Promising Strategies to Reduce Substance Abuse

U.S. Department of Justice

Office of Justice Programs

OJP

ISSUES &

PRACTICES

REPORT

OJP

Promising Strategies to Reduce Substance Abuse

01-Cover 1-4 11/2/00 3:43 PM Page 1

The research for Promising Strategies to Reduce Substance Abuse was conducted by

Drug Strategies, a nonprofit research institute based in Washington, D.C. Drug Strate-

gies’ 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).

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

01-Cover 1-4 11/2/00 3:43 PM Page 2

Promising Strategies

to Reduce Substance Abuse

Office of Justice Programs

September 2000

Contents

Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . v

Executive Summary. . . . . . . . . . . . . . . . . . . . . . . vii

Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix

Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

I. Teaching Prevention in Schools . . . . . . . . . . . . . . . . 2

II. Reaching Youths Outside School. . . . . . . . . . . . . . . . 7

III. Reaching High-Risk Groups . . . . . . . . . . . . . . . . . . 11

IV. Building Family Bonds . . . . . . . . . . . . . . . . . . . . . 15

V. Empowering Communities . . . . . . . . . . . . . . . . . . . 20

Treatment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

I. Family-Based Treatment. . . . . . . . . . . . . . . . . . . . . 28

II. Rehabilitating Criminal Offenders . . . . . . . . . . . . . . 34

III. Assessing and Treating Adolescents . . . . . . . . . . . . 39

IV. Connecting with the Community . . . . . . . . . . . . . . . 43

Law Enforcement . . . . . . . . . . . . . . . . . . . . . . . . 49

I. Community Policing . . . . . . . . . . . . . . . . . . . . . . . 50

II. Problem-Oriented Policing . . . . . . . . . . . . . . . . . . . 54

III. Reducing Drug Availability . . . . . . . . . . . . . . . . . . 57

An OJP Issues & Practices Report iii

Promising Strategies to Reduce Substance Abuse

IV. Alternatives to Incarceration. . . . . . . . . . . . . . . . . . 63

V. Alcohol-Related Approaches . . . . . . . . . . . . . . . . . 68

Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75

Endnotes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77

iv An OJP Issues & Practices Report

Foreword

Drug and alcohol abuse, drug trafficking, and related criminal activity remain seri-

ous 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 preven-

tion, 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 proxi-

mate cause of much criminal activity is the desperate need to feed a drug habit, if crimi-

nal 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 strate-

gies 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 coali-

tions, 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

An OJP Issues & Practices Report v

An OJP Issues & Practices Report vii

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 identi-

fied key elements of successful programming, discussed in the Prevention chapter.

Recognizing risk and protective factors is an essential component of successful pre-

vention 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 sub-

stance 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.

An OJP Issues & Practices Report ix

Overview

Promising Strategies to Reduce Substance Abuse is an assessment of the most effec-

tive 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 treat-

ment (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

Promising Strategies to Reduce Substance Abuse

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 increas-

ingly 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 enforce-

ment activities should be enhanced. Other communities may face problems of vio-

lence 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 high-

lighted in this report provide information on the cost of implementing and operating

the various activities. In addition to cost, other community resources, such as person-

nel and readiness, must be considered. Is there an existing agency that can incorpo-

rate 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:

■ 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.);

■ Challenges—describes the obstacles to implementing and/or operating the pro-

gram, 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;

■ 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 fore-

see when designing a similar program; and

■ Program Results—details the effectiveness of the program in meeting goals and

objectives. Some programs have been evaluated by external or internal investi-

gators using rigorous research designs; however, this standard does not hold

true for all of the promising approaches detailed in this report. Some programs

x An OJP Issues & Practices Report

An OJP Issues & Practices Report xi

were assessed as promising based on improvement observed in the communi-

ty, such as reductions in criminal activity and/or substance abuse. All pro-

grams 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 prob-

lems nationwide, and to assist them in selecting strategies and programs that will

effectively address their specific needs.

Overview

An OJP Issues & Practices Report 1

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 cir-

cumstances. 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 pre-

vention 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 fac-

tors” 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.

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 sig-

nificantly 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 pre-

dictors, as are school failure, early experimentation with drugs, and living in a com-

munity where substance abuse and dealing are pervasive.

While these risk factors are

all important predictors, the effect of any single factor can be mitigated by other cir-

cumstances. Research indicates that two risk factors produce four times the probabili-

ty 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 identi-

fying those at particularly high levels of risk. Selective interventions concentrate on

those who are particularly vulnerable to drugs because of personal, family, and com-

munity 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.

Effective prevention promotes the protective factors that reduce the poten-

tial for substance abuse and other closely linked behaviors, such as truancy, delin-

quency, 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

2 An OJP Issues & Practices Report2 An OJP Issues & Practices Report

■ Information dissemination is designed to

increase knowledge and alter attitudes about

issues related to alcohol, tobacco, and other

drug use and abuse;

■ Prevention education teaches participants criti-

cal personal and social skills that promote

health and well-being among youths and help

them avoid substance abuse;

■ 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;

■ Problem identification and referral involves rec-

ognizing 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;

■ Community-based process enhances community

resource involvement in substance abuse pre-

vention, for example, by building interagency

coalitions and training community members

and agencies in substance abuse education and

prevention; and

■ 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 com-

munities 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 pre-

vention 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, commu-

nication, 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.

Prevention efforts should begin early and contin-

ue 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 pro-

gram, help prevent or delay the initiation of drinking,

smoking, and using other drugs.

Delayed initiation is

beneficial, giving children time to develop social com-

petence 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.

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.

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 stu-

dents. Depending on the targeted population, preven-

tion 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 partici-

pants in a daily class focused on reducing or control-

ling drug use.

Promising Strategies to Reduce Substance Abuse

According to Making the Grade: A Guide to

School Drug Prevention Programs

, successful school-

based drug prevention programs incorporate a variety

of key elements:

■ 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;

■ develop personal, social, and refusal skills to

resist these pressures;

■ teach that using alcohol, tobacco, and other

drugs is not the norm among teenagers, even

if students believe that “everyone is doing it”;

■ provide developmentally-appropriate material

and activities, including information about the

short-term effects and long-term consequences

of alcohol, tobacco, and other drugs;

■ use interactive teaching techniques, such as

role plays, discussions, brainstorming, and

cooperative learning;

■ cover necessary prevention elements in at least

ten sessions a year (with a minimum of three

to five booster sessions in two succeeding

years);

■ actively involve the family and the communi-

ty; and

■ include teacher training and support, and con-

tain material that is easy for teachers to imple-

ment and culturally relevant for students.

School prevention efforts should also aim to

reduce school disorder and improve children’s atti-

tudes 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.

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 commu-

nities shape the larger social context in which children

Prevention

An OJP Issues & Practices Report 3

make decisions about alcohol, tobacco, and other

drugs. According to the 1997 report of the National

Longitudinal Study on Adolescent Health, close rela-

tionships with parents and teachers are powerful pro-

tective 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.

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.

In many communities,

police officers work as school resource officers (SRO)

to monitor students, provide advice and prevention

information, and link students to supervised recre-

ational activities, mentoring, and other services.

The following programs demonstrate the effec-

tiveness of these essential elements in building com-

prehensive 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 approxi-

mately 100 schools in six states and is recognized by

the Center for Substance Abuse Prevention as a prom-

ising High Risk Youth program and by the National

Association of Elementary School Principals.

Promising Strategies to Reduce Substance Abuse

4 An OJP Issues & Practices Report

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 stu-

dents. 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 encour-

aged 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 pro-

motes protective factors.

CDP has four basic principles: build supportive

relationships; attend to the social and ethical dimen-

sions of learning; honor students’ intrinsic motiva-

tion; 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, chal-

lenging tasks. Component three, developmental disci-

pline, 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 responsibili-

ty and competence. The fourth component gets par-

ents 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 contin-

ues 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 effec-

tive. Sedgewick was fortunate to have the support of

the entire school staff, and the school screens prospec-

tive teachers to ensure they are willing to follow the

CDP philosophy.

Costs and Funding Sources: Instructional and

curricular materials for the program cost approximate-

ly $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 lit-

eracy, 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, stu-

dent and teacher questionnaires, and student achieve-

ment scores. Over four years the following changes in

drug use were observed:

■ Alcohol use among students fell from 48 per-

cent to 37 percent in program schools while

rising from 36 percent to 38 percent in con-

trol schools;

■ Cigarette use declined from 25 percent of stu-

dents to 17 percent in program schools while

declining from 17 percent to 14 percent in

control schools; and

■ Marijuana use declined from 7 percent of stu-

dents 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 Develop-

ment Project is that it changed the atmosphere at

Sedgewick. Students are now more excited about

Prevention

An OJP Issues & Practices Report 5

learning and feel more a part of the school communi-

ty. 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 pro-

grams 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 sev-

enth 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, brain-

storming, 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 gen-

eral 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 exam-

ple, 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 vari-

ety of techniques for effectively managing anxiety,

including deep breathing, mental rehearsal, and mus-

cle 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 stu-

dents’ social skills. To help students feel comfortable

in social situations and less vulnerable to peer pres-

sure, LST provides training in general social tech-

niques, 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 tobac-

co, alcohol, or other drugs, as well as how to assert

themselves and express their feelings directly.

Challenges: One of the challenges to implement-

ing 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 test-

ing. 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 ses-

sions 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 cur-

riculum materials for program instructors and stu-

dents, and instructor salaries and trainings. Schools

using teachers to run the program do not have to hire

6 An OJP Issues & Practices Report

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. Addi-

tional 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 consis-

tently been shown to reduce cigarette smoking, prob-

lem 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 partici-

pating schools, compared with nonparticipating con-

trol 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 pro-

fessionals, 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, includ-

ing 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 dis-

tricts of Midland and Odessa, Texas, implemented

Reconnecting Youth in four schools in 1997; approxi-

mately 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. Recon-

necting 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 bond-

ing activities, and a school system crisis response plan.

The Reconnecting Youth class is taught for 55 min-

utes 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 increas-

ing protective factors, such as self-esteem.

Challenges: The most difficult part of imple-

menting the program in Texas was obtaining the

cooperation of the schools. School officials are often

reluctant to release pretest information, including stu-

dents’ 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 depend-

ing 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

Promising Strategies to Reduce Substance Abuse

people, plus trainer travel and expenses. A recom-

mended 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 facilita-

tors, 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 mari-

juana use were not affected. The program also re-

duced 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 consid-

ered a model program by the Center for Substance

Abuse Prevention.

In Midland and Odessa, students in Reconnect-

ing 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 gradua-

tion ceremony attended by the school board and

media.

II. Reaching Youths

Outside School

After-school hours are high-risk periods for alco-

hol 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.

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 inter-

vention, 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 Preven-

tion Council award for his role in creating the

Neutral Zone, a youth center which provides an array

of youth services, including substance abuse counsel-

ing. 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 ele-

mentary, 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.

An OJP Issues & Practices Report 7

Prevention

An OJP Issues & Practices Report 7

8 An OJP Issues & Practices Report

Promising Strategies to Reduce Substance Abuse

8 An OJP Issues & Practices Report

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 edu-

cational 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 commu-

nity 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 isola-

tion and insufficient supervision. A positive adult role

model also offers new perspectives to youths living in

situations rife with substance abuse and violence.

Well-developed and executed mentoring pro-

grams can effectively reduce drug use. A 1995 nation-

al evaluation of Big Brothers/Big Sisters of America,

which connects middle class adults with disadvan-

taged youths, found that young people in the pro-

gram 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.

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 men-

toring programs:

■ Creating collaboration between community-

based providers and local education agencies to

improve school performance and reduce school

drop out rates and juvenile delinquency;

■ Performing thorough background checks for

all volunteer mentors to establish a safe envi-

ronment for participating children;

■ Assessing young participants carefully so

appropriate matches can be established that

maximize opportunities for success;

■ Designing mentor and project activities that

enrich and enhance youth opportunities and

experiences; and

■ 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 week-

end 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 preven-

tion education into traditional activities. A 1992 eval-

uation of such programs offered in public housing

developments found greater reductions in drug use

among participating youngsters than among youths

not involved.

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; [email protected]; www.bbbsa.org.

Prevention

An OJP Issues & Practices Report 9An OJP Issues & Practices Report 9

Description: For nearly a century, Big Brothers

and Big Sisters of America (BBBSA) has been provid-

ing 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 agen-

cies, uses a case management approach developed by

the national organization. Case managers screen chil-

dren 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 educa-

tors, social workers, counselors, parents, and others,

and are considered at risk of substance abuse and oth-

er 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 exam-

ple, 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 imple-

ment 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, includ-

ing 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 approxi-

mately 700 boys and girls awaiting matches. While

the organization needs both male and female volun-

teers 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 signifi-

cantly from previous years.

Costs and Funding Sources: The national aver-

age 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 volun-

teers, administrative costs, employee salaries, and vari-

ous 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 partic-

ipating 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 aver-

age, 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:

■ 46 percent less likely to begin using illicit

drugs;

■ 27 percent less likely to begin using alcohol;

and

■ 53 percent less likely to skip school.

■ 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 pro-

grams 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:

■ 0.5 percent of Little Sisters become pregnant,

compared to 5.5 percent of area girls;

■ 1 percent of participants are arrested, com-

pared to 7.6 percent of local youths; and

■ 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

Promising Strategies to Reduce Substance Abuse

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 edu-

cators, given more than 500 performances, and con-

ducted 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, sui-

cide, 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 preven-

tion services in their community where they can seek

help. The troupe performs in schools, churches, pub-

lic housing projects, and malls.

SETT performers receive 80 hours of training cov-

ering substance abuse, violence prevention, health edu-

cation, 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 develop-

ment. 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 consulta-

tion services are available to communities and organi-

zations interested in replicating the program.

Challenges: One of the implementation chal-

lenges 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 knowl-

edge. 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 servic-

es agencies are regularly present at training sessions.

An additional 73 organizations are involved in the

10 An OJP Issues & Practices Report

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

, include:

■ A strong relationship with a parent or caring

adult who provides a consistent nurturing

environment;

■ Feelings of success and self-respect;

■ 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;

■ Social skills, including good communication

and networking skills, and the ability to make

good decisions;

■ Problem-solving skills that help children over-

come obstacles;

■ Hope that adverse circumstances can be over-

come with perseverance and hard work; and

■ 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 alco-

holism later in life.

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. Interven-

tions designed for this population can work in various

settings, including correctional facilities and residen-

tial 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 gener-

al.

Youngsters involved in the foster care system are

another target population for prevention services,

since their families often have histories of substance

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, con-

tract 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 Neigh-

borhoods ($30,000), and the Marshall Field Foun-

dation ($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 pub-

lic 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 Preven-

tion 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 pop-

ulations include children of substance abusers, preg-

nant teens, and juvenile offenders. These efforts,

which often involve home visits, counseling, and par-

ent training, enhance resilience and promote individ-

ual strengths.

The federal Center for Substance

An OJP Issues & Practices Report 11

Prevention

and the first group of 100 mothers will soon gradu-

ate. 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 pro-

gram focuses on five aspects of development: health,

parenting skills, environmental health (living condi-

tions), life skills, and the creation of solid support

networks. Women are encouraged to seek higher edu-

cation, 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 central-

ized tracking system for at-risk mothers, which made

recruiting mothers a challenge. Program staff had to

contact each agency working with the target popula-

tion, 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 pro-

gram, only 112 agreed to participate. Staff have taken

abuse.

Initiatives to assist foster families can be inte-

grated into programs for abused, neglected, orphaned,

or troubled adolescents.

As substance abuse and sexual activity often over-

lap, targeting prevention/intervention services to preg-

nant 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 preg-

nancy 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 nonpartici-

pants.

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 pre-

natal 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,

Promising Strategies to Reduce Substance Abuse

12 An OJP Issues & Practices Report12 An OJP Issues & Practices Report

Prevention

An OJP Issues & Practices Report 13

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 approxi-

mately $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 evalua-

tion found that program participants had:

■ 79 percent fewer reported cases of child abuse

and neglect;

■ fewer subsequent children (1.1 versus 1.6);

■ longer intervals between the births of their

first and second children (67 months versus

37 months);

■ 30 fewer months on welfare (60 months versus

90 months);

■ 44 percent fewer alcohol and other drug-

related behavioral problems and 69 percent

fewer arrests among mothers; and

■ 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 pro-

grams, 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 wel-

fare expenditures, crime, and health care costs are tak-

en into account.

The Oakland program has produced some impres-

sive 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, [email protected].

Description: The Residential Student Assistance

Program (RSAP) is a substance abuse prevention/

intervention program serving adolescents in the juve-

nile 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 interperson-

al 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

An OJP Issues & Practices Report 13

residential facilities where the program was being

implemented. RSAP encouraged facilities to imple-

ment EAPs for their staff members, offered staff train-

ing 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 person-

nel understand that while the program might require

children to miss a class or two, the benefits would sig-

nificantly 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 pro-

gram. The program budget consists only of the salary

of the full-time or part-time student assistance coun-

selor working in the facility and some supervision by

the agency implementing the program. For communi-

ties 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:

■ 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;

■ 72 percent of youth who drank, 59 percent

who used marijuana, and 27 percent who

facility; a nonsecure residential facility for juvenile

offenders; a facility for adolescents with severe psychi-

atric 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 fam-

ily member, other family problems, and stress. The

discussion groups help the youths and counselors get

acquainted and begin changing the participants’ atti-

tudes about alcohol and other drugs. The facility also

hosts 12-Step meetings, and residents are referred for

treatment outside the residential facility when neces-

sary. 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 coordi-

nate a Residential Facility Staff Task Force which

includes employees of the youth residential facility.

The group meets weekly to discuss policy and pro-

gram issues that affect prevention. SACs train residen-

tial staff to implement drug prevention strategies, and

an EAP is available to help those experiencing person-

al 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 Mass-

achusetts, and similar programs in Alaska, Arizona,

Connecticut, and Florida are in the planning stages of

implementation.

Challenges: One of the major obstacles to imple-

menting RSAP was recruiting, hiring, and retaining

project staff qualified to work with program partici-

pants. 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 counsel-

ing staff helped ensure success. Another obstacle was

building support among all staff working in the

Promising Strategies to Reduce Substance Abuse

14 An OJP Issues & Practices Report14 An OJP Issues & Practices Report

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.

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 effec-

tive programs promote positive relationships between

parents and children.

They provide training in com-

munication, 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

■ Reach families of children at each stage of

development;

■ Train parents in behavioral skills to reduce

conduct problems in children, improve parent-

child relationships, provide consistent disci-

pline and rulemaking, and monitor children’s

activities during adolescence;

■ Include an educational component for parents

with drug information for them and their

children;

■ Direct services to families with children in

kindergarten through 12th grade to enhance

protective factors; and

■ Provide access to counseling services to fami-

lies 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 com-

munication problems, too lax or too stringent disci-

pline, parental substance use, and child abuse or

neglect. Family protective factors include close-knit

smoked before entering the program reported

discontinued use at post-test;

■ past month alcohol use fell 46 percent (versus

a 2 percent drop among the control group);

■ marijuana use dropped 45 percent (versus a 12

percent increase in the control group); and

■ tobacco use fell 16 percent (versus an 8 per-

cent increase in the control group).

A major accomplishment of RSAP is that it

achieved such significant prevention results with ado-

lescents 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.

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 tradi-

tionally 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,

An OJP Issues & Practices Report 15

Prevention

An OJP Issues & Practices Report 15

Preventing substance abuse by building family

bonds is a growing trend among the nation’s commu-

nities; the following programs are noteworthy exam-

ples 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 par-

ents and their children and train teachers and com-

munity 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 reserva-

tion, 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 train-

ing 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 pro-

gram include improving parents’ sense of competence,

helping parents understand appropriate child manage-

ment 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

familial relationships, consistent discipline, and

parental supervision of children’s daily activities.

These programs can improve poor parent-child com-

munication, 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 moder-

ate and high risk.

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 effec-

tive 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.

Family therapy, the third approach, helps family

members improve the way they communicate, man-

age 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 preven-

tion efforts, such as in-home support and school-

based counseling.

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 chil-

dren. Anti-drug advertisements will run through

2002.

Promising Strategies to Reduce Substance Abuse

16 An OJP Issues & Practices Report16 An OJP Issues & Practices Report

Parents in the experimental group reported mul-

tiple positive benefits which reduce substance abuse

risk factors for their children:

■ increased satisfaction with their parenting role

(15.5 percent more than control group);

■ increased sense of personal worth (13.5 per-

cent more than control families);

■ a more positive relationship with their children

(6.5 percent more than control families); and

■ a 13.7 percent decrease in the use of harsh

punishment to discipline their children (use of

harsh punishment decreased less than one per-

cent 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 jus-

tice system and their families.

Years in Operation: 1996-present.

Program Goals: Change negative family behavior pat-

terns 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 chil-

dren (ages 11-18) and their families. The program

in the same building. Teenagers from the community

(sometimes older siblings of preschoolers in the pro-

gram) 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 logisti-

cally difficult to share work space. Dare to be You can

be implemented through any community organiza-

tion 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 pro-

gram was originally funded as a demonstration proj-

ect 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 pre-

school children. The evaluation involved 780 parents,

498 in the intervention group and 282 in the control

group.

Prevention

An OJP Issues & Practices Report 17An OJP Issues & Practices Report 17

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 com-

pare data.

Challenges: One of the challenges program

providers faced in Las Vegas was creating a partner-

ship 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 jus-

tice 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 super-

vision 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:

■ Deterring adolescents from moving into high-

er cost treatment services;

■ Preventing younger children in the families

from entering the system of care;

■ Preventing juveniles from entering the adult

criminal system; and

■ Avoiding future crime victim costs.

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 pro-

gram is provided by the Family Project—a collabora-

tive 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 chil-

dren and their families, FFT is designed as a phased

program, with modules that complement one anoth-

er. Each phase has special intervention and assessment

activities aimed at accomplishing specific goals of

individual families. The phases include:

■ Engage and motivate youths and their families

by decreasing the intense negativity so often

characteristic of these families;

■ Reduce and eliminate problem behaviors and

patterns by improving family communication

and parenting and problem-solving skills; and

■ 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 cas-

es 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.

Promising Strategies to Reduce Substance Abuse

18 An OJP Issues & Practices Report18 An OJP Issues & Practices Report

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 pub-

lic 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 separate-

ly 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 situa-

tions, 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 ses-

sions. 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 informa-

tional 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 demon-

strated 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, discus-

sions, skill-building activities, and family projects.

An OJP Issues & Practices Report 19

Prevention

An OJP Issues & Practices Report 19

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 follow-

ing baseline assessment:

■ 31 percent of program youths had ever been

drunk, compared to 46.5 percent of the con-

trol group;

■ 13 percent of program youths had smoked cig-

arettes in the past month, compared to 24.5

percent of the control group; and

■ 8.3 percent of program youths had used mari-

juana, compared to 17.6 percent of the control

group.

Two major accomplishments of the Pella pro-

gram are successfully involving parents in prevention

activities, often a difficult task, and forming a part-

nership 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 commu-

nity stakeholders—service providers, residents, com-

munity 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 prompt-

ed 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, cre-

ated 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 pro-

gram, 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 commu-

nity coalitions for youth substance abuse prevention

efforts. Funding for the program, which was $10 mil-

lion 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

■ Understanding the community’s needs and

resources;

■ Widely shared and comprehensive vision;

Promising Strategies to Reduce Substance Abuse

20 An OJP Issues & Practices Report20 An OJP Issues & Practices Report

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 estab-

lishing 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 fund-

ing. In Fort Wayne, Indiana, for example, funding for

the anti-drug coalition comes from money collected

from individuals arrested for driving under the influ-

ence 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 indus-

tries looking to support a good cause and garner local

publicity.

Evaluation of community coalitions is providing

data about what makes coalitions successful. The fol-

lowing programs exemplify how communities can

combine grassroots efforts with research-based theo-

ries 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 par-

ents, and communities.

Years in Operation: 1987-present.

Program Goals: To reduce youth drug use by coordi-

nating 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 pro-

gram began in 1984 and is now being used in five

states. The Midwestern Prevention Project was named

■ Clear and focused strategic plan;

■ Diverse membership (including key commu-

nity leaders, local government officials, and

volunteers);

■ Strong leadership and committed partners;

■ Diversified and relevant funding (coalitions

should not accept funding that may compro-

mise their mission); and

■ Well-managed structure (including organized

administration, effective communication

among members/volunteers/staff, and a com-

prehensive evaluation plan).

The growth of coalitions has also spurred the cre-

ation 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 drink-

ing. Recognizing the devastating effects of underage

drinking on communities, the Office of Juvenile

Justice and Delinquency Prevention supports coali-

tion 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 prosecu-

tors cooperate in “weeding out” criminals who partici-

pate in violent crime and drug abuse to prevent their

return to the target area; “seeding” brings human

services to the area, encompassing prevention, inter-

vention, treatment, and neighborhood revitalization.

An OJP Issues & Practices Report 21

Prevention

An OJP Issues & Practices Report 21

22 An OJP Issues & Practices Report

a Model Program in Blueprints for Violence Prevention

by the Center for the Study and Prevention of Vio-

lence 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 intro-

duced in sixth or seventh grade, before youths make

the transition into middle or junior high school. The

program is administered by teachers and student lead-

ers elected by the class and trained by the teacher.

During the first year there are between ten and 13

classroom sessions discussing resistance skills, promot-

ing 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 rein-

force the skills learned in the previous year. Through-

out 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 mem-

bers involved by keeping them informed of new pro-

gram 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 organiza-

tion 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 implement-

ing the MPP in Marion County was coordinating

program development among the key players, includ-

ing 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 dis-

trict 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 Endow-

ment. 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 mem-

bers of the parent group.

Outcome Measures: The University of Southern

California and the Kaufman Foundation are conduct-

ing 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:

■ 4.9 percent daily cigarette use;

■ 7.2 percent monthly drunkenness; and

■ 2.9 percent marijuana use more than twice a

week.

*Percent increase in control group minus percent increase

in program group.

Promising Strategies to Reduce Substance Abuse

Prevention

An OJP Issues & Practices Report 23

By early adulthood (age 23), program youths

continued to show less drug use than the control

group:

■ 1.9 percent less cigarette use;

■ 1.5 percent less marijuana use more than twice

a week;

■ 6.2 percent less lifetime amphetamine use; and

■ 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 communi-

tywide 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 com-

munity site had a part-time field coordinator to assist

in implementation.

Through Project Northland, community strate-

gies, action-based curricula, and peer leadership activ-

ities all encourage positive individual behavior and

environmental change. The first phase of the inter-

vention includes eight sessions each year for sixth,

seventh, and eighth grade students that focus on the

risks of drinking. These sessions are designed to pre-

vent 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 com-

munity training.

■ sixth grade—a strong family component tar-

gets 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.

■ 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 provid-

ing discounts for children who pledge to be

alcohol- and drug-free.

■ 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 rein-

force 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 alterna-

tives to drinking, community response to teen drink-

ing, 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.

24 An OJP Issues & Practices Report

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 administra-

tion. 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:

■ 30 percent less likely to drink in the past

week;

■ 20 percent less likely to drink in the past

month;

■ 20 percent less likely to smoke regularly; and

■ 15 percent less likely to use marijuana.

The second phase of the program was completed

in 1999, and evaluation of its effectiveness in prevent-

ing 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 edu-

cating 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 com-

munity 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 commu-

nity 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 coali-

tion 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 requir-

ing alcohol to be safeguarded, because youths were

stealing alcohol from grocery store shelves. In addi-

tion, the coalition trains pediatricians to work with

parents to help them understand the problems associ-

ated with underage drinking.

Through a decade of programming, the coalition

has identified several key elements of success:

■ Public officials are vital to the work of

coalitions;

■ Coalition programs must match or exceed

community perceptions of quality;

Promising Strategies to Reduce Substance Abuse

Prevention

An OJP Issues & Practices Report 25

■ Creative methods must be used to recruit,

retain, and recognize volunteers; and

■ 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 prob-

lems. 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 coali-

tion observed an increase in alcohol abuse among

newly retired senior citizens and created a senior vol-

unteer bureau to address this problem.

Another challenge is maintaining vital relation-

ships 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 oper-

ates 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, individ-

ual donors, and fundraisers make up the remaining

budget. Troy staff believe that all fundraisers, in addi-

tion to collecting money, should send significant pre-

vention 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 reduc-

tions between 1991 and 1998:

■ 12th-grade students who reported consuming

alcohol in the past month decreased from 62.1

percent to 53.3 percent; and

■ eighth-grade students who reported consum-

ing 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 resubmit-

ted 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.

An OJP Issues & Practices Report 27

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 possibil-

ity, 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.

A 1994 California study (CALDATA) found that $1 invested in alcohol

and other drug treatment saved taxpayers $7 in future costs.

The federal govern-

ment’s 1997 National Treatment Improvement Evaluation Study evaluated the effec-

tiveness 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.

Services offered by substance abuse treatment programs vary, as do the modali-

ties, staff, and target populations. The four most common types of substance abuse

treatment are

■ Outpatient methadone programs—provide methadone to reduce cravings for

heroin. Counseling, vocational training, and case management are often used

to stabilize patient functioning;

■ Long-term residential programs—offer drug-free treatment in a residential com-

munity of counselors and recovering addicts. Patients generally stay in the

programs a year or more;

■ 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

■ 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.

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:

28 An OJP Issues & Practices Report28 An OJP Issues & Practices Report

■ No single treatment is appropriate for all

individuals;

■ Treatment needs to be readily available;

■ Effective treatment attends to multiple needs

of the individual (such as medical, psychologi-

cal, social, vocational, and legal problems);

■ Treatment and services plans must be assessed

continually and modified as necessary to

ensure that the plan meets the individual’s

changing needs;

■ Remaining in treatment for an adequate period

of time is critical for treatment effectiveness;

■ Counseling (individual and/or group) and

other behavioral therapies are critical compo-

nents of effective treatment;

■ Medications are an important element of

treatment for many patients, especially when

combined with counseling and other behav-

ioral therapies;

■ Addicted or drug-abusing individuals with

coexisting mental disorders should have both

disorders treated in an integrated way;

■ Medical detoxification is merely the first stage

of addiction treatment and by itself does little

to change long-term drug use;

■ Treatment does not need to be voluntary to be

effective;

■ Possible drug use during treatment must be

monitored continuously;

■ Treatment programs should provide assess-

ments for HIV/AIDS and other infectious dis-

eases, and counseling to help patients modify

or change behaviors that place them or others

at risk of infection; and

■ 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 avail-

able for only one quarter of the almost six million

people needing treatment.

The federal government

estimates that the need for substance abuse treatment

in the United States will grow 57 percent over the next

20 years.

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 treat-

ment approaches involving families, communities,

and the criminal justice system. Effective strategies

include treating parents with their children, rehabili-

tating 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.

In addi-

tion, children of untreated addicts are at significant-

ly 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 par-

ents without access to transportation, child care, and

affordable services.

Pregnant addicts have a particularly difficult time

getting treatment, in large part because most treat-

ment 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.

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

Promising Strategies to Reduce Substance Abuse

Treatment

An OJP Issues & Practices Report 29

infants born to treated substance-abusing women.

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 tar-

gets 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.

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.

Women account for almost one-third of the total

number of substance abusers in treatment.

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.

The

1997 National Treatment Improvement Evaluation

Study also found that women addicts showed marked

improvement in the year following treatment.

Among women in the treated group, arrests declined

by two-thirds, while drug use dropped by almost

half.

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 chil-

dren 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. Re-

search 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.

Programs should offer access

to comprehensive services, such as family planning,

physical and mental health care, job training, parent-

ing, 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, pro-

viding treatment as well as parent training and job

readiness skills. An emerging trend is to combine pre-

natal care with drug treatment to protect unborn

babies from exposure to drugs and to prepare preg-

nant 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.

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

Promising Strategies to Reduce Substance Abuse

30 An OJP Issues & Practices Report

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 treat-

ment 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, multidisci-

plinary 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 com-

bines substance abuse/mental health treatment, pedi-

atrics, 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 res-

idential 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 inten-

sity in accordance with their progress. Ancillary ser-

vices, 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, especial-

ly those identified as having exceptional parenting

needs. A children’s service coordinator conducts pedi-

atric outreach and in-home assessments as well as

overall case management for CAP children and their

siblings.

Participants, primarily from Baltimore, are pre-

dominantly African American. The majority of

women have less than a high school education, live in

poverty, are single, and have an average of three chil-

dren. 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 work-

ing on ways to make treatment more user-friendly,

such as offering vouchers and hiring treatment advo-

cates. The program also provides transportation and

child care to help reduce barriers to treatment.

Treatment

An OJP Issues & Practices Report 31

Costs and Funding Sources: The total expendi-

tures 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:

■ 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;

■ 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;

■ Infants born to treated women averaged less

than one day in NICU, compared with more

than ten days for control group infants;

■ Women in treatment were significantly less like-

ly to use illicit drugs at the time of delivery

than women who did not participate in treat-

ment (37 percent and 63 percent, respectively).

■ 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 remain-

ing 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 suc-

cessful 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 com-

munity 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 mem-

bers 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 encoun-

ters with police or relapse; follow-up on client refer-

rals; and act as advocates in law enforcement settings.

The program also provides walk-in support and pre-

vention 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 return-

ing home after incarceration. The bilingual staff at La

Bodega helps families deal with substance abuse-

related problems, such as domestic violence, child

32 An OJP Issues & Practices Report

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 cri-

sis intervention support, 50 percent reported multi-

generational substance abuse, 35 percent reported

multigenerational involvement with the criminal jus-

tice 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 thera-

pists, judges, academics, doctors, and law enforce-

ment 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 start-

ing La Bodega was getting law enforcement and

health organizations to shift their focus from the indi-

vidual 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 real-

ized that the program increases public safety because

the family is the first to know when one of its mem-

bers 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 organiza-

tion. In New York clients are already receiving treat-

ment services funded by the New York Division of

Parole; La Bodega incorporates families into the treat-

ment to make it more successful. Other program

necessities include a local advisory board consisting of

criminal justice and health officials and program par-

ticipants, a neutral program space within the commu-

nity 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’ treat-

ment 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 treat-

ment agencies nationwide. The training will focus on

incorporating families into all aspects of substance

abuse treatment. La Bodega is already offering train-

ing and technical assistance to national drug courts

and to New York State parole and probation staff.

Promising Strategies to Reduce Substance Abuse

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 class-

es, physical rehabilitation, spirituality courses, educa-

tional 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 coun-

seling, 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 coordi-

nate activities with outside treatment specialists, doc-

tors, 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 need-

ed 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 responsi-

bility. 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 dor-

mitory style living, provides a more natural atmos-

phere 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 per-

mit 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 rehabilita-

tion process. PAR Village also works with an associa-

tion 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 pro-

gram’s counselors. As a result, staff turnover is rela-

tively 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 annu-

al 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.

An OJP Issues & Practices Report 33

Treatment

An OJP Issues & Practices Report 33

34 An OJP Issues & Practices Report

Promising Strategies to Reduce Substance Abuse

34 An OJP Issues & Practices Report

PAR Village benefits from some special advan-

tages 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:

■ Nearly two-thirds (64.7 percent) of clients are

drug-free, and 88 percent are arrest-free;

■ 95 percent of clients attain the educational/

vocational skills necessary for employment,

and more than one-third (35 percent) are

employed; and

■ 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 com-

mon denominator for most offenders in the criminal

justice system. Drug offenders constitute a rising pro-

portion 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 feder-

al 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.

According to BJS, four in ten violent offenders

were under the influence of alcohol when they com-

mitted their crimes.

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 signifi-

cantly between 1991 and 1997. One in ten state pris-

oners reported receiving treatment in 1997, down

from one in four in 1991, according to BJS data.

Without treatment, three in four offenders are rear-

rested within three years, continuing the costly cycle

of addiction and crime. Providing treatment to

offenders is a less expensive alternative than incarcer-

ating them for future illicit drug and alcohol-related

crimes. The most expensive drug treatment programs

cost about $10,430 per year for each offender, com-

pared to $20,142 per year for incarceration.

The major contributors to relapse among addic-

tion treatment patients are low socioeconomic status,

co-occurring psychiatric conditions, and lack of fami-

ly 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 sig-

nificantly 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.

Therapeutic communi-

ties 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 recov-

ery. Treatment gains can be lost if inmates are

returned to the general prison population after treat-

ment. 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).

The effects were still visi-

ble after three years, with one-third of treated offend-

ers remaining drug-free, compared to 5 percent of the

comparison group.

Treatment

An OJP Issues & Practices Report 35An OJP Issues & Practices Report 35

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 popula-

tion. According to the Center for Substance Abuse

Treatment, mandated sentencing without the parallel

development of treatment services has had a particu-

larly devastating impact on women in prisons.

1997, 79,600 women were serving sentences in feder-

al and state prisons, six times the number incarcerated

in 1980.

More than two-thirds of the women

inmates in federal prisons have been incarcerated for

drug offenses.

The criminal justice system is an important treat-

ment 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 treat-

ment 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 partici-

pants. 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.

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 screen-

ing, 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 envi-

ronment 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 after-

care 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, sepa-

rate from other inmates, and they spend seven days a

week focusing on treatment. To avoid distraction, par-

ticipants do not have access to television or tele-

phones 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 partici-

pate 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 demon-

stration 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 con-

tinuing 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 implement-

ing KEY/CREST was convincing those in the correc-

tions field that it was beneficial and cost effective to

treat substance-abusing criminal offenders. Many peo-

ple 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 train-

ing 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 pro-

grams 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 estimat-

ed that treatment costs are $7.50-$8.00 per day for

each offender in the program (this is for treatment

Promising Strategies to Reduce Substance Abuse

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 alco-

hol and other drug treatment. Three years after release

from prison:

■ 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.

■ 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 com-

parison 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 treat-

ment 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.

36 An OJP Issues & Practices Report

this problem, CIW tries to engage women in the pro-

gram 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 approxi-

mately $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 par-

ticipants 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 treat-

ment after being paroled. Program retention during

these years was high; 94.8 percent of women complet-

ed the program. Women who completed the in-prison

program and at least three months of community

treatment fared the best.

Twelve months after parole:

■ Only 9 percent of women receiving 120 days

or more of community treatment were re-

incarcerated; and

■ 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 per-

cent of women receiving continuing care.

Twenty-four months after parole:

■ Only 25 percent of women receiving more

than 120 days of treatment after being paroled

were returned to custody after two years; and

■ 60 percent of program drop-outs were reincar-

cerated, compared to 48 percent of the contin-

uing care group.

Despite changes in staff and prison management,

Forever Free has sustained effective programming for

Most women who participate in Forever Free do

so voluntarily. When offenders enter the prison sys-

tem, 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 his-

tory), 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 pro-

gram participants which detail their arrangements for

employment, housing, and further treatment. Clients

are encouraged to voluntarily enter community resi-

dential 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

An OJP Issues & Practices Report 37

Treatment

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 counsel-

ing. Participants meet with their parole officers regu-

larly, 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 coun-

selor 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 suc-

cessful in-prison therapeutic communities. Another

problem was achieving cooperation between the treat-

ment and correctional staff, which was addressed

through cross-training, allowing staff to learn more

about the treatment model and to appreciate the vari-

ous 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

almost ten years. A major accomplishment of the pro-

gram 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 pris-

ons and has been replicated in Oklahoma and New

Mexico. The primary goal of the program is to pro-

vide residents with the skills necessary to live as pro-

ductive members of society after their release from

prison. In order to be considered for the treatment

program, offenders must be assessed as having a sub-

stance 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 pro-

gram (approximately 750 offenders per year).

New Vision provides clients with educational sem-

inars 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 poli-

cies 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 pro-

gram, 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

Promising Strategies to Reduce Substance Abuse

38 An OJP Issues & Practices Report38 An OJP Issues & Practices Report

Treatment

An OJP Issues & Practices Report 39

completion of the New Vision aftercare component is

a critical factor in maintaining treatment success. The

recidivism rates were as follows:

■ prison treatment and aftercare 25 percent

■ aftercare dropout 64 percent

■ untreated 42 percent

The study further divided the subjects by severi-

ty. High-severity offenders had more serious criminal

and drug-related problems and were viewed as more

likely to be reincarcerated. However, offenders com-

pleting treatment and aftercare had significantly lower

recidivism rates than dropouts and untreated offend-

ers. Recidivism rates for the high- and low-severity

offenders were as follows:

High-severity

■ prison treatment and aftercare 26 percent

■ aftercare dropout 66 percent

■ untreated 52 percent

Low-severity

■ prison treatment and aftercare 22 percent

■ aftercare dropout 52 percent

■ 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.

Accord-

ing 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.

Since most substance abuse treat-

ment is designed for adult addicts, appropriate servic-

es 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.

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 old-

er clients. Adolescents also have unique treatment

needs. Teen treatment models tend to be less con-

frontational than treatment for adults. Concurrent

mental illness, legal problems, educational needs, fam-

ily 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 involve-

ment. Teaching parents the skills to support their

children through treatment can enhance family stabil-

ity 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 ado-

lescent’s involvement in treatment. For example, ado-

lescent 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 interven-

tion offered through a school-based student assistance

program, for example, can substantially reduce drink-

ing and marijuana use before more intensive services

are needed and is far less costly than making treat-

ment available only after teens develop an addiction,

drop out of school, or commit crimes.

An OJP Issues & Practices Report 39

While programs designed for adolescents are still

scarce, the following examples highlight how commu-

nities 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 institution-

alization 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 pre-

vent 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 leav-

ing, 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.

In addition to developing more youth-specific

treatment approaches, it is important to screen young

people to identify those most likely to need treat-

ment, such as teens who exhibit warning signs of

abuse, including substantial behavioral changes, sig-

nificant changes in academic performance, trauma

injuries, and contact with the juvenile justice or child

welfare systems. Homeless and runaway teens in shel-

ters and all teens who receive mental health assess-

ments 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 signifi-

cantly 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 organiza-

tions, and other providers of health and social services

in one plan. Case management is critical to coordi-

nate services for these children and to act as the cen-

tral 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).

They include:

■ Focusing treatment on risk factors associated

with criminal behavior, such as antisocial atti-

tudes and peers, rather than on risk factors

that are not particularly associated with crimi-

nal behavior, such as self-esteem;

■ Concentrating more intensive services on

those who are at risk of re-offending; and

■ 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 supervi-

sion, day treatment, evening and weekend programs,

and tutoring.

Promising Strategies to Reduce Substance Abuse

40 An OJP Issues & Practices Report40 An OJP Issues & Practices Report

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 approxi-

mately $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:

■ Reduced Recidivism: One year after program

discharge, only 19 percent of program partici-

pants (including those who did not complete

the program) have been reincarcerated, and

only 16 percent have been readmitted to inpa-

tient treatment programs. Only 10 percent of

youths completing the program have been

reincarcerated.

■ 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.

■ Improved Vocational and Educational

Performance: Since the program began, 85 per-

cent 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.

■ Reduced Costs to State: Since 1994, the pro-

gram has saved the state $800,000 in incarcer-

ation 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.)

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 manage-

ment, 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 manage-

ment during which the case manager maintains daily

contact with the adolescent, the family, and any agen-

cies 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 par-

enting skills and to create a healthy home environ-

ment 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 pro-

vides clients with less intensive treatment and services.

At the culmination of continuing care, a formal grad-

uation is held.

Challenges: The greatest obstacle to implement-

ing 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 toler-

ance 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.

An OJP Issues & Practices Report 41

Treatment

An OJP Issues & Practices Report 41

assessments, develop treatment plans, link juveniles

with Network services, and conduct ongoing moni-

toring 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 representa-

tives 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 philoso-

phies and ideals, and building linkages based on these

common elements. The Network then coordinated a

series of staff training sessions to familiarize the mem-

ber organizations with new methodologies.

Cost and Funding Sources: The Network’s origi-

nal 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 termi-

nation. 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 contract-

ed 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:

■ Abstinence increased from 20 percent to 52

percent;

■ Ability to remain alcohol- and drug-free went

from 19 percent to 49 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 sys-

tems 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 juve-

nile 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 uni-

versities, 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 rehabilita-

tion, family advocacy, and health services for offenders

ages 10 to 21. In the five years since its develop-

ment, 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 stream-

lined network of providers enables more comprehen-

sive 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 regularly

addressed in treatment, as is family advocacy.

Each point of entry in the juvenile justice system

performs a preliminary substance use screen to identi-

fy 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

Promising Strategies to Reduce Substance Abuse

42 An OJP Issues & Practices Report42 An OJP Issues & Practices Report

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 Treat-

ment (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)

■ Provide the client a single point of contact for

multiple health and social services systems;

■ Advocate for the client;

■ Be flexible, community-based, and client-

oriented; and

■ 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 individ-

ual counseling, 12-step meetings, relapse prevention,

vocational training and employment, primary and

mental health care, and parenting/family skills train-

ing 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, show-

ing 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 agen-

cies. They move patients from highly structured inter-

ventions to more flexible treatment as patients

progress toward self-sufficiency by living with peers,

■ Positive family relationships improved from 24

percent to 40 percent; and

■ Ability to respect and follow the law grew

from 20 percent to 47 percent.

A 1998 survey of key decision makers in partici-

pating member agencies involved in the Network

found an overwhelming majority surveyed (95 per-

cent) 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 out-

standing 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. Voca-

tional 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 super-

vision 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 treat-

ment clients’ needs for support services and the avail-

ability 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.

This decline reflected a substantial reduc-

tion 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

Treatment

An OJP Issues & Practices Report 43An OJP Issues & Practices Report 43

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 psycholo-

gist 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.

paying rent, and working. In Birmingham clients par-

ticipate in “contingency management” programs that

make access to housing and employment contingent

on staying clean. Program evaluation found partici-

pants 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.

Alcohol abuse may also increase

an individual’s risk of exposure to HIV by decreasing

the likelihood of condom use.

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.

Treatment presents disease

prevention opportunities, including screening, coun-

seling, 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 pro-

mote 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

According to the National Institute on Drug

Abuse’s Sixth Triennial Report to Congress (1999), com-

prehensive programs that include needle exchange,

community-based outreach, and drug treatment

remain the most cost-effective approaches to averting

new HIV infections.

Alcoholics and other drug addicts often have sig-

nificant 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 moti-

vation, are not receiving them. Community outreach is

critically important in engaging these individuals in

treatment. The following examples highlight how treat-

ment programs are connecting with communities.

Promising Strategies to Reduce Substance Abuse

44 An OJP Issues & Practices Report44 An OJP Issues & Practices Report

A unique treatment component of Healthcare for

the Homeless is the use of contingency rules, which

make housing and work dependent on drug-free liv-

ing. Housing is provided after clients have several

consecutive negative drug screens. To remain in hous-

ing, participants must remain drug-free. Upon testing

positive, participants are immediately placed in a shel-

ter 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 docu-

mentation for a collaborative study. In the second

phase of the program, a challenge was getting psychia-

trists 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 after-

care 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 treat-

ment (counseling, food, transportation), urine moni-

toring ($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 home-

less 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 sig-

nificantly higher in DT+. In addition, the second

study demonstrated reductions in AIDS risk behav-

iors 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

An OJP Issues & Practices Report 45

Treatment

An OJP Issues & Practices Report 45

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 mil-

lion annual operating budget is financed by the pro-

gram’s industrial activities.

The first phase of PHS programming is provided

by its community corrections and behavioral health

divisions. Behavioral health offers residential and out-

patient 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 exam-

ple, 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 sec-

ond phase of PHS, the employment and training pro-

grams. 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 manage-

ment office, two manufacturing plants, and a consult-

ing 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 specializa-

tion required, clients participate in a graduation cere-

mony. 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 ser-

vice agency, all staff members had to modify their out-

look. 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 sub-

stance abuse, and successful transition into the com-

munity. 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 entre-

preneurial options and develop systems for measuring

their outcomes. The cost is $800 per day in consult-

ing 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 pro-

gram graduates in the community. One of the pri-

mary 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

Promising Strategies to Reduce Substance Abuse

46 An OJP Issues & Practices Report46 An OJP Issues & Practices Report

the general workforce in 1998.

PHS programs have

been featured in articles in Newsweek, The Wall Street

Journal, and Forbes.

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

An OJP Issues & Practices Report 47

Treatment

An OJP Issues & Practices Report 47

An OJP Issues & Practices Report 49

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, driv-

ing 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 crimi-

nal 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 polic-

ing, reducing drug availability, and alternatives to incarceration. Often, these strate-

gies 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 ille-

gal drug and alcohol problems; these community coalitions can serve as valuable part-

ners for law enforcement agencies. In many jurisdictions, police partner with and

make referrals to various social, health, and legal agencies. By linking law enforce-

ment 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 fix-

tures in communities and increases police legitimacy in the eyes of residents.

Police departments are now training landlords and community leaders to imple-

ment 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 sell-

ing of illegal drugs more risky, thereby decreasing trafficking and related crime.

50 An OJP Issues & Practices Report50 An OJP Issues & Practices Report

Confronting establishments that sell alcohol to

minors minimizes underage drinking and the prob-

lems 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 pro-

grams that combine criminal sanctions and accounta-

bility 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 commu-

nities 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 commu-

nity 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 com-

munity 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 infor-

mation 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 Understand-

ing Community Policing: A Framework for Action,

community policing consists of two core components:

community partnership and problem solving.

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 depart-

ment has collaborated with community residents,

social service organizations, and city agencies to

resolve 80 percent of all illegal drug and alcohol prob-

lems they encounter.

The rise of community coali-

tions 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 sensitivi-

ty. 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 legit-

imize police efforts. Preventing Crime: What Works,

What Doesn’t, What’s Promising

discusses the strong

correlation between the perceived legitimacy of police

and citizen willingness to obey the law. Furthermore,

Promising Strategies to Reduce Substance Abuse

Law Enforcement

An OJP Issues & Practices Report 51

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 identify-

ing neighborhood crime problems, understanding

why the problems occur, developing and implement-

ing long-term solutions, and determining the solu-

tions’ 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 commu-

nity service and providing them with needed social

services. Court counselors also work with police offi-

cers 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 com-

munity 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 enforce-

ment 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, allow-

ing 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 technolo-

gy 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 aban-

doned 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 aware-

ness 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 ser-

vices 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

Promising Strategies to Reduce Substance Abuse

52 An OJP Issues & Practices Report

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 commu-

nity. Through this process, citizens have created sup-

port networks for crime victims and witnesses.

The success of CAPS is most striking in the

Englewood district. Englewood was chosen as an orig-

inal 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 dramati-

cally. Residents citing street drug dealing as a big

problem decreased from 63 to 49 percent, gang vio-

lence 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 implement-

ing 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 real-

ized 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 com-

munity. The police department spent money on mar-

keting 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 depart-

ment is just under $1 billion. Chicago adapted the

CAPS program to meet the needs of its police depart-

ment 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.

■ Since 1996, citizen awareness of CAPS has

grown from 53 percent to 79 percent;

■ Attendance at beat community meetings

increased to 69,700 in 1998 from 59,200 in

1995; and

■ 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 per-

cent. 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

Law Enforcement

An OJP Issues & Practices Report 53

implementing the Weed and Seed strategy nation-

wide. 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 con-

tributed to making the Weed and Seed program in

Stowe Village a success.

Community police officers in Hartford, called

Community Service Officers (CSOs), are not responsi-

ble for responding to emergency calls and can therefore

devote the vast majority of their time to problem solv-

ing. 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 bet-

ter 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, par-

ticipated 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 special-

ized 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 pur-

chasers, particularly those with significant serious

felony records.

The success of Stowe Village has prompted the

department to use its remaining Weed and Seed fund-

ing 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 prob-

lem, 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 posi-

tive 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 mil-

lion 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

54 An OJP Issues & Practices Report

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 evalua-

tion 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 per-

cent 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 dis-

placed 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 conduct-

ed 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:

■ 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;

■ 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;

■ 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

■ 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 environ-

ment? 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.

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 com-

mon underlying conditions and were part of a broad-

er pattern.

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 effective-

ness 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 strat-

egy 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.

Responding to a problem

means more than providing a quick fix; it means deal-

ing 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

■ Identifying neighborhood crime problems;

■ Understanding the conditions that give rise to

these problems;

■ Developing and implementing long-term

solutions tailored to the problems; and

■ Determining the solutions’ impact on the

problems.

Promising Strategies to Reduce Substance Abuse

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 persist-

ent 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, citi-

zens’ 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 tar-

geted problem, which in turn leads to the develop-

ment of effective solutions. Questions include: What

conditions or events precede or accompany the prob-

lem? 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 con-

venience 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 estab-

lished 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 ask-

ing the property owner to trim back the hedges.

An important element of problem-oriented polic-

ing 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 enforce-

ment 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 ser-

vices. 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 neigh-

bors 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

An OJP Issues & Practices Report 55

Law Enforcement

An OJP Issues & Practices Report 55

56 An OJP Issues & Practices Report

Promising Strategies to Reduce Substance Abuse

56 An OJP Issues & Practices Report

landlords attending the training between 1989 and

1992 reported recent drug activity on their property.

There are three main components to the pro-

gram: 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 implementa-

tion issues, including finding competent staff, devel-

oping 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 con-

cerns, 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 pro-

gram 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 approxi-

mately $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 train-

ers. Fifteen to 20 training sessions are conducted dur-

ing 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:

■ 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);

■ Improvements to the visibility of the property,

such as trimming back overgrown hedges (71

percent); and

■ 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 prob-

lems. 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:

■ 78 percent of the landlords said that they

would definitely change the way they manage

their property as a result of the training; and

■ 80 percent of the landlords felt that the train-

ing was worthwhile.

Law Enforcement

An OJP Issues & Practices Report 57An OJP Issues & Practices Report 57

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 con-

venience store, was generating a substantial number of

service calls and criminal activity in the area. The offi-

cers, utilizing a problem-oriented policing approach,

examined the store and the surrounding area to iden-

tify contributors to illegal activity. Contributing fac-

tors 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 offi-

cers 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 agen-

cies 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 commu-

nity 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 deal-

ers, 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 per-

sonally 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 prop-

erty were donated by community organizations. In

addition, the increased police involvement encour-

aged 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 specif-

ic 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 esti-

mated that 10 percent of locations generate about 60

percent of crimes.

The presence of uniformed offi-

cers at these locations tends to deter the activities of

would-be offenders; it also guarantees immediate

response to problems. By concentrating law enforce-

ment resources in specific locations for several hours a

day, hot spot strategies disrupt retail drug sales with-

out 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, distribu-

tion, 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 coordi-

nation 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,

Promising Strategies to Reduce Substance Abuse

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 ancil-

lary 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.

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.

Forming task forces to combat high rates of drug-

related crime is a popular option for many communi-

ties, 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

58 An OJP Issues & Practices Report

designed to rid prisons of illicit drugs by combining

interdiction methods, drug testing, and drug treat-

ment. 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 need-

ing treatment. All of Pennsylvania’s 24 prisons offer

drug treatment, and seven have therapeutic commu-

nities. 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 test-

ed for drugs each day. Those who test positive face

mandatory punishment and must undergo drug treat-

ment. 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

1982. Nine federal agencies participate in the pro-

gram, 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 enforce-

ment 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 vio-

lence 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, interna-

tional 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 multina-

tional drug trafficking organizations. Technological

advances are key to reducing drug flow into the coun-

try. 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

An OJP Issues & Practices Report 59

Law Enforcement

Contact Information: Drug Enforcement Administra-

tion, 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 net-

works 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 vio-

lent 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, sur-

veillance 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 pri-

mary 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 kilo-

grams of crack cocaine, 20 pounds of marijuana, sev-

en 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.

program would vary depending on how comprehen-

sively the program is replicated and might include

costs for drug screening equipment, phone equip-

ment, and computer equipment.

Program Results: The National Institute of

Justice evaluated the interdiction program in five pris-

ons representing a cross-section of all prisons in the

state and including both male and female inmates.

Urinalysis and hair tests were conducted on 917

inmates in 1996, prior to implementation of the pro-

gram; 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.

■ 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 per-

cent, and tests positive for opiates dropped

from 0.8 percent to 0.6 percent. Hair tests

positive for any drug dropped from 10.6 per-

cent to 2.3 percent.

■ 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 agen-

cies throughout the United States.

Years in Operation: 1995-present.

Program Goals: Deploy MET Special Agents nation-

wide to combat violent drug crimes and drug-related

gang activity.

Promising Strategies to Reduce Substance Abuse

60 An OJP Issues & Practices Report60 An OJP Issues & Practices Report

Law Enforcement

An OJP Issues & Practices Report 61

Challenges: One of the challenges for communi-

ties 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 sur-

veillance, 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:

■ cocaine: 1,637.23 lbs.

■ methamphetamine: 562.73 lbs.

■ heroin: 84.82 lbs.

■ 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 traf-

ficking, encourages community leaders to commit

themselves to implementing strategies that enhance

public safety, and equips leaders to fulfill these commit-

ments 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 sat-

isfied 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 neighbor-

hood 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 com-

munity’s most urgent problems. CNAP’s enforcement

team in North Hills was created using a multiagency

approach to community policing, and included repre-

sentatives from city, county, state, and federal agen-

cies. In order to reduce flagrant street sales of

narcotics in the area, officers conducted numerous

early morning buy/bust and reverse or sting opera-

tions. 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

An OJP Issues & Practices Report 61

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 depart-

ment to train officers on how to use abatement.

Costs and Funding Sources: The CNAP pro-

gram, including all of the integrated services and per-

sonnel from various agencies, costs approximately $9

million annually. The core nuisance abatement pro-

gram 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 pri-

vate resources. A critical cost is money to hire a com-

munity 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, busi-

nesses, 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:

■ Crime statistics show crimes (robbery, burgla-

ry, 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 proj-

ect (186 crimes compared to 254 crimes);

■ 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

addition to undercover operations, prosecutors,

narcotics officers, and code inspectors employed site-

specific narcotics abatement strategies. A gang abate-

ment 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 communi-

ty 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 translat-

ed to serve the predominantly Spanish-speaking com-

munity. 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 pro-

gram 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 nar-

cotics 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 implement-

ing 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).

Promising Strategies to Reduce Substance Abuse

62 An OJP Issues & Practices Report62 An OJP Issues & Practices Report

control of their own recovery and to hold them

accountable for failure to comply with treatment.

Communities often create alternatives to incar-

ceration 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 con-

centrate 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 pro-

gram targets.

Alternative to incarceration programs differ

depending on the stage in the justice system where

the intervention occurs. Different models include:

■ 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;

■ Plea model—before entering the program,

defendants enter a guilty plea which can be

stricken from their record upon successful

completion of the program;

■ Post-adjudication—used mainly for repeat

offenders who face increasingly severe penal-

ties. While prosecutors may be unwilling to

defer prosecution for these offenders, they will

consider more lenient sentencing if partici-

pants plead guilty and undergo treatment pri-

or to sentencing; and

■ Combination model—used by programs that

handle many different types of cases, including

first-time and habitual offenders. Such pro-

grams 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

■ 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:

■ 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

■ 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 over-

load 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.

Drug-abusing offenders are more likely than other

criminals to become repeat offenders. Fifty-one per-

cent of parolees who abuse drugs, regardless of their

offense, return to prison within three years of release,

compared to 40 percent of all parolees.

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 pro-

grams 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

An OJP Issues & Practices Report 63

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An OJP Issues & Practices Report 63

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 correction-

al institution. All treatment and rehabilitation services

are provided in concert with criminal justice sanc-

tions. 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 con-

struction 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 cre-

ating alternatives to incarceration for low-risk offend-

ers. 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 ser-

vices, including substance abuse treatment. Offenders

are sentenced to programs depending on the circum-

stances and the severity of their crime. Individual

continually with participants, increasing offender

accountability. Extensive studies show that, on aver-

age, drug courts reduce recidivism by two-thirds

among those who “graduate,” requiring a fraction of

the cost of incarceration.

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

■ Integrate alcohol and drug treatment services

with justice system case processing;

■ Use a nonadversarial approach in which prose-

cution and defense counsel promote public

safety while protecting participants’ due

process rights;

■ Identify eligible participants early for immedi-

ate referral to the program;

■ Provide access to a continuum of treatment

and rehabilitation services;

■ Monitor abstinence by frequent drug testing;

■ Coordinate court and treatment responses to

compliance or lack of compliance, including

contingency contracts that involve participants

in their own sanctions and incentives;

■ Require ongoing judicial interaction with drug

court participants;

■ Monitor and evaluate achievement of program

goals and program effectiveness;

■ Promote effective programs through interdisci-

plinary education of planning teams; and

■ Forge partnerships among drug courts, public

agencies, and community-based organizations.

Another program that employs the coercive pow-

er 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, pro-

vides a bridge between the criminal justice system and

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64 An OJP Issues & Practices Report64 An OJP Issues & Practices Report

■ Cost saving: The average annual cost for an

offender in the program is $7,000 per year, ver-

sus $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.

■ 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.

■ 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 peo-

ple 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 with-

draw within the first 14 days with no penalty. Before

services are provided by over 100 private, nonprofit

organizations throughout the state.

Offenders enter AIP at either the pretrial or post-

conviction stage of criminal processing. Offenders

held in pretrial detention are assessed by bail commis-

sioners who, based on the needs of the offenders and

their likelihood of rearrest, recommend an appropri-

ate 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. Comm-

unity safety is considered each time an offender is rec-

ommended 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.

Law Enforcement

An OJP Issues & Practices Report 65An OJP Issues & Practices Report 65

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 pro-

gram but did not participate. The evaluation found

that program participants had fewer arrests than non-

participants and that the amount of time spent in the

program had a positive effect on arrest rates. Two

years after leaving the program:

■ Program participants (graduates and nongrad-

uates) had 61 percent fewer total arrests than

the comparison group; program graduates had

76 percent fewer arrests than the comparison

group.

■ Program participants (graduates and nongrad-

uates) had 64 percent fewer felony arrests than

the comparison group; graduates had 80 per-

cent fewer felony arrests than the comparison

group clients.

■ Program participants (graduates and nongrad-

uates) 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 tax-

payers $23,235 in avoided costs per program partici-

pant 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 offend-

ers 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

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. Approxi-

mately 46 percent of the offenders who enter the pro-

gram graduate.

Substance abuse treatment is provided by InAct

Inc., a private agency. At the beginning of the pro-

gram clients are required to attend group and individ-

ual 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 uri-

nalysis 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 implement-

ing the Portland program, which is common among

drug courts, was deciding whether the judge or the

treatment provider would have the authority to termi-

nate 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, pub-

lished in 1998, was funded by the State Justice

Institute and conducted for the Multnomah County

Promising Strategies to Reduce Substance Abuse

66 An OJP Issues & Practices Report66 An OJP Issues & Practices Report

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 communi-

ties 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 mandato-

ry 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 pros-

ecution 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 cri-

teria 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 facili-

ties for participating offenders, and the judge presid-

ing 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 pro-

gram. 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 implement-

ing 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 advo-

cate 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 par-

ticipants were referred to the most appropriate treat-

ment 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, treat-

ment 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.

An OJP Issues & Practices Report 67

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An OJP Issues & Practices Report 67

Program Results: DTAP has proven successful

on many levels. As of October 15, 1999:

■ 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;

■ 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 per-

cent among those employed;

■ Recidivism—The three-year reincarceration

rate for program graduates was less than half

of the rate for the control group rate (23 per-

cent compared to 47 percent); and

■ 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 par-

ticipants versus 62 percent among the control group;

similar declines were found for cocaine (85 percent

versus 27 percent), crack (96 percent versus 51 per-

cent), 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.

In addi-

tion, national surveys indicate that ten million young

people under the age of 21 drink alcohol at least once

a month.

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).

Large num-

bers 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 abil-

ity to reduce drunk driving.

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 inter-

lock, 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

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68 An OJP Issues & Practices Report68 An OJP Issues & Practices Report

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 vio-

lence victims report that the offender had been drink-

ing 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 vari-

ous 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

law enforcement, including the use of sting opera-

tions targeting alcohol merchants and underage buy-

ers, is essential in reducing underage access to alcohol.

For example, the Denver Police Department’s compli-

ance 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 depart-

ments 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 resi-

dents 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 resi-

dents, mediated between the owner and residents,

trained the bar’s security staff to handle problems bet-

ter, 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 partner-

ships within the community. In North Carolina, for

example, Alcohol Law Enforcement officers conduct

a statewide B.A.R.S. (Be a Responsible Server) pro-

gram, 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 acci-

dents and other problems that degrade neighborhoods,

An OJP Issues & Practices Report 69

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An OJP Issues & Practices Report 69

70 An OJP Issues & Practices Report

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, presen-

tence voluntary program; offenders must be convicted

before they enter the program. Program participants

are supervised by DWI/Drug Court probation offi-

cers, receive mandatory alcohol and other drug treat-

ment, 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 pro-

gram. Clients often develop a positive relationship

with the judge, wanting to succeed in part to please

him.

Defendants who violate conditions of the pro-

gram 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 alter-

native 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 current-

ly operates five of these units.

Challenges: One of the challenges in implement-

ing the Bernalillo DWI/Drug Court was convincing

participants that they would benefit from the treat-

ment program. Most other drug courts operate at the

felony level, and judges have the power to dismiss cas-

es 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 rec-

ommending 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 pro-

gram 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.

■ 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

Promising Strategies to Reduce Substance Abuse

Law Enforcement

An OJP Issues & Practices Report 71

■ The program’s retention rate is 82 percent.

The DWI/Drug Court is in the process of con-

tracting with the University of New Mexico to con-

duct 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 check-

point 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 check-

points were conducted, compared to a previous annu-

al 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 addi-

tional 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 sub-

mit 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 pro-

vide 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 depart-

ments 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 detec-

tion 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 con-

duct 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 writ-

ten to guide other states in replicating the program.

Challenges: There were significant logistical chal-

lenges in implementing Checkpoint Tennessee, since

all of the checkpoints had to be scheduled one year in

advance. Another logistical difficulty was getting per-

sonnel and equipment to each checkpoint; four spe-

cially equipped vans had to be shared by eight THP

districts. After a few checkpoints were conducted and

the program became routine, personnel and equip-

ment 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, pub-

licity 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

72 An OJP Issues & Practices Report

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 check-

point. Once the equipment has been purchased, the

costs are primarily for staff salaries. Many larger com-

munities already have the equipment necessary to

conduct checkpoints, which would substantially

reduce program costs.

Program Results: Results from the NHTSA eval-

uation are promising. During the first year of the pro-

gram, 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, com-

pared 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 employ-

ing 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 invit-

ed to participate in the B.A.R.S. (Be A Responsible

Server) educational program. B.A.R.S. teaches mer-

chants how to sell alcohol responsibly by checking

identification and recognizing fake IDs. ALE agents

reinforce the state’s alcohol laws and introduce mer-

chants 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 vis-

its, 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 offi-

cials, not just ALE agents, will be invited to partici-

pate 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.

Promising Strategies to Reduce Substance Abuse

Law Enforcement

An OJP Issues & Practices Report 73

Challenges: The main implementation challenge

of Secret Shopper was targeting a random sample of

businesses. In order to do a random sample, all estab-

lishments randomly selected should be visited.

However, some of the establishments randomly select-

ed (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 cov-

ered all costs of the project, including overtime pay

for ALE agents and hourly wages for the youth work-

ers ($5.55). Additional costs included printing the

training manual and purchasing a color printer to

produce the fliers handed to merchants. For a com-

munity 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 pro-

gram and the B.A.R.S. program significantly con-

tributed to reduced alcohol sales to minors. During

the first phase of the program, 26 percent of the busi-

nesses visited sold alcohol to minors. During the sec-

ond phase of the program, of the establishments who

originally sold to minors:

■ 29 percent of those who did not attend

B.A.R.S. sold to minors a second time; and

■ Only 16 percent of those who attended

B.A.R.S. sold to minors a second time.

An OJP Issues & Practices Report 75

Conclusion

Promising Strategies to Reduce Substance Abuse describes the most effective preven-

tion, 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 resi-

dents 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 sys-

tems, personnel, and resources are all part of the continuum of care vital to the suc-

cess 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 communi-

ties 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 appeal-

ing 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 infor-

mation on what approaches are effectively reducing substance abuse and related prob-

lems nationwide and is intended to assist them in determining how strategies and

programs can address their specific needs.

An OJP Issues & Practices Report 77

Endnotes

1. Understanding Substance Abuse Prevention, Toward the 21st Century: A

Primer on Effective Programs. Center for Substance Abuse Prevention,

Monograph, 1999.

2. Understanding Substance Abuse Prevention, Toward the 21st Century: A

Primer on Effective Programs. Center for Substance Abuse Prevention,

Monograph, 1999.

3. J. David Hawkins, “Risk Focused Prevention: Prospects and Strategies,”

Presentation to the Federal Coordinating Council on Juvenile Justice and

Delinquency Prevention, June 23, 1989.

4. Barry S. Brown and Arnold R. Mills, eds., Youth at High Risk for Substance

Abuse, Rockville, MD: National Institute on Drug Abuse, 1987.

5. Preventing Drug Use Among Children and Adolescents: A Research-Based Guide.

National Institute on Drug Abuse, 1997.

6. Understanding Substance Abuse Prevention, Toward the 21st Century: A

Primer on Effective Programs. Center for Substance Abuse Prevention,

Monograph, 1999.

7. Making the Grade: A Guide to School Drug Prevention Programs. Drug

Strategies, 1999.

8. Making the Grade: A Guide to School Drug Prevention Programs. Drug

Strategies, 1999.

9. Bridget Grant and Deborah Dawson, “Age at Onset of Alcohol Use and Its

Association with DSM-IV Alcohol Abuse and Dependence: Results from the

National Longitudinal Alcohol Epidemiologic Survey.” Journal of Substance

Abuse, 9:103-110, 1997.

10. Making the Grade: A Guide to School Drug Prevention Programs. Drug

Strategies, 1999.

11. Making the Grade: A Guide to School Drug Prevention Programs. Drug

Strategies, 1999.

12. Denise C. Gottfredson, School-Based Crime Prevention, in Preventing Crime:

What Works, What Doesn’t, What’s Promising, prepared by the University of

Maryland, Department of Criminology and Criminal Justice for the Office of

Justice Programs, 1997.

13. Michael D. Resnick, Peter S. Bearman, Robert Wm. Blum et al., “Protecting

Adolescents from Harm: Findings from the National Longitudinal Study on

Adolescent Health.” Journal of the American Medical Association, 1997, 278

(10):823-832.

14. Making the Grade: A Guide to School Drug Prevention Programs. Drug

Strategies, 1999.

15. National Drug Control Strategy, Budget Summary. Washington, DC: Office of

National Drug Control Policy (February 1997).

16. Mentoring—A Proven Delinquency Prevention Strategy. Office of Juvenile Justice

and Delinquency Prevention, Juvenile Justice Bulletin, April 1997.

17. Joseph P. Tierney, Jean B. Grossman, and Nancy L. Resch, Making a

Difference: An Impact Study of Big Brothers/Big Sisters (Philadelphia, PA:

Public/Private Ventures, November 1995).

18. Preventing Crime: What Works, What Doesn’t, What’s Promising. Lawrence W.

Sherman, et al. U.S. Department of Justice Office of Justice Programs, 1997.

19. Understanding Substance Abuse Prevention, Toward the 21st Century: A

Primer on Effective Programs. Center for Substance Abuse Prevention,

Monograph, 1999.

20. Understanding Substance Abuse Prevention, Toward the 21st Century: A

Primer on Effective Programs. Center for Substance Abuse Prevention,

Monograph, 1999.

21. Deborah A. Ellis, Robert A. Zucker and Hiram E. Fitzgerald, “The Role of

Family Influences in Development and Risk.” Alcohol Health and Research

World, NIAAA, 21(3):218-226, 1997.

22. The Relationship Between Mental Health and Substance Abuse Among Adolescents.

Substance Abuse and Mental Health Services Administration, 1999.

23. Parental Drug Abuse Has Alarming Impact on Young Children. Washington, DC:

U.S. General Accounting Office, April 1994.

24. Olds, D., Henderson, C.R., Cole, R., et al., “Long-term Effects of Nurse

Home Visitation on Children’s Criminal and Antisocial Behavior: 15-year

follow-up of a randomized trial.” Journal of the American Medical Association,

280(14):1238-1244, 1998.

25. 1997 PRIDE Survey. Bowling Green, KY: Parents Research Institute for Drug

Education, October, 1997.

26. “National Survey Results on Drug Abuse from Monitoring the Future Study.”

NIDA, 1998.

27. Preventing Substance Abuse Among Children and Adolescents: Family-Centered

Approaches. Center for Substance Abuse Prevention, SAMHSA, 1998.

28. Preventing Drug Use Among Children and Adolescents: A Research-Based Guide.

National Institute on Drug Abuse, 1997.

29. Preventing Substance Abuse Among Children and Adolescents: Family-Centered

Approaches. Center for Substance Abuse Prevention, SAMHSA, 1998.

30. Preventing Substance Abuse Among Children and Adolescents: Family-Centered

Approaches. Center for Substance Abuse Prevention, SAMHSA, 1998. Also see

NIJ study.

78 An OJP Issues & Practices Report78 An OJP Issues & Practices Report

Promising Strategies to Reduce Substance Abuse

Endnotes

31. Preventing Substance Abuse Among Children and Adolescents: Family-Centered

Approaches. Center for Substance Abuse Prevention, SAMHSA, 1998.

32. The 48 Community Cross-Site Evaluation of Community Coalitions. Center for

Substance Abuse Prevention, in press.

33. Learning from Eight of the Best. Lessons Learned from Annie E. Casey Case Studies

of Effective Community Coalitions. Community Anti-Drug Coalitions of

America, in press.

34. Henrick J. Harwood, Martin Thomsom, and Travis Nesmith, “Healthcare

Reform and Substance Abuse Treatment: The Cost of Financing Under

Alternative Approaches” (Fairfax, VA: Lewin-VHI, Inc., February 1994).

35. Evaluating Recovery Services: The California Drug and Alcohol Treatment

Assessment (CALDATA) Executive Summary (Sacramento, CA: Department

of Alcohol and Drug Programs, 1994).

36. National Treatment Improvement Evaluation Study, SAMHSA (1997).

37. Drug Abuse Treatment Outcomes Study, NIDA, December 1997.

38. Mathea Falco, The Making of a Drug-Free America, Programs That Work (New

York, NY: Times Books, 1994).

39. Dean R. Gerstein and Henrick J. Harwood (eds.), Treating Drug Problems,

Volume I (Washington, DC: National Academy Press, 1990).

40. “Marijuana Initiates and Their Impact on Future Drug Abuse Treatment

Need.” Drug and Alcohol Dependence, April 1999.

41. R. Lennox, J. Scott-Lennox, H. Holder, “Substance Abuse and Family Illness:

Evidence from Health Care Utilization and Cost-Offset Research.” The Journal

of Mental Health Administration (Special Issue: Substance Abuse Services),

19(1):83-95, 1992.

42. Uniform Facility Data Set (UFDS), SAMHSA (December 1997).

43. Lauri Cawthon and Laura Schrager, “Substance Abuse, Treatment, and Birth

Outcomes for Pregnant and Postpartum Women in Washington State.”

Olympia, Washington: Department of Social and Health Services, January

1995.

44. Vicki Breitbart, Wendy Chavkin, and Paul H. Wise, “The Accessibility of

Drug Treatment for Pregnant Women: A Survey of Programs in Five Cities.”

American Journal of Public Health, Vol. 84, No. 10, October 1994, pp. 1658-

1661.

45. March of Dimes data; Shawn LaFrance, “Community-Based Services for

Pregnant Substance-Using Women,” American Journal of Public Health, Vol.

84, No. 10, October 1994.

46. Uniform Facility Data Set (UFDS), SAMHSA (December 1997).

47. Services Research Outcomes Study, SAMHSA (September 1998).

48. National Treatment Improvement Evaluation Study, SAMHSA (1997).

An OJP Issues & Practices Report 79

49. National Treatment Improvement Evaluation Study, SAMHSA (1997).

50. Shirley D. Coletti, John A. Schinka, Patrick H. Hughes, Nancy L. Hamilton,

Carol G. Renard, Donna M. Sicilian, and Robert L. Neri, “Specialized

Therapeutic Community Treatment for Chemically Dependent Women and

Their Children.” In Community as Method: Therapeutic Communities for

Special Populations and Special Settings. Ed. George De Leon. Westport,

Connecticut: Praeger Publisher, 1997.

51. Charles Winick and John T. Evans, “A Therapeutic Community Program for

Mothers and Their Children.” In Community as Method: Therapeutic

Communities for Special Populations and Special Settings. Ed. George De Leon.

Westport, Connecticut: Praeger Publisher, 1997.

52. Sally J. Stevens, Naya Arbiter, and Robin McGrath, “Women and Children:

Therapeutic Community Substance Abuse Treatment.” In Community as

Method: Therapeutic Communities for Special Populations and Special Settings.

Ed. George De Leon. Westport, Connecticut: Praeger Publisher, 1997.

53. L. Dahlgren and A. Willander, “Are Special Treatment Facilities for Female

Alcoholics Needed?: A Controlled 2-year Follow-up Study from a Specialized

Female Unit (EWA) Versus a Mixed Male/Female Treatment Facility.”

Alcoholism: Clinical and Experimental Research, 13(4):499-504, 1989.

54. Dace E. Svikis, Archie S. Golden, George R. Huggins, et al., “Cost-

Effectiveness of Treatment for Drug-Abusing Pregnant Women.” Drug and

Alcohol Dependence, 45:105-113, 1997.

55. Correctional Populations in the United States, 1994. Bureau of Justice Statistics,

1996.

56. Prisoners in 1997. Bureau of Justice Statistics, 1998.

57. Arrestee Drug Abuse Monitoring Program, National Institute of Justice, 1999.

58. Alcohol and Crime: An Analysis of National Data on the Prevalence of Alcohol

Involvement in Crime. U.S. Department of Justice, Bureau of Justice Statistics,

April 1998.

59. Substance Abuse and Treatment, State and Federal Prisoners, 1997. Bureau of

Justice Statistics, 1999

60. Keeping Score 1995, Drug Strategies, 1995.

61. Principles of Drug Addiction Treatment: A Research-Based Guide. National

Institute on Drug Abuse, 1999.

62. Inciardi, J.A., A Corrections-Based Continuum of Effective Drug Abuse Treatment.

National Institute of Justice’s Research in Progress Seminal Series, 1996.

63. Martin, S.S., Butzin, C.A., Saum, C.A., Inciardi, J.A., “Three-Year Outcomes

of Therapeutic Community Treatment for Drug-Involved Offenders in

Delaware: From Prison to Work Release to Aftercare.” The Prison Journal,

79(3):294-320, 1999.

80 An OJP Issues & Practices Report80 An OJP Issues & Practices Report

Promising Strategies to Reduce Substance Abuse

64. Planning for Alcohol and Other Drug Abuse Treatment for Adults in the Criminal

Justice System: Treatment Improvement Protocol (TIP) Series 17, SAMHSA,

1995.

65. Prisoners in 1997, Bureau of Justice Statistics, 1998.

66. Sourcebook of Criminal Justice Statistics, 1993. U.S. Department of Justice,

1994.

67. Principles of Effective Treatment: A Research-Based Guide. National Institute on

Drug Abuse, 1999.

68. Treatment Episode Data Set, SAMHSA, 1998.

69. Preliminary Results from the 1998 National Household Survey on Drug Abuse.

Substance Abuse and Mental Health Services Administration, 1999.

70. Keeping Score 1997, Drug Strategies, 1997.

71. Strategies for Integrating Substance Abuse Treatment and the Juvenile Justice

System: A Practice Guide. Center for Substance Abuse Treatment, 1999.

72. Etheridge RM, Craddock SG, Dunteman GH, and Hubbard RL, “Treatment

Services in Two National Studies of Community-Based Drug Abuse Treatment

Programs.” Journal of Substance Abuse, 7:9-26, 1995.

73. Comprehensive Case Management for Substance Abuse Treatment: Treatment

Improvement Protocol 27. Federal Center for Substance Abuse Treatment, 1998.

74. Drug Abuse and Addiction Research: 25 Years of Discovery to Advance the Health

of the Public. National Institute on Drug Abuse, 1999.

75. Lee Strunin and Ralph Hingson, “Alcohol Use and Risk for HIV Infection.”

Alcohol Health and Research World, 17(1):35-38,1993.

76. Principles of Effective Treatment: A Research-Based Guide. National Institute on

Drug Abuse, 1999.

77. J. Normand, D. Vlahov, and L.E. Moses (eds.), Preventing HIV Transmission,

The Role of Sterile Needles and Bleach (Washington, DC: National Academy

Press, 1995).

78. Drug Abuse and Addiction Research: 25 Years of Discovery to Advance the Health

of the Public. National Institute on Drug Abuse, 1999.

79. The 1998 figure is based on SmithKline Beecham’s Drug Testing Index for the

General Workforce.

80. Understanding Community Policing: A Framework for Action. Community

Policing Consortium, Monograph, 1994.

81. Forging New Links: Police, Communities and the Drug Problem. Drug Strategies,

1997.

82. Preventing Crime: What Works, What Doesn’t, What’s Promising. Lawrence W.

Sherman, et al. U.S. Department of Justice Office of Justice Programs, 1997.

An OJP Issues & Practices Report 81

Endnotes

83. Preventing Crime: What Works, What Doesn’t, What’s Promising. Lawrence W.

Sherman, et al. U.S. Department of Justice Office of Justice Programs, 1997.

84. Herman Goldstein, “Improving Policing: A Problem-Oriented Approach.”

Crime and Delinquency, 25(2):236-258, 1979.

85. Problem-Oriented Drug Enforcement: A community-based approach for effec-

tive Policing. Bureau of Justice Assistance, 1993.

86. Module Three: Community Policing Problem-Solving: Taking a Problem-Solving

Approach to Tackling Crime, Fear and Disorder. Community Policing

Consortium, 1997.

87. William Spelman and John E. Eck, “Sitting Duck, ravenous Wolves, and

Helping Hands: New approaches to Urban policing.” Public Affairs Comment,

35(2):1-9, 1989.

88. James R. Lasley, "Using Traffic Barriers to ‘Design out’ crime: A Program

Evaluation of LAPD’s Operation Cul-De-Sac.” Report to the National

Institute of Justice. California State University, Fullerton, 1996.

89. Policing Drug Hot Spots. National Institute of Justice, 1996.

90. Thomas E. Feucht and Andrew Keyser, “Reducing Drug Use in Prisons:

Pennsylvania’s Approach.” National Institute of Justice Journal, October 1999.

91. Cutting Crime: Drug Courts in Action. Drug Strategies, 1997.

92. Cutting Crime: Drug Courts in Action. Drug Strategies, 1997.

93. Cutting Crime: Drug Courts in Action. Drug Strategies, 1997.

94. Cutting Crime: Drug Courts in Action. Drug Strategies, 1997.

95. Defining Drug Courts: The Key Components. The National Association of Drug

Court Professionals in collaboration with Drug Courts Program Office, Office

of Justice Programs, 1997.

96. Alcohol and Crime: An Analysis of National Data on the Prevalence of Alcohol

Involvement in Crime. U.S. Department of Justice, Bureau of Justice Statistics,

April 1998.

97. Preliminary Results from the 1998 National Household Survey on Drug Abuse.

Substance Abuse and Mental Health Services Administration, 1999.

98. Alcohol and Crime: An Analysis of National Data on the Prevalence of Alcohol

Involvement in Crime. U.S. Department of Justice, Bureau of Justice Statistics,

April 1998.

99. Preventing Crime: What Works, What Doesn’t, What’s Promising. Lawrence W.

Sherman, et al. U.S. Department of Justice Office of Justice Programs, 1997.

100. “National Survey Results on Drug Abuse from Monitoring the Future Study.”

NIDA, 1998.

82 An OJP Issues & Practices Report82 An OJP Issues & Practices Report

Promising Strategies to Reduce Substance Abuse

101. Preusser, D.F., A.F. Williams, and H.N. Weinstein. Policing underage alcohol

sales. Journal of Safety Research. 25(3):127-133. 1994.

102. Richard Scribner, Deborah Cohen, Stephen Kaplan and Susan H. Allen,

“Alcohol availability and homicide in New Orleans: conceptual considerations

for small area analysis of the effect of alcohol outlet density.” Journal of Studies

on Alcohol, 60(3):310-316, 1999.

103. Alcohol and Crime: An Analysis of National Data on the Prevalence of Alcohol

Involvement in Crime. U.S. Department of Justice, Bureau of Justice Statistics,

April 1998.

An OJP Issues & Practices Report 83

Endnotes

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