One Toke Over the Line: National Drug Policies Enacted to Curb Substance Abuse

Susan L. Renes, M.S.

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Abstract

The history of social welfare policies enacted to reduce substance abuse began with whiskey

rationing in the military. Guided by ideology, circumstances, and public opinion, substance

abuse policy has followed a pattern of continually restricting drug use, with substance abuse

education and the intervention of substance use occurring in an increasing number of social

settings. Current policies have not kept up with recent developments in substance use and

substance abuse treatment. In many ways, the country is following somewhat revised versions of

the Anti-Drug Abuse Act of 1988, passed during the “Just Say No” campaign. While no final

answers are offered for how society should respond to substance abuse, policy suggestions are

made for youth, college and university students, and the workplace. Arguments are presented for

including harm reduction policies with the current reduction in use policies (Reuter & Caulkins,

1995).

Key Words: Drug policy, substance abuse, drug control, social welfare.

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Social welfare policy exists to provide protection for citizens, direction for governing

bodies, and opportunities for social learning (Reuter & Caulkins, 1995). Issues related to the

regulation of alcohol, tobacco, and other drugs (ATOD) often center on the question of what is in

the best interest of the public. Arguments based on fact, personal and public health, personal

choice, and moral and social order all become intertwined in social policy debates (Ray, 1983).

This article, addressing the history of the national drug policies enacted to curb substance abuse,

will show how substance abuse policy changed based on ideology, as well as circumstance and

public opinion. The article describes the early policies regarding alcohol and other drugs as well

as more recent policies addressing ATOD use. Elements of the policy in need of reform, along

with a policy action plan for youth, college students, adults in the workplace, and the nation, are

also described.

Developing social welfare policy that both meets the needs of those who are suffering

and protects the rights of the country’s citizens is no easy task. Presenting the history of such

policy will show the progression of thought regarding substance abuse along with the agony

experienced by those affected by this social problem (Axinn & Stern, 2005). The hope is that

substance abuse policy will continue developing to better meet the needs of all concerned.

Early Policies (Alcohol)

One of the earliest U.S. policies enacted to reduce substance abuse was the practice of

rationing whiskey in the military (Vargas, 2005). The idea was patterned after a British naval

tradition of rum rationing. In the British Navy, men could choose between a rum ration and

comparable pay (Museum of Canada, n.d.). If the rum was chosen, the ration was consumed in

front of an officer to prevent enlisted men from hoarding the rations. The British did not always

ration rum; in the four years of the Revolutionary War with the United States, British troops

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drank 2.9 million gallons of rum. The British government spent more to supply rum to soldiers

than on troop wages (Vargas). At the beginning of the American Revolution, a beer ration was

instituted, followed by a whiskey ration in 1782. The whiskey ration was enforced from 1782 to

1832. Allowing each soldier a daily gill (four ounces) of whiskey meant each man could drink

11.4 gallons a year. In 1830, the cost to the government was $22,132.

There was a reason for instituting the whiskey ration. The prevalence of alcohol abuse

became unmanageable. In the early years of the 19th Century, Army recruiters used alcohol to

encourage men to enlist; military service was often appealing to men with a reputation for

drinking. In addition, local taverns supplied the soldiers with alcohol (even during the time of the

whiskey rations). If the soldiers wanted to drink, the whiskey was available. Approximately 12 to

20 percent of the general court-martials and approximately 60 percent of the regimental court-

martials were due to alcohol abuse. The abuse of alcohol was partially responsible for the 20

percent desertion rate in the military in the 1820’s and 1830’s (Vargas, 2005).

Because the Army’s whiskey rations proved unsuccessful, a variety of other sanctions

were put in place. Finally, the whiskey ration policy was stopped altogether in 1832 (Vargas,

2005). Attempts to curb the use of whiskey reflected the military’s ideology regarding alcohol

use at the time. The abuse of alcohol was viewed by the military and by colonial society as a sin.

The goal was moderation of alcohol, rather than complete abstinence. Spirits were not

considered evil as God allowed their creation; however, abusing alcohol was seen as sinful or as

a sign of poor morals. Alcohol abuse was viewed as a choice, not as a disease.

The need for the US Army’s whiskey ration or “temperance movement” paralleled what

was happening in civilian society (Axinn & Stern, 2005). Whiskey was abundant and cheap

during the first thirty years of the 19th Century, due to growth in corn production in the Ohio

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River Valley and the presence of distilling companies in the East. Drinking was popular among

men, women, and children. Believing alcohol was nutritious, Americans consumed amounts of

whiskey that are hard to imagine (Vargas, 2005). For people fifteen years and above, the annual

consumption of ninety-proof whiskey in 1825 was nine and half gallons per year; however, two-

thirds of all the whiskey was consumed by only half of the adult male population (Vargas).

Civilian society also responded with temperance movements that were part of moral

reform programs (American Social History Project, n.d). The American Society for the

Promotion of Temperance was founded in Boston in 1826 in response to a growing concern that

alcohol abuse was leading to unemployment and pauperism (Axinn & Stern, 2005; Vargas,

2005). In the 1840’s, men from the working class formed Washingtonian Societies in order to

promote temperance. The most well known organization associated with temperance was the

Women’s Christian Temperance Movement. The National Women’s Christian Temperance

Movement (WCTU) formed in 1874; in 1894, WCTU had two hundred thousand members and

was described as the most powerful women’s group in the country (Axinn & Stern). The WCTU

responded to concerns that developed during the later years of the 19th Century. During this time,

alcohol use was a major source of leisure for men in the United States. Women became

concerned about the effects of alcohol abuse on the family and viewed temperance as a type of

protection for the family unit. There were also visible signs that alcohol abuse was associated

with domestic violence and women of the time were sensitive to this problem. The WCTU also

took up the causes of women’s suffrage, the 8-hour workday, and prison reform (Schultz &

Tishler, 2004).

The WCTU was the first organization to provide substance abuse prevention in the

schools (Parker, 1999). The program, known as Scientific Temperance Instruction (STI), became

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a legally mandated alcohol prevention curriculum. The STI program began in the 1880’s and was

a part of every school by 1903. In the 1920’s, alcohol prevention and tobacco prevention films

such as Safeguarding the Nation and Tobacco Plague also played a role in the health education

curriculum of public schools (Parker).

Largely as a response to the temperance movements, alcohol was made illegal in 3 states

in 1905, 9 states in 1912, and 26 of the 48 states in 1916 (Royce, 1981; Schultz & Tishler, 2004).

Prohibition (the ban of the manufacture, sale, transport, export, or import of alcoholic beverages)

began January 16, 1920, when the Eighteenth Amendment to the U.S. Constitution went into

effect. The Volstead Act, also known as the National Prohibition Enforcement Act, allowed

enforcement of the Eighteenth Amendment. The Act defined an alcoholic drink as any drink

containing an alcohol content greater than .05 percent.

Even though alcohol was illegal, people continued to drink. “Speakeasies” and other

underground establishments provided the opportunity (Royce, 1981). Government agents could

not force entry into an establishment if the door attendant refused admittance. Whiskey remained

legally available by prescription; “patients” consumed over a million gallons a year. The

prohibition police continually destroyed corn-alcohol stills created for personal consumption of

alcohol. Even President Harding kept the White House stocked with bootleg liquor, although

voting for Prohibition while serving as a U.S. Senator (Wikimedia Foundation, 2005). The

Twenty-first Amendment passed in 1933, repealing national prohibition; however, the

Amendment allowed individual states to continue to ban the purchase and sale of alcohol.

Early Policies (Other Drugs)

Alcohol was not the only drug of concern in the United States during the 19th Century.

Addiction to narcotics was a major concern after the Civil War (Ray, 1983). The invention of the

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hypodermic needle, the introduction of smoking opium, and the distribution of patent medicines

all contributed to the drug addiction problem. The use of patent medicines (which weren’t

always patented) declined after the Pure Food and Drug Act went into effect in June of 1906.

The Act prohibited the manufacture, sale, or transport of adulterated food products or mislabeled

patent medicines. The Act did not prohibit the sale of the drugs in patent medicines (which often

contained morphine, cocaine, opium, or heroin); the Act stated the label had to list how much or

what proportion of the various drugs was included in the medicine. The Pure Food and Drug Act

also did not regulate the importation of narcotics. Regulating the importation of narcotics was

part of the Opium Exclusion Act of 1909.

The Opium Exclusion Act of 1909 prohibited importation of opium and the derivatives,

except for medicinal purposes (Ray, 1983). While illegal to import, using or manufacturing

opium for nonmedical purposes was still legal. Opium, however, became very expensive, and

many who smoked opium began using heroin (Davenport-Hines, 2004). While the Pure Food

and Drug Act and the Opium Exclusion Act restricted drug use to some degree, the major law

imposing drug restrictions until 1970 was the Harrison Act of 1914. The Harrison Act required

those dispensing opium, cocaine, and their derivatives to register every year with the agency in

charge of enforcing the act, the Treasury Department’s Bureau of Internal Revenue (Ray, 1983).

Cannabis was originally included in the list of drugs in the legislation, but was eliminated due to

opposition from pharmaceutical and medical professionals (Sloman, 1998).

Although the Harrison Act was enacted to regulate and control the distribution rather than

the use of drugs, the Act made purchasing drugs difficult for people who were addicted.

According to Goode (1997), there were hundreds of thousands of addicts at the beginning of the

20th Century, largely due to the distribution of the patent medicines. By outlawing the over the

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counter sale of cocaine and opiates, addicts sought help from physicians and others who could

legally distribute these drugs; however, the overall result of the Harrison Act was the

development of illegal buying and selling of drugs.

Following the passage of the Harrison Act, two Supreme Court decisions continued the

practice of criminalizing drug use (Ray, 1983). In 1919, the Supreme Court ruled that physicians

could not prescribe narcotic drugs to help an addict maintain drug use, and in 1922, the Supreme

Court ruled that prescribing narcotics as part of a program to help an addict quit using drugs was

also illegal. The 1922 decision was eventually overturned. In the 1930s, marijuana use became a

concern; in 1937, Congress passed the Marijuana Tax Act, placing a tax on all marijuana sales.

The law was ineffective in reducing marijuana use. The Boggs Amendment to the Harrison Act

was passed in 1951 and the Narcotic Drug Control Act was passed in 1956; both laws increased

the punishment for drug use (now including marijuana), increasing minimum sentences, and

eliminating suspended sentences, probation, and parole for offenders (Ray, 1983).

Current Policies

The 1960’s saw a shift in the types of drug used and the reasons for the drug use (Ray,

1983). Drug users were looking for a way to alter mood and consciousness and were often more

educated than drug users in the past. The U.S. government’s response to this change was to pass

the Drug Abuse Control Amendments of 1965. The law brought any drug having a potential for

abuse due to a stimulant, depressant, or hallucinogenic effect (including barbiturates and

amphetamines) under federal control. In 1968, the Bureau of Narcotics, a part of the Treasury

Department, became the Bureau of Narcotics and Dangerous Drugs, operating under the

jurisdiction of the Department of Justice.

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In 1970, Congress passed the Comprehensive Drug Abuse Prevention and Control Act

(Ray, 1983). The 1970 Act was important legislation related to drug laws as the Act repealed and

updated all laws addressing narcotics and other dangerous drugs. The Act also addressed

prevention and treatment of drug abuse and supported the development of educational materials

for schools and for professionals working with drug abusers. Before the passing of the Act, the

collection of excise taxes was used to control drugs and to control drug use. After the Act, the

law became the enforcing agent. The Act also separated law enforcement of drug use from

scientific evaluation used to determine the drugs to control. Unfortunately, rather than decreasing

drug use, the Comprehensive Drug Abuse Prevention and Control Act caused drug users to buy

illegally manufactured drugs and increased the risks of drug use (Ray).

On November 18, 1988, President Ronald Reagan signed into law the Anti-Drug Abuse

Act, dedicating the bill to Nancy Reagan for her work in drug abuse prevention (Ronald Reagan

Presidential Library, 1988). The Act demands that employers or institutions receiving grants

from the federal government meet requirements that promote a drug-free workplace. The

requirements include publishing a drug abuse policy and distributing the policy to each

employee, imposing sanctions or requiring participation in rehabilitation when employees are

caught violating the drug policy, and promoting drug free awareness activities that discuss the

dangers of drug use and the availability of counseling programs. The Act also established the

White House Office of National Drug Policy (ONDCP). ONDCP’s purpose is to establish

policies, priorities, and objectives for drug control (ONDCP, 2005a). ONDCP also produces the

National Drug Control Strategy; the Strategy establishes a program, a budget, and guidelines for

cooperating with Federal, State, and local governments. The current Strategy approved by

President Bush calls for a 10 percent reduction in drug use by 8th, 10th, and 12th graders and by

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adults 18 years and older in the next two years (ONDCP, 2005b). The Strategy’s five-year goal is

a 25 percent reduction.

The Drug Free Schools and Community Act (DFSCA) was passed in 1986 (Iowa

Department of Education, n.d.) in response to high rates of ATOD use among student

populations. DFSCA provided funding to governors and state and local educational agencies to

begin drug prevention programs. The Drug Free Schools Act Amendment of 1989 required

elementary and secondary schools and all colleges and universities to enforce abstinence based

drug abuse policies for students (MacMaster, 2004). DFSCA was reauthorized as the Safe and

Drug Free Schools and Community Act in 1994. The reauthorization added violence prevention

to the ATOD prevention programs. School districts were now charged with addressing risk

factors for violence and ATOD use. In 2002, the Safe and Drug Free Schools and Community

Act was reauthorized as Title IV, Part A of the “No Child Left Behind” Act of 2001: 21st

Century Schools – Safe and Drug-Free Schools and Communities. The 2002 Act increased

accountability and allowed states to transfer funds among certain programs listed in the Act.

Elements of Policy in Need of Reform

Overall Changes

Current policies have not kept up with recent developments in substance use and

substance use treatment (Reuter & Caulkins, 1995). In many ways, the country is following

somewhat revised versions of the Anti-Drug Abuse Act of 1988, passed during the “Just Say No”

campaign. Harm reduction is a policy currently discussed by treatment providers and policy

makers as an alternative to the current policy. The current policy only allows for complete

abstinence of drug using behavior and supports substantial punishment for doing so (MacMaster,

2004; Reuter& Caulkins, 1995). Harm reduction as a treatment philosophy is viewed by the

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United Nations International Drug Control Programme as part of the ideology supporting the

legalization of drugs. According to Drucker (1995), this assessment is not accurate. Drucker also

reported that harm reduction is not mutually exclusive from an abstinence-oriented perspective.

According to MacMaster, the five assumptions underlying the harm reduction framework

are: (a) substance abuse is a part of our world and the focus should be on reducing drug-related

harm; (b) promoting abstinence reduces harm, but services can be provided without abstinence as

the only objective; (c) many of the problems associated with drug use (HIV/AIDS, hepatitis C,

overdoses, etc.) can be eliminated without complete abstinence; (d) effective substance abuse

services must be relevant to the drug user if the services are to be effective; and (e) drug use

must be viewed as an issue of public health, rather than as an individual act. Harm reduction

ideology affecting policy takes into account that heavy drug use is the cause of a great deal of the

crime, violence, incarceration, and loss of life in our country (Reuter & Caulkins, 1995). The

goals of harm reduction policy include: (a) reducing drug related violence; (b) lowering mortality

and morbidity among drug users; (c) reducing the harm experienced by family members and

friends; and (d) reducing the costs associated with drug control. Harm reduction policies do not

have to oppose use reduction policies. Harm reduction and use reduction can co-exist to form

more comprehensive drug policies, policies that address the high economic costs and the high

health costs of alcohol and nicotine use as well as the need to prevent adolescent drug use. Harm

reduction is the framework that supports policies and practices in the Netherlands, Germany,

New Zealand, and Switzerland (Maris, 1999; Webb, 1999).

Youth

National drug policies meant to reduce youth or adolescent substance abuse need to be

directed toward primary prevention (preventing initial substance abuse), secondary prevention

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(preventing further substance abuse), and treatment of substance use disorder (Tarter, 2002).

Effective prevention involves more than just preventing an unfortunate problem (such as

substance use disorder); effective prevention also promotes healthy behavior and healthy life-

style choices (Benard, Fafoglia, & McDonald, 1991).

Current substance abuse prevention programs limit the scope of prevention of ATOD use

(Project Alert, 2005). While date rape, suicide, and school failure might be mentioned as highly

correlated with substance abuse, the focus of current substance abuse prevention programs is still

limited to only the prevention of substance abuse. Changing the prevention programs to include

other problems such as violence, HIV/AIDS, suicide, school failure, teen pregnancy,

delinquency, and child abuse could increase the effectiveness of a prevention program to reduce

all of these harmful behaviors. Presenting prevention in this manner provides a more realistic

view of how the problems are connected (Benard et al., 1991).

Policy directed toward the prevention of adolescent substance abuse should also

recommend targeting and integrating prevention efforts with numerous social systems, including

families, schools, churches, and communities. Prevention programs should also target all youth,

not just those who have been identified as high risk for substance abuse disorders (Benard et al.,

1991). Prevention for youth should be connected to long-term prevention programs that occur

continually from kindergarten through high school and into adulthood.

School policies regarding substance use generally address primary prevention through

universal prevention programs (prevention for all students) and secondary prevention through

targeted and indicated programs for those who are at risk for substance abuse due to behavior or

life circumstances (National Student Assistance Association, 2003). According to Beyers, Evans-

Whipp, Mathers, Toumbourou, and Catalano (2005), there are often fewer written policies

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regarding substance use in schools serving younger children compared to schools serving middle

schools and high schools. Because tobacco and alcohol use often begin in younger grades,

written school policy at the primary or elementary level addressing substance use should be in

place.

Violations in school substance abuse policy are usually treated differently for tobacco

products than for alcohol and other drugs. Violating school policy with regard to alcohol and

other drugs often results in harsh punishment and required exposure to remediation services,

while violations regarding tobacco products often result in lenient consequences. The more

lenient response is unfortunate; tobacco use causes more health problems in the United States

than all other drugs combined (U.S. Department of Health and Human Services, 1994), making

tobacco the highest contributor to preventable public health costs. Successful prevention of

tobacco use during adolescence would likely show a significant reduction in long-term public

heath costs.

Adult

National drug policies meant to reduce substance use are usually limited to middle

school, high school, and college and university students. Very few prevention efforts are directed

toward adults, yet the Anti-Drug Act of 1988 requires employers or institutions receiving grants

from the federal government to promote drug free awareness activities that discuss the dangers of

drug use and the availability of counseling programs (Ronald Reagan Presidential Library,

1988). Completing the drug free awareness requirements to remain in compliance with the Anti-

Drug Act appears to involve minimal prevention education.

Substance abuse prevention education for all adults is something that should be

incorporated into all businesses and public health programs. The Substance Abuse and Mental

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Health Services Administration (SAMHSA) provides free online prevention courses to the public

(SAMHSA, 2005). Alcohol Abuse and Violence Against Women; Substance Abuse and Older

Adults; Alcohol, Medication, and Older Adults; and Uncovering Substance Use and Elder Abuse

are some of the topics addressed in the online courses offered by SAMHSA.

National drug policies meant to reduce substance use currently view complete abstinence

as the only acceptable goal for all illegal substance use (Reuter & Caulkins, 1995). While

complete abstinence certainly reduces the family, social, health, legal, and employment problems

associated with substance abuse, changing current policy to include programs to reduce harm as

well as support complete abstinence might be beneficial. Including the ideology of reducing use

as well as the ideology of reducing harm when creating policy could reduce overall harm from

substance abuse and lead more people with substance abuse problems to complete abstinence

(MacMaster, 2004). Changing the current substance abuse policy regarding adults would require

a change in the current perspective supporting national drug policies.

According to Maris (1999), the influence of U.S. drug policies on the rest of the world

has been profound; however, there is a history of U.S. policy being at odds with the policies of

the Netherlands. Most of Europe had a casual attitude toward drug use until the beginning of the

20th Century. International opium conferences held in Shanghai in 1909 and in the Netherlands in

1912, 1913, and 1914 (initiated by the United States) formed an international war on drugs. The

Dutch government, responding to the general social upheaval in the 1960s occurring in the

western world, amended the Dutch Opium Act in 1976 and changed to a policy reflecting a more

liberal tolerance of drug use (Maris). The Dutch government made a distinction between soft

drugs (such as cannabis and hashish) and hard drugs (such as heroin and cocaine); users and

dealers of small amount of soft drugs were no longer prosecuted after 1976. Legal interventions

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now focused on the hard drug trade; the Dutch government’s position was (and is) that

criminalizing drug use produces more harm than good.

Other countries have followed the Dutch in responding to the problem of drug abuse. In

1998, New Zealand launched a policy aimed to minimize harm to the individual and to

communities resulting from drug use (Webb, 1999). Following a public health model, the New

Zealand approach included five goals. The stated goals include: (a) limiting harm from ATOD

use in order to have more control over personal health; (b) reducing the use of tobacco and

reducing risks due to second hand smoke; (c) reducing hazardous and excessive consumption of

alcohol; (d) reducing cannabis use and the use of other drugs; (e) and reducing the health risks,

crime and social disruption associated with drug use. The New Zealand government hopes to see

a reduction in substance abuse in the population as a whole and in specific target groups. New

Zealand did not legalize certain drugs like the Dutch government, but the New Zealand policy

does follow the beliefs that a continuum of harm is associated with drug use and that several

strategies are needed to address the range of potential harms.

Incorporating certain aspects of harm reduction ideology into U.S. drug policies seems in

order, and incorporating harm reduction with the current use reduction polices of the United

States is possible (Reuter & Caulkins, 1995). The prohibition of alcohol clearly showed that the

law could not stop alcohol use. Prohibition led to criminal activities as well as the consumption

of liquor with higher concentrations of alcohol. Liquor sold with higher concentrations of alcohol

reduced the number of illegal sales, which in turn reduced the risk of being arrested. Addicts who

commit crimes to support an addiction are stealing not so much because of drug use but as the

result of a policy that makes the substances extremely expensive. While the country is not ready

for the legalization of drugs (nor is legalization necessarily a goal for U.S. drug policy),

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incorporating harm reduction programs into the current drug policy might reduce some of the

negative consequences of drug use.

Policy Action Plan

Plan for Youth

Policy reforms need to create resolutions that respond to modern situations and modern

needs. The need for primary prevention, secondary prevention, and treatment of substance abuse

disorders as well as the need to expand substance abuse prevention to include other problems

associated with substance use were previously described (Beyers et al., 2005). Targeting multiple

systems and looking at the role of school policy related to tobacco use were also described

(Beyers et al.; Benard et al., 1991; National Student Assistance Association, 2003). All of these

changes should be incorporated into existing policies.

Substance use policies directed toward youth should incorporate the successful

interventions used by HIV educators to prevent the spread of HIV/AIDS. According to Maylath

and Gray (1993), HIV education is part of the health education program and involves all students

from kindergarten through high school. HIV education addresses issues of abstinence and harm

reduction in a manner appropriate for the age of the student. Including all students in substance

abuse prevention and adding components from the harm reduction perspective should be a part

of youth policies. While school policies against substance use should remain firm, reductions in

use are helpful to the school environment and are important to consider.

HIV educators recommend that several school personnel become involved in HIV

education; and as a result, a team approach to HIV education appears to work to increase

awareness of the risk of HIV infection (Maylath & Gray, 1993). Using the team method, rather

than relying solely on prevention professionals to educate students, would provide a better

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approach to substance abuse prevention in schools. HIV educators and other public health

officials view school success as an important part of prevention. Failure to learn is viewed by as

the greatest pathway to problem behaviors that eventually compromise health and result in health

problems (Adelman & Taylor, 2000). Looking at the ways preventing adolescent substance

abuse might support school success and improve as the result of school success could help

schools and prevention professionals work together more effectively.

Plan for Colleges and Universities

As freshmen, students attending colleges and universities are often away from parental

monitoring for the first time. Preventing substance use can be particularly challenging given the

desire on the part of students to experiment with new behaviors while living in conditions of

newfound freedom. Recent tragedies resulting from alcohol and substance abuse have prompted

a review of policies and procedures on college and university campuses for all students

(University of Puget Sound, n.d.). The codes of conduct for university students, faculty, and

employees should prevent the unlawful possession, use, and distribution of drugs and alcohol on

campus. There should be an expectation that the policies will be read, understood, and followed

(University of Puget Sound, n.d.).

Conducting programs that address both prevention and harm reduction should also be

part of a college or university program. The BASICS program at the University of Washington

was designed to reduce the negative consequences of drinking (MacMaster, 2004). Students

participating in the BASICS program reduced the amount of alcohol consumed compared to a

control group. Both groups consisted of high-risk drinkers. Participants were also referred to

abstinence-based programs when the referral seemed appropriate. The University of

Washington’s prevention program supports both no use and harm reduction principles within one

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policy. Successful prevention efforts include the components of comprehensiveness and

intensity, effective strategies, and effective processes (Benard et al, 1994) and should be included

in the drug policies of a college or university.

In addition to policies addressing code of conduct expectations regarding substance use

and implementing substance abuse prevention programs, Larimer, Kilmer, & Lee (2005)

suggested colleges and universities make drug treatment programs available for students.

Reporting, in 2003, that approximately 5 % of college students used marijuana daily, Larimer et

al. emphasized that treatment of substance use disorders should be accessible on college and

university campuses.

Many universities have considered drug testing to reduce substance use. Drug-testing

policies are in place in private industry, drug treatment programs, and collegiate and professional

athletic groups to identify individuals for disciplinary actions and referral to treatment; however,

this practice does not extend to most college campuses. In a study completed by Fudala and

Fields (1994), drug testing of enrolled students occurred at less than 2% of the responding

colleges and universities. Students were not in favor of drug testing, but opinions of campus

alcohol and drug policies favored policies that are more restrictive. When asked about alcohol

and drug policies on campus, college students from the countries of Iran, Bulgaria, the United

States, Italy, Canada, Ireland, and the Netherlands supported non-moralistic drug restrictions

(Alexander & Dawes, 1998).

Plan for the Workplace

According to the U.S. Department of Labor (1995), 70% of the users of illegal drugs are

employed. Close (2005) suggested that not until drug testing is introduced do most owners of

manufacturing companies realize the level of drug use in the workplace. Most business owners

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and operators are concerned about substance abuse in the workplace as the behavior affects two

important concerns: (a) the health and safety of employees; and (b) the amount of profit a

company will see. The Anti-Drug Abuse Act of 1988 requires a drug free workplace for all

employers or institutions receiving grants from the federal government (Ronald Reagan

Presidential Library, 1988).

All employers need to consider developing policies and procedures regarding substance

abuse. For those in industry, substance use threatens the safety of all workers on the job. When

workers operating machinery are under the influence of alcohol or other drugs, job safety is

compromised. According to Close (2005), workers abusing alcohol or other drugs have a higher

incidence of workplace injuries, higher absenteeism, and higher workplace place aggression than

workers who do not abuse drugs.

Drug testing by random urinalysis is a policy many employers have in place to provide

protection for employees. Close (2005) suggested setting clear objectives for drug testing and

advising employees of the objectives before implementing the testing. All employees need to

know why the testing is taking place and how the testing will be carried out. Close also

suggested informing employees what drugs the test will screen for and at what levels. A plan

should be developed for responding to a positive test, including what repercussions will occur.

Disciplinary procedures, the availability of Employee Assistance programs, and action taken on

any future positive tests all need to be explained to employees and policies and procedures given

to each employee in written form.

Drug testing, if implemented, needs to be part of a more complete workplace substance

abuse policy. The U.S. Department of Labor (1995) suggested developing a substance abuse

program by following five steps. First, a comprehensive substance abuse policy should be

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written that explains why alcohol and drug use on the job, or alcohol and drug use that affects

job performance (such as being hungover) is not permitted. The written policy should also

include what will happen to an employee if the policy is violated and what resources the

company offers to provide assistance with a substance abuse problem. Second, supervisors need

to understand the policy and learn how to observe, document, and discuss with an employee

unsatisfactory work performance. Supervisors cannot be expected to diagnose or treat substance

abuse problems. Third, employees need to be educated on substance abuse problems by

providing awareness programs focused on substance abuse. Fourth, an employee assistance

program should be made available to help employees identify problems, provide confidential

short-term counseling, make referrals to outside sources, and provide follow-up services. Fifth,

whether implementing a drug-testing program is appropriate should be considered. (An attorney

operating on behalf of the company or institution should approve policies written regarding drug

testing in the workplace.) All of these steps are recommended for employees or those in charge

of administrating an institution. Additional help in developing fair and responsible policies can

be obtained from the Drug-Free Workplace Hotline, 1-800-843-4971. This service, provided by

the federal government, is there to help business, industry, and union leaders develop and

implement comprehensive drug-free workplace programs (U.S. Department of Labor).

Plan for the Nation

United States history contains numerous responses to ATOD use. Policies have been

enacted to reduce substance abuse based on current ideology. Policies were replaced over time as

methods failed and more information became available. Currently the United States responds

differently to alcohol, than to other drugs that produce a psychoactive effect. U.S. drug policies

support the ideology that responsible use of alcohol is possible, but responsible use of other

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mood altering substances is not possible. This supports the belief that all drug use (other than

alcohol) is abuse. There are written policies and social norms around the use of alcohol that serve

to regulate and moderate alcohol use. These written policies and social norms include: (a) don’t

drink and drive; (b) don’t drink on the job; (c) don’t come to work hungover, (e) don’t offer an

alcoholic beverage to someone with a professed alcohol problem, and (f) don’t sanction any

alcohol use until the body has fully developed into adulthood. Social norms cannot develop

openly about other drugs, as any use is illegal and strictly taboo. While the country is decades

away from even considering legalizing other drugs (and this is not necessarily the best answer to

reducing substance abuse), policy changes could take into account why people become involved

in ATOD use and could provide better support for someone recovering from a substance abuse

problem (Reuter & Caulkins, 1995).

The current national policy regarding drug use focuses on prevalence of use with the

overall strategy centered on reduction of use (Reuter & Caulkins, 1995). The policy needs to

expand to include reducing the harm that accompanies the use and distribution of illegal drugs.

After intensifying law enforcement efforts in 1985, there was a reduction in the prevalence of

drug use; however, prevalence for heavy or problem use did not decline significantly (Reuter &

Caulkins), and there has been no reduction in damage associated with illicit drug use. In fact,

tuberculosis and hepatitis seem to be increasing among those who are dependent on drugs.

Amending the 1988 Anti-Drug Abuse Act to include reducing related harm seems appropriate.

Including harm reduction goals that seek to reduce violence related to drug distribution, lower

mortality and morbidity of drug users, and reduce the suffering experienced by friends and

family members allow reduction in use to operate in conjunction with reduction of harm.

Understanding that drug use will probably always be with us (as the U.S. government finally

22

admitted at the end of Prohibition), and developing policy that speaks to reducing harm, as was

done in response to the HIV/AIDS problem, will lower the overall threat drug abuse brings to the

country.

Harm reduction working along with use reduction can also play a role in substance abuse

treatment (MacMaster, 2004). Combining the goal of total abstinence with harm reduction

provides a complete continuum of care for those experiencing problems due to substance abuse

and fits with how changing problem behavior is currently viewed. Prochaska, DiClemente, &

Norcorss (1992) developed a stage of change model currently followed by many substance abuse

providers. The stage of change model allows the ideologies of harm reduction and reduction in

use to work together. In the first stage of the model, called “precontemplation”, there is no

intention to change. In the second stage, referred to as “contemplation”, there is an awareness

that the problem exists, but no commitment is made to change. In the third stage, known as

“preparation”, plans are made to make a behavioral change in the near future. In the fourth stage,

called “action”, the process of change begins as the behavior is modified and the environment is

changed to overcome the problem. In the fifth stage, “maintenance”, the behavior change that

occurred in the action stage is maintained with changes being integrated while working to

prevent relapse. Combining the harm reduction and use reduction ideologies to produce policy

changes at the macro-level of the social structure of the United States are appropriate for the

micro-level as well.

Conclusion

National drug policies enacted to curb substance abuse began with rationing whiskey in

the military and progressed to substance abuse policies for youth as well as adults in the home, in

school and in the workplace. From repealing a firm grip on alcohol through Prohibition (Vargas,

23

2005) to trying to regulate the use of drugs by regulating drug trade, society has continually

attempted to combine the desire to use psychoactive substances with the need to regulate use.

The United Nations International Drug Control Programme supports the need for strict drug laws

(Drucker, 1995); others (Reuter & Caulkins, 1995) believe any regulation at all promotes further

abuse and crime. The idea that the government can regulate morals is not an idea easy to

abandon. The potential problems resulting from a free and permissive society regarding drug use

are too overwhelming for most policy makers to consider.

How do we regulate a behavior that still confuses and mystifies both those involved in

ATOD use and those who treat ATOD abusers? How do we make policy when theories of

initiation, causation, risk management, and reduction in use often oppose and contradict each

other? The key is to keep searching. What seems impossible and dangerous today regarding

substance abuse policy may look more appealing in the future (Reuter & Caulkins, 1995). The

danger is not failing to progress with the times; the danger is in failing to move forward in policy

development. History has shown that substance abuse policy continues to expand and change.

This pattern of change will likely continue in the years to come.

24

References

Adelman, H. S. & L. Taylor (2000). Moving prevention from the fringes into the fabric of school

improvement. Journal of Educational and Psychological Consultation, 11, 7-36.

Retrieved January 28, 2006, from Academic Search Premier database.

Alexander, B.K., & Dawes, G.A. (1998). The ‘temperance mentality’: A comparison of

university students in seven countries. Journal of Drug Issues, 28(2), 265-282. Retrieved

October 30, 2005, from Academic Search Premier database.

American Social History Project. (n.d.). The temperance archive. Retrieved October 28, 2005,

from http://www.lostmuseum.cuny.edu/archives/temperance.htm

Axinn, J., & Stern, M. (2005). Social welfare: A history of the American response to need (6th

ed.). Boston: Allyn and Bacon.

Benard, B., Fafoglia, B., & McDonald, M. (1991). Effective substance abuse prevention: School

social workers as catalysts for change. Social Work in Education, 13(2), 90-114.

Retrieved October 28, 2005, from Academic Search Premier database.

Beyers, J., Evans-Whipp, T., Mathers, M., Toumbourou, J.W., & Catalano, R.F. (2005). A cross-

national comparison of school drug policies in Washington State, United States, and

Victoria, Australia. Journal of School Health, 75(4), 134-140. Retrieved October 28,

2005, from Academic Search Premier database.

Close, L. (2005). Drugs in the workplace an issue for industry. Manufacturers’ Monthly, 5, 52-

53. Retrieved October 30, 2005, from Business Source Premier database.

Davenport-Hines, R. (2004). The pursuit of oblivion: A global history of narcotics. New York:

W.W. Norton & Company.

25

Drucker, E. (1995). Harm reduction: A public health strategy. Current Issues in Public Health, 1,

64-70

Goode, E. (1997). Between politics an reason: The drug legalization debate. New York: St.

Martins Press.

Iowa Department of Education (n.d.). Safe and drug-free schools and communities. Retrieved

November 24, 2005, from http://www.state.ia.us/educate/ecese/cfcs/sdfsc

Larimer, M.E., Kilmer, J.R., & Lee, C.M. (2005). College students drug prevention: A review of

individually-oriented prevention strategies. Journal of Drug Issues, 35, 431-455.

Retrieved March 5, 2006, from Academic Search Premier database.

Maris, C.W. (1999). The disasters of war: American repression versus Dutch tolerance in drug

policy. Journal of Drug Issues, 29(3), 493-510. Retrieved October 28, 2005, from

Academic Search Premier database.

Maylath, N.S., & Gray, A.M. (1993). HIV education in-service programming for school

personnel: A model from the United States. Journal of Education for Teaching, 19(3),

263-271. Retrieved October 30, 2005, from Academic Search Premier database.

MacMaster, S. (2004). Harm reduction: A new perspective on substance abuse service. Social

Work, 49(3), 356-363. Retrieved October 28, 2005, from Academic Search Premier

database.

National Student Assistance Association. (2003). NSAA. Retrieved July 28, 2005, from

http://www.nasap.org/components.html

Parker, A.M. (1999). Hearts uplifted and minds refreshed: The Women’s Christian Temperance

Union and the production of pure culture in the United States, 1880-1930. Journal of

26

Women’s History, 11(2), 135-158. Retrieved October 28, 2005, from Academic Search

Premier database.

Prochaska, J.O., DiClemente, C.C., & Norcorss, J.C. (1992). In search of how people change:

Applications to addictive behaviors. American Psychologist, 47, 1102-1114. Retrieved

November 24, 2005, from PsycARTICLES database.

Project Alert. (2005). Welcome to Project Alert. Retrieved November 24, 2005, from

http://www.projectalert.best.org/Default.asp?bhcp=1

Ray, O. (1983). Drugs, society, and human behavior. (3rd ed.). St. Louis: C.V. Mosby

Company.

Reuter, P., & Caulkins, J.P. (1995). Redefining the goals of national drug policy:

Recommendations from a working group. American Journal of Public Health, 85(8),

1059-1063. Retrieved October 28, 2005, from Academic Search Premier database.

Ronald Regan Presidential Library. (1988). Remarks on signing the anti-drug abuse act of 1988.

Retrieved November 24, 2005, from

http://www.reagan.utexas.edu/archives/speeches/1988/111888c.htm

Royce, J.E. (1981). Alcohol problems and alcoholism: A comprehensive survey. New York: The

Free Press.

Schultz, S.K., & Tishler, W. P. (2004). American history 102: Civil War to the presents.

Retrieved November 10, 2005, from

http://us.history.wisc.edu/hist102/lectures/lecture17.html

Sloman, L. R. ( 1998). Reefer madness: A history of marijuana. New York: St. Martins Press.

Substance Abuse Mental Health Services Administration. (2005). CSAP’s prevention pathways.

Retrieved October 30, 2005, from http://pathwayscourses.samhsa.gov

27

Tarter, R.E. (2002). Etiology of adolescent substance abuse: A developmental perspective. The

American Journal on Addiction, 11, 171-191.

University of Puget Sound. (n.d.). Drug free schools and communities act. Retrieved November

24, 2005, from http://www.ups.edu/x4736.xml

U.S. Department of Health and Human Services. (1994). Preventing tobacco use among young

people: A report of the surgeon general. Retrieved November 24, 2005, from

http://www.health.state.mo.us/SmokingAndTobacco/MO_Schools.pdf

United States Department of Labor. (1995). An employer’s guide to dealing with substance

abuse. Retrieved November 24, 2005, from MasterFILE Premier database.

Vargas, M. (2005). The progressive agent of mischief: The whiskey ration and temperance in the

United States army. Historian, 67(2), 199-216. Retrieved October 30, 2005, from

Academic Search Premier database.

Virtual Museum of Canada (n.d.). Rum rations. Retrieved October 29, 2005, from

http://www.virtualmuseum.ca/Exhibitions/Militaris/eng/sea/themes/sthpopup/b.2.5a.html

Webb, M.B. (1999). New Zealand’s national drug policy. Drug and Alcohol Review, 18, 435-

440. Retrieved October 28, 2005, from Academic Search Premier database.

White House Office of National Drug Policy. (2005a). About ONDCP. Retrieved November 24,

2005, from http://www.whitehousedrugpolicy.gov/about/index.html

White House Office of National Drug Policy. (2005b). The president’s national drug control

strategy. Retrieved November 24, 2005, from

http://www.whitehousedrugpolicy.gov/publications/policy/ndcs05/intro.html

Wikimedia Foundation. (2005). Prohibition. Retrieved November 10, 2005, from

http://en.wikipedia.org/wiki/Prohibition.

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Susan Renes is a doctoral candidate at Capella University, School of Human Services. She currently supervises Student Assistance Professionals working in middle schools and high schools in Washington State. Sue’s dissertation study will address substance abuse prevention for adolescent females. For information, please contact the author at srenes@olypen.com