Overview
Each year, drug- and alcohol abuse contributes to the death of more than 120,000 Americans. Drugs and alcohol cost taxpayers nearly $276 billion annually in preventable health care costs, extra law enforcement, auto crashes, crime and lost productivity. The Clinton Administration has made reducing substance abuse a top priority -- with a particular focus on preventing youth substance abuse. Overall use of drugs in the United States has fallen by half in the past 20 years and there has been a consistent moderating trend over the last three years among adolescents.
The Department of Health and Human Services (HHS) plays a key role in the Administration's substance abuse strategy, leading drug abuse research, prevention and treatment. HHS funding accounts for about 52 percent of the federal government's demand reduction activities, and -- as part of the overall Administration strategy -- HHS is increasing its resources dedicated to preventing youth substance use. In fiscal year 2000, HHS invested approximately $350 million in youth-focused substance abuse activities, which worked to raise awareness among youth and support communities in their efforts to adopt science-based, proven substance abuse prevention strategies. The HHS investment included $61.7 million for State Incentive Grants for Community-Based Action to governors' offices in 27 states and the mayor's office in the District of Columbia to support planning for coordinated substance abuse prevention services. In fiscal year 2000, HHS was appropriated a total of $3.1 billion for substance abuse-related activities and has requested $3.3 billion in fiscal year 2001.
According to the 2000 Monitoring the Future Survey, overall use of illicit drugs among teenagers remained unchanged in the past year; the fourth year in a row that drug use stayed level or declined. The survey confirms the declines in teens' use of illicit drugs, marijuana, and cigarettes found in the 1999 National Household Survey over the last three years.
Among the overall population, illicit drug use also remained flat in 1999, according to the National Household Survey.
Recent Findings
HHS is responsible for three major drug surveys: the National Household Survey (NHS), the Monitoring the Future Survey (MTF) and the Drug Abuse Warning Network (DAWN). NHS monitors trends in illicit drug, alcohol and tobacco use and attitudes about drugs among Americans age 12 and older; MTF monitors teenage students in the eighth, 10th and 12th grades; and DAWN records drug-related hospital emergency-department episodes and drug-related deaths.
In 1999, an estimated 14.8 million Americans (6.7 percent of those 12 years and older) were current illicit drug users, which was nearly half the 1979 peak level of 25 million current users. [1999 NHS]
NHS national trend data shows that the total number of current (at least once in the past month) illicit drug users age 12 and older in the U.S. has remained level since 1992. [NHS 1999]
Among adolescents' use of illicit drugs, the results from the last three years of Monitoring the Future and the National Household Survey show a consistent moderating trend after dramatic increases in the early 1990s.
The 2000 Monitoring the Future Survey suggests that lifetime, past year and past month use of illicit drugs and marijuana among teenagers remained stable or declined for the fourth year in a row. According to 1999 NHS national trend data, there is also a significant consistent downward trend among youths 12-17 from 11.4 percent in 1997 to 9.9 percent in 1998 and 9.0 percent in 1999. [2000 MTF, 1999 NHS]
The DAWN survey confirms an overall trend of stability in the numbers of drug-related emergency room visits over the past five years in the general population. Among 12-17 year olds, there was an 11 percent decrease in emergency room visits for drug-related reasons from 1998 to 1999. [1999 DAWN]
An estimated 66.8 million Americans age 12 and older used a tobacco product in 1999. This estimate represents 30.2 percent of the population, and has remained steady. [1999 NHS]
According to the 2000 MTF, past month use of cigarettes decreased significantly among 8th graders from 17.5 percent to 14.6 percent and among 12th graders from 34.6 percent to 31.4 percent. Reductions in other categories of smoking also occurred among 8th, 10th, and 12th graders in the 2000 MTF survey. This is consistent with a similar downward trend in cigarette use among youth age 12-17 from 1997-1999 in the 1999 NHS. [2000 MTF, 1999 NHS]
In 1999, 105 million Americans (47.3 percent) reported current use of alcohol. About 45 million people (20.2 percent) engaged in binge drinking, and 12.4 million (5.6 percent) were heavy drinkers. [1999 NHS]
For the past few years, alcohol use has remained stable among Americans age 12 and older, according to NHS national trend data. [1999 NHS]
Alcohol use has generally remained stable in the past few years among teenagers, even though daily use of alcohol among 8th graders decreased significantly from 1.0 percent to 0.8 percent from 1999 to 2000. [2000 MTF, 1999 NHS]
According to the NHS, an estimated 18.6 percent of young people age 12-17 used alcohol in the month prior to the survey. [1999 NHS]
Alcohol use among all teenagers remains at unacceptably high levels. In 2000, 30.0 percent of 12th graders, 26.2 percent of 10th graders, and 14.1 percent of 8th graders reported binge drinking, defined as five or more drinks in a row, at least once in the two weeks prior to the survey. [2000 MTF]
HHS Substance Abuse Initiatives, Research, and Programs
Marijuana Initiative
To reduce marijuana use among American youth, HHS in July 1995 began a comprehensive marijuana initiative. As part of this initiative, HHS has funded new research on the effects of marijuana and launched major prevention-oriented campaigns to help parents educate children about the dangers of drugs -- like the Substance Abuse and Mental Health Administration's "Reality Check" anti-marijuana campaign and free publication for parents "Keeping Youth Drug Free." In December 1998, the National Institute on Drug Abuse (NIDA) kicked off its NIDA Goes to School Initiative by distributing information kits to every middle school in the United States. The kits contain research-based materials, including the award-winning "Mind Over Matter" poster magazine series and "Marijuana: What Parents Need to Know" and "Marijuana: Facts for Teens." These and other free materials may be obtained by calling 1-800-729-6686.
HHS has also conducted outreach to the media and entertainment industries, enlisting their help in communicating the facts about marijuana to the American people; and implemented an aggressive communications strategy, including collaborations with Weekly Reader, Scholastic and Reader's Digest magazines and the National Association of Broadcasters, to reach children in their homes and in their classrooms with prevention messages.
Club Drugs
In 1999, NIDA launched a new national education, prevention and research initiative to combat the increased use of club drugs such as ecstasy. This new initiative includes raising funding for research on club drugs by 40 percent to a total commitment of $54 million and a multi-media public education strategy including a specially-designed Web site, www.clubdrugs.gov, to alert teens, parents and educators about the dangers of club drugs such as ecstasy, GHB and Rohypnol. These drugs are often used at all night "raves" or dance parties and have potentially life-threatening effects.
Additionally, the Substance Abuse and Mental Health Services Administration (SAMHSA) has begun an educational program on club drugs targeted to adolescents and young adults, as well as to parents, health professionals, community organizations, and workplaces. Information on club drugs has been included in SAMHSA's Tips for Teens series, and is being incorporated into the Reality Check 2001 monthly planner for teens, the Retro Spective - Parents' Guide to Youth Culture, Keeping Youth Drug Free in the New Millennium booklet, and the For Real Web site. Further information will be posted on existing Web sites geared to young people, adults, and prevention professionals. SAMHSA will also identify and disseminate effective prevention practices through its existing Community Initiated Interventions program. Funds from this program are being earmarked to target club drugs.
Steroid Initiative
Recognizing from the 1999 MTF data that steroid abuse may be on the rise, NIDA took a preemptive strike to curtail this problem by joining with seven national partners to launch in April 2000 an initiative designed to alert the public about the risks associated with anabolic steroid use. The Institute's partners in the initiative include the National Collegiate Athletic Association, American College of Sports Medicine, American Academy of Pediatrics, National Association of School Nurses, National Federation of High Schools, International Students in Action, and Dr. Drew Pinsky, co-host of MTV's Loveline and drDrew.com. The initiative includes a new Web site, www.steroidabuse.org, the release of an updated Research Report on anabolic steroids, and distribution of over 500,000 copies of a Community Drug Alert Bulletin and "art cards" with messages about the harmful effects of steroid abuse. NIDA also developed an anabolic steroids video news release that had over 50 airings and reached over 2.3 million households.
Supporting and Maintaining State Prevention and Treatment Systems
Research shows that for every dollar spent on drug abuse prevention, communities can save $4 to $5 in costs for drug abuse treatment and counseling. SAMHSA provides funds directly to states through the Substance Abuse Prevention and Treatment Block Grant. These grants, administered by SAMHSA, support almost 40 percent of all substance abuse treatment provided through state agencies. Using these federal resources, the states were able to provide treatment to almost 338,000 persons with serious substance abuse problems in 1999.
Recognizing the importance of prevention, the block grant law also provides that states use a minimum of 20 percent of their block grant funds to deliver state substance abuse primary prevention services in community and school settings. The set-aside supports approximately 60 percent of prevention services provided through state agencies. Block grant services are generally targeted to populations with greatest need, including high-risk youth, youth involved with the criminal justice system, pregnant and postpartum women, and people with HIV infection. The total Substance Abuse Prevention and Treatment Block Grant for fiscal year 2000 is $1.6 billion.
Knowledge Development and Application Grants
Investments in improving performance and quality of substance abuse prevention and treatment services through SAMHSA's Knowledge Development and Application (KD&A) program is funding the discovery of new, more effective ways to deliver services paid for through block grant funding, Medicaid, Medicare and private sector insurance. For example, SAMHSA's Center for Substance Abuse Treatment (CSAT) has launched an initiative to determine the effectiveness of available methamphetamine addiction treatments for various populations and the cost effectiveness of the various treatment approaches. CSAT is investing in improving treatment services available for adolescents and adults dependent on marijuana.
SAMHSA's Center for Substance Abuse Prevention (CSAP) is also working in a number of targeted areas, including underage drinking, family-focused prevention programs, and children of substance-abusing parents, to improve system performance and service quality. For example, CSAP has awarded 95 grants totaling $9.8 million to communities to provide parenting and family support services that are proven by research to reduce substance abuse. Through SAMHSA's Starting Early Starting Smart Initiative, a special emphasis is being placed on addressing the needs of young children (birth to age seven) who are at high risk for developing substance abuse or mental health-related problems. This initiative, developed in partnership with The Casey Family Program, is integrating substance abuse and mental health services into service settings that families already use for child care and primary care.
In addition, CSAP and the National Institute on Alcohol Abuse and Alcoholism (NIAAA) have a study underway to examine the effects of alcohol advertising on underage drinking and are also working to identify, develop and test effective interventions to prevent and reduce alcohol-related problems, illnesses and even death, among college students. The total funding for KD&A grants is estimated at $160 million in fiscal year 2000.
Targeted Capacity Expansion Grants
The goal of SAMHSA's Targeted Capacity Expansion (TCE) Grants Program is to identify and aggressively contain emerging substance abuse trends and related public health (HIV/AIDS) problems before they intensify. With these grants, officials from municipalities including Indian tribal governments are able to provide a rapid, strategic response to the demand for services that are more regional or local in nature.
For example, these grants are being used to respond to the outbreak of methamphetamine use that has spread across the Southwest as well as dramatic heroin use increases reported in localized areas. In addition, TCE grants are funding gender-specific treatment services to women and substance abuse treatment and services related to HIV/AIDS in African American, Hispanic/Latino and other racial and ethnic minority communities that have been affected by substance abuse and HIV/AIDS. The total funding for TCE grants is estimated at $195 million in fiscal year 2000.
SAMHSA is also working with governors in 27 states and the mayor of the District of Columbia, all awardees of the State Incentive Grant program, to develop state/city-wide strategies and deliver science-based substance abuse prevention services. A full 85 percent of incentive grant funds are being directed to community prevention programs, resulting in the funding of programs in more than 1000 communities.
Drug Abuse Research
The National Institute on Drug Abuse (NIDA) provides more than 85 percent of the support for research on drug abuse and drug addiction in the world. This research provides the scientific foundation for prevention and treatment programs all across America. Examples of recent and ongoing research include: studying the biological basis of addiction by measuring changes in the brain resulting from drug use; developing medications to treat drug addiction; assessing and improving behavioral and psychosocial treatments; studying the organization and financing of drug abuse treatment and linkage to primary medical care; studying marijuana use and its effect on learning and memory, motivation and health consequences; studying the long-term consequences of prenatal exposure to drugs; identifying protective and resiliency factors that prevent drug use in those individuals with multiple risk factors so that more effective prevention techniques can be developed; and studying the application of state-of-the-art neuroimaging techniques to the problems of drug abuse prevention and treatment.
Alcohol Research
The National Institute on Alcohol Abuse and Alcoholism (NIAAA), provides leadership and financial support for approximately 90 percent of all alcohol-related research in the United States. NIAAA supports research on the causes, consequences, treatment and prevention of alcohol-related problems. Highlights of NIAAA research include: determining how genetic and environmental factors interact in the development of alcoholism; conducting neuroscience research to understand the brain mechanisms involved in alcoholism and its hallmark features - impaired control over intake, tolerance, physiological dependence and craving following sustained abstinence; developing new treatment approaches and medications; assessing alcohol's effects on the liver, heart, pancreas and other organs of the body; studying the risk/benefit tradeoffs of moderate alcohol use; developing and testing prevention strategies, including the impact of public policy, regulation and economic factors; evaluating the effects of alcohol in the development of birth defects and identifying the most effective approaches to preventing these problems; and assessing alcohol treatment and prevention services through the study of health services research. NIAAA had a $42.8 million fiscal year 2000 budget for prevention and treatment research on underage alcohol use and its consequences.
Leadership to Keep Children Alcohol Free
A multiyear national campaign, led by NIAAA and several governors' spouses from around the country, to prevent early onset drinking among children aged 9 to 15. The initiative is supported with federal and private funds, while representatives of many prestigious national organizations serve on an advisory body. This unique coalition is the only nation-wide effort that specifically targets prevention of drinking in this young age group.
A recent survey revealed that an overwhelming majority of Americans are concerned about underage drinking and would support measures to reduce it, such as stricter controls on alcohol sales, advertising and promotion. In view of this concern, the leadership initiative has defined two major objectives: to raise awareness about the problem of alcohol consumption by 9- to 15-year-olds and make it a national priority and to mobilize and sustain prevention activities at community, state and national levels.
Community-Based Resource Centers
These centers, administered by the Administration for Children and Families (ACF), serve as comprehensive family service centers that can provide referrals to treatment programs for parents and other family members. The Head Start program, also administered by ACF, helps families access substance abuse services and provides training for Head Start workers in substance abuse issues.
Programs Serving Native Americans
Substance abuse continues to be a leading contributor to health problems among American Indians and Alaska Natives. The Indian Health Service (IHS) funds approximately 400 alcoholism and substance abuse programs that provide a number of treatment and prevention services to rural and urban communities, including: the IHS Alcoholism and Substance Abuse Program, where the IHS contracts with tribal and Indian-managed organizations to provide treatment services, and Community-Based Youth Treatment, where the IHS manages community-based services and regional residential treatment centers that focus on youth. IHS has $45 million for substance abuse activities in fiscal year 2000. Also, there are currently two IHS employees assigned to SAMHSA to coordinate and enhance services for American Indians and Alaska Natives.
Inpatient/Outpatient Benefits
The Medicare and Medicaid programs help thousands of Americans each year overcome drug addiction and related problems. Inpatient Medicaid benefits may cover some of the emergency treatment of drug-related symptoms, detoxification and rehabilitation. Rehabilitation may also be covered by Medicaid on an outpatient basis. Substance abuse services may be provided by a physician, clinic, rehabilitation, home health or targeted case management service; under home and community-based waivers; and as part of the Early and Periodic Screening, Diagnosis and Treatment benefit (EPSDT), which mandates all coverable services be made available to Medicaid-eligible children under age 21. Many states have also used freedom-of-choice waivers or exceptions to their state plans to implement managed care programs targeted at substance abuse.
Comprehensive Runaway and Homeless Youth Drug Abuse and Prevention.
ACF provides counseling, educational, referral and other services to high-risk youth.
Early Warning System
HHS data collection efforts help the nation identify potential drug-problem areas and ensure that resources are targeted to areas of greatest need. For example, data from SAMHSA's Drug Abuse Warning Network (DAWN) indicated a substantial increase in methamphetamine-related hospital emergency room episodes from 1991 to 1995 and other club drugs from 1996 to 1999. In response, as part of the 1996 National Drug Control Strategy, the President launched a comprehensive methamphetamine initiative that includes enhanced law enforcement, research, prevention and treatment. Additionally, in 1999 NIDA launched a national education, prevention and research initiative that targets ecstasy and other club drugs. HHS is working to gather and disseminate the most current information on promising prevention and treatment programs tailored to club drug use, especially among youth.
Workplace Programs
Working with private corporations and managed care organizations, SAMHSA is supporting an effort to improve substance abuse prevention programs in the workplace. SAMHSA also supports a Workplace Helpline, 1-800-967-5752 (WORKPLACE), which provides assistance to employers developing and implementing substance abuse prevention programs. In addition, the agency oversees the Federal Drug-Free Workplace program and the National Laboratory Certification Program for drug testing.
Girl Power! Campaign
Girl Power! is a national public education campaign sponsored by HHS to help encourage and motivate 9- to 14-year-old girls. Launched in 1996, the Girl Power! campaign provides accurate health information to girls and their caregivers; raises public awareness about substance abuse and risky behaviors; and helps girls develop the skills they need to resist unhealthy influences and make positive choices. The first national substance abuse prevention program focused specifically on girls, Girl Power! has been formally endorsed by over 300 local organizations and more than 60 national organizations including the Girl Scouts of the U.S.A., American Association of University Women, National 4-H Council, YMCA, Avon Running and American Psychological Association. In excess of 5,000 community-based organizations are using and distributing Girl Power! materials and products. The program is reaching girls directly through the Girl Power! Web site, with over 32 million visits since its launch.
National Alcohol and Drug Addiction Recovery Month
Aims to celebrate the gains made by people in recovery from alcohol or substance abuse and to laud the benefits of substance abuse treatment. This public education campaign is celebrated in September of each year. The 2000 observance will highlight the needs and concerns of adolescents in recovery and features extensive community involvement through community forums and other events.
National Alcohol Screening Day (NASD)
NASD is a national outreach program designed to educate people about alcohol use disorders, screen them for a range of problems and refer those in need to treatment resources. In addition to reaching out to members of the public, a special college component targets students who are risky drinkers, with a focus on binge drinkers. NASD is the result of a collaboration among NIAAA, SAMHSA and the nonprofit organization, Screening for Mental Health, Inc.
Finding Local Treatment Options with the Click of a Mouse
In 1999, SAMHSA introduced a new on-line system that provides a private, convenient way to find treatment for substance abuse problems. Available on the Internet, this system gives consumers, as well as professionals, maps showing treatment facilities closest to their homes that offers services consistent with their needs. Information on more than 11,000 facilities located in all parts of the country is up-dated annually through a national survey and only facilities recognized by States are included in the data base.
Model Programs for Youth Substance Abuse Prevention
SAMHSA's Center for Substance Abuse Prevention has identified and is making available to communities nationwide through its Model and Exemplary Programs web-site and publications, a series of proven and promising prevention programs that have produced consistent positive, replicable results in prevention with high-risk youth populations. To date, 19 model programs have been identified through a rigorous peer review process for this dissemination effort to build resilience and self-esteem among youth at high risk for substance abuse.
Treatment Improvement Protocol Series (TIPS) Guide Treatment Providers
The SAMHSA Treatment Improvement Protocol (TIP) series (38 volumes published to date) provides substance abuse treatment professionals with state-of-the-art, consensus-built "best practices" in treatment. SAMHSA's Center for Substance Abuse Treatment draws on the experience and knowledge of clinical, research, and administrative experts to produce each TIP. New areas for TIP development are generated by the TIPs Editorial Board, a distinguished group of substance use experts and professionals, working in collaboration with State Substance Abuse Treatment Directors to assess and delineate the field's current needs for information and guidance. Copies of TIPS are available through the SAMHSA web site (http://www.samhsa.gov) and through the National Library of Medicine's Health Assessment Technology Text.
Guide to Preventing Youth Drug Use
The first research-based guide to "Preventing Drug Use Among Children and Adolescents" provides 14 prevention principles based on 20 years of research to help schools and community groups develop more effective drug prevention programs.
Treatment Referral Services
Through the National Drug Information and Treatment Referral Hotline, 1-800-662-HELP, SAMHSA's CSAT provides drug-related information to individuals seeking local treatment programs and directs those affected by the substance abuse of a friend or family member to support groups or services.
National Clearinghouse
SAMHSA's Center for Substance Abuse Prevention maintains the National Clearinghouse for Alcohol and Drug Information (NCADI), which can be reached at 1-800-729-6686 for assistance in English or Spanish, or at TDD 1-800-487-4889 for hearing-impaired callers. In fiscal year 1999, NCADI responded to 497,000 requests for information and distributed nationally 14,952,555 pieces of printed material and information, averaging 1.25 million pieces per month. It is estimated that more than 100 million Americans benefit from Clearinghouse services each year. PREVLine (PREVention on-Line), a 24-hour Web-based prevention information portal and search engine, is maintained by CSAP and is accessible through the Internet at https://store.samhsa.gov/.
NIDA Infofax (Discontinued)
Callers can access pre-recorded information and request fact sheets on drug abuse and addiction in English and Spanish 24 hours a day by calling NIDA's toll-free Infofax service at 1-888-NIH-NIDA (644-6432). Hearing-impaired callers can access the system at 1-888-TTY-NIDA (889-6432).
National Youth Anti-Drug Media Campaign
In 1997, President Clinton launched the bipartisan-supported National Youth Anti-Drug Media Campaign. The campaign uses the full power of the modern media from television, radio, the Internet, newspapers and magazines to sports marketing to educate young people to reject drug use. Complementing several HHS initiatives, the campaign also targets parents, teachers, mentors, coaches and other responsible adults to help them talk to kids about drugs and get them more involved in the lives of young people.
For more information on substance abuse, government Web sites of interest include:
- Substance Abuse and Mental Health Services Administration (http://www.samhsa.gov)
- National Institute on Drug Abuse (http://www.nida.nih.gov)
- National Institute on Alcohol Abuse and Alcoholism (http://www.niaaa.nih.gov)
- Office of National Drug Control Policy (http://www.whitehousedrugpolicy.gov)