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Drug abuse prevention—a community approach
PREVENTIVE
MEDICINE
Drug
2,
524-528
Abuse
(1973)
Prevention MERLIN
Osborne
Medical
-A
Community
Approach
W. KAMPFER
Center, Phoenix, Arizona
85013
The people of the United States are faced with solving the problem of the greatest epidemic of drug abuse in history. We are accepting the drugoriented society with anguished uncertainty and concern about potential casualties from illicit drug use. Current fads preoccupy many of us older Americans with better living through chemistry; while the younger Americans are ever pressed with the choice of whether or not to chemically alter their mental states for conformity, curiosity, kicks, recreation, or escape. The central issue for all of us is the style of life referred to and reinforced by drug talk. Drug interest is now a transnational social phenomenon, shifting in style and emphasis because of the rapidity with which impressions and values are widely conveyed. A variety of populations and age groups are at risk. As some subcultures of drug experimenters leave the drug scene new ones find it. These fads are confused in their intent and puzzling in their as yet untested consequences. The United States seems to lead the rest of the world in such drug-centered activities. Drug abuse has so intermeshed itself into America that it is now affecting our way of life and undermining the family, church, and school. Rural areas are no longer exempt from drug-abuse activities. Drug-abuse prevention, through education, and health care treatment facilities must be established on a nationwide basis. The federal government has requested that each state initiate drug-abuse prevention programs and has seen fit to financially assist states in this endeavor. For a drug-abuse prevention program to be effective within a state it must be functional and effective on a community level. Conversely, an effectively coordinated community program offers tremendous impetus to a state’s success in its total fight against drug abuse. Before a community anywhere can combine its people, efforts, and resources into a definitive position to fight drug abuse, it has to recognize its own problems. After accepting the problem of drug abuse, the community must then be sufficiently inspired to surmount individualism for a united cooperative effort not only in education, treatment, and rehabilitation, but also to write into every program a concerted effort to prevent effectively further drug abuse by their subjects. We of Maricopa County, Phoenix, Arizona chose to call our program CODAC. The Community Organization for Drug Abuse Control was organized to combat drug abuse on a community-wide basis with an estimated target population of 1.2 million persons. Its major function was to provide a forum whereby representatives of all agencies, public or private, could work together in a coordinated effort to attack the drug-abuse problem with a minimum of duplication and wasted effort. CODAC was formed as a result of a 524
Copyright 0 1973 by Academic Press, Inc. All rights of reproduction in any form reserved.
DRUG
ABUSE
PREVENTION
FORUM
525
number of problems confronting our citizenry early in 1969. Physicians were being confronted with more and more drug abuse and/or drug overdose problems. Schools found growing evidence of drug use in either the classroom or within or near campus activities. Experimentation with drugs was an ever-increasing pastime of our youth. The Phoenix Police Department reported arrests made for drug abuse were rising steadily each month and substantiated the medical data that we indeed had a drug crisis on our hands. It is not necessary to examine statistics to validate this view because any other community in the country can establish the same supposition simply by looking at their own arrest rates during this time. We had a crisis; but what should we do about it? We were all convinced that finding cases of drug abuse and simply treating and rehabilitating them was not the whole answer. We needed an effective prevention program along with all other efforts to combat the plague. The facilities under the arm of CODAC are structured so that, whatever the primary function is, the program has an effective prevention effort. CODAC’s responsibilities are divided into two major categories: financial services and professional services. The financial structure includes (1) funding, (2) budgeting, and (3) resource development. The professional program encompasses (1) education and prevention, (2) treatment and rehabilitation, and (3) training and research. To appreciate the role of a communityoriented program in drug-abuse prevention one must look at the programs that now exist under the arm of the CODAC umbrella structure. 1. ABZBZFO KORYE KUW (A Bantu Dialect Black People’s Association)
term meaning
This program is equipped for treatment of emergency drug crisis and drugand alcohol-related medical problems. Functions also include community information service on drugs and drug usage, limited detoxification, drug crisis intervention, and referral. This outreach program maintains a “no heat” policy with the cooperation of local law-enforcement agencies. This “policy” relates to drug users and drug-use problems only and is not meant to create a sanctuary from authorities. Patients are predominantly over 18 years of age; however, the program includes persons of every age and race. 2. Arizona
Boys Community
This is a nonsectarian, nonprofit rehabilitative facility for boys which offers a professional program of individual counseling and group therapy. The home exercises continuous control on a 24-hr basis and insures a common philosophy of treatment. It is a live-in center for the purpose of rehabilitating delinquent youth. 3. Arizona
Family
Incorporated
This is a long-term residential rehabilitation program for drug users. Its overall purpose is the rehabilitation and resocialization of the addict as a selfsupporting individual. T)le, Family operates a residential facility where clients are sent after they have undergone detoxification procedures as recom-
M. W.
526
KAMPFER
mended by the Family staff. Clients stay in the highly structured residential program from 9 to 12 months. This therapeutic community, operating on a 24-hr basis, is run by a staff of ex-addicts. 4. Central
Professional
Services
This team of professional people provides supportive services to all CODAC funded and affiliated agencies and programs. They function in the role of consultative staff to provide continuity of care within CODAC’s drugabuse treatment and prevention network. 5. Creative
Living
Foundation
Creative Living Foundation is a private nonprofit corporation, incorporated in Arizona and operating within Maricopa County. Its function is the operation of an outpatient and residential care facility, serving the therapeutic needs of dysfunctional adolescents and young adults with drug-related problems on a 24-hr basis. 6. Parents Anonymous Parents Anonymous is an informal group of persons concerned about drug abuse and comprised primarily, but not entirely, of parents with drug problems in their families. Weekly meetings of the group provide parents of children with a drug-abuse problem an opportunity to discuss common problems, relieve the initial panic and bewilderment, and substitute a reasonable act& program to improve the family situation. The organization has an answering service offering assistance around the clock. 7. Synergy This is a short-term, intensive, behavioral evaluation residential center designed to potentiate CODAC agencies and CODAC affiliates’ work in the rehabilitation of drug users. The program offers {a) a specialized program for individuals who need to be removed from their immediate environment, (b) referral to another environment or agency, (c) temporary holding and evaluation for complex or difficult cases, (d) short-term preparation for placement and referral. This program operates 24 hr a day. 8. Teen Involvement Working together as part of CODAC’s total community response, Teen Involvement has grown into what is now called CODAC’s Education Division and is directly involved with schools, municipalities, service agencies, service clubs, parent groups, religious groups, business, and industry within the state. Teen Involvement is the major prevention operation of CODAC and is designed to supplement the existing school program not replace it. Teen Involvement recruits, trains, and supervises high school volunteers to be Teen Counselors. Teen Counselors, in turn, visit participating elementary classrooms county wide. In teams, they divide the classroom into groups where participation in exercises called “success experiences” is encouraged.
DRUG
ABUSE
PREVENTION
FORUM
527
Success experiences are communication games which demonstrate skills needed for healthy interpersonal relationships and personal growth. Hundreds of thousands of personal contacts are made with this program in a true grass roots drug-abuse prevention program. 9. Terros This agency provides 24-hr emergency service for young people with bummer overdoses. The primary function of Terros is to act as a contact point for drug abusers in crisis situations through the use of telephone, walk-in contact, and operation of the only fully equipped emergency vehicles operated by such a center in the country. Terros provides an interface between the dope and straight communities where, with the consent of the police department, nonjudgmental, confidential emergency aid may be obtained. Staff members have been trained in emergency medical procedures, interim counseling, handling emotional crisis, and evaluating clients for future referral. They also maintain a free clinic where treatment is provided and is staffed by a registered nurse and volunteer physicians. 10. Valle de1 Sol Narcotic
Prevention
Project
The entire staff of this project are former residents of low-income areas. Staff members have either participated in or been exposed to an environment with a high rate of drug use. The project provides individual counseling, group therapy, chemotherapy follow-up, court intervention, preventive education, preventive information, job placement, and/or vocational training. A drug-free component has also been developed. Members enrolled in this component are recipients of all center services except chemotherapy, and, in addition, chemotherapy members are encouraged with much effort to transfer to this component. Approximately 50% of all project members are now drugfree. These agencies and programs saw approximately 5000 individuals in 1972. A breakdown by unit is depicted in Table I.
TABLE
I
NUMBERS OF PERSONSTREATED IN 1972 BY VARIOUS AGENCIES UNDER THE CODAC UMBRELLAS Abibifo Koyre Kuw” Arizona Boy’s Community Arizona Family Creative Living Foundation Synergy Terros Valley de1 Sol 4 Figures are approximate. b Program started late in 1972.
38 40-50 154 161 188 3276 205
528
11. CODAC-Accredited
M. W.
KAMPFER
Agencies
Besides the 10 agencies and programs funded by CODAC there are 36 agencies coordinated under the CODAC umbrella; time and space will not permit a description of the services of each of these agencies. They are involved directly or indirectly with drug-abuse problems or their prevention. In order to assure the most efficient and effective matching of needs and resources of drug abuse control efforts in Maricopa County, such agencies agree to affiliate and coordinate their activities with other CODAC agencies to assure no overlap or fragmentation of services. With the completion of a description of a number of community-oriented and community-coordinated drug-abuse programs, one asks, does it really work? Do they succeed in drug abuse prevention, which should be the ultimate goal of such programs? After all, one must decrease the pool of potential drug abusers or eventually drug abuse programs would be inundated with clients. Certainly in Maricopa County, Arizona we have an informed and aware community. This type of community is needed to offer any long-term solution to drug abuse. The problems of drug abuse must be recognized early and referred to an appropriate treatment facility promptly. This much we have succeeded in doing with CODAC. As long as drug abuse exists, an informed and aware citizenry must carry heavier and broader responsibibties to recognize, rehabilitate, and prevent drug abuse. To meet these responsibilities, we, as citizens, must extend our knowledge of the problem and participate as both teacher and pupil in training programs. The final solution for the drug-abuse problem will come through flexibility and innovation of approach. To achieve these goals we must have an aware and knowledgeable community. This can only come about by community-oriented drug-abuse prevention efforts such as those modeled by CODAC.
MEDICINE
Drug
2,
524-528
Abuse
(1973)
Prevention MERLIN
Osborne
Medical
-A
Community
Approach
W. KAMPFER
Center, Phoenix, Arizona
85013
The people of the United States are faced with solving the problem of the greatest epidemic of drug abuse in history. We are accepting the drugoriented society with anguished uncertainty and concern about potential casualties from illicit drug use. Current fads preoccupy many of us older Americans with better living through chemistry; while the younger Americans are ever pressed with the choice of whether or not to chemically alter their mental states for conformity, curiosity, kicks, recreation, or escape. The central issue for all of us is the style of life referred to and reinforced by drug talk. Drug interest is now a transnational social phenomenon, shifting in style and emphasis because of the rapidity with which impressions and values are widely conveyed. A variety of populations and age groups are at risk. As some subcultures of drug experimenters leave the drug scene new ones find it. These fads are confused in their intent and puzzling in their as yet untested consequences. The United States seems to lead the rest of the world in such drug-centered activities. Drug abuse has so intermeshed itself into America that it is now affecting our way of life and undermining the family, church, and school. Rural areas are no longer exempt from drug-abuse activities. Drug-abuse prevention, through education, and health care treatment facilities must be established on a nationwide basis. The federal government has requested that each state initiate drug-abuse prevention programs and has seen fit to financially assist states in this endeavor. For a drug-abuse prevention program to be effective within a state it must be functional and effective on a community level. Conversely, an effectively coordinated community program offers tremendous impetus to a state’s success in its total fight against drug abuse. Before a community anywhere can combine its people, efforts, and resources into a definitive position to fight drug abuse, it has to recognize its own problems. After accepting the problem of drug abuse, the community must then be sufficiently inspired to surmount individualism for a united cooperative effort not only in education, treatment, and rehabilitation, but also to write into every program a concerted effort to prevent effectively further drug abuse by their subjects. We of Maricopa County, Phoenix, Arizona chose to call our program CODAC. The Community Organization for Drug Abuse Control was organized to combat drug abuse on a community-wide basis with an estimated target population of 1.2 million persons. Its major function was to provide a forum whereby representatives of all agencies, public or private, could work together in a coordinated effort to attack the drug-abuse problem with a minimum of duplication and wasted effort. CODAC was formed as a result of a 524
Copyright 0 1973 by Academic Press, Inc. All rights of reproduction in any form reserved.
DRUG
ABUSE
PREVENTION
FORUM
525
number of problems confronting our citizenry early in 1969. Physicians were being confronted with more and more drug abuse and/or drug overdose problems. Schools found growing evidence of drug use in either the classroom or within or near campus activities. Experimentation with drugs was an ever-increasing pastime of our youth. The Phoenix Police Department reported arrests made for drug abuse were rising steadily each month and substantiated the medical data that we indeed had a drug crisis on our hands. It is not necessary to examine statistics to validate this view because any other community in the country can establish the same supposition simply by looking at their own arrest rates during this time. We had a crisis; but what should we do about it? We were all convinced that finding cases of drug abuse and simply treating and rehabilitating them was not the whole answer. We needed an effective prevention program along with all other efforts to combat the plague. The facilities under the arm of CODAC are structured so that, whatever the primary function is, the program has an effective prevention effort. CODAC’s responsibilities are divided into two major categories: financial services and professional services. The financial structure includes (1) funding, (2) budgeting, and (3) resource development. The professional program encompasses (1) education and prevention, (2) treatment and rehabilitation, and (3) training and research. To appreciate the role of a communityoriented program in drug-abuse prevention one must look at the programs that now exist under the arm of the CODAC umbrella structure. 1. ABZBZFO KORYE KUW (A Bantu Dialect Black People’s Association)
term meaning
This program is equipped for treatment of emergency drug crisis and drugand alcohol-related medical problems. Functions also include community information service on drugs and drug usage, limited detoxification, drug crisis intervention, and referral. This outreach program maintains a “no heat” policy with the cooperation of local law-enforcement agencies. This “policy” relates to drug users and drug-use problems only and is not meant to create a sanctuary from authorities. Patients are predominantly over 18 years of age; however, the program includes persons of every age and race. 2. Arizona
Boys Community
This is a nonsectarian, nonprofit rehabilitative facility for boys which offers a professional program of individual counseling and group therapy. The home exercises continuous control on a 24-hr basis and insures a common philosophy of treatment. It is a live-in center for the purpose of rehabilitating delinquent youth. 3. Arizona
Family
Incorporated
This is a long-term residential rehabilitation program for drug users. Its overall purpose is the rehabilitation and resocialization of the addict as a selfsupporting individual. T)le, Family operates a residential facility where clients are sent after they have undergone detoxification procedures as recom-
M. W.
526
KAMPFER
mended by the Family staff. Clients stay in the highly structured residential program from 9 to 12 months. This therapeutic community, operating on a 24-hr basis, is run by a staff of ex-addicts. 4. Central
Professional
Services
This team of professional people provides supportive services to all CODAC funded and affiliated agencies and programs. They function in the role of consultative staff to provide continuity of care within CODAC’s drugabuse treatment and prevention network. 5. Creative
Living
Foundation
Creative Living Foundation is a private nonprofit corporation, incorporated in Arizona and operating within Maricopa County. Its function is the operation of an outpatient and residential care facility, serving the therapeutic needs of dysfunctional adolescents and young adults with drug-related problems on a 24-hr basis. 6. Parents Anonymous Parents Anonymous is an informal group of persons concerned about drug abuse and comprised primarily, but not entirely, of parents with drug problems in their families. Weekly meetings of the group provide parents of children with a drug-abuse problem an opportunity to discuss common problems, relieve the initial panic and bewilderment, and substitute a reasonable act& program to improve the family situation. The organization has an answering service offering assistance around the clock. 7. Synergy This is a short-term, intensive, behavioral evaluation residential center designed to potentiate CODAC agencies and CODAC affiliates’ work in the rehabilitation of drug users. The program offers {a) a specialized program for individuals who need to be removed from their immediate environment, (b) referral to another environment or agency, (c) temporary holding and evaluation for complex or difficult cases, (d) short-term preparation for placement and referral. This program operates 24 hr a day. 8. Teen Involvement Working together as part of CODAC’s total community response, Teen Involvement has grown into what is now called CODAC’s Education Division and is directly involved with schools, municipalities, service agencies, service clubs, parent groups, religious groups, business, and industry within the state. Teen Involvement is the major prevention operation of CODAC and is designed to supplement the existing school program not replace it. Teen Involvement recruits, trains, and supervises high school volunteers to be Teen Counselors. Teen Counselors, in turn, visit participating elementary classrooms county wide. In teams, they divide the classroom into groups where participation in exercises called “success experiences” is encouraged.
DRUG
ABUSE
PREVENTION
FORUM
527
Success experiences are communication games which demonstrate skills needed for healthy interpersonal relationships and personal growth. Hundreds of thousands of personal contacts are made with this program in a true grass roots drug-abuse prevention program. 9. Terros This agency provides 24-hr emergency service for young people with bummer overdoses. The primary function of Terros is to act as a contact point for drug abusers in crisis situations through the use of telephone, walk-in contact, and operation of the only fully equipped emergency vehicles operated by such a center in the country. Terros provides an interface between the dope and straight communities where, with the consent of the police department, nonjudgmental, confidential emergency aid may be obtained. Staff members have been trained in emergency medical procedures, interim counseling, handling emotional crisis, and evaluating clients for future referral. They also maintain a free clinic where treatment is provided and is staffed by a registered nurse and volunteer physicians. 10. Valle de1 Sol Narcotic
Prevention
Project
The entire staff of this project are former residents of low-income areas. Staff members have either participated in or been exposed to an environment with a high rate of drug use. The project provides individual counseling, group therapy, chemotherapy follow-up, court intervention, preventive education, preventive information, job placement, and/or vocational training. A drug-free component has also been developed. Members enrolled in this component are recipients of all center services except chemotherapy, and, in addition, chemotherapy members are encouraged with much effort to transfer to this component. Approximately 50% of all project members are now drugfree. These agencies and programs saw approximately 5000 individuals in 1972. A breakdown by unit is depicted in Table I.
TABLE
I
NUMBERS OF PERSONSTREATED IN 1972 BY VARIOUS AGENCIES UNDER THE CODAC UMBRELLAS Abibifo Koyre Kuw” Arizona Boy’s Community Arizona Family Creative Living Foundation Synergy Terros Valley de1 Sol 4 Figures are approximate. b Program started late in 1972.
38 40-50 154 161 188 3276 205
528
11. CODAC-Accredited
M. W.
KAMPFER
Agencies
Besides the 10 agencies and programs funded by CODAC there are 36 agencies coordinated under the CODAC umbrella; time and space will not permit a description of the services of each of these agencies. They are involved directly or indirectly with drug-abuse problems or their prevention. In order to assure the most efficient and effective matching of needs and resources of drug abuse control efforts in Maricopa County, such agencies agree to affiliate and coordinate their activities with other CODAC agencies to assure no overlap or fragmentation of services. With the completion of a description of a number of community-oriented and community-coordinated drug-abuse programs, one asks, does it really work? Do they succeed in drug abuse prevention, which should be the ultimate goal of such programs? After all, one must decrease the pool of potential drug abusers or eventually drug abuse programs would be inundated with clients. Certainly in Maricopa County, Arizona we have an informed and aware community. This type of community is needed to offer any long-term solution to drug abuse. The problems of drug abuse must be recognized early and referred to an appropriate treatment facility promptly. This much we have succeeded in doing with CODAC. As long as drug abuse exists, an informed and aware citizenry must carry heavier and broader responsibibties to recognize, rehabilitate, and prevent drug abuse. To meet these responsibilities, we, as citizens, must extend our knowledge of the problem and participate as both teacher and pupil in training programs. The final solution for the drug-abuse problem will come through flexibility and innovation of approach. To achieve these goals we must have an aware and knowledgeable community. This can only come about by community-oriented drug-abuse prevention efforts such as those modeled by CODAC.