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NIDA Town Hall Meeting Part 1 of 2

This lively one hour discussion highlights how new scientific approaches combined with commitment at the community level can reduce the chances of children becoming involved with drugs.



Please stand-by, video will begin momentarily.

Nora Volkow: 

Hello, I'm Nora Volkow.

I Direct the National Institute on Drug Abuse.

And I want to welcome you all to this program where we will be discussing how to empower communities to implement effective preventions for substance abuse in the community.

I want to introduce now Carol Krause who will be the moderator for this program. Carol...

Carol Krause: 

Thank you Dr. Volkow.

Well we know that no two communities in America are alike.

So, today we are going to talk about some exciting developments in substance abuse prevention science and how communities can develop prevention programs that will work for their own unique needs.

This virtual town hall will look at evidence-based prevention principles and programs in general.

And we will take a special look at the Communities That Care prevention system.

A community-wide system designed to reduce risky behaviors among middle schoolers and increase protective factors within communities, schools, and families.

Communities That Care or CTC is sponsored by the U.S. Department of Health and Human Services, more specifically the Center for Substance Abuse Prevention, CSAP and SAMSHA, the Substance Abuse and Mental Health Services Administration.

But first let's see what they are saying about Substance Abuse Prevention in the five-town community of Appleton, Camden, Hope, Lincolnville and Rockport, Maine.

Adam Kohlstrom:

Well, I first came to hear about Communities That Care back in 2003 when Communities That Care was being the very inception of it here in our community.

I was at the original training events that happened at the YMCA.

Maria Libby:

Each year our school participates in a survey that provides CTC with data on a variety of different factors. I

t's through that survey and the work that CTC did in evaluating it that we realized that we had a higher than usual abuse of inhalants in our middle school community.

Adam Kohlstrom:

When I preach and prepare and if I'm speaking specifically to something that bears upon the teen culture and teen population, the fact is I'm able to speak with greater clarity with greater directness and with greater understanding of what they are facing.

Sarah Post:

I definitely believe that kids need some wonderful opportunities, Some structure too and mentoring from adults. People to really look up to beyond their parents.

Andrew Lesmerises:

And now, they'll more readily accept the messages of, you know, don't do drugs, don't smoke, stay in school. Learn. Get active.

Phil Roberts:

I hear comments back from the officers who are doing the foot patrol and having the contact with people out here on the street.

But the attitude is much better, much more receptive.

They don't get the hostility that we did a few years ago.

Adam Kohlstrom:

I think one of the biggest advantages of Communities That Care is that it has really brought together the entire community.

Carol Krause:

And there they are. The good citizens from the five-town community in Maine.

Our partners in this first ever night of Prevention Town Hall.

Camden, can you hear us? We can hear you.

The folks in Maine have a lot of questions for our experts today.

We have some questions for them. But, first let's meet our expert panel.

The people who are front and center in our nation's Drug Abuse Prevention efforts.

Mr. Gil Kerlikowske, Director, White House Office of National Drug Control Policy.

You've met Dr. Nora Volkow, Director of National Institute on Drug Abuse, National Institutes of Health.

Frances Harding, Director of SAMHSA's Center for Drug Abuse Prevention and Dr. David Hawkins, lead author of the Community Youth Development Study at the University of Washington in Seattle.

I would also like to point out that in the audience here at the National Press Club we are joined by scientists and other prevention experts in both the public and private sector who are instrumental in the nation's prevention efforts so thanks to everyone for joining us.

So, let's get started. First, let's hear from Director Gil Kerlikowske.

Newly selected by President Obama to head the White House Office on National Drug Control Policy.

Before being selected to head the nation's Drug Control efforts Director Kerlikowske was Chief of Police in Seattle and has a long history with community prevention.

Director Kerlikowske, could you begin by telling us a little bit about the President's commitment to prevention?

Director Gil Kerlikowske:

I could. Certainly this administration has a renewed re-energized focus on the importance of prevention.

We know that evidence-based prevention programs can be very effective.

We know that they can save money.

For instance, for a dollar invested in prevention programs you can have up to a ten dollar savings in substance abuse treatment.

And so those are the things that President Obama is very interested in.

The other thing that the President really wants to ensure is that as we think about his drug control strategy which by law has to come out at the end of or in the beginning of next year.

That he gets as much input from people across the United States.

That's why I'm particularly indebted to Dr. Volkow and to NIDA for letting me participate in this and have this opportunity to hear a lot of different people. Let me just mention a couple of other things about prevention in particular.

That is, that it can't be just any prevention programs.

The President has made a strong commitment to evidence-based programs.

The science should drive what we are doing. And so these programs have to have a defined population.

They have to be appropriate to the risk.

They have to look at the protective factors involving substance abuse.

They should intervene at the early stages and transitions because we know that addiction is a disease.

We know it is treatable, diagnosable.

That is has an age of onset and, therefore, prevention programs that are evidence-based can be very effective.

They have to have sound management.

They need to have people that are not only active and caring and involved in these programs.

But they have to be widely and soundly managed.

They should intervene in appropriate settings and domains.

Parents are a key focus in all of the prevention programs.

And that's critical. Not only in preventing drug abuse in the future, but it is also quite critical in building kids' social skills.

Lastly, the approach is about effectiveness having to have been demonstrated. And I could not be more pleased to be a participant in this today.

And thank you all and thank you to the people in Maine.

Carol Krause:

We could not be more pleased to have you here.

So thank you very much. Now, of course there is a lot of information on ONDCP's prevention efforts on its website whitehousedrugpolicy.gov.

Next we will hear again from NIDA Director Dr. Volkow.

Dr. Volkow tell us a little bit about prevention science.

Dr. Volkow:

Well, substance abuse and drug addiction can have very catastrophic consequences to the individual, and yet they can be fully prevented.

So we actually use science in order to help identify actually what are the principles that our community can use in order to prevent that use of substances.

And through science we have come to actually understand that prevention measures are effective and can decrease drug utilization in an individual and in its community.

So what are the principles?

One of the crucial principles is that drug prevention should be initiated early in life.

And this is because the highest risk for substance abuse is during adolescence and unfortunately sometimes during childhood.

So, an effective prevention can actually gear that individual to where positive attitudes and behaviors while decreasing the risk of taking substance abuse.

Ultimately affecting what the life of that person will be.

A second very important principle, which is basically the backbone of the prevention strategies, is the identification of both risk and resiliency factors that can actually enhance the ability of a young person to actually say no to drugs.

Both — we want the prevention measures to elevate preventive factors while decreasing those risk factors, and these are at the level of the individual, the family, the peers, the school and their community.

And the community has motivation to actually change them can have effective results in decreasing substance abuse of the individual at the community level.

After aspect of the principles is targeting the prevention of multiple substances, such that one can observe how these universal preventions strategies that go after different risky behaviors will result in a decrease of behaviors not just related to substance abuse, but also to the delinquency and criminal acts.

Finally, what are the challenges that we have ahead of us.

Well, one of them is how we must educate our communities to take action to empower and try to address the issues in the community for substance abuse.

The other one is how that community identifies a unique characteristics that they have, while at the same time being able to implement evidence-based prevention.

And finally, the big challenge is how to sustain those prevention programs because what science has told us is that prevention programs to be effective have to be sustainable.

Thanks very much.

Carol Krause:

Thank you, Dr.Volkow.

You can find more on NIDA's website on drugabuse.gov.

Before we hear more about the recent results from the Communities That Care research.

Fran Harding I'm going to hand you the remote for the Power Point.

With more than twenty-five years in state substance abuse leadership Ms. Harding was appointed to head CSAP last year.

Fran, what are the general kinds of community prevention programs that are offered through SAMSHA?

Frances Harding:

When we talk about community prevention, we talk about the problem of substance abuse across the country, we're really talking about each community having individual problems and we focus on the community.

And the science supports this because we know that our communities, the people that reside in our communities, know the problems best, and they are also the best people to be able to come up with the solution to approach some of the issues.

Some of the — we create our goals at SAMHSA is to create a healthy and safe communities across our country.

What that basically means is that we are looking at programs that approach the workplace, schools, and also families.

We want to have supportive communities in both all communities and in neighborhoods if we are looking at the urban settings across our country.

We are looking to help our communities become safer, healthier and free of crime, and of course substance abuse.

And we do this, of course, by also having working with our partners across what we call continuum of services, which includes prevention through treatment.

So we want to have access to those services.

As Carol said when she began our talk today, we know that one size doesn't fit all.

The science has helped us to be able to focus in on the individual issues that each community presents.

SAMHSA has an enormous amount of programming that we focus on and what you are looking at now is a slide that shows you the different types of programs that we have that is focusing on our substance abuse block grant dollars and also our communities, our drug-free communities programs, and a thousand different discretionary programs across our country.

We're specifically talking about our Strategic Prevention Framework.

Our Strategic Prevention Framework Grant is a process where there are five steps that a community engages.

Starting with an assessment of the problem right straight through of how to utilize data, how to approach the data to prioritize our local problems, and then help with science to identify the appropriate program to help with that.

Something to note in Maine, the Strategic Prevention Framework is very similar to the process that you have gone through with the Communities That Care process.

One of our biggest programs. We also go through a life span.

We can look at just one age group so we also have programs in SAMHSA that covers the kids as young as three years old to six.

We also have programs that focus on underage drinking with fifth and sixth grade students.

Too Smart to Start is another science-based program that we also look at for underage drinking.

Underage drinking is a priority for SAMHSA.

Around some of you hopefully have known and been participating in some of our community programs or some of the teachers out there may actually have been involved with our Reach Out Now teach-ins.

All of our underage drinking programs are primarily focused on the Surgeon General's Call to Action paper which actually motivated the country to focus in on underage drinking and some of the programs and the tasks to follow.

Lastly, we have targeted initiatives.

The reason why we go beyond just focusing on adolescence is because substance abuse problem is a community problem so we want to offer programs for all community — all members of the community.

For instance, we have a program for Fetal Alcohol Spectrum Disorder and I mentioned that specifically today because today, September 9th, is the awareness day across our country for FASD.

We have tried to focus on different groups. We have programs for Native Americans.

We have programs along the border of our country that have issues.

We have programs that focus on the workplace and of course I would be remiss if I didn't focus on our older adults in the audience and across the country as well.

So to be — prevention is — if I was to leave you with one message I'd say that prevention is a good investment.

The more we can work with prevention within health care and within crime and local problems, and to be engaged.

We want to be able to get all of the members of the community, you all have a part so parents, teachers, law enforcement officers, health care workers, faith-based organizations, we want all of you — as you're doing in Maine, and to show that you are the model for the rest of the country to bring all of the partners that have a say in community health and safety.

Carol Krause:

Thank you, Director Harding.

Well, we will guide you to SAMHSA's prevention website in a minute.

But first let's get to the Communities That Care system. One of these systems, one of these prevention programs.

In particular, we're here to discuss newly released results of the Community Youth Development Study. Research conducted by the University of Washington Scientists to examine the effectiveness of the Communities That Care prevention system.

The study was funded by NIDA, your host for today's event.

SAMHSA's center for substance abuse prevention along with several other NIH institutes, The National Cancer Institute, The National Institute of Mental Health, and the Eunice Kennedy Shriver National Institute of Child Health and Human Development.

And we do have some very good news.

To tell us about it I'd like to introduce Dr. David Hawkins.

Lead author of the Community Youth Development Study. His results were just published in the Journal Archives of Pediatrics and Adolescent Medicine. Dr. Hawkin's what's the news?

Dr. David Hawkins:

The good news is that communities armed with the advances of prevention science and using the Communities That Care system can prevent adolescent tobacco use, alcohol use, and crime — all at the same time by really using these advances of prevention science that Dr. Volkow was talking about earlier.

Communities That Care is an operating system for prevention.

It is not a program. It is a system that, like an operating system on your computer, Linux or Windows, gets you to the right application or program to meet your needs.

Communities That Care helps the community identify the risk factors that are elevated in that community.

The protective factors that are lower depressed in that community and then a coalition of diverse stakeholders in that community use that information on risk and protective factors to choose from a menu of tested and effective preventative interventions that have been shown in controlled trials to prevent these problem behaviors in young people.

Those programs that address the risk factors that are elevated in the community and strengthen the protective factors that are needed in that community.

We were able to to test the Communities That Care system in a randomized controlled trial involving twenty-four communities, matched initially within states and then randomly assigned to either get Communities That Care or to serve as a control community across seven states in this country.

We have been following a panel of students who were fifth graders at the beginning of the study, and we've been following them through the eighth grade, and we are now reporting on the effects of Communities That Care on that panel of all of the fifth graders whose parents allowed them to be engaged in this longitudinal study followed through the eight grade.

You can see from the slides that the communities in the Communities That Care trial, that we are talking about our small towns and middle-sized towns from Washington to Maine.

Matched communities randomly assigned within each state to either get Communities That Care or not Communities That Care.

Communities That Care has five phases.

The first phase is to get organized and that means to get all of the stakeholders concerned about the successful development of young people involved.

It is important to have everyone involved in the community because depending on which risk factors are elevated in that community, different organizations may need to implement the prevention policies and programs that are needed in the community.

And you can see from this slide the variety of organizations and groups that are involved in Communities That Care and the communities participates in the Community Youth Development Study.

Those coalitions in the twelve experimental or CTC communities got training in the first year in Communities That Care — six training events during that year and then they conducted a survey of all of the sixth, eighth, tenth, and twelfth graders in their community that allowed young people to tell what their experiences were with regard to the levels of risk and and levels of protection.

Based on that data, the communities were able to choose elevated risk factors.

So for example, if sixty-five percent of the young people in a community said my parents don't know where I am and who I am with when I'm not at home, then that's a family management risk factor and that risk factor could be a priority for attention in that particular community.

So communities chose two to five priority risk factors, and then they chose prevention programs targeted to those risk factors.

So if family management was a risk factor or family conflict was a risk factor, they might choose the Guiding Good Choices program or Strengthening Families 10 to 14.

If academic failure or low commitment to school is a risk factor, they might choose individual tutoring for young people falling behind in school.

If they found rebelliousness or children needing more skills to resist drug offers was a problem, they might implement life skills training, or the Olweus Bullying Prevention program in the schools.

The risk factors.

There are twenty major risk factors that are identified through longitudinal studies of young people.

The communities in this study chose these nine risk factors.

Different combination's of risk factors in different communities were chosen because as you said at the beginning, different communities have different profiles.

Different communities and Communities That Care choose different risk factors to focus their attention on.

These nine risk factors were the ones that were prioritized in at least one of the communities in the trial that we are conducting of Communities That Care called The Community Youth Development Study.

Based on the assessment from the menu of Communities That Care, the Prevention Strategies Guide to Prevention that is on the CSAP web page, the SAMHSA web page, the communities chose tested and effective preventive interventions.

Things that have been tested just like we test drugs before we make them available to the public.

These programs have been tested and well controlled trials and that was the menu from which communities chose their prevention programs.

What we can see is that when you use this Communities That Care system, you can significantly reduce health and behavior problems among young people.

What you are looking at in this slide is the profile of risk exposure from grade five through grade eight in the panel of young people who are following.

We know that as young people enter adolescence, their risk exposure increases. Children develop more favorable attitudes towards drugs sometimes.

They begin to run into peers who started smoking or drinking or stealing.

Their parents may become more lax in their monitoring because they have a teenager now instead of a little child.

But what we see from this slide is that the risk exposure in the controlled communities in red went up significantly faster than risk exposure in the blue Communities That Care communities.

And what that led to was a significant decrease in both the incidence that is new, young people starting to smoke,or starting to drink, or starting to become involved in delinquent behavior.

As well as in the prevalence of alcohol use, and delinquent behavior in the CTC communities when compared to those same young people in the eighth grade young people in the controlled communities.

And just to illustrate this what you are looking at here is the onset of delinquent behavior among young people who hadn't started the delinquent behavior by the fifth grade.

And what you can see is that by the eighth grade, that slide should say 0.18 in the seventh grade compared to 0.13.

Eighteen percent of the kids who hadn't yet started delinquent behavior in the controlled communities began a delinquent act in the seventh grade compared to thirteen percent in the CTC communities.

By the eighth grade Twenty-one percent of those kids who hadn't yet been delinquent started the delinquent behavior in the controlled communities as compared to about fifteen percent in the Communities That Care community.

When you look at alcohol use, this slide should actually say at the eighth grade twenty-five percent of the kids who hadn't yet started drinking in the — by the seventh grade actually started drinking in the eighth grade.

One out of every four kids who hadn't been drinking in the seventh grade, started drinking in the eighth grade in the control communities.

But only seventeen percent of those young people who hadn't been drinking before eighth grade, started drinking in the eighth grade in the CTC communities.

And with regard to cigarette use, twelve percent of those kids who hadn't yet started smoking before the eighth grade, started smoking in the controlled communities, compared to eight percent in the CTC communities.

What we are seeing is that we are cutting the initiation of these behaviors by about a third in the CTC communities.

There is also an effect on actual prevalence of these behaviors. Just to illustrate, about 21.4 percent of the eighth graders in the controlled communities were current users of alcohol.

That is they had had alcohol in the last thirty days. In the CTC communities, that was only about 16.4 percent.

And if you think about binge drinking, that is children who have had five or more drinks in a row in the last two weeks, nine percent, almost one out of every ten kids in the controlled communities, were in the eighth grade say, Yes I have had five or more drinks in a row in the last two weeks, compared to 5.7 percent in the CTC communities.

Also significant reductions in the prevalence of delinquent behavior.

What we are seeing is that by addressing these shared risk factors for a variety of health and behavior problems among young people we can actually reduce not only tobacco use, and alcohol use; but crime as well among young people in these communities.

CTC works because it provides a complete set of manualized trainings.

All of the manuals for CTC are available on the SAMHSA website.

It provides a process whereby communities can decide whether this is the right set of tools for them.

Whether they're ready for CTC or whether CTC is ready for them.

It provides a set of milestones and benchmarks step-by-step guides all the way through the five phrases of the CTC process.

It provides a survey that allows you to assess risk and protection among sixth, eighth, tenth, and twelfth graders across the community.

A menu of test and effective preventions and importantly training and tools that are used to implement those programs with fidelity and sustain those programs over time.

The other key to the successful Communities that Care, is a community coordinator who facilitates the implementation of this process in the local community of Communities That Care.

What we know now is that when you use these tools from prevention science you can actually prevent substance abuse and crime community-wide, population level effects.

Carol Krause:

Dr. Hawkins, thank you so much.

All of the information you heard him talking about on the CTC program or any of the other prevention options, can be found on SAMHSA's website, prevention.samhsa.gov.

Now it's time to meet the folks in Maine.

Where a lot of folks have turned out to talk about substance abuse prevention.

Let's meet out moderator in the five-town area, Marie Roda.

Marie owns her own communications firm in Pennsylvania and has been in the trenches for many years promoting health programs.

She has been an active champion of Communities That Care in both Pennsylvania and Maine.

Marie, Hello.

Marie Roda:

Hello! Hello Carol, and welcome to Maine. We're very excited to be here and welcome to everyone in Washington.

Carol Krause:

So, what do you have for us?

Marie Roda:

Would you like to meet — we would like to introduce the CTC coordinator here in the five-town communities which is Dalene Dutton.

Dalene is the Executive Director at the five-town Communities That Care initiative and she would like to introduce a few special people seated behind her.

Dalene Dutton:

Thank you Marie. I have here with me my Board of Directors and folks from the Community Coalition. We're happy to be here. Thank you.

Marie Roda:

It's a great group I'd also like to introduce a few special guests that have joined us from CTC communities across the country.

We're are going to go over here and meet Mr. Ted Tomita He is from Freeport Illinois, and we also have with us Esmeralda Blancas and her daughter, Christina, who have come all of the way from the state of Washington, from Quincy Washington.

So thank you very much for joining us.

Now, what we would like to do is explain a little bit more about what CTC has done here in the five-town communities in Maine.

So Dalene, if you would join me and could you briefly explain what CTC has done in this community and in this region?

Dalene Dutton:

Sure. What CTC has helped us do is to identify our unique profile risk and protective factors.

Once we identified that, we were able to match our profile with some tested and effective programs, and then the CTC system helped us to monitor how well our programs were working.

And we're really pleased to report they are working very well.

One of the little pieces of data we have had is that we had a sixty-six percent reduction in eighth grade marijuana use in our community in just four years.

So we are really happy about that. The other thing that's allowed us to do it to increase the amount of collaboration in our communities.

The tools are really wonderful for helping us do that.

Marie Roda:

That's phenomenal.

Well thank you, and I think this is a perfect time to show a small video clip of one of the evidence-based prevention programs that they implemented here in the five-town area which is called The Star Program.

Now, The Star Program is an evidence-based prevention program that has multiple components that includes family and classes.

And it is meant to focus specifically on specific protection factors that they focused on here in the community.

So, what you are about to see are some kids who are involved in The Star Program, and for these kids, evidence-based prevention means that they get to be involved in and experience rather some interesting and challenging after-school activities.

This page was last updated December 2013