Looking to the Future

The answers to Detroit's myriad problems associated with drug abuse begin with the city?s public leaders but certainly do not end there. The private sector has a crucial role to play.
Although insufficient financial resources have often limited the city's ability to measure the needs of its residents and reach those who need services, Detroit's public agen-cies now feature a host of new leaders. Their arrival presents an opportunity to renew each agency's focus and commitment to addressing the city's drug problems. In addition, Detroit's private sector has demonstrated its willingness to support local drug abuse strategies, and many community groups are committed to tackling drug problems. The city's leadership should work to strengthen partnerships with all local organizations that share these aims. Successful collaborations can leverage new resources for the city, help place drug abuse at the forefront of public policy and increase the effectiveness of Detroit's exist-ing anti-drug efforts.

Data Gathering. Detroit has not conducted studies of local drug use trends on a regular basis, but recently the city has begun to make data collection a higher priority. For example:

In 1998, the Detroit Bureau of Substance Abuse (BSA) received state and federal funds to conduct the city's first Prevention Needs Assessment, which will be imple-mented by Wayne State University's Center for Urban Studies.
The Michigan Department of Community Health began a statewide youth survey- the first to be representative of Michigan households with young people aged 12-18 and the first to include school dropouts. The results will provide information on drug use trends in Detroit that was previously unavailable.
The Target Cities project provides an unprecedented opportunity to collect drug abuse data among criminal offenders in Wayne County. Evaluation of treatment ser-vices funded by Target Cities will be released in 1999.

Nonetheless, Detroit still lacks critical data in many areas. For example: binge drinking among adults has not been measured; tobacco-related deaths are not tracked by the Health Department; and correctional facilities do not track the communities from which their prisoners originate, making it difficult to identify locations that would benefit from targeted intervention. Lack of data is not the only problem. Frequently, existing data are difficult to access. Obtaining certain types of information on drug enforcement efforts and arrests from the Detroit Police Department, for instance, is impossible without contacting each of 13 police precincts individually.

Due to all of the above data-related problems, the city is essentially striving to combat drug abuse without comprehensive information to help shape sound policy. Therefore:

The city's public agencies should establish a more unified system of data collection, analysis and dissemination.This should include a method for ensuring that numbers from various agencies are compatible.
Detroit should gather drug use trend and needs assessment data every two years to stay abreast of changes in the popula-tions that should be targeted with drug abuse services and the interventions that are needed. ?
Detroit's public agencies should make more thorough use of evaluation data, such as the upcoming Target Cities data, to learn which interventions are working.Those that are working should be replicated and expanded, while those that are not should be modified or eliminated.
State and local criminal justice and corrections officials should collect data on the residency of criminal offenders, as well as citywide drug arrest data, to facilitate crime prevention efforts.

Collaboration and Partnership. Detroit is home to a variety of col-laborative efforts to combat drug abuse and related crime. For instance, the Detroit Police Department works with various prevention groups to teach youth about the dan-gers of drugs and assists other city agencies in their efforts to reduce crime and social problems related to drugs. Similarly, Detroit businesses including DaimlerChrysler and General Motors support alcohol and other drug prevention efforts in the city.
In 1998, BSA launched a collaboration among prevention and treatment experts, community leaders, local agencies and businesses to combat drug problems. BSA is also facilitating an organized effort within the faith community to foster treatment and prevention efforts across the city. These initiatives are exactly what is needed, but they are just a start. Better collaboration would also allow all public agencies to gain a fuller understanding of the city's drug abuse picture. For example, Detroit criminal justice officials suspect that young adulthood is an especially high-risk period in which alcohol and other drug use increases dramatically, but the actual rates of use among adults aged 18-25 are unknown.The ideal solution would be to obtain this information, but even in its absence, discus-sions with other local officials would help criminal justice officials to deter-mine whether others on the front lines share their theory. If so, appropriate collaborative responses should be developed.
Generally, within and among public agencies, knowledge is poorly shared, and one department is often unaware of what oth-ers are doing. Lack of communication among BSA and other public agencies impairs the city's ability to ascertain trends and mount coordinated interventions. Multidisciplinary interventions are particularly important for young drug users, who often have multiple needs. Many young people who become involved with drugs have a history of abuse or neglect, truancy, criminal activity or other problems. Comprehensive approaches are needed to address these problems, with multifaceted follow-up to ensure lasting success. Therefore:

The Health Department should ensure that agencies under its supervision manage and share information more effectively, should ensure that staff are aware of available information and resources, and should hold agencies and their personnel accountable for improvements in these areas.
BSA should develop a citywide public agency working group to coordinate intervention efforts. The group, consisting of key representatives from every public agency involved in addressing drug problems, should meet monthly so that all players can exchange information, share ideas and coordinate planning.
On an ongoing basis, these public players should increase inter- and intra-agency collaboration, and increase outreach to private sector partners. BSA in particular should increase its collaboration with these partners in order to expand available resources and services.

Prevention. Currently, BSA supports 45 drug prevention programs in Detroit, targeting people of all ages. They range from Detroit's "Denounce the 40-Ounce" campaign, which targets large-size carry-out containers in heavily African American communities, to the Wayne County MADD chapter's efforts to educate communities about the dangers of drinking and driving. The effectiveness of community-based programs is, however, difficult to determine, since Detroit does not collect data on the location of alcohol sales.
Other entities that work to prevent alcohol and other drug abuse include the Detroit Recreation Department and the Detroit Public Schools. School programs, however, have been inconsistently implemented.The Michigan Model for Comprehensive School Health Education, for instance, is a good program. However, while the Detroit school district has adopted the Michigan Model, not all schools teach it; those that do often teach only parts of it. Finally, few prevention programs in Detroit have been thoroughly evaluated. But beginning in 2000, the Michigan Department of Community Health will require that all prevention programs be based on research in order to receive public funding.Therefore:

Detroit should track alcohol sales locations throughout the city.
The city should emphasize prevention for its most vulnerable citizens. For example, since chil-dren and adolescents are especially vulnerable, city agencies should expand their efforts to reach young people of all ages.
The public school system should implement teacher training to improve the consistency of implementation of the Michigan Model. In addition, students and parents should be educated about the dangers of inhalants.
Based on outcome evaluations, prevention programs that work best should be replicated, and ineffective programs should be modified or eliminated.

Treatment. Drug treatment is scarce in Detroit; currently 93 percent of the city's addicts go untreated. Certainly, part of this problem is attributable to limited funding for BSA, but available funds also may not be used optimally.
BSA must study how well funding allocations match local needs, and ultimately distribute funds more effectively. Upcoming BSA-funded studies, such as those to be undertaken by the Center for Urban Studies and the Addiction Research Institute at Wayne State University, will contribute to this body of knowledge.
Generally, treatment program evaluations are scarce in Detroit and are not a standard part of future program planning. Only through evaluation can the city assess and improve program effectiveness. Therefore:

The Health Department should determine whether treatment funds are being used in the most efficient and effective manner.
BSA and private funders should require evaluation of local treatment programs.
Detroit's treatment programs, like its prevention programs under the new requirements of the Michigan Department of Community Health, should be research-based in order to receive public funding.

Tackling Tobacco. Despite the 1994 state tobacco tax increase of 50?, adult smoking rates are higher in Detroit than statewide and across the country. Unfortunately trend data are unavailable, as is information regarding the amount and location of tobacco sold in Detroit.Therefore, the impact of the tax hike and other prevention measures is difficult to determine.
Local efforts to decrease adult smoking in Detroit are comprehensive, but insufficient. They must continue to grow if the city is to address the scope of this problem.This is especially true of programs for youth, who are unlikely ever to start smoking if they do not start by age 21. Data on the impact of efforts to reduce tobacco sales to minors-some of which will be available this year-will be helpful for guiding future initiatives. Therefore:

Detroit should expand the collection of trend data, outcome data and other data in order to answer key questions regarding local tobacco use and prevention.
Based on these figures, the city should expand and strengthen its existing tobacco control and prevention efforts.
Private employers should assist local anti-tobacco efforts by continuing to establish smoke-free workplaces.