Table of Contents:

• Overview
• Recent Findings
• HHS Substance Abuse Initiatives, Research, and Programs

Overview

Each year, drug- and alcohol-related abuse kills 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 downward 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 $441 million in youth-focused substance abuse activities, which worked to raise awareness among youth, counter pro-drug messages 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 governor's offices in 20 states and the mayor's office in the District of Columbia to support state/city-wide 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 National Household Survey, there has been a significant downward trend in illicit drug use, including marijuana use, among youths age 12-17 over the past three years. Among the overall population 12 and older, illicit drug use generally remained flat in 1999.

The 1999 National Household Survey's results of general stability or decline in illicit drug, marijuana and cigarette use among teenagers is similar to findings from the Monitoring the Future Study, which has noted a general overall leveling or decline of substance use among youth in the past three years.

Recent Findings

HHS is responsible for three major drug surveys: the National Household Survey (NHS), the Monitoring the Future Study (MTF) and the Drug Abuse Warning Network (DAWN) survey. 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 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]

After dramatic increases in the early 1990's, the results from the last three years of the National Household Survey show a consistent downward trend among adolescents' use of illicit drugs.

The NHS national trend data reported that 9.0 percent of youths age 12-17 in 1999 reported current use of illicit drugs. While the rate of use did not change significantly between 1999 and 1998, there is a significant consistent downward trend over time from 11.4 percent in 1997 to 9.9 percent in 1998 and 9.0 percent in 1999. In 1999, the Monitoring the Future Study suggests that lifetime, past year, and past month use of illicit drugs and marijuana among teenagers remained stable for the third year in a row. [1992-1999 MTF, 1993-1999 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 1999 NHS national trend data, current cigarette smoking among youths age 12-17 was 15.9 percent, not statistically different than in 1998 (18.2 percent), but significantly lower than the rate in 1997 (19.9 percent). [1999 NHS]

In 1999, 105 million Americans (52.0 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. 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]

For the past few years, alcohol use has remained stable among Americans age 12 and older, according to NHS national trend data. [NHS 1999]

Use of alcohol has generally remained stable in the past few years among eighth and 10th graders, and more recently among 12th graders, as reported in the 1999 MTF. Daily use among 12th graders did decrease from 3.9 percent in 1998 to 3.4 percent in 1999. [1999 MTF]

But, alcohol use among all teenagers remains at unacceptably high levels. Past month use of alcohol in 1999 was 24 percent for all eighth graders, 40 percent for 10th graders, and 51 percent for seniors. [1999 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. 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.

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 recently 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 colleges 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 all 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, SAMHSA is currently working with governors in 20 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 500 communities.

The Targeted Capacity Expansion program also addresses the regional nature of drug abuse by targeting states, cities, counties or other entities that identify a need for and can rapidly put into place effective treatment services for emerging drug epidemics. 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.

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.

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.org, to alert teens, parents and educators about the dangers of club drugs such as ecstasy, GHB and Rohypnol. These drugs are often used as at all night "raves" or dance parties and have potentially life-threatening effects.

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 has a $42.8 million fiscal year 2000 budget for prevention and treatment research on underage alcohol use and its consequences.

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.

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 at 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 indicated a substantial increase in methamphetamine-related hospital emergency room episodes from 1991 to 1995. 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. HHS is working to gather and disseminate the most current information on promising prevention and treatment programs tailored to methamphetamine 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! HHS' Girl Power! campaign, launched in November 1996, is working with national, state and local organizations that serve girls aged 9-14 to send girls strong "no-use" messages about drugs and to provide them with positive opportunities. For more information about Girl Power! call the National Clearinghouse for Alcohol and Drug Information at 1-800-725-6686, or visit the Girl Power! Web site at www.health.org/gpower/.

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.

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. For a free copy, call the National Clearinghouse for Alcohol and Drug Information (NCADI) at 1-800-729-6686.

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 http://www.health.org.

NIDA Infofax. 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). All fact sheets from NIDA Infofax are also available on the NIDA home page at www.nida.nih.gov.

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 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 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)