and substance abusers since 1962. The nonprofit organization
serves over 6,000 people each year in its employment/training, treatment,
community corrections, and  residential facilities. Since the program
began, PHS has served more than 50,000 clients. In 1999, PHS clients
were 34 percent female, 49 percent white, and 30 percent African
American. The program employs 1,100 staff members, and 70 percent of
the $55 million annual operating budget is financed by the program's
industrial activities.

The first phase of PHS programming is provided by its community
corrections and behavioral health divisions. Behavioral health offers
residential and outpatient alcohol and other drug, mental health, and case
management services to clients living in PHS substance-free transitional
residences, including a 153-bed chemical dependency facility (Pioneer
Center North) and over 600 units of low-income housing. Treatment
services vary depending on the needs of the client. Pioneer Center North,
for example, serves severe alcohol and other drug addicts who have been
involuntarily assigned to the program by civil courts. In 1999, 2,638
people were served by behavioral health. Community corrections operates
six correctional residences for adults and juveniles with a total of 239
beds. Four of the residences are work-release residential facilities for men
and women, and two are for juvenile male offenders sentenced to
detention by the courts. In 1999, a total of 1,360 were served by the
community corrections division.

Clients from the community corrections and behavioral health divisions
are recruited for the second phase of PHS, the employment and training
programs. In 1999 about 80 percent of PHS enterprises employees were
recruited from PHS-run corrections and treatment programs. Clients
receive training in one of the businesses operated by PHS, which include
two food service businesses, two food distribution companies, a printing
company, a real estate management office, two manufacturing plants, and
a consulting service. The businesses serve such firms as Hasbro,
Starbucks, Nintendo, and Microsoft. After receiving job training from
PHS, which lasts from three weeks to 18 months depending on the degree
of specialization required, clients participate in a graduation ceremony.
After graduating, clients can opt to remain with PHS or find employment
elsewhere in the community.

Challenges: The greatest obstacle to implementing the program was
getting staff from different fields to work together, social service workers
being client-focused and business managers tending to look more 
at profits. Since PHS is both a business and a social service agency, all
staff members had to modify their outlook. The collaboration has paid off,
and provision of social services have improved, because like a business,
PHS now focuses on obtaining results. PHS collects data to measure its
effectiveness in helping clients. Among the 200 monthly outcome
indicators measured are improved cognitive skills, decreased risk of
substance abuse, and successful transition into the community. The
business personnel have also benefitted by learning to focus on the
personal health of the clients in addition to the financial health of the
company.

Costs and Funding Sources: The annual budget for Pioneer Human
Services is $55 million, which covers all services, including its business
enterprises, educational and treatment programs, housing, and staff costs.
Seventy percent of the budget comes from the revenues of its business
operations. The remainder comes from contracts with federal, state, and
local agencies.

Pioneer Consulting Services (PCS) was recently created to help nonprofit
organizations explore entrepreneurial options and develop systems for
measuring their outcomes. The cost is $800 per day in consulting fees;
however, this price varies depending on whether PCS provides a one-time
consultation or ongoing services.

Program Results: A case study of PHS, funded by the Ford and Annie E.
Casey Foundations and conducted by researchers at the University of
Washington, was completed in January 2000. The study found that PHS
clients had lower recidivism rates compared to ex-offenders in another
work release program (6.4 percent versus 15.4 percent). In addition, with
funding from the Ford Foundation, PHS recently initiated a longitudinal
study of program graduates in the community. One of the primary findings
is that one year after release from PHS job training, 96.6 percent of clients
are employed.

In addition, according to internal program data, PHS graduates pass
workplace drug tests more frequently than the general public. In 1999,
PHS conducted over 17,000 random urinalysis and blood tests on its
clients and found that only 1.4 percent were positive, compared to a figure
of 7.3 percent for the general workforce in 1998.[79] PHS programs have
been featured in articles in Newsweek, The Wall Street Journal, and
Forbes.

-------------------------------




Law Enforcement

Substance abuse accounts for most of the criminal activity in cities and
towns nationwide. Illicit drug and alcohol-related crime includes a broad
range of illegal activity--possession or sale of illicit drugs, crimes to obtain
money to buy drugs, driving under the influence of alcohol, underage
drinking, and crimes such as child abuse and domestic violence resulting
from illicit drug and alcohol abuse. The myriad criminal offenses related
to substance abuse require various approaches, and criminal justice
personnel--from police officers to corrections personnel to judges--are
well-positioned to affect the amount of alcohol- and other drug-related
crime in communities.

Law enforcement efforts are often dependent on local factors, such as
personnel and financial resources, populations served, and the nature of
drug problems. Despite differences in community characteristics many
police agencies focus significant resources on local drug problems. The
following section details some of the different strategies used by law
enforcement and criminal justice agencies to address illicit drug and
alcohol abuse, and related crime: community policing, problem-oriented
policing, reducing drug availability, and alternatives to incarceration.
Often, these strategies overlap. In addition to these four strategies,
alcohol-related approaches are discussed in depth.

Drug enforcement has evolved over the decades. Traditionally, federal,
state, and local law enforcement agencies had focused primarily on
wholesale drug activity, often using specialized narcotics units. The
introduction of crack cocaine in the mid-1980s led local police to focus
more on retail street sales. In addition, since the late 1980s, many
communities have mobilized grassroots groups to respond to local illegal
drug and alcohol problems; these community coalitions can serve as
valuable partners for law enforcement agencies. In many jurisdictions,
police partner with and make referrals to various social, health, and legal
agencies. By linking law enforcement with social services, police improve
the overall quality of their responses.

Law enforcement officers working with community residents to reduce
illicit drug and alcohol-related crime and improve quality of life is a
growing trend in cities and towns nationwide. Community policing
evolved out of foot patrol experiments in the 1980s. Putting officers back
on the beat has helped them become regular fixtures in communities and
increases police legitimacy in the eyes of residents.

Police departments are now training landlords and community leaders to
implement problem-solving techniques to deter drug use on their
properties and within their neighborhoods. Close relationships with
community agencies can help police identify and refer individuals in need
of substance abuse services. Working with the community is a central
tenet of problem-oriented policing, which trains the officer to assess why
crimes occur in certain areas, to identify circumstances contributing to
those crimes, and to decide how to best solve crime problems.

Police tactics are crucial to reducing the availability of illicit drugs and
alcohol. Targeting of hot spots of criminal activity by the police can make
the buying and selling of illegal drugs more risky, thereby decreasing
trafficking and related crime.

Confronting establishments that sell alcohol to minors minimizes underage
drinking and the problems that often accompany it, such as driving under
the influence and delinquency. Probation and parole officers can reduce
drug use and criminal recidivism by referring offenders with substance
abuse problems to treatment. Corrections officials can reduce the
availability of drugs in prison through programs that test and sanction
prisoners for drug use.

Judges, prosecutors, and defense attorneys can take advantage of
alternatives to incarceration programs that combine criminal sanctions and
accountability with substance abuse treatment. Drug courts enable judges
to use their sentencing power to get substance-abusing offenders into
treatment, while still holding them accountable for their crimes.

This chapter discusses various promising law enforcement approaches that
may help other communities develop strategies to meet their specific
needs. Whatever law enforcement approaches are used in a community,
the need to evaluate their effectiveness is critical to furthering knowledge
of what works.

I. Community Policing

Community policing involves police officers and private citizens working
together to reduce crime and disorder and restore community cohesion.
The central figure in this strategy is the community police officer, whose
mission is to maintain direct contact with the citizens of a small, defined
area. This officer serves as liaison between the community and the police.
The Department of Justice's Weed and Seed program, for example,
requires that each local site have a community policing initiative to link
the "weeding out" of drugs and crime with the "seeding in" of community
prevention, treatment, and other anti-crime tactics. Community policing
has become a popular approach to fighting drug-related crime and bolsters
traditional police anti-drug tactics.

Policing reforms in the 1920s, while helping to professionalize law
enforcement, also distanced the police from the community.
Government-sponsored reports on the causes of the urban riots of the
1960s found that police had lost touch with minority group residents, both
by changing from foot patrols to cars and by taking a more legalistic
approach to law enforcement. Police were urged to increase their daily
contact with citizens in everyday settings rather than just responding to
emergencies. As a result, the community policing model has flourished
under the  theory that increasing the quantity and quality of police-citizen
contact reduces crime.

The Violent Crime Control and Law Enforce-ment Act of 1994--popularly
known as the "Crime Act"--authorized $8.8 billion over six years for grants
to local policing agencies to add 100,000 officers and to promote
community policing in innovative ways. To implement the law, Attorney
General Janet Reno created the Office of Community Oriented Policing
Services (COPS) within the U.S. Department of Justice to put additional
police officers on the streets using community policing strategies. For
more information on community policing initiatives, visit the COPS
website at www.usdoj.gov/cops.

According to the Bureau of Justice Assistance and the Community
Policing Consortium's Understanding Community Policing: A Framework
for Action, community policing consists of two core components:
community partnership and problem solving.[80] The police become an
integral part of community culture, and the community assists in defining
future law enforcement priorities and in allocating resources. In
Georgetown, Texas, for example, the police department has collaborated
with community residents, social service organizations, and city agencies
to resolve 80 percent of all illegal drug and alcohol problems they
encounter.[81] The rise of community coalitions addressing substance abuse
and related crime since the 1980s has created increased opportunities for
citizen and police collaboration.

By working with community groups and being more familiar with their
concerns and problems, police can be more responsive to the needs and
fears of the community and increase their cultural sensitivity. Publishing
drug-related materials and delivering law enforcement messages to
immigrant communities in their primary (and sometimes only) language
can help resolve public distrust of the police, which runs deep in certain
locations and cultures. Community relations efforts are essential to
community policing to forge bonds with community members and
legitimize police efforts. Preventing Crime: What Works, What Doesn't,
What's Promising[82] discusses the strong correlation between the perceived
legitimacy of police and citizen willingness to obey the law. Furthermore,
establishing and maintaining mutual trust will give the police greater
access to information that can lead to the prevention and solution of
crimes.

The second component of community policing--problem solving 
(described in depth under Problem-Oriented Policing)--involves identifying 
neighborhood crime problems, understanding why the problems occur, 
developing and implementing long-term solutions, and determining the solutions' 
impact on the problems.

The success of community policing has led to innovations in forging
partnerships with communities to prevent and solve problems. For
example, the Midtown Community Court in New York City is the first
criminal court in the country with on-site social services, such as
counseling, health care, education, and substance abuse treatment. The
sentencing process is viewed as an opportunity to solve root problems by
requiring offenders to perform community service and providing them
with needed social services. Court counselors also work with police
officers on patrol to identify and find treatment for homeless individuals
and alcoholics and other drug addicts before their behavior leads to arrest.

The following examples demonstrate how community policing is
addressing illicit drug and alcohol-related crime in neighborhoods
nationwide.

Chicago Alternative Policing Strategy, Chicago, Illinois

Program Type: Community Policing.

Target Audience: All residents of Chicago.

Years in Operation: 1993-present.

Program Goals: For the police and the community to work together to
reduce crime and increase public safety.

Contact Information: Barbara McDonald, Assistant Deputy
Superintendent, Chicago Police Department, 312-745-6071.

Description: The Chicago Alternative Policing Strategy (CAPS) has
changed the way law enforcement agencies in Chicago operate by bringing
police, the community, and city agencies together to identify and solve
neighborhood crime problems. During the 30 years prior to the program,
steady increases in arrests had produced a backlog of court cases.
However, crime rates were not dropping, and citizens' fear of crime was
increasing. CAPS was created to make a lasting impact on crime by
partnering police with community groups to solve neighborhood crime
problems. The strategy began in five of Chicago's police districts in April
1993; by the end of 1994 it had been introduced in the remaining 20
districts. In 19 of the 25 districts, community assessments found drugs to
be the main cause of concern among citizens. Since 1993, more than 2,000
new police officers have been hired for CAPS.

CAPS uses a number of activities to fight crime, including beat meetings,
beat officers, and rapid response officers. Officers are assigned to one of
Chicago's 279 police beats for at least one year, allowing them to get to
know the community and its  particular crime problems. The system also
permits community members to work directly with their beat officers to
solve crime problems. Teams of rapid response officers have been set up
to answer many of the emergency calls so beat officers have more time to
work with residents.

The police department has added new technology to support the CAPS
program. A computerized crime analysis system called ICAM allows
police  officers to analyze and map crime hot spots and cross-reference the
data with information about the community, such as number of bars and
sites of abandoned buildings. Police share the ICAM information with the
community to increase public safety and awareness. The department has
also developed an advanced 9-1-1 center and increased the use of cellular
phones and pagers to support beat officers.

Community members can get involved in CAPS by attending monthly beat
meetings, where residents identify and prioritize neighborhood crime
problems and discuss ways to solve them. During 1995 and 1996, the
police department held CAPS orientation programs throughout the city to
increase public awareness of the program. The program is also promoted
through television, posters, signs, and newsletters.

CAPS has established a special protocol with a number of city agencies to
prioritize requests for services that have an impact on crime and public
safety. By the end of 1995, more than 90 percent of the 60,000 requests for
city services, including improved street lighting and trash pick-up, had
been responded to. Police officers also help community members track
court cases that are of major concern to the community. Through this
process, citizens have created support networks for crime victims and
witnesses.

The success of CAPS is most striking in the Englewood district.
Englewood was chosen as an original CAPS district because it is a
disenfranchised neighborhood where 99 percent of residents are black, 36
percent live below the poverty line, and 31 percent of families are single
mother households. In 1993, community residents cited street drug
dealing, gang violence, abandoned buildings, and trash as "big problems"
in their neighborhood. In 1994, after the implementation of CAPS, the
percentage of residents citing these issues as big problems decreased
dramatically. Residents citing street drug dealing as a big problem
decreased from 63 to 49 percent, gang violence from 41 to 35 percent,
abandoned buildings from 45 to 28 percent, and trash from 38 percent to
24 percent.

Challenges: One of the challenges to implementing the program was
skepticism about a new approach. Police officers felt that they were not
able to make an impact on drug-related crime and were not sure that a new
policing strategy would make a difference. Once the program was
implemented, however, officers realized that they were able to address
some of the larger community problems, such as poor coordination
between law enforcement and city agencies, rather than spend all of their
time answering emergency calls. Another challenge was getting assistance
from the community. The police department spent money on marketing to
educate citizens about the CAPS program, explain what police needed
from them, and help the communities set realistic expectations.

Costs and Funding Sources: Since this program involved a total
restructuring of the Chicago Police Department, all department funds and
resources went into the program. The annual budget of the department is
just under $1 billion. Chicago adapted the CAPS program to meet the
needs of its police department without incurring additional costs. A
smaller city or town could replicate a similar community policing strategy
using existing resources.

Program Results: A consortium of four Chicago-area
universities--Northwestern, DePaul, Loyola, and the University of Illinois
at Chicago--is conducting an ongoing evaluation of the CAPS program.
The evaluation is being funded by the Illinois Criminal Justice Information
Authority, the National Institute of Justice, and the MacArthur Foundation.
The most recent evaluation report, published in May 1999, showed
promising results.

o Since 1996, citizen awareness of CAPS has grown from 53 percent to
79 percent;

o Attendance at beat community meetings increased to 69,700 in 1998
from 59,200 in 1995; and

o Attendance at beat community meetings is higher among residents in
low-income areas.

Although it is impossible to draw a direct link between CAPS and
reduction of crime in Chicago, statistics show that crime has decreased
dramatically since the program was introduced. Since 1992, the year
before CAPS began, violent crime has decreased 38 percent, and property
crime has decreased 27 percent. It is important to note that crime
decreased in cities nationwide in the 1990s.

Weed and Seed, Stowe Village, Hartford, Connecticut

Program Type: Community Policing.

Target Audience: Residents of Stowe Village, a high drug and crime area
in Hartford.

Years in Operation: 1995-Present.

Program Goals: To work with the community to reduce drugs and crime
and increase community leadership.

Contact Information: Sergeant Gordon Jones, 860-527-7300, ext. 5585.
For general information on Weed and Seed, contact the Executive Office
for Weed and Seed, 202-616-1152, www.ojp.usdoj.gov/eows/.

Description: Stowe Village, a public housing development in Hartford
with substantial gang and drug activity, became a Weed and Seed target
area in 1995. The Weed and Seed program, administered by the Executive
Office for Weed and Seed within the Department of Justice, aims to
"weed" out drugs and crime in targeted areas and "seed" in community
programs. Currently, over 230 communities are implementing the Weed
and Seed strategy nationwide. Community policing initiatives are required
at each Weed and Seed site to serve as a link between the police and the
community, and have greatly contributed to making the Weed and Seed
program in Stowe Village a success.

Community police officers in Hartford, called Community Service
Officers (CSOs), are not responsible for responding to emergency calls
and can therefore devote the vast majority of their time to problem solving.
The goal of CSOs is to enhance police-community relations and to
improve citizen satisfaction with the delivery of police services. Prior to
the implementation of Weed and Seed in Hartford, there was only one
Community Service Officer assigned to the Northeast Neighborhood, a
large area that includes Stowe Village. The new program enabled
additional community policing coverage, which resulted in a CSO being
assigned specifically to Stowe Village.

The Stowe Village CSO focuses on building better community relations,
organizing community activities, and participating in school and
community programs. For example, in 1996, the CSO helped organize an
annual police summer youth academy. Twenty-four Stowe Village youths,
ages 11 to 13, participated in the program. They learned what police do on
the job and went on field trips with the Stowe Village CSO and two other
community officers. The CSO has also trained residents to become
community leaders through the Building Captain program. Applicants
from the 23 apartment buildings in Stowe Village were chosen and trained
to serve as Building Captains who report illegal activities to the police and
provide information to residents.

The CSO works within the broader enforcement activities supported by
Weed and Seed funding. The Hartford Police Department has overall
responsibility for weeding activities and has utilized a variety of
department resources, including the patrol division, the vice and narcotics
division, the CSO unit, the mounted patrol unit, and the traffic
enforcement unit. The vice and narcotics division conducted a series of
surveillance and undercover buy operations, with the goal of identifying
and obtaining warrants on as many drug sellers in Stowe Village as
possible. Following this effort, high visibility patrol operations were
implemented, which involves assigning specialized police units on an
as-needed basis. Vehicular barriers were installed to discourage drive-up drug 
purchases. Weed and Seed tactics also include using prosecutorial review to target 
drug sellers and purchasers, particularly those with significant serious felony records.

The success of Stowe Village has prompted the department to use its
remaining Weed and Seed funding to target services to the entire Northeast
Neighborhood. Two additional Community Service Officers and two
additional patrol units have been assigned to the neighborhood.

Challenges: The biggest challenge to community policing efforts in Stowe
Village was overcoming community distrust of police. To address the
problem, the Community Service Officer assigned to Stowe Village made
no arrests within the community for two years. Instead, the officer focused
on getting to know the residents, going to community functions, and
helping residents access services established through the seeding process.
The officer also worked at the elementary school in Stowe Village, getting
to know the children and their parents. All enforcement work was left to
beat officers in the area. As a result, the community service officer was
able to forge positive relationships with area residents.

Another constant challenge is getting people involved in community
activities and communicating with the police. Giving Stowe Village
residents an incentive helped overcome the obstacle. Building Captains are
given free basic phone service so they can call the police to report illegal
behavior, and they receive a $100 rent credit each month. According to the
evaluators of the program, buildings with Captains are much cleaner and
more orderly than those without Captains. Although financial incentives
were required to recruit Building Captains, they are a benefit to the
community.

Costs and Funding Sources: The Hartford Weed and Seed program was
funded through federal grants from the Executive Office for Weed and
Seed totaling $1.8 million between fiscal year 1994 and fiscal year 1998.
In addition, Hartford received nearly $1 million in asset forfeiture funds
from the Department of Justice. As part of the weeding funds, the
department received between $100,000 and $180,000 annually (totaling
over $750,000) to support its enforcement efforts. As of June 2000, the
program is funded by grant money left over from the first five years. The
city plans to apply for new funds when this reserve is depleted.

Program Results: The Hartford site is one of eight included in the National
Weed and Seed evaluation funded by the National Institute of Justice.
According to evaluation data, crime in Stowe Village dropped 25.9 percent
from 1994 to 1995 (the first year of Weed and Seed) and an additional
27.1 percent from 1995 to 1996. In the area surrounding Stowe Village,
crime also dropped substantially: 21.4 percent and 36.6 percent in the first
two years of Weed and Seed, suggesting that crime was not displaced to
other areas in the Northeast Neighborhood. Crime rates in Stowe Village
continue to remain below their original levels.

Surveys of Stowe Village residents were conducted as part of the national
evaluation. The Institute for Social Analysis conducted one survey in
1995, and Abt Associates conducted another in 1997. Major findings from
the two surveys include:

o In 1997, 21 percent of respondents indicated that drug use is "not a
problem at all" or "a small problem," up from 12 percent in 1995;

o In 1997, 68 percent of respondents indicated that the police were doing
a "very good job" or a "good job" of controlling the use and sale of drugs,
up from 55 percent in 1995;

o In 1997, 79 percent of respondents indicated that the police were doing
a "very good job" or a "good job" in responding to community concerns,
up from 51 percent in 1995; and

o In 1997, 55 percent of respondents indicated that Stowe Village had
become a better place to live over the preceding two years, up from 45
percent in 1995.

II. Problem-Oriented Policing

Problem-oriented policing compels officers to think creatively to find
solutions to persistent crime problems within a community.
Problem-oriented police are trained to uncover patterns of crime, to
identify solutions, and to find the resources needed to address the
problems. The focus shifts away from the limited perspective offered by
crime statistics to broader questions about the root causes of crime: Why
in this location? Why this behavior? What impact is being made on people
and the environment? According to Preventing Crime: What Works, What
Doesn't, What's Promising, the basic theory behind problem-oriented
policing is that the more accurately police can identify and minimize
causes of specific crime patterns, the less crime will exist.[83]

In the late 1970s, Herman Goldstein, a University of Washington law
professor, published an article, "Improving Policing: A Problem-Oriented
Approach," in which he asserted that many seemingly separate crime
incidents actually stemmed from common underlying conditions and were
part of a broader pattern.[84] Under a more traditional model of policing,
success might be measured by the number of arrests made at a drug
location; however, using a problem-solving approach, police measure
effectiveness as shutting down the operation. Arrest is only one of several
strategies, and all strategies are assessed by how effectively drug crime is
reduced. If one strategy is ineffective, then alternatives are tried.

The Bureau of Justice Assistance (BJA), in Problem-Oriented Drug
Enforcement: A community-based approach for effective policing, defines
a problem as something that concerns or causes harm to citizens, not just
the police; it is a group or pattern of crimes, cases, calls, or incidents.[85]
Responding to a problem means more than providing a quick fix; it means
dealing with the underlying conditions that create the problem. Problems
must be analyzed thoroughly so that solutions can be specifically tailored
to address them. According to the Community Policing Consortium's
Community Problem Solving training module (1997), problem solving is
best defined by its parts[86]:

o Identifying neighborhood crime problems;

o Understanding the conditions that give rise to these problems;

o Developing and implementing long-term solutions tailored to the
problems; and

o Determining the solutions' impact on the problems.

One problem-solving model developed by Goldstein and used by various
police departments is SARA: Scanning, Analysis, Response, and
Assessment. Scanning consists of searching for patterns or persistent
problems in the community to enable officers to focus their efforts on
concentrations of crime. Identification of crime problems can come from a
variety of sources, including officer observations, citizens' surveys,
community meetings, information from other agencies, and analysis of
crime statistics.

Analysis, often the most difficult step in the process, facilitates a greater
understanding of the targeted problem, which in turn leads to the
development of effective solutions. Questions include: What conditions or
events precede or accompany the problem? What are the problem's
consequences? How often does the problem occur? Based on the answers
to these and other questions, a hypothesis is formed about why the
problem occurs. For example, if convenience store robberies are a problem
in a particular neighborhood, police might examine what the stores being
robbed have in common. The next step is to define a tentative goal,
identify resources that may be of assistance in solving the problem, and
identify what procedures, policies, or rules have been established to
address the problem.

Developing a response to the problem involves identifying various
solutions and choosing the most feasible. Officers decide what needs to be
done before implementing the plan and who will be responsible for
preliminary actions. Stating specific goals of the plan and identifying data
sources during the response phase facilitates the assessment phase, which
examines the outcomes of the plan and identifies any changes to be made.
Using the example of the convenience store robberies, if several of the
stores had bushes that hid robbers from view, officers might respond by
asking the property owner to trim back the hedges.

An important element of problem-oriented policing is working with
various community groups to solve problems. Police face two separate
challenges: dealing with the immediate situation, and working to establish
long-term community safety. Law enforcement is a necessary tool in the
short term, but police also need to help the community identify underlying
problems and solutions. Some problem-oriented police departments have
developed resource books listing agencies, contact persons, descriptions of 
services, criteria for participation, and costs of services. Other police
departments routinely invite outside agencies to inform officers 
about services and to offer tips on how to access them.

Problem-oriented policing often works in tandem with community
policing. A police officer may realize that drug sales in a certain locale are
facilitated by a nearby building with lax management, many vacant rooms,
and conveniently placed pay phones. Had the neighborhood been equipped
with a community policing officer, the building's role in encouraging drug
activity might have been pointed out by neighbors long before arrests were
necessary.

The following programs highlight how law enforcement organizations are
effectively using  problem-oriented policing to address drug-related crime.

Landlord Training Program, Portland, Oregon

Program Type: Problem-Oriented Policing.

Target Audience: Landlords.

Years in Operation: 1989-present.

Program Goals: To teach landlords how to reduce drug-related problems in
rental properties.

Contact Information: John Campbell, Campbell Delong Resources, Inc.,
503-221-2005.

Description: Launched in 1989 by Campbell Delong Resources, the
Portland Landlord Training Program has trained over 8,500 landlords to
recognize drug activity in their rental properties. More than 80
jurisdictions in 20 states have adopted elements of the Portland program,
which has been recognized as an Innovation in State and Local
Government by the Kennedy School of Government at Harvard
University.

Developed with input from landlords, attorneys, tenant advocates, and
police officers, the program teaches landlords effective property
management to reduce drug activity. Landlords learn simple steps they can
take to reduce drugs and crime on their property. Police teach landlords
how to screen rental applicants, make their property less conducive to
crime, create a feeling of community within their buildings, and work with
police officers to solve problems. The need for the program is great; an
average of 27 percent of landlords attending the training between 1989 and
1992 reported recent drug activity on their property.

There are three main components to the program: a training manual,
marketing and outreach, and the training itself. The training manual is
designed to be user-friendly and can be adapted to reflect tenant/landlord
laws in specific communities. Marketing and outreach is critical; the more
landlords trained, the greater the benefit to the community. The Portland
Chief of Police sent letters to landlords in high-crime neighborhoods,
attracting over 7,000 landlords to the program between 1989 and 1995.
Word of mouth and local media attention are also important marketing
tools.

A manual for police officers interested in starting a similar program is
available through Campbell Delong Resources, Inc. (see contact
information above). The guide discusses important implementation issues,
including finding competent staff, developing a local training manual, and
designing and marketing the training. Successful program replication
requires six basic elements: an appropriate trainer, a program tailored to
the needs of the community, a complete understanding of landlords' needs
and concerns, partnerships with both tenant and landlord advocates, a
focus on immediate solutions to illegal activity (as opposed to discussing
how laws should be changed), and effective marketing.

Challenges: One of the major challenges to implementing the program was
defining the roles of the people involved. Landlords initially felt that any
criminal activity taking place on their property was the responsibility of
the police and were reluctant to get involved. When landlords learned that
they were responsible for crime on their property and that they could take
action against problem tenants, they were willing to partner with police.

Costs and Funding Sources: Initially, the program was funded through a
grant from the Bureau of Justice Assistance. The program is now funded
by the city's Office of Planning and Development Review. It is estimated
that each training session costs approximately $1,300, which includes
logistics and trainer time. Program marketing is an additional cost.

The Landlord Training Program is designed to be replicated, and
communities seeking to implement their own programs have many
options. Large cities often want to tailor the national manual to their own
needs and policies, which can take up to six months and requires a
full-time staff person. Large cities also need a part-time program director
and multiple trainers. Fifteen to 20 training sessions are conducted during
the first two years, with approximately five held in each of the following
years. Programmers in small cities can order the national manual and
participate in state or national training sessions. Small cities usually
conduct one or two training sessions per year. Landlord training programs
are often funded by the Office of Community Oriented Policing Services
within the Department of Justice.

Program Results: In 1992, Campbell Delong Resources conducted a
follow-up study of the 1,512 landlords who attended the program in 1991.
The survey found that 91 percent of the landlords changed the way they
managed their property after the training. The most common actions taken
by the landlords were:

o More frequent and careful inspections of the property (71 percent) (they
visited the site more often and were more aware of what signs of drug
activity to look for);

o Improvements to the visibility of the property, such as trimming back
overgrown hedges (71 percent); and

o Purchasing updated rental forms to match the current landlord tenant
law.

The survey also found that 220 landlords had to deal with drug problems
on their property after the training; 95 percent of them said that what they
learned in the training helped them address the problems. Results of
post-training questionnaires given to the 3,335 landlords who attended
training sessions between 1989 and 1993 indicate that the program was
useful:

o 78 percent of the landlords said that they would definitely change the
way they manage their property as a result of the training; and

o 80 percent of the landlords felt that the training was worthwhile.

Mario's Market, Delray Beach, Florida

Program Type: Problem-Oriented Policing.

Target Audience: Drug buyers and sellers and other perpetrators of crime
in the vicinity of Mario's Market.

Years in Operation: 1993-1995.

Program Goals: To work with the community to solve drug and crime problems 
at Mario's Market, a local convenience store, and the surrounding area.

Contact Information: Sergeant Javaro Sims, Delray Beach Police
Department, 561-243-7888.

Description: Two community police officers working in an eight-man foot
patrol in Delray Beach, Florida, recognized that Mario's Market, a local
convenience store, was generating a substantial number of service calls
and criminal activity in the area. The officers, utilizing a problem-oriented
policing approach, examined the store and the surrounding area to identify
contributors to illegal activity. Contributing factors included the layout of
the property (the market was open on all sides, and a T-shaped alley in
back provided easy entry and escape for buyers and sellers of drugs), poor
lighting, and a drug house located behind the store.

Upon completion of the assessment, the two officers invited the other
officers on their beat, the chief of police, the local fire chief, the property
owners and proprietors, and supervisors from other public agencies to a
meeting to discuss possible solutions to the problem. The officers
presented an itemized list of what they wanted to accomplish at Mario's
Market and what assistance they required. Before beginning their work,
the officers knew they needed community cooperation, which they got by
appealing to community leaders early in the process.

The officers employed a wide variety of tactics to solve the problem at
Mario's Market. They started a nuisance abatement case against the owners
of the drug house, and the dealers were eventually evicted. The officers put
up a chain-link fence to deter dealers, and barriers to stop cars from
entering and exiting the alley. They installed a fake video camera (donated
by a local TV-repair company), and enlisted the help of probationers on
community-service detail to fix up the parking lot. Delineating parking
spaces helped eliminate the drive-through nature of the drug market, and
establishing handicap parking spaces in the front of the store meant drug
buyers were subject to a $240 fine if they parked there.

Challenges: A major challenge in Delray Beach was bridging the gap
between the community and the police. The store proprietors were hesitant
to help the police because they were afraid of retaliation from the drug
dealers. When the police increased their presence in the area, the
proprietors' fear was alleviated and they cooperated with police. To further
engage the proprietors, the police painted the store to make it more
attractive. Enhancing the store's appearance attracted more law-abiding
customers.

A second challenge was enlisting the help of city departments and private
organizations. Officers personally met with supervisors of specified
agencies and explained what they wanted to do and how it would benefit
the community. This approach, in addition to the initial meeting with
community leaders, brought people on board to assist the officers. One
private organization, Florida Power and Light, agreed to install
bullet-resistant lights on the property for free. The owners pay $18 a
month for each light to cover the additional electric costs.

Costs and Funding Sources: Police overtime costs were the largest
community expenditure. Most of the materials the officers used to enhance
the property were donated by community organizations. In addition, the
increased police involvement encouraged the owners of the property to
spend their own money on renovation.

Program Results: The officers' work contributed to a reduction in calls for
service on the block from more than 100 in 1994 to fewer than ten in
1995. Additionally, there were no robberies on the property in 1995. The
project helped institutionalize problem-oriented policing in the area by
proving to both the community members and law enforcement officers that
resources can be effectively pooled to solve specific neighborhood crime
problems.

III. Reducing Drug Availability

Drug problems vary widely among cities, towns, and neighborhoods. As a
result, anti-drug tactics used by local law enforcement agencies differ
depending on community need. According to the Police Executive
Research Forum (PERF), there are over 17,000 state and local law
enforcement agencies engaged in almost 160 different anti-drug tactics.
PERF's 1996 report, Police Antidrug Tactics: New Approaches and
Applica-tions, lists a wide range of activities, including police observation
of drug sales in plain view, directed patrols that concentrate police
presence in areas of heavy drug activity, undercover operations, regulatory
code enforcement, community-based programs, and anti-drug efforts
targeting locations, individuals, and events.

Police have long known that there are "hot spots" in many communities
that generate a large number of calls for service. Research confirms this
view. It is estimated that 10 percent of locations generate about 60 percent
of crimes.[87] The presence of uniformed officers at these locations tends to
deter the activities of would-be offenders; it also guarantees immediate
response to problems. By concentrating law enforcement resources in
specific locations for several hours a day, hot spot strategies disrupt retail
drug sales without necessarily increasing arrests. Charleston, South
Carolina, has adopted a hot spot strategy that includes stationing police at
the busiest drug markets and photographing drug buyers. Police can reduce
drug transactions by increasing the risk to buyers and sellers.

A federally administered program designed to address hot spots of drug
activity is the High Intensity Drug Trafficking Area (HIDTA) program.
The Office of National Drug Control Policy (ONDCP) directs funds to
areas within the United States which exhibit serious drug trafficking
problems. Law enforcement organizations within HIDTAs assess these
problems and design specific initiatives to reduce or eliminate the
production, manufacture, transportation, distribution, and chronic use of
illegal drugs. Since 1990, 31 areas within the country have been
designated as HIDTAs. The key priorities of the program are to assess
regional drug threats; develop and fund efforts that combat drug
trafficking threats; facilitate coordination among federal, state and local
efforts; and improve the effectiveness of drug control efforts to reduce or
eliminate the harmful impact of drug  trafficking.

Effectively enforcing local regulatory codes can reduce drug activity.
Nuisance abatement programs, for example, target rental properties that
are hot spots of drug activity. Police threaten court action to seize property
unless owners take action to curtail drug dealing. In Oakland, California, a
nuisance abatement project has produced significant reductions in arrests,
field contacts, and citizen calls.

Another local effort that reduces drug activity in high crime areas,
particularly when used as an ancillary activity to increased police
crackdowns, is altering traffic patterns. By changing the flow of traffic,
police can make it difficult for drug dealers to use routes that permit easy
access to drive-by purchases. Street closures used in a Los Angeles
neighborhood with a high level of drug activity and shootings reduced
homicides by 65 percent.[88]

Technological advances in law enforcement enhance police ability to
identify hot spots of drug activity. The National Institute of Justice's Drug
Market Analysis Project (DMAP), for example, uses computer technology
to map drug activity, which improves police departments' ability to
analyze their crime and drug problems. One DMAP experiment in Jersey
City, New Jersey, found consistent and strong effects on emergency calls
for service in the targeted area with little displacement of drug activity to
the surrounding area. The data, presented in Policing Drug Hot Spots,
suggests that the benefits of tighter control also spread to areas around the
hot spots.[89]

Forming task forces to combat high rates of drug-related crime is a popular
option for many communities, often in concert with the federal
government. The Drug Enforcement Administration (DEA) administers
several programs designed to help localities address drugs and crime. The
Mobile Enforcement Team (MET) program, created by DEA in 1995, is
designed to help local law enforcement combat violent drug organizations
in their neighborhoods. Over 200 deployments have been completed
nationwide. DEA also supports the State and Local Task Force Program,
which provides a federal presence in sparsely populated areas. Such
programs combine federal funds and expertise with local officers'
investigative talents and detailed knowledge of their own jurisdictions.

The Organized Crime Drug Enforcement Task Force Program is another
federal program that has been working with local law enforcement
agencies fighting major drug trafficking organizations since 1982. Nine
federal agencies participate in the program, including the DEA, the Federal
Bureau of Investigation (FBI), the U.S. Marshals Service, the U.S. Coast
Guard, and the Bureau of Alcohol, Tobacco and Firearms. State and local
law enforcement officers can be deputized as federal officers for the
duration of a task force investigation, and local agencies are eligible for
reimbursement for certain expenses incurred during the program. Another
option for states and localities is the FBI Safe Streets Gang Task Force,
which addresses gang-related violence and drug trafficking by initiating
investigations of violent street gangs; for example, the New Orleans Gang
Task Force increased the percentage of murder cases solved in the city
from 58 percent in 1998 to 65 percent in 1999.

Along with domestic anti-drug tactics, international efforts target illegal
drugs entering the country. These efforts include cooperative efforts with
other nations in building their institutions, attacking illegal drug
production, interdicting drug shipments in both source and transit
countries, and dismantling multinational drug trafficking organizations.
Technological advances are key to reducing drug flow into the country.
For example, the Office of National Drug Control Policy is examining the
use of computer mapping to study how drugs flow from source countries.

The following are examples of how community law enforcement efforts
are successfully reducing the availability of illicit drugs.

Drug Interdiction Program, the State of Pennsylvania

Program Type: Reducing Drug Availability.

Target Audience: Prison inmates using illicit drugs.

Years in Operation: 1996-present.

Program Goals: To reduce drug use among prison inmates and enhance
inmate and staff safety.

Contact Information: Major Daniel Nagy, Chief of Security, Pennsylvania
Dept. of Corrections, 717-730-5012.

Description: In response to increases in drug overdoses and violence
among inmates, the Drug Interdiction Program was implemented in all
Pennsylvania prisons in 1996. The program, launched by the Pennsylvania
Department of Corrections, is designed to rid prisons of illicit drugs by
combining interdiction methods, drug testing, and drug treatment. In 1997,
the Pennsylvania Department of Corrections opened the state's first
substance abuse treatment prison.

All offenders entering the Pennsylvania prison system undergo a substance
abuse assessment; on average, 92 percent of inmates are identified as
needing treatment. All of Pennsylvania's 24 prisons offer drug treatment,
and seven have therapeutic communities. The prisons also have highly
sensitive drug detection equipment that can identify drugs smuggled in by
visitors, personnel, or through the mail. In 1998, 734 of the 22,074 visitors
were found to be possessing drugs. A new phone system allows staff to
randomly monitor inmates' conversations for evidence of drug smuggling
or use. Drug-sniffing dogs search cells for evidence of drugs or weapons.
In 1998 the dogs were responsible for 137 drug and 23 weapon
confiscations.

Using software developed by the department, corrections officers
randomly select inmates to be tested for drugs each day. Those who test
positive face mandatory punishment and must undergo drug treatment.
Corrections officers also conduct drug tests on prisoners in treatment or
with previous disciplinary problems. Both urinalysis (which detects drug
use in the previous 48-hours) and hair analysis (which can detect use in the
previous three months) are used. In 1999, Pennsylvania correctional
officers conducted 148,444 random and targeted drug tests. In addition to
selecting prisoners for testing, the software also serves as a database to
track the results of all drug tests.

Challenges: One of the greatest challenges to implementing the Drug
Interdiction Program was training prison staff in how to use the new
computer software. Although all corrections staff knew how to test
inmates for drugs, many did not have a great deal of experience with
computers and all were unfamiliar with the new software. To educate
prison staff, the department held two statewide training sessions.

Costs and Funding Sources: All components of the program are funded
through the Pennsylvania Department of Corrections. In 1999, the total
cost of the program was $500,140 which covered staff salaries and
operating costs. Start-up expenses for the program would vary depending
on how comprehensively the program is replicated and might include costs
for drug screening equipment, phone equipment, and computer equipment.

Program Results: The National Institute of Justice evaluated the
interdiction program in five prisons representing a cross-section of all
prisons in the state and including both male and female inmates.[90]
Urinalysis and hair tests were conducted on 917 inmates in 1996, prior to
implementation of the program; 1,031 inmates were tested in 1998. Tests
were conducted only on inmates who had been in prison for at least three
months to ensure that any indicated drug use occurred after entering
prison. Results of the evaluation showed a dramatic reduction in drug use.

o Positive hair tests for marijuana dropped from 9.3 percent to 0.8
percent, tests positive for cocaine dropped from 2.3 percent to 1.2 percent,
and tests positive for opiates dropped from 0.8 percent to 0.6 percent. Hair
tests positive for any drug dropped from 10.6 percent to 2.3 percent.

o Positive urinalysis tests for marijuana dropped from 2.0 percent to 1.6
percent; cocaine dropped from 0.1 percent to zero, and opiates rose
slightly, from 0.6 percent to 0.8 percent. Positive urinalysis tests for any
drug dropped from 3.4 percent to 2.2 percent.

In addition to decreasing drug use in the prisons, violence declined as well.
The department found that inmate-on-inmate assaults dropped 20.2
percent between 1995 and 1998 (from 534 to 426). Inmate-on-staff
assaults decreased 20.8 percent during the same time period, from 869 to
688.

Mobile Enforcement Team (MET) Deployment, Key West, Florida

Program Type: Reducing Drug Availability.

Target Audience: State and local law enforcement agencies throughout the
United States.

Years in Operation: 1995-present.

Program Goals: Deploy MET Special Agents nationwide to combat
violent drug crimes and drug-related gang activity.

Contact Information: Drug Enforcement Administration, Office of
Domestic Operations, Mobile Enforcement Section, 202-307-8799.

Description: The Mobile Enforcement Team (MET) program was
implemented in 1995 in response to increased drug-related violent crime in
local communities. At the request of local law enforcement, the Drug
Enforcement Administration (DEA) deploys special agents to work
hand-in-hand with local law enforcement to identify major sources of
drug-related crime; to collect, analyze, and share data; to cultivate
investigations; to arrest offenders; to seize assets; and to support state,
local, and federal prosecutors. Key West, Florida, is one of over 200 MET
deployment sites implemented nationwide since the DEA developed the
program.

The Key West MET deployment, which lasted from June 1999 to
December 1999, was requested by the chief of police. The Key West
Police Department was having difficulty infiltrating drug trafficking
networks due to limited staff, lack of financial resources, and the
"closeness" of the community, which made it difficult for police officers to
work undercover. A violent group of drug traffickers formed an alliance
(known as TROCHE/ALSTON) to control the crack and heroin market in
the Bahama Village section of Key West.

The Miami MET used technical equipment, surveillance tactics and
undercover penetration to gather evidence on members of the
TROCHE/ALSTON organizations. The tactics led to the indictment of 65
drug distributors and helped MET uncover the primary sources of crack
cocaine. A total of 56 officers from the DEA, U.S. Customs Service, and
the Key West Police Department took part in the operation.

The project concluded on December 9, 1999, with the arrest of 65
individuals and the seizure of approximately four kilograms of cocaine,
three kilograms of crack cocaine, 20 pounds of marijuana, seven ounces of
heroin, 50 LSD tablets, and 50 ecstasy tablets. In addition, approximately
$70,000 in firearms were seized. The drug operation had been the largest
ever in Key West, which is renowned for its long history of drug
smuggling.

Challenges: One of the challenges for communities requesting MET
assistance, including Key West, is the lack of state and local manpower
and funding to fight violent drug traffickers on their own. In some
instances the community is so small that local police are well-known and
undercover tactics, such as surveillance, cannot be used. DEA meets these
challenges through the MET program.

Costs and Funding Sources: For fiscal year 2000, Congress appropriated
$8 million to DEA for operation of the MET program.

Outcomes Measures: DEA agencies track the results of MET operations.
As of April 30, 2000, the 262 MET deployments had achieved the
following results:

Drug Seizures:

o cocaine: --1,637.23 lbs.

o methamphetamine: --562.73 lbs.

o heroin: --84.82 lbs.

o marijuana: --3,043.33 lbs.

Asset Seizures (value): --$14,984,433

Arrests:-- 10,128 (includes 52 arrests for murder)

Recently, with financial assistance from the Bureau of Justice Assistance
and technical assistance from the National Crime Prevention Council, the
DEA piloted MET-II, which provides training in community mobilization
and drug demand reduction to leaders from MET communities. In fiscal
year 1999 there were three regional training sessions involving 40 MET
communities in 23 states. Each community sent a team of up to five
individuals that included elected officials, judges, law enforcement
officers, city and school administrators, community activists, and
representatives of the business and faith communities.

The purpose of the training sessions is to prevent a re-emergence of
drug-related violent crime in the target communities. The training stresses
the importance of a systemwide approach to preventing drug use and
trafficking, encourages community leaders to commit themselves to
implementing strategies that enhance public safety, and equips leaders to
fulfill these commitments by teaching them techniques for planning,
organizing, and evaluating prevention programs.

According to surveys of participants after the training sessions, 89 percent
stated that they were satisfied with the workshops and benefitted from
them. At least four MET-II training sessions were planned for 2000.

North Hills Block Project, Citywide Nuisance Abatement Program, Los
Angeles, California

Program Type: Reducing Drug Availability.

Target Audience: Residents of North Hills, a neighborhood with severe
drug-related crime problems.

Years in Operation: 1997-2000.

Program Goals: Reduce drug-related crime problems in North Hills and
increase quality of life among residents.

Contact Information: Mary Clare Molidor, Assistant City Attorney,
Director of Nuisance Abatement, 310-575-8552.

Description: Launched in early 1997, the Citywide Nuisance Abatement
Program (CNAP) is  a multiagency task force that targets Los Angeles
neighborhoods with histories of pervasive narcotics activity. Participating
agencies include the Los Angeles Police Department, City Attorney's
Office, Housing Department, Department of Building and Safety, and
Planning Department. CNAP's Neighborhood Block Projects combine
enforcement, enhancement, and outreach efforts to revitalize communities.
The North Hills Block Project covers the portion of the San Fernando
Valley once considered by police as the most concentrated area of
narcotics sales in the city of Los Angeles.

The first step in the North Hills Block Project was to conduct a needs
assessment survey in which residents identified drug and gang activity as
the community's most urgent problems. CNAP's enforcement team in
North Hills was created using a multiagency approach to community
policing, and included representatives from city, county, state, and federal
agencies. In order to reduce flagrant street sales of narcotics in the area,
officers conducted numerous early morning buy/bust and reverse or sting
operations. A prosecutor from the city attorney's office worked closely
with local narcotics detectives to ensure that narcotics arrests were
reviewed, and to train the officers regarding new drug-related laws. In
addition to undercover operations, prosecutors, narcotics officers, and code 
inspectors employed site-specific narcotics abatement strategies. A gang 
abatement lawsuit was filed which led to an injunction against 24 street gang 
members named in the lawsuit.

The enhancement team in North Hills formed  a community impact team
(CIT) broken down into five subcommittees: the North Hills Business
Organizing Committee, the Neighborhood Watch Committee, the
Community Outreach Committee, the Sepulveda Park West Committee,
and the North Hills Beautification Committee. A public park for
neighborhood soccer leagues is being built, streets and alleys have been
re-paved, increased street lighting plans have been proposed, a plan to
divert drug- related traffic from the area has been successfully
implemented, and residents have access to a published list of city
resources and community contacts.

Results from the community needs assessment identified a lack of
communication among community groups already operating in North
Hills. CNAP's outreach team worked to bring these organizations together
to respond to community needs. A monthly calendar of events was
developed, which was translated to serve the predominantly
Spanish-speaking community. CIT members publicized local events and
trained new leaders in the community. As a result, Familias Unidas, a
nonprofit, community-based organization, was formed in the project area
to serve families.

Currently, CNAP is preparing to expand the program into other
neighborhoods. However, personnel will remain available to assist local
law enforcement and community members. For example, abatement
prosecutors will continue to handle site-specific narcotics abatement, and a
community resource specialist will be available for residents and agencies
seeking assistance. In addition, CNAP will include North Hills in its Kid
Watch L.A. Program, which focuses on ensuring the safe transit of school
children through high crime areas using local neighborhood volunteers.

Challenges: The major challenge to implementing CNAP was in
organizing agencies that had never worked together before and were
unfamiliar with one another's goals and responsibilities. CNAP resolved
this problem by creating the Community Impact Team (CIT).

Another challenge is familiarizing prosecution and police personnel with
using civil remedies, such as abatement, to respond to criminal acts. It is
critical to get a commitment from local prosecutors to use civil abatement
remedies and from the police department to train officers on how to use
abatement.

Costs and Funding Sources: The CNAP program, including all of the
integrated services and personnel from various agencies, costs
approximately $9 million annually. The core nuisance abatement program
costs $3.8 million. Although the budget is quite large, program staff say
smaller municipalities can operate a similar program for much less money
by tapping into already existing governmental and private resources. A
critical cost is money to hire a community resource specialist, at an
average cost of $50,000 to $60,000 per year. These specialists work within
a particular neighborhood to combine resources and act as a liaison
between residents, businesses, governmental agencies, and other interested
parties. The North Hills specialist has a background in grassroots
community organizing and is responsible for door-to-door surveys,
meeting planning and set-up, and keeping participants in the community
impact team on task. CNAP activities are funded by the City of Los
Angeles' General Fund. In addition, the city directs funds from federal
block grants to the project, including the Edward Byrne Formula Grant
Program and the Community Development Block Grant.

Program Results: The success of the North Hills Block Project is being
measured by progress in both enforcement of the laws and enhancement of
the community.

Enforcement:

o Crime statistics show crimes (robbery, burglary, rape, assault, and grand
theft auto) in the Block Project Area from July through September of 1999
were 27 percent lower than for the same three-month period in 1997, just
prior to the beginning of the project (186 crimes compared to 254 crimes);

o Gang-related crime in the Devonshire area (most of which originates in
the North Hills area) decreased 39 percent from February 1999 to February
2000; and

o Over 40 separate locations were investigated for nuisance abatement
during the project; only three remain open, and investigations of these
locations are still pending.

According to a survey of area residents one year after implementation of
the North Hills Block Project, the enforcement activity improved the life
of the community. For the first time in years, people could walk to the
grocery store without being approached by gang members or drug dealers.

Enhancement:

o In 1999 the percentage of school children re-enrolling for the next term
at a North Hills elementary school was nearly 60 percent, up from 30
percent in 1997; and

o The vacancy rate in area apartment complexes dropped from 50 percent
in 1997 to 5 percent in 1999.

IV. Alternatives to Incarceration

Drug offenses are the primary cause of case overload in all parts of the
criminal justice system. Thirty percent of state prisoners and 60 percent of
federal prisoners are sentenced for drug law violations. At least half of
drug offenders sentenced to probation in state courts are rearrested for
felony offenses within three years; a third are rearrested for drug
offenses.[91] Drug-abusing offenders are more likely than other criminals to
become repeat offenders. Fifty-one percent of parolees who abuse drugs,
regardless of their offense, return to prison within three years of release,
compared to 40 percent of all parolees.[92]

Alternatives to incarceration are designed to stop the revolving door of 
drug abuse and crime by using the coercive power of the court to engage 
drug-abusing offenders in treatment. The criminal justice and substance abuse 
treatment systems work together to provide offenders with the services they 
need while still holding them accountable for their crimes. Compliance with 
alternatives to incarceration programs is generally based on measurable performance 
goals, such as completion of treatment phases and abstinence. Programs often 
provide clear choices, sanctions, and incentives to help individuals take control 
of their own recovery and to hold them accountable for failure to comply
with treatment.

Communities often create alternatives to incarceration programs by
determining their specific needs. What types of cases are most prevalent?
Which offenders return to the system repeatedly? Some programs target 
first-time offenders, while others concentrate on repeat offenders.

Programs can serve offenders who may not have committed a drug offense
but have an addiction problem. Program developers must consider what
treatment strategies, incentives, and sanctions will be most effective for
the types of offenders that the program targets.

Alternative to incarceration programs differ depending on the stage in the
justice system where the intervention occurs. Different models include:[93]

o Diversion/deferred prosecution model--for first-time offenders who
enter the program prior to prosecution. Charges may be reduced or
dropped altogether if participants meet the requirements of the program;

o Plea model--before entering the program, defendants enter a guilty plea
which can be stricken from their record upon successful completion of the
program;

o Post-adjudication--used mainly for repeat offenders who face
increasingly severe penalties. While prosecutors may be unwilling to defer
prosecution for these offenders, they will consider more lenient sentencing
if participants plead guilty and undergo treatment prior to sentencing; and

o Combination model--used by programs that handle many different types
of cases, including first-time and habitual offenders. Such programs often
use different models to meet the needs of a particular case.

One innovative alternative to incarceration is drug court. Drug courts place
nonviolent, drug-abusing offenders into intensive court-supervised
treatment instead of prison. Instead of a traditional adversarial courtroom
scenario (the defense versus the prosecution), everyone works together to
develop a positive outcome for the offender. Judges interact continually
with participants, increasing offender accountability. Extensive studies
show that, on average, drug courts reduce recidivism by two-thirds among
those who "graduate," requiring a fraction of the cost of incarceration.[94]
The first drug court began in Miami in 1989, and as of June 2000, 440
drug courts have been implemented nationwide and an additional 279 are
in the planning stages. Information on drug court programs nationwide can
be found on the Drug Courts Program Office website at
www.ojp.usdoj.gov/dcpo/.

The National Association of Drug Court Professionals has developed a
manual explaining the ten key elements of successful drug courts[95]:

o Integrate alcohol and drug treatment services with justice system case
processing;

o Use a nonadversarial approach in which prosecution and defense
counsel promote public safety while protecting participants' due process
rights;

o Identify eligible participants early for immediate referral to the
program;

o Provide access to a continuum of treatment and rehabilitation services;

o Monitor abstinence by frequent drug testing;

o Coordinate court and treatment responses to compliance or lack of
compliance, including contingency contracts that involve participants in
their own sanctions and incentives;

o Require ongoing judicial interaction with drug court participants;

o Monitor and evaluate achievement of program goals and program
effectiveness;

o Promote effective programs through interdisciplinary education of
planning teams; and

o Forge partnerships among drug courts, public agencies, and
community-based organizations.

Another program that employs the coercive power of the criminal justice
system to get individuals into treatment is TASC, Treatment
Accountability for Safer Communities. TASC, created in the 1970s by the
Law Enforcement Assistance Administration, provides a bridge between
the criminal justice system and the drug treatment community. Some drug
offenders are diverted out of the criminal justice system and into
community-based supervision, others receive treatment as part of
probation, and still others enter into transitional services when they leave a
correctional institution. All treatment and rehabilitation services are
provided in concert with criminal justice sanctions. There are over 200
TASC programs operating throughout the United States.

Many communities are using alternatives to incarceration to break the
cycle of drug abuse and crime. The following examples highlight several
of these efforts.

Alternative Incarceration Program, the State of Connecticut

Program Type: Alternatives to Incarceration.

Target Audience: All offenders who are not a threat to the community,
including many drug offenders.

Years in Operation: 1990-present.

Program Goals: Provide alternatives to incarcerating offenders while
protecting the safety of the community.

Contact Information: William Carbone, Director, Court Support Services
Division, 860-563-1332.

Description: Connecticut's Alternative Incarceration Program (AIP), begun
in 1990, provides alternatives to incarceration for offenders who are not
considered dangerous to society. The program was initiated in response to
Connecticut's skyrocketing prison construction expenditures; between
1985 and 1990, the state spent over $1 billion building prisons. In 1990 the
newly created Office of Alternative Sanctions (OAS) (now the Court
Support Services Division of the State Judicial Branch) was assigned the
task of creating alternatives to incarceration for low-risk offenders. As of
1999, 165,280 offenders had been processed through AIP. The program's
capacity is approximately 4,500 adult and 700 juvenile offenders at any
one time.

The Alternative Incarceration Program was designed to give judges an
array of alternatives to incarceration when sentencing an offender. Judges
can choose from eight programs that provide various services, including
substance abuse treatment. Offenders are sentenced to programs depending
on the circumstances and the severity of their crime. Individual services
are provided by over 100 private, nonprofit organizations throughout the
state.

Offenders enter AIP at either the pretrial or postconviction stage of
criminal processing. Offenders held in pretrial detention are assessed by
bail commissioners who, based on the needs of the offenders and their
likelihood of rearrest, recommend an appropriate alternative sanction
program to the judge. Offenders entering the program at the postconviction
stage are assessed by probation officers who work directly with individual
AIPs to ensure that offenders are channeled to appropriate programs. The
officers also help guide judges in offender placement. Community safety
is considered each time an offender is recommended for a program.

Offenders successfully completing AIP, which can last from four months
to two years, do not serve prison time. However, offenders who are
dismissed from the program for any reason must complete their prison
sentence.

Challenges: Connecticut faced many obstacles in implementing AIP. The
program had to overcome public fear of placing offenders in the
community. Careful placement of offenders in programs with the
appropriate amount of supervision, along with the low recidivism rates of
program participants, helped alleviate these fears. Another problem was
that many communities did not want an AIP program housed in their
neighborhood. The state overcame this by requiring offenders to complete
community service hours in the neighborhood where their program was
located. In 1996 alone, more than 7,000 offenders participated in
community service projects, providing 250,000 hours of work valued at
$1.3 million.

Costs and Funding Sources: The 2000 budget for the program is $55
million, $30 million of which is for adult programs and $25 million for
juveniles. All of the funds are provided by the state.

Program Results: Connecticut's Alternative Incarceration Program has
proven successful on many levels. The legislation establishing the program
included a five-year "sunset clause" stating that a number of goals had to
be met or the program would be canceled. In 1994, based on the positive
results of the program, the legislature unanimously passed a bill to
continue AIP indefinitely with no further sunset clauses.

o Cost saving: The average annual cost for an offender in the program is
$7,000 per year, versus $25,000 for incarceration. In 1998 it was estimated
that it would have cost $525 million in prison construction costs and an
additional $94 million in operating costs to imprison the 150,000
offenders in the program.

A three-year longitudinal study by the Justice Education Center, Inc.
completed in 1996, found that program participants were less likely to
commit crimes than offenders who had been in prison.

o Three years after release, offenders in a Department of Corrections
comparison group were rearrested for drug offenses at three times the rate
of AIP participants.

o Three years after release, there were two felony arrests of program
clients for every three among the comparison group.

Multnomah County S.T.O.P. Drug Diversion Program, Multnomah
County, Oregon

Program Type: Alternatives to Incarceration.

Target Audience: People charged with their first drug offense.

Years in Operation: 1991-present.

Program Goals: To reduce recidivism and substance abuse among drug
offenders through a treatment and sanctions program.

Contact Information: The Honorable Harl Haas, 503-248-3052.

Description: The Sanction-Treatment-Opportunity-Progress (STOP) Drug
Diversion Program was launched in 1991 to reduce the backlog of cases in
the Multnomah County court system and to provide needed treatment for
first-time drug offenders. The program serves between 400 and 500 clients
per year. Since the program began, 1,750 people have graduated, and 65
drug-free babies have been born to program clients.

To be eligible for STOP, offenders must be charged with drug possession
and cannot have any manufacturing or distribution charges. Defendants
choose to participate in the program and can withdraw within the first 14
days with no penalty. Before entering the program, offenders agree to give
up their right to contest the charges against them. If they fail the treatment
program, their cases are tried solely on the police reports which shortens
case processing time to less than one minute. Charges are dropped for all
offenders who successfully complete STOP. Approximately 46 percent of
the offenders who enter the program graduate.

Substance abuse treatment is provided by InAct Inc., a private agency. At
the beginning of the program clients are required to attend group and
individual therapy each weekday and later once or twice per week. Clients
also go to court once a month and are given random urinalysis tests. The
frequency of urinalysis and drug court appearances depend on how well
the client is doing in treatment; clients who are having problems are tested
and appear in court more frequently than those who have clean drug
screenings and are doing well in treatment. InAct Inc. also offers
educational and employment services and treatment for clients with mental
health problems. Offenders who do not comply with the treatment program
are sanctioned with jail time or work camp. Clients are usually enrolled in
the program between one year to 18 months.

Challenges: One of the challenges to implementing the Portland program,
which is common among drug courts, was deciding whether the judge or
the treatment provider would have the authority to terminate clients from
the program. A consensus was reached in Portland that the judge should
have this authority because the offenders, while involved in treatment, are
under the jurisdiction of the criminal justice system. Resolving that issue
enabled the court and the treatment providers to work together to best
serve the clients.

Costs and Funding Sources: The annual budget of STOP averages $1.2
million and covers only the cost of treatment. There are no costs for
salaries because duties of probation officers, district attorneys, the drug
court judge, and staff are recalculated to include the drug court. Funding
for STOP comes from a federal block grant and through the County
Department of Community Justice.

Program Results: An evaluation of STOP, published in 1998, was funded
by the State Justice Institute and conducted for the Multnomah County
Department of Community Corrections by the Northwest Professional
Consortium. The evaluation examined arrests of STOP participants within
two years after leaving the program and compared them with arrests of
offenders who were eligible for the program but did not participate. The
evaluation found that program participants had fewer arrests than
nonparticipants and that the amount of time spent in the program had a
positive effect on arrest rates. Two years after leaving the program:

o Program participants (graduates and nongraduates) had 61 percent
fewer total arrests than the comparison group; program graduates had 76
percent fewer arrests than the comparison group.

o Program participants (graduates and nongraduates) had 64 percent
fewer felony arrests than the comparison group; graduates had 80 percent
fewer felony arrests than the comparison group clients.

o Program participants (graduates and nongraduates) had 72 percent
fewer drug arrests than the comparison group; program graduates had 85
percent fewer drug-related arrests than the comparison group.

It was estimated that STOP saved Oregon taxpayers $23,235 in avoided
costs per program participant in the first two years after completing the 
program. The majority of cost savings are to the Multnomah County
Criminal Justice System at $5,629 per client.

Drug Treatment Alternative-to-Prison, Brooklyn, New York

Program Type: Alternatives to Incarceration.

Target Audience: Criminal offenders with substance abuse problems.

Years in Operation: 1990-present.

Program Goals: To divert drug-using criminal offenders to treatment while
protecting community safety.

Contact Information: Anne Swern, Deputy District Attorney,
718-250-3939.

Description: In 1990, Brooklyn became the first community in the country
to have a prosecutorial program providing alternatives to incarceration for
drug offenders. Drug Treatment Alternative-to-Prison (DTAP), as the
program is called, diverts prison-bound felony offenders to drug treatment.
The District Attorney's office is primarily responsible for screening
offenders, referring them to treatment and contracting with treatment
providers. As of March 2000, 1,136 defendants had been accepted into the
program. Of this group, 439 successfully completed the program and had
their charges dismissed; 235 clients were still in treatment. Federal
legislation is currently being drafted to provide funds to communities
replicating DTAP.

DTAP began under the premise that offenders were better prepared to
resist drugs and crime if they received treatment rather than more costly
prison time. The program targets drug-addicted defendants arrested for
nonviolent felony offenses who have at least one prior felony conviction
and face a mandatory prison sentence under New York State's
Second-Felony Offender Law. Defendants enter a guilty plea and receive a
deferred sentence. After 15 to 24 months in treatment, successful
graduates have their charges dismissed. The program used a deferred
prosecution model (offender does not have to enter a plea) up until 1998,
when the program was changed to increase retention rates. DTAP uses a
graduated system of rewards and sanctions which allows clients to make a
few mistakes before being sent to prison to complete their full sentence.

An assistant district attorney screens all potential DTAP clients; those who
meet program eligibility criteria are further screened by Treatment
Alternatives to Street Crime (TASC), a drug assessment and referral
organization. DTAP and TASC personnel work together to find the most
appropriate treatment facilities for participating offenders, and the judge
presiding over the case allows the defendant to enter treatment rather than
prison. If the defendant is on probation or parole, the New York City
Department of Probation and the New York State Division of Parole must
approve as well. Of the 132 defendants accepted into treatment in 1999,
the average age was 36, 61 percent were employed, 30 percent were
receiving public assistance, 53 percent reported that heroin was their drug
of choice, and 38 percent reported crack or cocaine.

TASC also performs case management and monitors defendants' treatment
progress. Clients are treated in a therapeutic community, consisting of
three treatment phases: orientation, during which clients examine their
beliefs about addiction and their own patterns of behavior; primary
treatment, which involves individual, group, and family counseling; and
re-entry, where clients focus on relapse prevention and adjusting to
independent living. Participants also receive vocational training and
assistance in securing housing when returning to the community.

In order to assure public safety in the event of treatment failure, the district
attorney's enforcement team collects contact information on each client in
DTAP to ensure that they can be located and returned to custody if they
leave the treatment program. The team has a record of returning 97 percent
of clients to court in a median time of nine days.

Challenges: The greatest challenge in implementing DTAP was
convincing the treatment community that it would be beneficial for them
to work with criminal justice clients. Treatment providers feared that
partnering with the criminal justice system would compromise their ability
to protect and advocate for their clients, assure the safety of treatment
staff, and maintain records of success with criminal offenders. However,
treatment providers soon realized that the threat of criminal sanctions
produced better treatment results for criminal justice clients. After criminal
justice and treatment personnel understood each other's responsibilities
and goals, they worked well together.

Another challenge was ensuring that DTAP participants were referred to
the most appropriate treatment programs, and that DTAP personnel could
keep track of their progress in treatment. To solve this problem, the TASC
systems were integrated to help DTAP refer and follow up on clients.

Costs and Funding Sources: To replicate DTAP would cost approximately
$270,000 annually, not including the cost of treatment. In New York,
treatment costs are covered by the state, with 40 percent coming from
public assistance, 40 percent from the Office of Alcoholism and Substance
Abuse, and the remainder from private sources. DTAP costs
$18,000-$21,000 per year per client (compared to more than $60,000 per
year for incarceration). DTAP costs would be lower in communities where
services and salaries are not as expensive as in New York.

Program Results: DTAP has proven successful on many levels. As of
October 15, 1999:

o Retention Rates--The one-year retention rate for clients was 66 percent
overall and had risen to 74 percent since January 1998, when the program
shifted from a deferred prosecution model to a deferred sentencing model;

o Employment--92 percent of employable graduates were currently
working, whereas only 26 percent were employed upon arrest. In addition,
a study of 117 graduates found that three-year recidivism was 33 percent
among those who were unemployed, but only 13 percent among those
employed;

o Recidivism--The three-year reincarceration rate for program graduates
was less than half of the rate for the control group rate (23 percent
compared to 47 percent); and

o Cost Saving--The 439 successful DTAP clients saved $16.1 million in
corrections, health care, public assistance, and recidivism costs.

DTAP is currently being evaluated by the National Center on Addiction
and Substance Abuse at Columbia University. The $2 million evaluation is
being funded by the National Institute on Drug Abuse, and preliminary
results are promising. A six month follow-up found that drug use declined
more for offenders in DTAP than for offenders in prison. Heroin use
declined 71 percent among program participants versus 62 percent among
the control group; similar declines were found for cocaine (85 percent
versus 27 percent), crack (96 percent versus 51 percent), and marijuana
(83 percent versus 69 percent).

V. Alcohol-Related Approaches

Alcohol, more than any other drug, is associated with high rates of
criminal activity. According to the Bureau of Justice Statistics, nearly four
in ten violent offenders report having committed their crimes under the
influence of alcohol, and about four in ten fatal motor vehicle accidents
are alcohol-related.[96] In addition, national surveys indicate that ten
million young people under the age of 21 drink alcohol at least once a
month.[97] Underage drinkers often get alcohol from adults, who sell or
provide it illegally. Law enforcement has a large role to play in reducing
alcohol-related problems. Police officers are vital in identifying and
arresting drunk drivers. Efforts by police to solve alcohol-related problems
in communities improves quality of life and reduces crime.

One in ten arrests made in 1997 was for driving under the influence of
alcohol (DUI).[98] Large numbers of DUI arrests stem from proactive
approaches to arresting drunk drivers, such as checkpoints, which
concentrate police resources at key times in high-risk places. According to
Preventing Crime: What Works, What Doesn't, What's Promising, the
greater the effort police put into proactive arrests, the greater their ability
to reduce drunk driving.[99] Unfortunately, the time required to process a
DUI arrest is often a deterrent to more enforcement. The Impaired Driver
Enforcement Unit (IDEU), developed by the National Highway Traffic
Safety Administration (NHTSA), is designed to reduce the time a patrol
officer spends processing a DUI arrest. Once an officer determines that a
driver is impaired, an IDEU van responds to the call and helps officers
complete the booking process. In Phoenix, Arizona, which has six such
vans in service, the time required to complete the arrest and booking
process decreased from over three hours to just one hour.

Repeat DUI offenders pose a significant threat to the community.
Innovative approaches targeting these high-risk drivers are gaining
popularity. Ignition interlock, for example, which connects a breathalyzer
to the car ignition, is an alternative to long-term license revocation. DUI
probationers must blow into the device before starting their vehicles; if
they have been drinking, their ignitions will not operate. In Hancock
County, Indiana, almost all repeat DUI offenders had the device in their
cars by 1993. Between 1990 and 1995, DUI arrests in the county dropped
40 percent, and law enforcement officers attributed the decline to ignition
interlock. Another example is DUI court, which combines criminal
sanctions with treatment to reduce DUI recidivism among drunk drivers
with multiple arrests.

According to the 1999 Monitoring the Future study, conducted by
researchers at the University of Michigan, nearly 90 percent of tenth
graders in the United States think alcohol is easy to get.[100] Increased law
enforcement, including the use of sting operations targeting alcohol
merchants and underage buyers, is essential in reducing underage access to
alcohol. For example, the Denver Police Department's compliance check
program, aimed at package beer outlets, reported that sales to underage
buyers decreased from nearly 60 percent of attempts at the program's start
to 26 percent after two waves of compliance checks.[101]

When targeting merchants, police officers often employ youths to attempt
illegal sales, while other police crackdowns on underage drinking target
the drinkers instead. Cops in Shops is one such program which has police
officers posing as retail clerks. Offending youths are issued citations and,
in some programs, are required to attend educational sessions on the
consequences of alcohol use. Police departments often notify the media
prior to implementing a Cops in Shops program in an effort to deter
underage buyers.

In many instances, police officers work with residents to address
alcohol-related issues that are causing problems in communities. In
response to resident complaints about a neighborhood bar in Hayward,
California, for example, police officers met with residents, mediated
between the owner and residents, trained the bar's security staff to handle
problems better, educated residents about civil court options, and worked
with the Alcohol Beverage Control Board. After the police intervention,
calls for service in the area decreased from an average of 20 per month to
just one or two.

Working with alcohol servers and retailers is another way for law
enforcement to create partnerships within the community. In North
Carolina, for example, Alcohol Law Enforcement officers conduct a
statewide B.A.R.S. (Be a Responsible Server) program, which educates
licensed establishments and their employees about responsible sales of
alcohol and checking for proper identification.

In addition to bars and taverns, stores licensed to sell alcohol for
off-premises consumption can create problems. A 1999 study of alcohol
outlets in New Orleans found a 2 percent increase in the homicide rate for
every 10 percent increase in the density of such establishments.[102]
Alcohol outlet density has  also been associated with increased motor
vehicle accidents and other problems that degrade neighborhoods, such as
street corner drinking. Police in Portland, Oregon worked with residents
and local merchants to ban oversized bottles of beer and malt liquor in an
area experiencing problems that stemmed from street drinking.
Detoxification holds (which are indicators of heavy drinking) and
drinking-in-public incidents were both cut in half in Portland between
1993 and 1996.

While crimes such as driving under the influence are directly linked to
alcohol consumption, the role of alcohol in other crimes, such as domestic
violence, is less obvious. More than two-thirds of domestic violence
victims report that the offender had been drinking prior to the offense.[103]
Police officers can be trained to identify the role of alcohol in a domestic
violence incident and to respond accordingly. Being familiar with
treatment options in the community can help police officers deal
effectively with victims and assailants.

The following are successful examples of the various law enforcement
initiatives that are underway to reduce alcohol-related crime in
communities.

DWI/Drug Court Program, Bernalillo, New Mexico

Program Type: Alcohol-Related Approach.

Target Audience: Nonviolent offenders convicted of multiple DWIs.

Years in Operation: 1997-present.

Program Goals: To reduce recidivism of persons charged with driving
while intoxicated (DWI).

Contact Information: Mark Pickle, Program Director, 505-841-8184.

Description: In Bernalillo County, New Mexico, 5,000 people are arrested
annually for driving while intoxicated (DWI). In an effort to reduce the
number of arrests, Judge Michael Kavanaugh opened a DWI/Drug Court
Program in July 1997. Eligible offenders go before a judge who combines
criminal penalties with court-mandated treatment in an effort to break the
cycle of DWI recidivism. Since it opened, 327 offenders have participated
in the program, and 128 have graduated.

Nonviolent offenders convicted of at least three, but not more than five,
DWIs are eligible for the program. Although almost all--98 percent--of the
participants are DWI offenders, the court also accepts other types of
offenders who are addicted to alcohol or other drugs. The court is a
postconviction, presentence voluntary program; offenders must be
convicted before they enter the program. Program participants are
supervised by DWI/Drug Court probation officers, receive mandatory
alcohol and other drug treatment, comply with random drug testing,
complete community service, attend victim impact panels, and appear
regularly before the judge. The judge is responsible for imposing sanctions
on clients as well as rewarding them when they comply with the program.
Clients often develop a positive relationship with the judge, wanting to
succeed in part to please him.

Defendants who violate conditions of the program face sanctions, which
include a mandatory appearance before the judge and either a reduction  in
"points" (a certain number are needed to progress through treatment) or
jail time. Upon completion  of the treatment program, offenders are
sentenced. They receive the mandatory minimum sentence, but instead of
serving time in jail they may enter an alternative program in which they
are allowed to work but must remain at home during nonworking hours.

Participants receive an average of 24 weeks of treatment, which includes
counseling and 12-step meetings. During the treatment phase of the
program, clients regularly appear before the drug court judge and meet
with the probation officer. Urinalysis is used to detect alcohol and other
drug use. Education and job training are also provided. During 12 weeks
of aftercare, clients meet with a probation officer weekly, attend at least
one counseling session per week, attend 12-step meetings and receive
random urinalysis and breathalyzer testing. Program participants are
required to pay for their treatment on a sliding scale.

Taking advantage of recent technological advances, Bernalillo is working
with BI Inc. of Boulder, Colorado, to monitor repeat DWI offenders at
home using remote breathalyzer units. These units are installed in the
mouthpieces of standard telephone systems and transmit test information
over telephone lines to a monitoring station. At random times during the
day or evening, a preprogrammed computer can call the remote unit and
lead the offender through an impromptu breath test. The unit is very
accurate and is nearly impossible to circumvent. Typically, a judge will
order a unit installed in a repeat offender's home for approximately six
weeks. Bernalillo currently operates five of these units.

Challenges: One of the challenges in implementing the Bernalillo
DWI/Drug Court was convincing participants that they would benefit from
the treatment program. Most other drug courts operate at the felony level,
and judges have the power to dismiss cases when clients successfully
complete treatment. In Bernalillo, however, offenders convicted of their
third DWI arrest must serve a minimum sentence whether or not they enter
a treatment program. In order to make the program worthwhile for clients,
the court guarantees that those who successfully complete the program
will receive no more than the mandatory sentence, will be allowed to serve
their sentence at home while remaining employed, and will not be put on
probation after the minimum amount of time is served.

A second challenge was convincing the public defender's office that the
program was beneficial to its clients. At first, public defenders were wary
about recommending the program to their clients because they would not
get credit for their time in treatment if they failed the program. A few
months after the program began, however, it was clear that clients were
benefitting from it.

Costs and Funding Sources: Cost per client is approximately $2,400,
which covers treatment and administrative costs. Funding comes from
local, state, and federal sources as well as clients' co-pays (average
$1,500-$1,800 per month for all clients). Costs for replicating the program
would include treatment costs and the costs of paying a program director,
one parole officer for every 30 clients, and a judge working a few hours
per week.

Program Results: According to internal data from the DWI court, statistics
for the 128 clients graduating the program between July 1997 and March
2000 are promising.

o Only 9 percent of program graduates have been rearrested for DWI,
compared to the 35 to 40 percent national average recidivism rate for DWI
offenders sentenced to traditional probation; and

o The program's retention rate is 82 percent.

The DWI/Drug Court is in the process of contracting with the University
of New Mexico to conduct a two-year follow up study of program
participants.

Checkpoint Tennessee, The State of Tennessee

Program Type: Alcohol-Related Approach.

Target Audience: Drivers with blood alcohol levels exceeding the legal
limit.

Years in Operation: 1994-present.

Program Goals: To implement a statewide sobriety checkpoint in an effort
to reduce alcohol-related crashes and fatalities.

Contact Information: Trooper Tim Dover, Tennessee Highway Patrol,
615-741-0065.

Description: In March 1994, the Tennessee Highway Patrol (THP)
partnered with the National Highway Traffic and Safety Administration
(NHTSA) to conduct and evaluate a statewide sobriety checkpoint
program that uses random testing to determine whether a driver has been
drinking. Between April 1, 1994, and March 31, 1995, a total of 882
checkpoints were conducted, compared to a previous annual average of ten
to 15. A total of 144,299 drivers passed through these checkpoints,
resulting in 773 arrests for driving under the influence and an additional
201 arrests for other drug violations. One of the goals of Checkpoint
Tennessee is to deter people from driving while intoxicated, and all
checkpoints are advertised ahead of time.

During the first year of the program there were checkpoints in at least four
counties every weekend, and in all counties on five weekends. Every
Monday morning, all eight THP districts were required to submit reports
of activity at checkpoints conducted the previous weekend. The reports
were tabulated by the THP planning and resources section and used to
monitor implementation of the program and to provide information for
news releases.

One of the goals of the program is to ensure that states wishing to replicate
the model can do so with little outside help. Toward this end, NHTSA
funds are used only for equipment and evaluation; the checkpoints are
staffed by reassigning Tennessee Highway Patrol officers. Each
checkpoint is required to have a minimum of four uniformed officers for
reasons of safety and visibility. The Tennessee Highway Patrol invites
officers from local departments in the region of each checkpoint to
participate. In each of the eight THP districts, four officers were trained to
operate vans outfitted with alcohol detection equipment, such as
breathalyzers and passive alcohol sensors (flashlights which can detect the
smell of alcohol).

Publicity is an important aspect of Checkpoint Tennessee. The program is
covered on television and advertised on billboards statewide. Press
releases announce checkpoints and detail the number of cars passing
through checkpoints and the number of drunk drivers arrested. Surveys
administered in driver license renewal offices throughout Tennessee
before, during, and after the first year of the program found that 90 percent
of citizens supported the use of checkpoints.

Based on the success of the Tennessee program, NHTSA awarded grants
of $1 million to Tennessee, Texas, Louisiana, Pennsylvania, and Georgia
to conduct a 30-month program, beginning in the summer of 2000, aimed
at reducing drunk driving fatalities using checkpoints, saturation patrols,
and increased public awareness. NHTSA will evaluate the results of the
programs, and a best practices manual will be written to guide other states
in replicating the program.

Challenges: There were significant logistical challenges in implementing
Checkpoint Tennessee, since all of the checkpoints had to be scheduled
one year in advance. Another logistical difficulty was getting personnel
and equipment to each checkpoint; four specially equipped vans had to be
shared by eight THP districts. After a few checkpoints were conducted and
the program became routine, personnel and equipment challenges were
overcome.

Costs and Funding Sources: The total cost of the two-year demonstration
project was $927,594. The state provided $475,339 for police salaries,
publicity costs, and other program expenses. The funds used for the
salaries were reallocated Tennessee Highway Patrol funds rather than new
funding. NHTSA funding covered educational materials, equipment, and
the program evaluation. Of the NHTSA funding, $350,000 was for
equipment, including the vans, passive alcohol sensors, generators to run
the equipment at the checkpoints, mobile lighting to illuminate the
checkpoint area, and road signs alerting drivers to the presence of the
checkpoint. Once the equipment has been purchased, the costs are
primarily for staff salaries. Many larger communities already have the
equipment necessary to conduct checkpoints, which would substantially
reduce program costs.

Program Results: Results from the NHTSA evaluation are promising.
During the first year of the program, drunk-driving fatal crashes were
reduced by 20.4 percent, a reduction of nine fatal crashes per month. This
reduction was sustained for at least 21 months after completion of the
formal program. Another important measure of success is that the
Tennessee Highway Patrol has continued to conduct checkpoints more
often than before the program began. In 1999 there were 287 checkpoints,
compared to the usual ten to 15 conducted annually.

Secret Shopper, The State of North Carolina

Program Type: Alcohol-Related Approach.

Target Audience: Establishments with liquor licenses.

Years in Operation: 1999-present.

Program Goals: Reduce alcohol sales to minors.

Contact Information: Angela Hayes, North Carolina Alcohol Law
Enforcement, 919-733-4060.

Description: In 1999, North Carolina Alcohol Law Enforcement (ALE)
initiated Secret Shopper with funding from the Combating Underage
Drinking Program, a grant program of the Office of Juvenile Justice and
Delinquency Prevention (OJJDP). Secret Shopper is a statewide program
designed to reduce underage alcohol sales by employing young people
who have been trained by police to attempt to purchase alcohol illegally
from retailers. The need for the program was great. According to the 1997
North Carolina Youth Risk Behavior Survey, two-thirds of high school
students said it was easy to purchase alcohol from stores. During 1999,
youths employed by ALE visited 1,000 Alcohol Beverage Control (ABC)
licensed outlets. ALE has received a second OJJDP grant and will conduct
4,100 Secret Shopper visits in 2000.

During the first phase of the program, conducted in March 1999, youths
were sent into 500 randomly selected businesses while ALE agents waited
outside. If merchants were willing to make the sale, minors handed them
fake money along with a flier stating that if the money had been real the
merchant would have been arrested by the agents waiting outside. The
program is designed to foster a working relationship between retailers and
the police. Merchants who refused to sell to minors were given a
certificate of appreciation from the chief of police, along with a button
reading "I survived Secret Shopper."

The second phase of the program was conducted in October and
November of 1999. All of the retailers who sold to minors in the first
phase were revisited, along with randomly selected sites which did not sell
and some randomly selected new sites, a total of 500 businesses.

All merchants visited by Secret Shopper are invited to participate in the
B.A.R.S. (Be A Responsible Server) educational program. B.A.R.S.
teaches merchants how to sell alcohol responsibly by checking
identification and recognizing fake IDs. ALE agents reinforce the state's
alcohol laws and introduce merchants to any new laws. Although the
program has not been evaluated, results from the Secret Shopper program
show that merchants who attend B.A.R.S. are less likely to sell alcohol to
minors.

Along with conducting 1,000 Secret Shopper visits, ALE used the OJJDP
grant to educate local law enforcement agencies throughout the state in
three training sessions. Participating officers received copies of a training
video and manual on how to conduct compliance checks. Copies of the
video and manual were also mailed to all law enforcement agencies that
did not attend.

The second OJJDP grant will allow ALE to  conduct 4,100 additional
visits; 2,600 of these visits will be in the ten counties with the highest rates
of alcohol-related youth crime and traffic crashes. The remainder of the
visits will be randomly dispersed throughout the state. All local law
enforcement officials, not just ALE agents, will be invited to participate in
the program and will receive a fee for each site visit they conduct. Unlike
visits conducted under the first grant, law enforcement officials will have
the option of arresting merchants who sell alcohol to minors. Visits are
scheduled to begin in August 2000.

Challenges: The main implementation challenge of Secret Shopper was
targeting a random sample of businesses. In order to do a random sample,
all establishments randomly selected should be visited. However, some of
the establishments randomly selected (topless bars and establishments with
a history of violence) were unsafe for youths and were therefore excluded
from the program.

Costs and Funding Sources: Secret Shopper was funded with a $168,250
grant from OJJDP. This covered all costs of the project, including
overtime pay for ALE agents and hourly wages for the youth workers
($5.55). Additional costs included printing the training manual and
purchasing a color printer to produce the fliers handed to merchants. For a
community looking to implement a similar program, costs would be
minimal. Local law enforcement can conduct the site visits, and the only
costs are youths' wages and any rewards for merchants who refuse to sell
to minors.

Program Results: According to ALE data, the program showed that both
the Secret Shopper program and the B.A.R.S. program significantly
contributed to reduced alcohol sales to minors. During the first phase of
the program, 26 percent of the businesses visited sold alcohol to minors.
During the second phase of the program, of the establishments who
originally sold to minors:

o 29 percent of those who did not attend B.A.R.S. sold to minors a
second time; and

o Only 16 percent of those who attended B.A.R.S. sold to minors a
second time.

---------------------------

Conclusion

Promising Strategies to Reduce Substance Abuse describes the most
effective prevention, treatment, and law enforcement strategies. Programs
that incorporate elements of these strategies are included to demonstrate
how some communities are combating substance abuse and related
problems. The report is designed to give community residents and local
policy makers tools for constructing approaches best suited to meet their
goals.

An essential component of effective local programming is collaboration
among various sectors of the community. Prevention, treatment, and law
enforcement systems, personnel, and resources are all part of the
continuum of care vital to the success of anti-drug strategies, and they can
work together to respond to the costs of substance abuse. Community
leaders from schools, family groups, social services, police, probation, the
courts, and others are more effective working together than working alone.

To combat substance abuse and related crime, it is also important for
communities to spend their often limited resources implementing
programs that have shown promise. The growing emphasis on "what
works" requires that communities learn from each other and implement
program models with track records of success. The programs in the report
can be modified to fit the needs and resources of a specific community.
When a program model is replicated, it must be evaluated to ensure it is
working in the new community. Incorporating an evaluation plan into
program development is critical. Evidence that a program works is also
essential when appealing for public and private funding.

Communities looking to implement promising anti-drug approaches
should first assess their greatest areas of need. For example, increases in
youth alcohol, tobacco, and other drug use may call for a greater focus on
prevention and treatment, while violent drug-trafficking may require
heightened law enforcement activities. Determining gaps in services
currently provided is an essential step. The local health department, police
department, other state and local agencies, and citizens should all be
involved in assessing community need.

Promising Strategies to Reduce Substance Abuse provides communities
with information on what approaches are effectively reducing substance
abuse and related problems nationwide and is intended to assist them in
determining how strategies and programs can address their specific needs.

----------------------------

Endnotes

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