DRUG ABUSEwhich substance abuse takes place (Saxe, Reber,
HalFors, et al. 1997).
The belief that substance abuse is sustained by
community norms represents an ecological ap-
proach. Environmental conditions, whether they
reflect physical conditions in the community, pov-
erty, or available health care, are thus seen as risk
factors for drug use and abuse. Supporters of this
view believe that what is needed are coordinated,
community-wide efforts to address drug abuse
at multiple levels of social organization and the
collaboration of many groups. The idea that
multicomponent community-action efforts can pre-
vent drug abuse derives from earlier studies of
programs designed to cope with cardiovascular
disease. It is consistent with efforts to promote a
variety of other health issues, but substance abuse
is now a primary focus of these efforts.
The largest of these comprehensive efforts is
the federal government’s Community Partnership
Program, which has supported over 250 partner-
ships. The Community Partnership Program was
initiated in 1990 after the Robert Wood Johnson
Foundation had begun to develop a model and
sponsor broad-based community efforts. Called
‘‘Fighting Back’’ programs, they now provide long-
term support to more than a dozen communities
to develop comprehensive demand-reduction in-
terventions. The foundation has also provided
support and technical assistance to hundreds of
additional communities through groups such as
Join Together.
A significant element of many such preven-
tion programs is the presence of a strong media
component. The Partnership for a Drug-Free Ameri-
ca, for example, develops and places hundreds of
millions of dollars of advertising each year, and
communities are encouraged to leverage local me-
dia to present anti-drug messages directed at youth.
Although there is limited direct evidence of the
effectiveness of media campaigns, it is likely that
they reinforce education and prevention messages
being delivered to youth through other means.
Schools play a central role in prevention pro-
grams, under the assumption that drug abuse will
be more easily prevented if programs are started
early. The goal of these programs is to provide
youth with the skills to become successful adults
and to teach them the community’s norms and
values. There is substantial evidence that positive
school experiences are linked to lower levels of
drug use and conversely, that drug use is related to
delinquency and problems in school.The role of school environments in affecting
adolescent substance use has been validated by
specific school-based trials. In both the Midwest-
ern Prevention Project and Project Northland,
significant reductions in the prevalence of sub-
stance use by adolescents were reported (Pentz,
Dwyer, MacKinnon, et al. 1989; Perry, William,
Veblen-Martenson 1996). Designed for students in
grades six through eight, the programs include
academic curricula, along with parental and com-
munity involvement. Often, a significant mass me-
dia component is part of the effort, with a focus on
correcting misperceptions about the consequences
of drug use and providing alternative positive
behavior. The D.A.R.E. program (Drug Abuse Re-
sistance Education) also has been a widely used
school-based prevention strategy.Schools are not the only public institution that
affect youths’ likelihood to abuse drugs. The po-
lice and justice agencies, as well as the network of
health and social service agencies that serve a
community, have a crucial influence and preven-
tion activities typically involve such agencies. The
ability of health and social service professionals to
attend to drug use is clearly important, but their
role is often reactive, providing treatment rather
than prevention.One of the most important programs that has
contributed to attempts by law enforcement agen-
cies to deal with drug abuse is community policing.
It represents a shift from reactive policing where
the goal is to arrest offenders, to an active strategy
designed to identify crime problems and work
with citizens—including offenders—to avoid fur-
ther difficulties. The heart of the approach is that
officers get to know citizens and help them deal
with minor transgressions and, in so doing, avoid
serious crime. A collateral approach, widely used
in the 1990s (‘‘fixing broken windows’’) is de-
signed to improve morale and confidence and
stem the physical and social deterioration of com-
munities by prompt attention to small visible mani-
festations of community dysfunction or decay.
There is evidence that such approaches are, at
least partly, responsible for declines in violent