Twenty years ago, CASAColumbia was just a gleam in my eye. We started with only four of us: Herb Kleber, the world-renowned psychiatrist and expert in substance abuse and addiction who had been Bill Bennett’s deputy when Bill was White House Drug Czar; Susan Brown, who came from Washington to handle our financial and administrative needs; JoAnn McCauley, my executive assistant; and me.
Since then, we have assembled a staff of some 50 professionals—the best and brightest group in this field—and have raised more than $260 million, including an endowment of about $50 million.
CASAColumbia was founded on this postulate: The problem is substance abuse and addiction, not a specific drug like nicotine, alcohol, marijuana, cocaine, heroin, tranquilizers, painkillers, steroids or any other individual legal, illegal, prescription or performance-enhancing substance. The organizing concept was to put under one roof all the different skills—medicine, law, communications, social work, psychology, statistics, education, government, economics—needed to identify the corrosive impact of substance abuse and addiction in all sectors of our society.
My objective has been to give this nation an asset with the independence to seek practical, effective ways to combat substance abuse and addiction, independent of any ideological commitment, preconception or prejudice, with no political drug war to defend or attack.
From our initial board meeting, when First Lady Betty Ford spoke of addiction as a disease—a physical, neurological, psychological, emotional and spiritual one—our board recognized that addiction is not some moral defect or bad habit easily discarded. Addicted smokers, drinkers or heroin addicts have tenacious gorillas, not playful monkeys, on their backs.
Over the first 20 years, we have issued more than 75 reports and white papers, published three books and 200 articles, conducted 20 teen surveys, and tested preventive and corrective programs in more than 270 schools and other sites in 37 states across the country.
What have we achieved?
We established the statistical relationship between smoking, drinking, marijuana use and the use of other drugs. That helped prompt scientists at Scripps in California, and in Madrid and Italy, to do the laboratory bench work to establish that all these substances influence dopamine levels in the brain through common pathways. More recently, scientists like Dr. Nora Volkow, Director of the National Institute on Drug Abuse at the National Institutes of Health, have used sophisticated neurological imaging to show the common impact of these substances on the brain.
Our analysis of the effectiveness of the nation’s first drug courts, in Florida and elsewhere, provided evidence for the federal government and states to create more than 2,400 drug courts throughout the country, thus reducing recidivism and saving thousands of drug-involved young offenders.
In 2000, at the request of the White House Drug Czar, we examined the involvement of performance-enhancing drugs in Olympic sports. Armed with our report, he convinced the Olympic Committee to establish sophisticated testing to eliminate this form of cheating in Olympic competition.
Our 2001 report, Shoveling Up: The Impact of Substance Abuse on State, Federal and Local Budgets, revealed that 96 cents of every taxpayer dollar spent on substance abuse and addiction was used to shovel up its healthcare, crime and other consequences, and only two cents was devoted to prevent and treat this disease. This work gave Congress enough ammunition to enact the Drug Abuse Education, Prevention, and Treatment Act the following year.
Our reports, Under the Counter: The Diversion and Abuse of Controlled Prescription Drugs in the U.S. (2005) and You’ve Got Drugs (2004–2008), exposed the sharp increase in adolescent (and adult) prescription drug abuse and the easy online availability of such drugs. In 2008, citing those reports, the Senate Judiciary recommended and the Congress passed the Ryan Haight Online Pharmacy Consumer Protection Act to curb online access.
The CASAColumbia book, Women under the Influence, published in 2008 by the Johns Hopkins University Press and the product of a decade of research on women and substance abuse, led Florida to develop a statewide approach to address addiction among girls and women, and provided practical ideas to improve treatment programs nationally.
Through our teen surveys, we have learned that the more often kids have dinner with their parents, the less likely they are to smoke, drink or use drugs. Recognizing that dinner is a surrogate for parental engagement, we have created Family Day—A Day to Eat Dinner with Your ChildrenTM, which is endorsed by the president, governors, and more than1,000 cities and counties.
Our annual teen survey has provided other insights for parents about the world of their teens, and forms much of the basis for my book, How to Raise a Drug Free Kid: The Straight Dope for Parents, which has sold 39,000 copies.
We sparked the movement to make college campuses smoke free with a 1993 report by our Commission on Substance Abuse at Colleges and Universities, Smoke-Free Campus, and in 1994 we identified the explosion of excessive drinking on college campuses (especially among women).
CASAColumbia’s research found that 85 percent of inmates committed their violent crimes while high on alcohol or some other drug, stole money to buy drugs, were alcohol or drug addicts or abusers, or violated drug and alcohol laws; 70 percent of children in child welfare programs are there because of drug and alcohol abusing parents; and about half of all college students binge drink or abuse illegal or prescription drugs, and a quarter of them meet the medical criteria for addiction. We demonstrated that 30 percent of Medicare and Medicaid costs is due to smoking, drinking and drug use, and the total healthcare cost is more than $500 billion annually. In short, we have made the case beyond a reasonable doubt that substance addiction and abuse are implicated in just about every social problem the nation faces.
Illegal drugs and abuse of prescription drugs garner the lion’s share of media attention and spawn the most fear in parents, but the two marauding monsters are smoking— which kills more than 440,000 Americans each year—and excessive drinking—which kills more than 100,000.
Each also cripples hundreds of thousands more, through diseases, accidents and violence.
With all of that, I believe the most important finding of 20 years of research is this: A child who gets through age 21 without smoking, using illegal drugs or abusing alcohol is virtually certain never to do so. More than 90 percent of Americans who are addicted started smoking, drinking or using other drugs before the age of 18.
In February 2012, I stepped down as chairman of CASAColumbia. Our board of directors has elected Jeffrey B. Lane to succeed me. Jeff is the ideal leader for CASAColumbia as it moves to build on its reputation as the premier institution in the field and seeks to expand its influence. He is committed, thoughtful, creative and determined to amplify CASAColumbia’s voice in raising awareness of addiction’s impact and costs; shaping healthcare practice and public policy promoting prevention and treatment; creating proven, effective approaches to keep American families and children healthy and drug free; and providing health professionals, politicians, educators, judges, social workers, journalists, employers and workers—as well as community organizations and parents—with accurate and insightful information on substance abuse and addiction.
This year also brought new strength to our impressive board with the addition of three new directors: Melinda Hildebrand, a committed mother of teens and leader of Choices at Episcopal High School in Houston, Texas; Ralph Izzo, PhD, Chairman, President and CEO of Public Service Enterprise Group, Incorporated (PSEG); and Jeffrey Kindler, former Chairman and CEO of Pfizer.
We have accomplished much over the past 20 years, but much more remains to be done. In 1978, I called smoking Public Health Enemy Number One, and it has retained its sordid title. In 1979, I called alcoholism “not only a treatable disease, but a beatable disease,” but we haven’t yet beaten it. Betty Ford’s prayer to strip the shame from the disease of addiction has not yet been answered by our nation and our people. And millions of families and children suffer incalculable anguish because of this problem. So, in this, my final chairman’s message, I ask you to help us with a generous contribution to enable CASAColumbia to continue its efforts to create a world in which every child can grow up healthy—and tobacco, alcohol and drug free.