Field of Work: A community-wide approach to drug problems
Problem Synopsis: Drug and alcohol abuse are pervasive throughout the United States. There are more deaths, illnesses, and disabilities from substance abuse than from any other preventable health condition. Of the two million deaths each year in the United States, more than one in four is attributable to alcohol, illicit drug, or tobacco use.
Synopsis of the Work: The Fighting Back® program addressed drug problems in 11 communities of 100,000 to 250,000 people through a community-wide approach, involving business, health care, the public school system, local government and its agencies, the police, community groups, local media, and the clergy. RWJF provided $87.9 million from 1988 until the fall of 2003.
The largest number of initiatives mounted by these communities was environmental in nature, almost half addressed social or physical environments that promote or sustain alcohol and drug use. Only about a third attempted to strengthen individuals to resist alcohol and drug use; only one in five targeted the supply, cost, or availability of alcohol and other drugs.
Evaluation Findings and Conclusions: The evaluation by Brandeis University has shown that a sustained, 10-year community-based coalition approach with ample technical assistance and direction, top-notch people, and sites that were pre-selected, did not produce robust results in terms of decreasing substance abuse. One conclusion is that community coalitions alone are not a sufficient solution to the substance abuse problem.
The indicators of substance abuse across the sites have not decreased sufficiently for RWJF to be able to say that Fighting Back's approach should be heralded as the solution. Legislators should not think that spending money on community coalitions alone will be enough to solve such a pressing problem. Yet, coalitions may be a necessary piece of any effective strategy, and through the Fighting Back program, many lessons were learned about how to initiate and sustain community coalitions.