U.S. GOVERNMENT AGENCIES

The following articles appear in this section:

Bureau of Narcotics and Dangerous Drugs (BNDD) ;
Center for Substance Abuse Prevention (CSAP) ;
Center for Substance Abuse Treatment (CSAT) ;
National Institute on Alcoholism and Alcohol Abuse (NIAAA) ;
National Institute on Drug Abuse (NIDA) ;
Office of Drug Abuse Law Enforcement (ODALE) ;
Office of Drug Abuse Policy (ODAP) ;
Office of National Drug Control Policy (ONDCP) ;
Special Action Office for Drug Abuse Prevention (SAODAP) ;
Substance Abuse and Mental Health Services Administration (SAMHSA) ;
U.S. Customs Service ;
U.S. Public Health Service Hospitals

Bureau of Narcotics and Dangerous Drugs

Presidential Reorganization Plan No. 1 of 1968 created the Bureau of Narcotics and Dangerous Drugs (BNDD) in the U.S. Department of Justice. The new agency combined the drug law enforcement functions of two predecessor organizations—the Federal Bureau of Narcotics (FBN) in the Department of the Treasury and the Bureau of Drug Abuse Control in the Food and Drug Administration, Department of Health and Human Services. Long-standing conflicts between two Department of the Treasury agencies that shared drug-enforcement responsibilities—the Federal Bureau of Narcotics and the Bureau of Customs—led to the decision to move the FBN functions into a new agency (BNDD) in a different cabinet department (Justice).

MISSION AND EXPERIENCE

BNDD's role was to suppress illicit narcotics trafficking and to control the diversion of legally manufactured drugs. BNDD was responsible for working with foreign governments to halt international drug traffic, immobilizing domestic illegal drug-distribution networks, providing a wide range of technical assistance and training to state and local officers, and preparing drug cases for prosecution.

BNDD emphasized investigations of high-level drug trafficking to identify and target major national and international violators. Director John E. Ingersoll described the success of BNDD as being "able to apprehend scores of illicit drug traffickers who were previously immune to the feeble efforts which law enforcement was formerly able to mount." In 1968 and 1969, BNDD contributed to major international success in stopping heroin traffic originating in Turkey.

The Bureau of Customs continued interdiction of drug smuggling at the borders and ports of entry. Customs special agents investigated drug cases based on seizures made by Customs inspectors and on antismuggling intelligence. Conflict between BNDD and Customs continued, with allegations of lack of cooperation and failure to share intelligence with each other.

The White House and Office of Management and Budget (OMB) tried to resolve the conflict and, in early 1970, President Richard M. Nixon directed BNDD and Customs to work out a set of operating guidelines. After considerable interagency discussion, formal guidelines were prepared to give to BNDD full jurisdiction over drug-enforcement operations both within the United States and overseas. Customs was to be limited to border operations. The president approved the guidelines, but the conflicts continued. Neither Congress nor the White House was satisfied. Senator Abraham Ribicoff described the detailed guidelines as "more reminiscent of a cease-fire agreement between combatants than a working agreement between supposedly cooperative agencies."

ADDITIONAL DRUG ENFORCEMENT COMPLICATIONS

The "war against drugs" continued to expand. In 1972, President Nixon established two new drug agencies in the Department of Justice—the Office of Drug Abuse Law Enforcement (ODALE) and the Office of National Narcotics Intelligence (ONNI). ODALE's operational involvement with state and local law enforcement against local drug dealers was intended to complement BNDD's focus on high level traffickers. ODALE, however, depended on existing federal agencies for agents and attorneys, and BNDD was required to lend over 200 narcotics agents to ODALE. The additional antidrug agencies, combined with sensational reporting of conflicts between special agents from BNDD and Customs, added to the public perception of fragmentation and disorder in federal drug law enforcement.

In early 1973, another presidential reorganization plan was designed to eliminate the overlap and duplication of effort in drug enforcement. A factual assessment of the BNDD/Customs situation, provided to the Congress by the chief of OMB's Federal Drug Management Division, Walter C. Minnick, reported "Having attempted formal guidelines, informal cooperation and specific Cabinet-level mediation, all without success, the President concluded in March of 1972 that merging the drug investigative and intelligence responsibilities of Customs and BNDD into a single new agency was the only way to put a permanent end to the problem." Under Reorganization Plan No. 2 of 1973, BNDD, ODALE, and ONNI were eliminated; their functions and resources, along with 500 Customs special agents (those previously involved in drug investigations), were consolidated in the new Drug Enforcement Administration (DEA) in the Department of Justice.

(See also: Anslinger, Harry J., and U.S. Drug Policy )

BIBLIOGRAPHY

Bonafede, D. (1970). Nixon seeks to heal top-level feud between customs, narcotics units. National Journal, 2 (15), 750-751.

Bonafede, D. (1970). Nixon approves drug guidelines, gives role to Narcotic Bureau. National Journal, 2 (29), 1532-1534.

Finlator, J. (1973). The drugged nation. New York: Simon & Schuster.

Moore, M. H. (1978). Reorganization Plan #2 reviewed: Problems in implementing a strategy to reduce the supply of drugs to illicit markets in the United States. Public Policy, 26 (2), 229-262.

Rachal, P. (1982). Federal narcotics enforcement. Boston: Auburn House.

U.S. Congress, Senate, Committee on Government Operations. (1973). Reorganization Plan No. 2 of 1973, Hearings before the Subcommittee on Reorganization, Research, and International Organizations. 93rd Congress, 1st sess., Part 1. April 12, 13, and 26, 1973. Washington, DC.

Richard L. Williams

Center for Substance Abuse Prevention (CSAP)

This agency was originally established as the Office for Substance Abuse Prevention (OSAP). It was created by the Anti-Drug Abuse Act of 1986 for the prevention of alcohol and other drug (AOD) problems among U.S. citizens, with special emphasis on youth and families living in high-risk environments. Dr. Elaine Johnson was appointed as the first director of the office. From 1986 to 1992, OSAP operated as a unit of the Alcohol, Drug Abuse, and Mental Health Administration (ADAMHA), one of the eight Public Health Service agencies within the U.S. Department of Health and Human Services.

In 1992, Public Law 102-321 reorganized ADAMHA and renamed it the Substance Abuse and Mental Health Services Administration (SAMHSA); it also created CSAP to replace OSAP.

The goal of CSAP is to promote the concepts of no use of any illicit drug and no illegal or high-risk use of alcohol or other legal drugs. (High-risk alcohol use includes drinking and driving; drinking while pregnant; drinking while recovering from alcoholism and/or when using certain medications; having more than two drinks a day for men and more than one for women, or to intoxication).

These are the principles that guide the prevention work of CSAP:

1. The earlier Prevention is started in a person's life, the more likely it is to succeed.
2. Prevention Programs should be knowledge based and should incorporate state-of-the-art findings and practices drawn from scientific research and field expertise.
3. Prevention programs should be comprehensive.
4. Programs should include both process and outcome evaluations.
5. The most successful programs are likely to be those initiated and conducted at the community level.

To utilize these principles and achieve its goals, CSAP performs the following functions:

1. Carries out demonstration projects targeting specific groups and individuals in high-risk environments.
2. Assists communities in developing long-term, comprehensive AOD-use prevention programs and early intervention programs.
3. Operates a national clearinghouse for publications on prevention and treatment and other materials and services, including the operation of the Electronic Communication System and the Regional Alcohol and Drug Awareness Resource (RADAR) Network.
4. Supports the National Training System, which develops new drug-use prevention materials and delivers training.
5. Supports field development.
6. Conducts an evaluation strategy consisting of individual grantee evaluations, contractual program-wide evaluations, and the National Evaluation Project.
7. Provides technical assistance for capacity building and promotes collaborations to help states, communities, and organizations develop and implement communications, drug-use prevention, and early intervention efforts.
8. Develops and implements public information and educational media campaigns and other special-outreach and knowledge-transfer prevention programs.
9. Maintains a national drug-use prevention database to provide information on substance-abuse prevention programs.
10. Provides technical assistance and materials to small businesses for the development of Employee-Assistance Programs.
11. Operates the National Volunteer Training Center for Substance Abuse Prevention.

To promote interagency cooperation and facilitate jointly sponsored prevention activities, CSAP's staff meets routinely with various federal organizations, including the departments of defense, justice, education, transportation, labor, housing and urban development, the Bureau of Indian Affairs, and others.

CSAP also develops partnerships with the research community, parent groups, foundations, policymakers, health-care practitioners, state and community leaders, educators, law enforcement officials, and others to enhance opportunities for comprehensive approaches to prevention and early intervention.

(See also: Education and Prevention ; Parents Movement ; Prevention Movement )

Elaine Johnson

Center for Substance Abuse Treatment (CSAT)

The Center for Substance Abuse Treatment (CSAT) was established in January 1990 as the Office for Treatment Improvement (OTI) of the Alcohol, Drug Abuse, and Mental Health Administration (ADAMHA) in the Department of Health and Human Services (DHHS). Dr. Beny J. Primm, a physician who had spent more than twenty years developing a major treatment program in New York City, was appointed its first director. Following reorganization of ADAMHA in 1992, the agency was renamed and is now part of the Substance Abuse and Mental Health Services Administration (SAMHSA), which replaced ADAMHA.

The congressional mandate of CSAT is to expand the availability of effective treatment and recovery services for people with drug and alcohol problems. One of its goals is to ensure that new treatment technology is absorbed by the addiction-treatment infrastructure—that is, the system of state and local government agencies and public and private treatment programs providing addiction-treatment services. In carrying out this responsibility, CSAT collaborates with states, communities, and treatment providers to upgrade the quality and effectiveness of treatment and enhance coordination among drug-treatment providers, human-services, educational and vocational services, the criminal-justice system, and a variety of related services. CSAT provides financial and technical assistance for this purpose to targeted geographic areas and patient populations, with emphasis on assistance to minority racial and ethnic groups, Adolescents, Homeless people, Women of childbearing age, and people in rural areas.

CSAT also collaborates with other government agencies, such as the National Institute on Drug Abuse (NIDA), the National Institute on Alcohol Abuse and Alcoholism (NIAAA), the National Institute of Mental Health (NIMH), the Center for Substance Abuse Prevention (CSAP), and state and local governments to promote the utilization of effective means of treatment and to develop treatment standards. In addition, CSAT has interagency agreements with the Department of Labor and the Department of Education that are designed to improve the coordination of health and human services, education, and vocational training. CSAT also promotes the mainstreaming of alcohol-, drug-abuse, and mental-health treatment into the primary health care system, and it is responsible for administering the Substance Abuse Prevention and Treatment (SAPT) Block Grant program, which provides federal support to state substance-abuse prevention and treatment programs (funded at $1.13 billion in fiscal year 1993).

Research has generated a vast body of knowledge regarding the nature of chemical dependency and about what works in the treatment of addiction and addiction-related primary health and mental-health disorders. From this research, three key observations formed the basis for CSAT's initial treatment philosophy. First, addiction is a complex phenomenon; people's addiction cannot be treated in isolation from addressing their primary health, mental health, or socioeconomic deficits. Second, addiction is frequently a chronic, relapsing disorder; the gains made during treatment often are lost following a person's return to the community. CSAT therefore tried to foster programs that provided those treated for chemical dependency with a series of interventions along a sustained continuum. These two observations constituted the basis for CSAT's Comprehensive Treatment Model, which was a central principle in all of its demonstration grant programs and technical-assistance initiatives. During its first few years of existence, CSAT targeted resources to the people it perceived as most adversely affected by extreme socioeconomic problems and at highest risk for addiction because of exposure to Crime, abuse, Poverty, and Homelessness, and also because of lack of access to primary health and mental health care, social services, and vocational training and education. For this reason, the early CSAT Comprehensive Treatment Model demonstration grants fostered a wide array of primary interventions geared to addressing each patient's health and human service needs, coupled with a readily accessible, intensive aftercare component.

At the core of CSAT's overall approach is, quite simply, the conviction that treatment works. Treatment has proved effective in reducing the use of illicit drugs and alcohol, improving rates of employment, reducing rates of Human Immunodeficiency Virus (HIV) seroconversion, reducing criminal activity, and reducing overall patient morbidity.

In addition to the SAPT Block Grant, CSAT awarded grants for a variety of demonstration and service programs: The treatment-capacity expansion program provided resources to the states to expand capacity in areas of demonstrated shortage; Target Cities assists metropolitan areas with particularly high-risk populations in providing treatment services and in developing systems to coordinate and improve the infrastructure of the programs. Critical Populations is a demonstration project for treatment program enhancement aimed at particularly at-risk groups—Adolescents; racial and ethnic minorities; residents of public housing; women and their infants and children; rural populations; drug and alcohol abusers who are homeless; patients with HIV or AIDS. Criminal justice-related programs include drug-abuse treatment programs in Prisons and Jails; diversion to treatment; special services for probation or parole clients; screening, testing, referral, and treatment services for HIV/AIDS, TB, and other communicable diseases; literacy, education, job training, and job placement services; and case management and Drug Testing. CSAT also supported demonstration treatment campus programs; several programs aimed specifically at Women and their infants and children; AIDS outreach for substance abusers; linkage of primary care and substance abuse model programs; state systems development programs; professional training and education; and collaborative efforts with other federal agencies.

After Dr. Primm's return to New York in 1992 and following Mr. David Mactas's appointment to head the agency in 1994, and as part of the Clinton administration's effort to reinvent government (redefine and refine its functions), CSAT's demonstration grant program emphasis shifted from improvement of services for the populations in greatest need to the development of knowledge about the effectiveness of treatment for different subgroups of the drug-using population.

Information regarding CSAT's current programs and technical initiatives is available from the CSAT Public Affairs Office, Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, 5600 Fishers Lane, Rockville, MD 20857.

(See also: Ethnic Issues and Cultural Relevance in Treatment ; Treatment Types ; Vulnerability As Cause of Substance Abuse )

Beny J. Primm

The National Institute on Alcohol Abuse and Alcoholism

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) is the principal Federal agency for research on the causes, consequences, treatment, and prevention, of alcohol-related problems. NIAAA supports studies both biological and behavioral research; research training and health professions development programs; and research on alcohol-related public policies. The NIAAA budget for Fiscal Year 2000 is $293 million.

ORGANIZATION

NIAAA is one of 18 research institutes of the prestigious National Institutes of Health (NIH), a component of the U.S. Department of Health and Human Services. Three principal staff offices and four Divisions manage and coordinate NIAAA activities: Office of Collaborative Research Activities -manages activities with other NIH Institutes, government agencies, and other organizations interested in alcohol-related problems and the Institute's international activities and science education programs; Office of Policy, Legislation, and Public Liaison monitors alcohol-related legislative developments and proposals; provides science-based recommendations for changes in public policies; and supports programs aimed at bridging the gap between research and practice; Office of Planning and Resource Management provides financial, grants, contracts, and other administrative support for Institute programs and activities; Division of Basic Research manages the Institute's biological research grants portfolio in areas such as neurosciences, genetics, and molecular biology. Division of Clinical and Prevention Research supports studies aimed at developing practical and effective ways to prevent and treat alcohol use problems, including new medications development; interventions with high-risk populations s; and behavioral therapies; Division of Intramural Clinical and Biological Research manages the NIAAA intramural research program.

MAJOR PROGRAMS AND ACTIVITIES

NIAAA supports research principally through extramural grants awarded to scientists at leading U.S. research institutions and through research conducted by NIAAA's own intramural staff scientists. Findings from these research areas are made available and accessible through a wide variety of research dissemination activities.

Extramural Research.

Genetics.

NIAAA supports research aimed at discovering the genes that predispose individuals to alcoholism and the environmental factors that influence its development. Areas of genetics research include: twin studies to define precisely what is being inherited; genetic linkage and association studies to identify the genes for alcoholism and their precise number, identity, and modes of action; genetic analysis of alcohol-related behavior in animals, the genes that influence these behaviors, and studies to determine the contributions of the environment and genetics to an individual's susceptibility for developing alcohol-related medical disorders such as liver cirrhosis, pancreatitis, and fetal alcohol syndrome.

Alcohol and the Brain.

Many of the behaviors associated with alcohol use problems are the result of alcohol's effects in the brain. NIAAA research is designed to learn how these effects influence the development of alcohol abuse and alcoholism. Molecular biology and genetic techniques, including the use of transgenic animals, are becoming an integral part of this research. In addition, noninvasive, functional imaging techniques are used in animal and human studies to identify neural circuits influenced by alcohol.

Medications Development.

NIAAA is strongly committed to developing medications to diminish the craving for alcohol, reduce risk of relapse, and safely detoxify dependent individuals undergoing treatment. Naltrexone, an opioid antagonist, the first medication approved as a safe and effective adjunct to psychosocial treatment for alcoholism since 1949 was developed from neuroscience research. NIAAA anticipates that this number will increase over the next several years as findings from neuroscience and from genetics point to promising targets for pharmacological intervention.

Prevention.

NIAAA prevention research is aimed at developing effective measures to reduce alcohol-related problems, including studies of alcohol-related intentional and unintentional injury, alcohol-related violence, alcohol in the workplace; drinking and driving deterrence, and the relationship between alcohol availability and alcohol-related problems. New methodologies permit prevention researchers to target high-risk neighborhoods within larger cities.

Treatment.

NIAAA continues to emphasize research to improve treatment of alcohol abuse and alcoholism and supports a range of treatment or clinical studies including clinical trials of treatment therapies, patient-treatment matching studies, and behavioral/pharmacological treatment approaches.

Epidemiology.

Alcohol epidemiology provides the foundation for monitoring the health of the population, developing and evaluating prevention and treatment services for alcohol problems, and establishing alcohol-related social policies. NIAAA-supported epidemiology research examines the context, volume, and specific drinking patterns that lead to particular alcohol-related problems as well as the impact of age, gender, race/ethnicity, and other sociodemographic factors; genetic, environmental, and other factors which influence injury or disease occurrence.

Intramural Research.

Scientists in the NIAAA Intramural Research Program (IRP) focus on research opportunities that allow intensive, long-term commitment as well as the flexibility to adjust research priorities in response to new findings. Because clinical and laboratory studies occur side by side, new findings from basic research may be transferred readily for appropriate testing and application, and clinical hypotheses may, in turn, be posited to lab scientists. Areas of study include identification and assessment of genetic and environmental risk factors for the development of alcoholism; the effects of alcohol on the central nervous system, including how alcohol modifies brain activity and behavior; metabolic and biochemical effects of alcohol on various organs and systems of the body; noninvasive imaging of the brain structure and activity related to alcohol use development of animal models of alcoholism; and the diagnosis, prevention, and treatment of alcoholism and associated disorders. NIAAA utilizes a combination of clinical and basic research facilities, which enables a coordinated interaction between basic research findings and clinical applications in pursuit of these goals. An 11-bed inpatient ward and a large outpatient program are located in the NIH Clinical Center in Bethesda, Maryland.

RESEARCH DISSEMINATION

NIAAA shares relevant findings from alcohol research with health care practitioners, policy makers and others involved in managing alcohol-related programs, and the general public through publications in scientific and clinical journals, general and specialized brochures, and pamphlets, manuals clinical bulletins. Research findings are also shared with the alcohol and general health care communities through three online database services supported by the institute: Quick Facts, an epidemiological data base; ETOH, an alcohol-related bibliographic reference database; and the NIAAA clinical trials database.

Publications, reports, and database services are accessible online at http://www.niaaa.nih.gov.

Enoch Gordis, M.D.

National Institute on Drug Abuse (NIDA)

The National Institute on Drug Abuse is the world's premier research institute supporting research on the health aspects of drug abuse and addiction. NIDA's vast portfolio supports research on all drugs of abuse from opiates and cocaine to new and emerging drugs such as methamphetamine and ecstasy. In addition to research on illegal drugs, NIDA supports an extensive research portfolio to combat what may be the nation's most critical and costly public health problem—tobacco use. NIDA's nicotine research continues to increase our understanding of the social, economic, cultural and biological factors that influence smoking initiation and vulnerability to nicotine addiction, and continues to bring the nation the most effective prevention and treatment approaches available. Additionally, NIDA supports research on the health consequences of nicotine as well as on the medical consequences of all illicit drugs. Given that drug abuse is the greatest vector for the spread of HIV, a significant portion of NIDA's research investment is spent on researching effective prevention and treatment strategies to combat HIV/AIDS and other infectious diseases. NIDA's comprehensive research portfolio includes studies on the causes and consequences, the prevention and treatment, and the biological, social, behavioral, and neuroscientific bases of drug abuse and addiction. NIDA is also charged with the development of medications to treat drug addiction. Additionally, NIDA supports research training and career development, science and public education, and research dissemination.

NIDA is the largest institution devoted to drug-abuse research in the world, supporting almost 85 percent of all drug-abuse research through grants to scientists, primarily at major research facilities in the United States, abroad, and at NIDA's own Intramural Research Program (IRP).

HISTORY

Drug-abuse research and treatment have been a concern of the U.S. Public Health Service since the early 1930s. The Public Health Service Hospitals at Lexington, Kentucky, and at Fort Worth, Texas, were established in 1929—and the research laboratories were established at Lexington in 1935.

NIDA was formally established in 1974 as one of three research institutes within the Alcohol, Drug Abuse, and Mental Health Administration (ADAMHA), a Public Health Service agency within the Department of Health and Human Services. NIDA's mandate was to collect information on the incidence, prevalence, and consequences of drug abuse, to improve the understanding of drugs of abuse and their effects on individuals, and to expand the ability to prevent and treat drug abuse. Through scientific research, NIDA has built a base of information on how drugs affect us—what they do to our bodies; to our behavior, thoughts, and emotions; to our relationships; and to our society. This understanding of the biological, social, behavioral and environmental influences that place individuals at risk for drug abuse is of great importance to prevention and treatment practitioners, to educators, and to policymakers.

In October 1992, the drug, alcohol, and mental-health activities within the Department of Health and Human Services (NIDA, along with the National Institute on Alcohol Abuse and Alcoholism and National Institute on Mental Health) were transferred from ADAMHA to the National Institutes of Health.

FUNCTIONS

To improve the ability to prevent drug abuse, NIDA is concentrating on the variety of biological, behavioral, social, and environmental factors involved in vulnerability to drug abuse. This information enables NIDA to improve both prevention and treatment approaches—which are key to overcoming the demand for drugs—and to inform effective U.S. demand-reduction policies.

Drug addiction is a chronic, relapsing disorder, but research has shown that treatment can be an effective tool in helping some to break the addiction cycle. Successful treatment offers the best means for overcoming a life cycle revolving around drug-seeking behaviors and also reduces the spread of AIDS and other infectious diseases among drug abusers. Accordingly, NIDA is researching ways to improve the effectiveness of treatment and working to increase retention rates and reduce relapse rates. Through an understanding of the effects of drugs on the brain, NIDA is developing more effective treatments-including medications-for specific drugs of abuse, such as Cocaine and Heroin, and for the toxic effects on the Brain and other organs that drugs of abuse produce. NIDA has engaged in a major effort to improve research on, and its application to, services for drug-abusing pregnant and postpartum women. NIDA also seeks to develop strategies to prevent or ameliorate the consequences of drugs of abuse on the children of drug-abusing parents.

To support this array of research programs, the research community needs an adequate supply of scientists with up-to-date skills and knowledge. Accordingly, NIDA sponsors drug-abuse research programs in the biomedical and behavioral sciences. These programs include support of pre- and post-doctoral training in medical schools, universities, and other institutions of higher education in basic, clinical, behavioral, and epidemiological research, to assure the steady supply of trained scientists. A final important function of NIDA is to make research findings available to the widest audience possible. NIDA has an extensive outreach and public education program to rapidly provide research-based information to scientists, practitioners, policy makers, and the general public. NIDA staff works closely with local community-based networks to hold town meetings at various locations across the country, as well as other major conferences to ensure that the latest scientific information is disseminated to those working to prevent and treat drug abuse and addiction. NIDA also develops written and electronic materials for researchers, prevention practitioners, treatment practitioners, young people, parents, policy-makers, and others. Additionally, NIDA has a Science Education Program, which develops materials for K-12 students and teachers, as well as the general public, and funds grants with educators and scientists for the development of programs, materials and museum exhibits. Through NIDA's research dissemination programs, science-based information can then be used to educate, prevent, treat, and rehabilitate.

CONCLUSION

NIDA conducts and supports Research that has as its underlying principles the goals of eliminating drug abuse, treating those whom prevention fails, increasing retention and decreasing relapse, and improving the health and well-being of all Americans, their families, their communities, and the nation.

NIDA collaborates with other research institutes, and with other agencies and departments of the U.S. government. For more information visit the NIDA website at www.nida.nih.gov.

Richard A. Millstein

Revised by Alan. I. Leshner

Office of Drug Abuse Law Enforcement (ODALE)

Located within the U.S. Department of Justice, the Office of Drug Abuse Law Enforcement (ODALE) was established by President Richard M. Nixon with Executive Order 11641 in January 1972. Myles J. Ambrose was appointed director of ODALE and held two other concurrent titles: special consultant to the president for drug abuse law enforcement and special assistant attorney general.

FEDERAL, STATE, AND LOCAL TEAMWORK

Complementing federal efforts directed at "high-level drug traffickers," ODALE was charged with attacking the heroin-distribution system at the street level to reduce the drug's availability there. Patterned after the justice department's Organized Crime Strike Forces, the ODALE program included task forces of federal, state, and local law-enforcement officers and attorneys. The full use of federal, state, and local narcotics laws, the availability of assigned attorneys, and the use of the investigative grand jury made possible a wide range of approaches in pursuing violators.

ODALE established task forces in thirty-four cities in 1972 and encouraged citizens to "report information regarding alleged narcotics law violators in strict confidence." The federal government paid for task force equipment and operational expenses, including payments for a portion of the salaries and overtime of state and local officers. ODALE was credited with more than 8,000 narcotics arrests with a conviction rate of more than 90 percent during its 17 months of operation. Nevertheless, ODALE agents were widely criticized for conducting several drug raids involving unauthorized forcible entries into private homes and failures in identifying themselves as law officers during drug raids.

REORGANIZATION

ODALE was abolished on July 1, 1973, by Presidential Reorganization Plan No. 2 of 1973 and "those Federal operations designed to attack narcotics traffic at the street level in cooperation with local authorities" were transferred to the newly established Drug Enforcement Administration (DEA). The ODALE program was redesignated as DEA's State and Local Task Force program. ODALE's Deputy Director John R. Bartels, Jr., became the first administrator of the DEA.

(See also: Anslinger, Harry J., and U.S. Drug Policy )

BIBLIOGRAPHY

Rachal, P. (1982). Federal narcotics enforcement. Boston: Auburn House.

U.S. Congress, Senate, Committee on Government Operations. (1973). Reorganization Plan No. 2 of 1973, Establishing a Drug Enforcement Administration in the Department of Justice. Report of the Subcommittee on Reorganization, Research, and International Organizations, 93rd Congress. 1st sess., Report No. 93-469. Washington, DC.

U.S. General Accounting Office. (1975). Federal drug enforcement: Strong guidance needed. Report No. GGD-76-32. Washington, DC.

Richard L. Williams

Office of Drug Abuse Policy

In March 1976, Congress authorized the creation of the Office of Drug Abuse Policy (ODAP) in the Executive Office of the President, with an annual budget of $1.2 million. President Jimmy Carter opened the office in March 1977 and appointed Dr. Peter G. Bourne as director.

The director of ODAP was given wide responsibilities in assisting the president with all federal drug-abuse matters, including providing "policy direction and coordination among the law enforcement, international and treatment/prevention programs to assure a cohesive and effective strategy that both responds to immediate issues and provides a framework for longer-term resolution of problems." The statutory authority included setting objectives, establishing priorities, coordinating performance, and recommending changes in organization.

During the first year of operation, ODAP conducted several international missions and worked closely with United Nations narcotics organizations. In coordinating federal drug activities, ODAP relied on biweekly discussion meetings with the heads of the principal drug agencies. Policy determination was executed through cooperative inter-agency study efforts. ODAP completed six comprehensive interagency policy reviews: border management, drug law enforcement, international narcotics control, narcotics intelligence, demand reduction, and drug abuse in the armed forces.

The ODAP staff coordinated preparation of President Carter's August 1977 Message to the Congress on Drug Abuse and initiated the planning for a comprehensive federal strategy to be published by the revitalized Strategy Council.

REORGANIZATION

After one year of successful operation, ODAP was abolished by Reorganization Plan No. 1 of 1977, effective March 31, 1978. Six ODAP staff members were transferred to a special drug-policy unit (Drug Policy Office) within the White House Domestic Policy Staff. The drug-policy staff continued to report to Dr. Bourne who became special assistant to the president for health issues.

(See also: Anslinger, Harry J. and U.S. Drug Policy )

BIBLIOGRAPHY

Havemann, J. (1978). Carter's reorganization plans—Scrambling for turf. National Journal, 10 (20), 788-794.

U.S. Executive Office of the President. Office of Drug Abuse Policy. (1978). 1978 Annual Report. Washington, DC: Government Printing Office.

Richard L. Williams

Office of National Drug Control Policy

The Office of National Drug Control Policy (ONDCP) was established on January 29, 1989, by Public Law 100-690 (21 USC 1504) as the drug-coordination agency for the Executive Office of the President (EOP) under President George H. Bush. ONDCP is responsible for coordinating federal efforts to control illegal drug abuse. It is the product of almost two decades of congressional efforts to mandate a so-called drug czar—the law providing for cabinet-level status and congressional involvement in drug-control policy. Its initial five-year authorization, which expired November 17, 1993, was extended.

ONDCP oversees international and domestic antidrug functions of all executive agencies and ensures that such functions sustain and complement the government's overall antidrug efforts.

THE DIRECTOR

ONDCP is led by a director (commonly referred to as the drug czar) with cabinet-level rank (Executive Level 1), two deputies (supply reduction and demand reduction), and one associate director (state and local affairs), all appointed by the president with the advice and consent of the Senate.

The director has a broad mandate for establishing policies, objectives, and priorities for the National Drug Control Program. Serving as the president's drug-control adviser and as a principal adviser to the National Security Council (NSC), the director has extraordinary management tools available to influence the national drug-control efforts.

ONDCP is required to produce an annual National Drug Control Strategy for the president and Congress and is responsible for overseeing its implementation by the federal departments and agencies. Included is an annual consolidated National Drug Control Program budget and the director's certification that the budget is adequate to implement the objectives of the strategy. In addition to the strategy and program oversight, the director has two other legislated management tools—(1) approval of reprogramming of each agency's drug funds and (2) formal notification to the involved agency and the president when a drug-program agency's policy does not comply with the strategy. The director also recommends changes in organization, management, and budgets of departments and agencies engaged in the drug effort, including personnel allocations.

Reflecting congressional desire to participate in drug policy, the director must represent the administration's drug policies and proposals before Congress. Additionally, the authorizing legislation specifically allows Congress access to "information, documents, and studies in the possession of, or conducted by or at the direction of the Director" and to personnel of the office.

The first director of ONDCP was William J. Bennett, 1989-1990, previously the secretary of education during the administration of President Ronald W. Reagan. Director Bennett had the difficult job of starting the new agency from scratch and developing a new national drug-control strategy within the first year of operation. Reagan's successor, President Bush, declined to include the cabinet-level ONDCP director in his immediate cabinet, bringing congressional criticism. Bob Martinez (the former governor of Florida) was the next director, 1991-1992. The third director, Lee P. Brown, a criminologist and a former New York City police commissioner, was appointed by President Bill Clinton in 1993 and was given cabinet status. The fourth director, retired Army General Barry R. McCaffrey, a decorated combat veteran in Vietnam, was also appointed by President Clinton, in 1996. McCaffrey is expected to be replaced with a change in administrations after the November 2000 Presidential election.

ORGANIZATION AND AUTHORITY

Initially, ONDCP had approximately 127 staff positions and 40 additional members detailed from other federal agencies. ONDCP's Fiscal Year (FY) 1992 appropriation of $105 million included $86 million to be transferred to support the High Intensity Drug Trafficking Areas (HIDTA). The HIDTA funding provides $50 million for federal law-enforcement agencies and $36 million for state and local drug-control activities. President Clinton drastically reduced the size of the ONDCP staff soon after his election, from 146 to 25. With the appointment of General Barry R. McCaffrey President Clinton intended to bring the number of staff back up to its original capacity. Additionally, President Clinton wished to appropriate money from the Department of Defense.

The director is responsible for a Special Forfeiture Fund, funded by the department of Justice Assets Forfeiture Fund, "to supplement program resources used to fight the war on drugs." For FY 1992, this fund included over $50 million for transfer to federal program agencies.

Additionally, ONDCP reviews and recommends funding priorities for the annual budget requests for over fifty federal agencies and accounts involved in the drug program (more than $12 billion in FY 1993).

ONDCP's authority to provide direction to diverse federal departments and agencies is based on a program-management structure known as the National Drug Control Program. The ONDCP program and budget authority coexists with the line authority of the cabinet departments and with the president's annual budget process (directed by the Office of Management and Budget). The structure for the parallel drug-control system is created by designating National Drug Control Program agencies, defined as "any department or agency and all dedicated units thereof, with responsibilities under the National Drug Control Strategy." The designated federal departments and agencies have special program and budget responsibilities to the director of ONDCP.

ONDCP's broad coordination authority over budgets and program activity also presents extraordinary opportunities for conflict with the existing line authority in the departments and agencies. Simultaneously, ONDCP receives congressional and press criticism regarding lack of influence over the operating activities.

POLICY DEVELOPMENT AND COORDINATION

The continued success of the complex drug-policy system depends on a continuing high priority for the drug programs, preventing bureaucratic turf battles, and seeking widespread understanding and endorsement of the goals and objectives of the national program. An essential element in communicating is a public document that explains the strategy, goals, and responsibilities—including a dynamic process of evaluating results and updating the strategy.

The annual National Drug Control Strategy, with accompanying Budget Summary (the February 1999 strategy was the most recent in the series) contains a description of the drug-abuse situation, an assessment of progress, and national priorities—with two-year and ten-year objectives and a federal budget "cross-cut" and analysis. ONDCP has brought together a complex set of drug-control program functions and budgets in an understandable way; by function in the strategy and by agency in the budget summary. Under Lee P. Brown the office produced an interim strategy for 1993 and a fully developed strategy in February 1994. McCaffrey's 1999 strategy, similar to previous years' versions, concentrated on five areas: (1) increasing anti-drug education aimed at children; (2) decreasing the number of addicted people by closing the "treatment gap"; (3) breaking the cycle of drugs and crime; (4) securing the nation's borders from drugs; and (5) reducing the overall drug supply. The goal of this strategy is to shrink the use and availability of illegal drugs by 25 percent by 2002 and by 50 percent by 2007. Additionally, the plan assures a 30 percent reduction in drug-related crimes by 2007, as well as a 25 percent reduction in health- and social-related drugs costs. (Advocates, 1999).

The National Drug Control Strategy acknowledges that no single tactic will solve the drug problem. Therefore, the annual strategies call for improved and expanded treatment, prevention and education; increased international cooperation; aggressive law enforcement and interdiction; expanded use of the military; expanded drug intelligence; and more research.

ORGANIZATION FOR COORDINATION

ONDCP has established a drug-control management agenda, including federal coordinating mechanisms and senior-level management committees and working groups. The organization of ONDCP includes staff for supply reduction, demand reduction, and state and local affairs. ONDCP working groups and committees coordinate the implementation of the policies, objectives, and priorities established in the National Drug Control Strategy.

The federal drug-control agencies and departments are represented on the various working groups and committees, along with ONDCP staff. The organizational structure includes the following coordinating mechanism:

ONDCP Supply Reduction Working Group.

Chaired by the ONDCP deputy director for supply reduction, the working group includes three committees:

The Border Interdiction Committee.

Coordinates strategies and operations aimed at interdicting drugs between source and transit countries and at U.S. borders. The ONDCP may become more internationally-oriented in the future as the policy of source control continues to dominate US policy. For example, McCaffrey continues to work with the Mexican government to control drug trafficking at the U.S. southern border (Dettmer, 1997). Also, there has been a recent push by McCaffrey, with support from President Clinton, to provide more than a billion dollars in aid to Colombia for drug interdiction endeavors (ONDCP, Statement, 2000). According to a March 29, 2000 press release from the ONDCP that aid package was passed by the House of Representatives (ONDCP, Press Release, 2000).

The Public Land Drug Control Committee.

Coordinates federal state, and local drug control programs (primarily marijuana eradication efforts) on federal lands.

Southwest Border and Metropolitan HIDTA Committees.

Coordinates drug law enforcement activities in designated areas, including federal, state, and local enforcement task forces and intelligence activities. Four metropolitan HIDTAs have been designated: New York City, Miami, Houston, and Los Angeles.

ONDCP Demand Reduction Working Group.

Chaired by the ONDCP deputy director for demand reduction, the working group coordinates policies, objectives, and outreach activities for treatment, education and prevention, workplace, and international demand reduction.

Research and Development Committee.

Chaired by the director of ONDCP, the committee provides policy guidance for R&D activities of all federal drug control agencies, including the following R&D working committees—

The Data Committee.

Improves the relevance, timeliness, and usefulness of drug-related data collection, research studies, and evaluations of both demand-related and supply-related activities.

The Medical Research Committee.

Coordinates policy and general objectives on medical research by federal drug-control agencies and promotes the dissemination of research findings.

The ONDCP Science and Technology Committee.

Chaired by the ONDCP chief scientist, the committee is responsible for oversight of counterdrug research and development throughout the federal government.

RELATED POLICY ACTIVITIES

The Counter-Narcotics Technology Assessment Center, established by Public Law 101-509 in 1991, provides oversight of the federal government's counternarcotics research and development activities. ONDCP's chief scientist is responsible for defining scientific and technological needs for federal, state, and local law-enforcement agencies, and for determining feasibility and priorities. The chief scientist also coordinates the technology initiatives of federal civilian and military departments, including research on substance-abuse addiction and rehabilitation.

ONDCP works with the NSC, chairing the Policy Coordinating Committee for Narcotics to oversee coordination among agencies with law-enforcement and national-security responsibilities. The director also participates in meetings of the Domestic Policy council, which reviews the annual drug control strategy before it goes to the president.

ONDCP's state and local affairs staff sought wide public involvement in developing and implementing drug policy at all levels of government. Several national conferences on state and local drug policy were sponsored by ONDCP during 1990 and 1991 to highlight successful state and local programs, seek input to the national strategy, and inform participants of funding and initiatives available to them. ONDCP staff coordinated with both the White House Office of National Service and the president's Drug Advisory Council in encouraging private-sector and state-and-local initiatives for drug prevention and control.

ONDCP also provides administrative support to the president's Drug Advisory Council. With thirty-two private citizens as members, the Drug Advisory Council focuses on private-sector initiatives to support national drug-control objectives, and it assists the ONDCP. The advisory council is financed by private gifts.

(See also: Anslinger, Harry J., and U.S. Drug Policy ; Opioids and Opioid Control, History of )

BIBLIOGRAPHY

Advocates say Ondcp Strategy Offers Few Solutions. (1999). Alcoholism & Drug Abuse Weekly, 11, issue 7, 3-4.

Antidrug czar Gen. Mc Caffrey:make treatment key WEAPON. (1996). American Media News, 39, no. 26, 27-28.

Dettmer, J.&Linebaugh, S. (1997). McCaffrey's no-win war on drugs. Insight on the News, 13, no. 7, 8-12.

A general focuses on community leaders in the drug war. (1996). The Addiction Letter, 4, no. 4, 4-5.

Office of National Drug Control Policy, Executive Office of the President. Press Release: McCaffrey Commends House on Passage of Colmbia/Andrean Drug Emergency Assistance Package, Urges Senate to Act Swiftly. Washington, D.C.: March, 2000.

Office of National Drug Control Policy (ONDCP). Statement of Directory Barry R. McCaffrey Announcement of Emergency and Increased Funding Proposal for Colombia and the Andean Region. (Washington, D.C., 2000).

Ondcp Match Information Now Available Online. (2000). Insight on the News, 12, issue 19, 6.

Ondcp Media Campaign Could Receive Funding Cut (Offic of National Drug Control Policy). (2000). Alcoholism & Drug Abuse Weekly, 12, issue 31, 5.

Report on Mc Caffrey departure adds grist to D.Crumor mill. (1999). Alcoholism & Drug Abuse Weekly, 13, issue 8, 5&ndas;6.

Report to question strength of Ondcp After Mc Caffrey. (2000). Alcoholism & Drug Abuse Weekly, 12, issue 27, 5.

U.S. Executive Office of the President. Office of National Drug Control Policy. (1989). National drug control strategy, September 1989. Washington, DC: Government Printing Office.

U.S. Executive Office of the President. Office of National Drug Control Policy. (1990). National drug control strategy, January 1990. Washington, DC: Government Printing Office.

U.S. Executive Office of the President. Office of National Drug Control Policy. (1991). National drug control strategy, February 1991. Washington, DC: Government Printing Office.

U.S. Executive Office of the President. Office of National Drug Control Policy. (1992). National drug control strategy, January 1992. Washington, DC: Government Printing Office.

Richard L. Williams

Revised by Chris Lopez

Special Action Office for Drug Abuse Prevention (SAODAP)

The Special Action Office for Drug Abuse Prevention (SAODAP) was created by Executive Order of President Richard M. Nixon on June 17, 1971, as a response to public concern about drug abuse, particularly heroin addiction. SAODAP was given legislative authority by the Drug Abuse Office and Treatment Act on March 21, 1972. The formation of SAODAP represented the first attempt to establish a stable focus within the federal government for the coordination of the many facets of U.S. drug policy, including law enforcement, border control, control of selected medicines, treatment, prevention, education, and research.

More than twenty agencies, offices, and bureaus within the U.S. government were responsible for activities relating to drug problems. Yet there was no evident central authority other than the president. Congress and the public seemed eager to be able to hold accountable the head of one agency who, unlike the president, could be asked to testify before congress—a "drug czar." Although the term "drug czar" was popularly used, and it was expected that the person holding the office would exert power over the various agencies dealing with both law enforcement (supply side) and treatment and prevention (demand side) aspects of the problem, neither the president nor the Congress were entirely comfortable with delegating such broad authority to only one individual.

The legislation submitted to Congress by the White House, which finally emerged from debate, gave SAODAP unprecedented authority over demandside activity—treatment, prevention, education, research—wherever these were carried out within the federal government. However, its mandate with respect to drug-control agencies such as the U.S. Customs Bureau, which reported to the secretary of the treasury, and the Bureau of Narcotics and Dangerous Drugs, which reported to the attorney general, was limited to coordination. SAODAP was also charged with developing a formal, written, national strategy for drug-abuse prevention. To head the new office, President Nixon appointed Dr. Jerome H. Jaffe, then a professor of psychiatry at the University of Chicago and director of the Illinois Drug Abuse Programs. Dr. Jaffe, who had helped the White House develop its response to Heroin use in Vietnam, was also appointed special consultant to the president on narcotics and dangerous drugs.

A primary goal of SAODAP, stated at the press conference that announced the new office, was to make treatment so available that no addicts could say they committed crimes because they could not get treatment. Although the Bureau of Narcotics and Dangerous Drugs (BNDD) had estimated that there were about a half million heroin users in the United States, in mid-1971 the true extent of the drug-abuse problem was unknown. The estimating techniques that were developed in the 1970s—the National household survey on drug abuse, the DAWN system (or Drug Abuse Warning Network), and the High School Senior Survey—did not yet exist, but the rising rate of heroin-related deaths in several major cities and the thousands of addicts waiting for treatment because there was not enough treatment capacity gave stark evidence for the growing size of the heroin problem. There were drug Overdose (OD) deaths among U.S. troops in Vietnam also. Surveys generally indicated widespread drug use among U.S. servicemen in Vietnam, with the extent of the problem estimated at 15 to 30 percent, but it was not known if these estimates were of drug users or of addicts.

In addition to the mandate to coordinate all the demand side drug-abuse activities of the federal bureaucracy so as to reduce overlap and redundancy and to expand treatment capacity, some of the additional tasks of the office included overseeing and coordinating the Vietnam drug-abuse intervention; creating a new federal agency with competence to develop national policy; creating the data systems by which the effectiveness of national policy could be evaluated; creating a science base so that research might lead to better ways to treat and prevent addiction; and developing a formal, written National Strategy for drug-abuse treatment and prevention.

Four major policy changes helped the agency achieve its objectives. The first was made by the president when the Vietnam testing and treatment program was initiated: Drug use was no longer a court martial offense. The second was having the federal government take responsibility for developing and funding treatment. The third made Methadone-Maintenance treatment, already being used for 20,000 people, an established and acceptable treatment method rather than an experiment. The fourth had to do with changes that were made in the thinking, language, and means by which treatment was supported.

A central effort for SAODAP was the expansion of treatment capacity, increasing not only the number of programs, but also their actual capacity and geographic distribution. In addition, recipients of funding for treatment programs became accountable for what they provided, such as the number of treatment slots and the type of treatment. While legitimizing methadone-maintenance treatment and developing regulations for its use were highly visible and highly controversial activities, they were only incidental to the overall mission of making effective treatment central to the nation's response to the drug problem. Within the first 18 months of SAODAP's efforts, the number of communities with federally supported drug-treatment programs increased from 54 to 214, and the number of programs grew to almost 400. More federally supported treatment capacity was developed within two years than over the previous fifty years.

Some of the other projects SAODAP initiated, funded, or grappled with were the Vietnam drug intervention and the Vietnam drug intervention follow-up study; the development of confidentiality regulations to protect the medical records of people seeking treatment; funding clinical research on new pharmacological treatments for drug dependence; initiating with other agencies projects such as Treatment Alternatives to Street Crime (TASC), research centers for clinical and basic research on drug abuse and addiction, the Career Teachers program that incorporated drug abuse into medical school curricula, and a National Training Center. SAODAP introduced formula or block grants that gave money through the National Institutes on Mental Health (NIMH) to the states for treatment and prevention programs; it also introduced management concepts and language into treatment systems. SAODAP played a major role in improving drug-abuse treatment in the Veterans Administration; establishing laboratory standards for urine-testing facilities; and initiating several of the epidemiological tools that continue to shape policy, such as the National Household Survey of Drug Abuse and the Drug Abuse Warning Network (DAWN) system. Many of the programs and activities developed with interagency cooperation were implemented by the agencies involved in the collaboration. Many of the activities are ongoing in the mid-1990s. SAODAP also produced the first written national strategy, entitled "Federal Strategy for Drug Abuse and Drug Traffic Prevention."

Since the baseline funding for drug-abuse treatment, prevention, and research was so low in 1971, the new resources given to SAODAP for the task represented a manyfold increase—and in some instances were the very first resources available for the purpose. The same legislation that authorized SAODAP provided for the establishment of the National Institutes on Drug Abuse (NIDA); in addition, the resources and policies for an invigorated research effort were put into place over the three budgetary cycles that preceded NIDA's creation. Dr. Robert Dupont, who succeeded Dr. Jaffe as director of SAODAP, became the first director of NIDA. Dr. Peter Bourne and Mr. Lee Dogoloff, both of whom worked at SAODAP during the first two years, later became key advisors on drug policy to President Jimmy Carter.

A noted researcher, Dr. Solomon Snyder, credits the SAODAP support he received with enabling him to discover the opiate Receptor a year or two later. This discovery forms the basis for much of the neuroscience research into understanding the biology of drug dependence.

SAODAP was able to change the national response to illicit drug use by developing an infrastructure for treatment that is largely still in place, one that recognizes the heterogeneity of the drug-using population, their need for several different types of treatment, and the need for research on the efficacy of treatment. For a brief period after SAODAP's mandate expired in 1975, drug-abuse policy was coordinated by a smaller office within the Office of Management and Budget (OMB) under President Gerald R. Ford, and then by the Drug Abuse Policy Office within the White House under presidents Jimmy Carter and Ronald W. Reagan. However, until President George H. Bush established the Office of National Drug Control Policy (ONDCP), there was no formal agency with substantial authority for coordinating federal drug policy.

(See also: Industry and Workplace, Drug Use in )

Faith K. Jaffe

Jerome H. Jaffe

Substance Abuse and Mental Health Services Administration (SAMHSA)

This Agency, established by Congress on October 1, 1992 (Public Law 102-321), works with States, communities and organizations to strengthen the Nation's capacity to provide substance abuse prevention, addiction treatment and mental health services for people experiencing or at risk for mental and substance abuse disorders. The newest agency of the U.S. Department of Health and Human Services, SAMHSA's fiscal year 2000 budget is approximately $2.6 billion; it employs a staff of approximately 550.

The Agency houses three programmatic Centers: the Center for Substance Abuse Prevention (CSAP), the Center for Substance Abuse Treatment (CSAT), and the Center for Mental Health Services (CMHS). SAMHSA also includes an Office of the Administrator, an Office of Applied Studies, and an Office of Program Services.

Grant portfolios include both block and discretionary grants. Block grants enable States to maintain and enhance their substance abuse and mental health services. Targeted Capacity Expansion grants give communities resources to identify and address emerging substance abuse and mental health service needs at their earliest stages. SAMHSA's Knowledge Development and Application discretionary grants implement and assess new community-based prevention and treatment methods.

The Center for Substance Abuse Prevention (CSAP) is the Nation's focal point for the identification, promotion, and dissemination of effective strategies to prevent drug and alcohol abuse, and the use of tobacco. CSAP programs identify prevention strategies-such as targeted family and community strengthening-that work best for specific populations at risk of substance abuse. Program approaches emphasize both cultural relevance and competence. The Center oversees Federal workplace drug testing programs as well as State implementation of the Synar youth tobacco access reduction law. Finally, CSAP supports the National Clearinghouse for Alcohol and Drug Information (NCADI), the Nation's largest information source on substance abuse research, treatment, and prevention. NCADI's toll-free number is 1-800-729-6686; its Internet address is: www.health.org.

The Center for Substance Abuse Treatment (CSAT) is enhancing the quality of substance abuse treatment services and working to ensure that services are available to everyone who need them. It supports the identification, evaluation and dissemination of science-based, effective treatment services. CSAT administers the State Substance Abuse Prevention and Treatment block grant and undertakes knowledge development, education, and communications initiatives that promote best practices in substance use/abuse treatment and intervention. CSAT's Targeted Capacity Expansion Program-and its specialized program focused on HIV/AIDS services-help communities respond rapidly to emerging local drug use trends.

SAMHSA's Center for Mental Health Services (CMHS) works to improve the availability and accessibility of high-quality care for people with or at-risk for mental illnesses and their families by creating a nationwide community-based mental health service infrastructure. Its education programs are helping to end the stigma associated with these illnesses. While the largest portion of the Center's annual budget supports the Community Mental Health Services Block Grant Program to States, CMHS also supports grant programs to develop and apply knowledge about best community-based practices designed to serve adults with serious mental illnesses and children with serious emotional disturbances. The Center also collects and analyzes national mental health services data to help inform future services decision-making. CMHS's information clearinghouse—the Knowledge Exchange Network (KEN)—can be reached by toll-free telephone (1-800-789-2647) and on the Internet at www.mentalhealth.org.

While SAMHSA's Office of the Administrator and Office of Program Services are primarily administrative in nature, the Office of Applied Studies (OAS) has program authority to gather, analyze, and disseminate data on substance abuse practices in the United States. OAS directs the annual National Household Survey on Drug Abuse, the Drug Abuse Warning Network, and the Drug and Alcohol Services Information System, among other studies. Through these studies, SAMHSA is able to identify trends in substance abuse and, soon, also in mental health care. OAS also coordinates evaluation of models developed through SAMHSA's knowledge development and application programs.

New program topics are identified by SAMHSA in varying ways. Some are developed by SAMHSA leadership and staff; others result from Congressional mandate. Still other topics grow from Center-sponsored meetings that highlight empirically validated, intervention models ripe for replication. Some new program directions originate at the State and local levels, some from SAMHSA and Center National Advisory Councils, and some from the research community.

Programs are bringing new science-based knowledge to community-based prevention, identification and treatment of mental and substance abuse disorders. The results are being measured in improved approaches to addiction treatment, substance abuse prevention and mental health services at the federal, state and community levels. Equally important, the results are being measured in the improved quality of people's lives. For further information, write to SAMHSA Office of Communications, Room 13C05, 5600 Fishers Lane, Rockville, MD 20857.

Elaine Johnson

Revised by Theodora Fine

U.S. Customs Service

The U.S. Customs Service (USCS), in the Department of the Treasury, is the principal border-enforcement agency. Customs conducts a wide range of statutory and regulatory activities ranging from interdicting and seizing contraband entering the United States to intercepting illegal export of high-technology items. Customs officers also assist over forty other federal agencies with border-enforcement responsibilities, including public-health threats, terrorists, agricultural pests, and illegal aliens.

With a fiscal year 1993 budget of over $1.6 billion and 18,000 employees, Customs is a major revenue-producing agency; it collected $21.5 billion in duty, taxes, and fees in 1993.

CUSTOMS ROLE IN DRUG ENFORCEMENT

Customs is both a leader and a major player in stopping drug contraband from entering the United States. Approximately $570 million of the 1993 Customs budget was related to antidrug operations. Customs' inspection and control function is directed at stopping illegal entry of drugs and other contraband while accommodating the normal traffic of persons and cargo entering the United States and enforcing export laws.

As the federal lead agency at U.S. ports of entry, Customs inspects individuals, conveyances, mail, and cargo entering the United States at these ports (land, sea, and air). Customs has broad search and seizure authority at the U.S. borders and handles enormous workloads; for example, some 450 million international travelers arrive at U.S. borders each year. Customs operates a comprehensive computerized border information system and uses other domestic and international drug-intelligence networks. Priority efforts are targeted on illegal traffic in precursor chemicals, improving interdiction intelligence, and special high-intensity enforcement operations, particularly along the southwest border.

As a large, multipurpose border-control agency, Customs has considerable flexibility in determining the most effective means to meet its responsibilities. The traditional approach involves the physical presence of uniformed officers at the border to detect and seize violators and contraband. Customs emphasizes development of the best possible detection capabilities and information systems, including drug-sniffing Dogs, electronic chemical detectors, advanced computer systems, and sophisticated surveillance equipment. Reflecting the high priority for drug interdiction, over 650 National Guard personnel in twenty-seven states have been assigned to assist Customs with inspection of containerized cargo, vessels, and aircraft.

Customs has also developed major aviation and marine interdiction programs since the 1970s. Initially dependent on aircraft borrowed from the Department of Defense (DOD) and seized from smugglers, Customs now operates over 130 aircraft and 150 vessels. Customs supports a series of Command, Control, Communications, and Intelligence Centers (known as C3I) to provide coordinated tactical control for air interdiction. Using sophisticated aircraft, helicopters, and vessels, Customs works closely with the U.S. Coast Guard and U.S. military forces in providing surveillance, interception, and deterrence against drug smuggling by air and sea.

In addition to the tactical interdiction program, Customs conducts investigations of financial reporting and smuggling violations, developing both criminal and civil cases. USCS is represented in various interagency enforcement task forces.

Customs is an active participant in developing federal drug policy and has used its high public visibility to contribute to national drug-abuse prevention efforts, emphasizing "user responsibility" and drug education. Historically, Customs has provided staff assistance to executive and congressional drug-policy offices and committees. The Customs commissioner was included in the Executive Office of the President (EOP) drug-policy coordinating activities, including the Principals' Group, the Oversight Working Group, the National Narcotics Border Interdiction System, and others. The commissioner of Customs chairs the Office of National Drug Control Policy's (ONDCP) Border Interdiction Committee, with subcommittees that develop and guide the implementation of strategies for air, land, and sea interdiction. Customs also works with the international Customs Coordinating Council in developing new procedures and techniques.

(See also: Anslinger, Harry J., and U.S. Drug Policy ; Drug Interdiction ; International Drug Supply Systems ; Operation Intercept ; Zero Tolerance )

BIBLIOGRAPHY

Price, C. E., & Keller, M. (1989). The U.S. Customs Service, a bicentennial history. Washington, DC: Department of the Treasury, U.S. Customs Service. (An overview of 200 years of Customs history; a chapter on drug enforcement.)

U.S. Executive Office of the President, Office of Drug Abuse Policy. (1977) Border management and interdiction—an interagency review. Washington, DC. (Description of borders and border responsibilities.)

U.S. Executive Office of the President, Office of National Drug Control Policy. (1992). National drug control strategy. Washington, DC.

U.S. Executive Office of the President, Office of National Drug Control Policy. (1992). National drug control strategy budget summary. Washington, DC.

Richard L. Williams

U.S. Public Health Service Hospitals

In 1929, President Herbert C. Hoover signed a law enacted by the U.S. Congress to establish two federal institutions for treatment of narcotic addiction. The principal purpose of the institutions was to confine and treat persons addicted to narcotic drugs who had been convicted of offenses against the United States. However, the law also provided for voluntary admission and treatment of addicts who were not convicted of any offense. The two institutions were named U.S. public health service hospitals. One was opened in 1935 at Lexington, Kentucky, and the other in 1938 at Fort Worth, Texas. The Lexington hospital had a capacity of 1,200 patients; the Fort Worth hospital could accommodate 1,000 patients. From opening to closure in 1974, the hospitals admitted over 60,000 narcotic addicts; because of readmissions, the total admissions exceeded 100,000. Most of the admissions were voluntary. The term narcotic addiction has been replaced in modern diagnostic terminology by the term opioid dependence, but in this discussion the older term is retained because it was regularly used during the era reviewed here. The history of the hospitals is divided into three periods.

FIRST PERIOD, 1935-1949

From the start, the hospitals were designed to treat not only the physical dependence but also the mental and emotional problems thought to be related to addiction. This was an advanced conception, for treatment of narcotic addiction until then had been focused almost exclusively on the Physical dependence. The initial treatment programs at both hospitals emphasized residence in a drugfree environment for at least six months, during which time the patient could not only recover from the physical dependence but perhaps also overcome the mental difficulties or learn to adapt to them without using drugs. While all patients received psychological help in the form of encouragement and persuasion, only small numbers received formal psychotherapy. That was because few of the staff were trained in psychotherapy. All patients considered physically able had work assignments, and all had access to educational and vocational services, recreation, and religious activities. Treatment of voluntary patients was hindered because most left during or shortly after Withdrawal treatment (often to return to lower doses of their drug—before readmission). In 1948, the research division of the Lexington hospital reported that a new synthesized narcotic drug called Methadone was effective in the treatment of opiate withdrawal. Methadone substitution followed by a gradual decrease of its dose subsequently became the standard treatment for morphine and heroin withdrawal in the United States. Also in 1948 the research division of the Lexington hospital was administratively separated from the hospital, renamed the Addiction Research Center (ARC) and made a part of the National Institute of Mental Health (NIMH).

SECOND PERIOD, 1950-1966

After World War II, the prevalence of Heroin addiction in the United States markedly increased. Heroin replaced morphine as the primary narcotic used. Annual admissions to the two hospitals doubled from the 1940s to the 1950s. The prewar addicts differed from their postwar counterparts. More of the postwar addicts came from large cities, and more came from minority groups (mainly black and Hispanic).

While residence in a drug-free environment continued as a major feature, new psychosocial treatments were made a part of the program. Psychoanalytically oriented Psychotherapy was offered, but few patients seemed willing or able to engage in this form of therapy. Group therapy, however, seemed more acceptable, and most patients participated in it to some extent. Influenced by new concepts of the therapeutic community, staff members tried to improve the quality of the patients' psychosocial experience in the hospital.

THIRD PERIOD, 1967-1974

In 1967, a research mission was assigned to the two hospitals, and each was renamed a National Institute of Mental Health Clinical Research Center. Before the research mission could be developed, however, a new clinical mission was assigned to the two institutions. The Narcotic Addict Rehabilitation Act (NARA), enacted in 1966, provided for the Civil Commitment of addicts instead of prosecution on a criminal charge, or sentence after conviction, or by petition with no criminal charge. The law authorized the Public Health Service to enter into contracts with any public or private agencies to provide examination or treatment of addicts committed under the NARA, but it was decided to use the two clinical research centers to implement the act quickly. Admission of prisoners and voluntary patients was phased out, and the centers concentrated on service to the NARA patients. From 1967 through 1973, over 10,000 NARA patients were admitted to the two centers. Nearly all were admitted under the provision of the law that permitted commitment with no federal criminal charge.

The NARA civil commitment seemed a promising way to eliminate the problem of voluntary patients who signed out prematurely. In practice, it only reduced the problem. Patients learned that commitment could be avoided or terminated if they refused to participate in treatment activities or engaged in disruptive or antagonistic behavior. Only about one-third of the NARA patients completed a six-month period of institutional treatment.

The NARA program led to the closure of the two centers. As more contracts were made with local facilities for examination and treatment of NARA patients, admissions to the two centers decreased. In addition, a new federal program, started in the late 1960s, of grants to states and communities for drug-abuse treatment programs made the centers less needed. The Fort Worth Center was closed in 1971 and the Lexington Center in 1974. The facilities were transferred to the Federal Bureau of Prisons and were converted into correctional institutions.

HISTORIC ROLES OF THE HOSPITALS

For approximately three decades, from the 1930s into the 1960s, the two Public Health Service hospitals were almost the only institutions in the United States engaged in the study and treatment of narcotic addiction. They became international centers of expertise. Staff members published many reports on the psychosocial characteristics of the addicts, the treatment programs, treatment outcomes, and related topics. Many clinicians and investigators who worked at Lexington and Fort Worth left these institutions to become leaders in treatment of or research on narcotic addiction at other locations. Despite great efforts, however, the hospitals failed to develop an enduring cure for narcotic addiction. Hospital treatment often produced a temporary remission in the addiction, but relapse within a year was the typical outcome.

(See also: Opioid Dependence ; Treatment, History of ; Wikler's Pharmacologic Theory of Drug Addiction )

BIBLIOGRAPHY

Leukefeld, C.G., &Tims, F.M. (Eds.) (1988). Compulsory treatment of drug abuse: Research and clinical practice. National Institute on Drug Abuse Research Monograph 86. DHHS Publication no. (ADM) 88-1578. Rockville, MD: U.S. Department of Health and Human Services.

Martin, W. R., & Isbell, H. (Eds.) (1978). Drug addiction and the U.S. Public Health Service. DHEW Publication no. (ADM) 77-434. Rockville, MD: U.S. Department of Health, Education, and Welfare.

James F. Maddux