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National Conference on Drug Abuse Prevention Research:
Presentations, Papers, and Recommendations


Opening Plenary Session

Keynote Address

General Barry R. McCaffrey
Office of National Drug Control Policy
Executive Office of the President

National Conference on Drug Abuse Prevention Research

Let me thank Secretary Shalala for including me in today's activities, and certainly Dr. Alan Leshner, the NIDA Director. I embarrass him frequently because I boast about his leadership and his example, along with others, including Nelba Chavez, Elaine Johnson, David Mactas, the people in the Justice Department, and the people in the Department of Education, who provide me with background information on those aspects of the drug challenge that I need in order to seriously address policy options in this arena.

One of Dr. Leshner's slogans is one that I have adopted: "By the turn of the century we are going to replace ideology with science." The bottom line is that I know far more definitive information about North Korean nuclear weapons than I do about heroin addiction, who is taking heroin, why they are doing it, and what treatment methodologies work. That is a disgrace, and that is why this conference is so enormously important to all of us.

Let me briefly salute people like Dr. Robert Pandina at Rutgers University, Dr. Gilbert Botvin at Cornell University, Dr. Mary Ann Pentz at the University of Southern California, Dr. Thomas Dishion at the Oregon Social Learning Center, and Dr. William Hansen at Tanglewood Research, and those of you who came here from all over the country. You are very busy people who have come to share your thinking about what is, unarguably in my own judgment, the key issue in the national drug strategy: the prevention of drug abuse. Many of you have devoted your entire adult lives to trying to understand and deal with the problem of substance abuse in America.

What the National Drug Strategy represents is what our President put forth to the American people a few months ago in Miami. We wanted to emphasize a comprehensive approach to addressing substance abuse in America rather than just picking one variable and addressing that.

I think cancer may be akin to the type of problem you and I are facing with substance abuse. First of all, substance abuse, like cancer, is a fairly common challenge that most families have faced. You have to do pain management, and you have to get to the root cause. You take 5-year survival rates and talk about the dignity of the individual. You take a holistic approach. The President faced the American people and said that our drug abuse strategy has to be a long-term engagement. It is not a military campaign but rather a very complex social, medical, legal, and law enforcement issue. It will be solved not by Washington, but by parents, school teachers, ministers, coaches, and community coalitions, and, it is hoped, with the very direct involvement of the research community. This involvement has been the missing factor.

You and I learned in Philosophy 101 that you do not argue about facts. They either are facts or they are not facts. You have to start with a set of common assumptions to have any kind of serious discussion of policy alternatives. These assumptions are part of our challenge. We are still arguing about the facts. A lot of our data are soft and inadequate. If you are a serious scholar in the field, you understand the limitations of your own data. On the other hand, there is a lot that is known, and certainly there is a mountain of anecdotal information to buttress many of the arguments you make, particularly in the field of drug prevention.

We have to move forward in some systematic fashion so that we end up with conclusions based on scientific analysis that are subject to peer group review and can be reproduced by other investigators. That is where we need to go, and we need researchers to help us. One of the many joys of this job is to be able to talk to members of the research community, hear what you are doing, and learn about your conclusions as they emerge.

The National Drug Strategy has five goals. Any cunning bureaucrat in Washington learns early on that you do not tell people what your priorities are. If you have 10 priorities, those people who hear they made priority number 4 or number 8 are enraged and want to know why they cannot be number 3 or number 7. So we do not have multiple priorities in the National Drug Strategy - we have only one. Absolutely without question, the single priority is to motivate American youth to reject substance abuse.

We understand, both on an intuitive level and from experience in studies, that if American kids can get from sixth grade to age 20 without smoking cigarettes, abusing alcohol, or using illegal drugs, they are "home free," statistically speaking, and will not suffer addiction problems for the remainder of their lives.

You and I essentially are concerned about only two facts. The first fact is that when people use illegal drugs or abuse alcohol, they experience intense pleasure. I think we have been inadequate in telling young people up front that this is why people use drugs. There is a pleasure-seeking dimension to it. The second fact is that drugs cause you to act like a jerk, and we have not made that point. We have not said that heroin abuse also gives you enormous nausea, makes your skin crawl, constipates you, and diminishes your sex drive. Now, that is the "good" news about heroin use. The bad news is that, as with most addictive substances, you develop drug dependency and tolerance, and your life becomes one of unending misery from trying to satisfy this addiction. And this second dimension is a tough one because, as you know better than I, once you are addicted, the challenge is to effectively treat the addiction.

Along with this challenge is the relapsing nature of the disorder and the way we provide treatment. Our limited therapeutic tools are a big problem. Getting folks unhooked from the rewired neurochemical brain processes of drug addiction is a tough challenge at best, but we think it is doable and certainly worth the money. It is a no-brainer for a taxpayer to want to invest in drug treatment, but treatment itself is difficult.

So drug use prevention for the 68 million kids 18 years and younger is what we are going to focus on. It is the spearhead of the whole effort. Secretary Shalala already mentioned one of our challenges: we have stopped talking to kids about drugs. You and I know heroin is an enormous risk. Eighty-five percent of us will say that, but 50 percent of 12- to 17-year-olds say they fear heroin experimentation. We have not been talking to the children.

The news media stopped focusing on it. The school systems backed off, saying they felt inadequately equipped, and they were not sure it was an appropriate role for them. And the ministers, where are the ministers? We simply have to send a consistent prevention message appropriate for each age group to children from kindergarten through the 12th grade. If we do, then more adolescents and children will not be exposed to these drugs and become at risk of addiction.

We have to remind ourselves that drug use is not inevitable: 80 percent of our children have never touched an illegal drug. But we do have a problem, and we have to get moving. We have to get organized. We also are going to have to listen, and I think the renewed election year debate about drug use is probably a very helpful thing. In the flurry of body blows, the American people and the news media inevitably will come to balanced, correct conclusions.

We have a 1997 budget before Congress now, and we need help. We need to get the budget of $15.1 billion and the $250 million supplemental funding request passed by Congress. Most of that money is for law enforcement and prisons, and that is okay. Drugs are wrong, and you have to uphold the law. We must have law enforcement authorities address the issue because if we do not, prevention, education, and treatment messages will not work very well. But having said that, I also believe that we have created an American gulag. We have 1.6 million people behind bars, and probably two-thirds of those in the Federal system are there for drug-related crimes.

We are having a difficult time making an adequate case to responsible men and women in Congress, State legislatures, and city councils that drug prevention works. I need your help. You need to make the case, and you need to talk to your Government representatives at the State, local, and Federal levels. You need to back up what you have intuitively learned throughout your professional careers - that drug prevention is the absolute centerpiece of a sensible national drug strategy.

Let me also ask you to do several additional things. It seems to me you have to speak to the news media more frequently. Come forward and help us make the case. We have a debate right now - Proposition 215 in California is simply outrageous, and Proposition 200 in Arizona is incredible. It is unclear what those two propositions will do. But what Secretary Shalala, law enforcement officers, and I do know is that it is bad science and bad medicine. It also will expose children in California and Arizona to widespread use of another psychoactive substance [marijuana], which we believe, along with cigarette smoking and alcohol abuse, is absolutely a gateway behavior that sets kids up to lose in life. We have to do something about it.

Who is in the debate? The people who ought to speak to the issue are the professionals who understand it, and that includes you, the medical community, treatment community, and prevention community, along with parents, educators, and others who have responsibility for children. We simply have to stand up in that debate.

I would like to suggest a final note of optimism that has been lacking in this entire issue. I commonly have people clap me on the back and say what a brave lad I am to sign up to work on a problem that seems impossible to break out of. Am I not industrious for agreeing to take on this whole challenge? I told the President there are only two things that I bring to the table that are unique. One overwhelming credential I bring to the table is that I was confirmable by the Senate. But the second one is a sense of optimism. I have three grown kids who married people who are like them. They are drug-free and they are responsible, hard-working youngsters, like most of America. The overwhelming majority of Americans do not use illegal drugs and do not have substance abuse problems. Our problem is that many Americans do.

I watched the U.S. Armed Forces go through this issue in the 1970s. It was a nightmare. If you were in uniform between 1971 and 1981, [you know that] the impact of substance abuse on our professionalism, discipline, and spiritual strengths was beyond belief. About one-third of the Armed Forces were using drugs all the time, and maybe another third would use them when they could get their hands on them. I do not know which was worst: marijuana, Quaaludes, or alcohol. They were all mixed in there and had a destructive effect on our physical and moral ability to defend America. We worked our way out of it, and contrary to what many people believe, we did not do it through punishment. We did it because we had an advantage over civilian institutions, called sergeants. These sergeants were men and women ages 25 to 35, who cared about the 19-year-olds under their control. They set standards and articulated a work atmosphere of dignity, caring, and monitorship. I might add it took us nearly 10 years to get out of it, and drug testing was a key component of that effort. Drug testing is a tool that is not necessarily available in American society. We prize our liberty and our right to privacy, so we cannot assume that we can go about this problem as Singapore does or as the U.S. Marine Corps does.

But the youngsters in the Armed Forces are the same beautiful people that are here in the streets of Washington and in your community, and they respond to the same motivations. I would suggest that we take a long-term approach and encourage a sense of partnership. You have the most important task of all - drug education and prevention. You have to tutor us and the American people, using information from scientific inquiry, about what works and what does not work. You can assume that Secretary Shalala, Secretary Riley, and I will take the results of your work and be your public servants.

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