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Continued Decline in Youth Substance Abuse

Current illicit drug use among teens is continuing to decline, according to a new report by the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) released today. The study also shows positive signs that teens are seeing the dangers of abusing prescription drugs and methamphetamine and are pushing back. Among youth ages 12-17, the 2007 National Survey on Drug Use and Health (NSDUH), the Nation's largest substance use survey, shows that the significant decline in overall past month illicit drug use that began in 2002 continued through 2007, from 11.6 percent to 9.5 percent.

The survey, released at the start of the 19th Annual National Alcohol and Drug Addiction Recovery Month, shows that the reductions in youth drug use occurred for nearly every type of illicit drug including marijuana, cocaine, hallucinogens, LSD, and Ecstasy. The survey also shows dramatic declines in meth use, down by 67 percent (from 0.3% to 0.1%) and prescription drug abuse among teens, which declined overall by 18 percent, from 4 percent to 3.3 percent between 2002-2007.

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The Cost of Putting Policy Before Ethic

Columns - Ask the Ethicist

Tuesday, 31 May 2005

Even though the concept of building community has become almost clichÈ, today’s political environment seems to polarize communities — red states vs. blue states — progressives vs. conservatives. The disconnect between values and policies even reaches into the Substance Abuse and Mental Health Services Administration (SAMHSA). In an effort to be inclusive, SAMHSA’s National Clearinghouse for Alcohol & Drug Information includes several pages of notes and bibliographies about the unique treatment and prevention needs of lesbian, gay, bisexual, and transgender (LGBT) people (http://www.health.org/features/lgbt). Among the key facts are:

— Stigma, homophobia, and heterosexism permeate the social, economic, legal, and political aspects of the members of the LGBT groups. As a result, this impacts the mental, emotional, and psychological states of individuals in these groups.

— Prevention professionals who work with LGBT individuals need to be aware of, understand, and address specific LGBT issues before they can begin to address their patients’ substance use and abuse issues (SAMHSA, 2005).

However, SAMHSA’s administration is not so clear about how to live out this vision. During the planning of a recent SAMHSA-sponsored conference, Preventing Suicide in Public Health Regions IX and X, to be held in Portland, Ore., SAMHSA officials requested that the Suicide Prevention Resource Center (SPRC), the group hosting the conference, remove the words “gay, lesbian, bisexual, and transgender” from a conference session highlighting prevention programs targeting these groups. SAMHSA reportedly suggested that “sexual orientation” be used as an alternative (Washington Post, 2005), which really makes about as much sense as using “race” synonymously with “African American” or “age” with “geriatric.”

Ultimately, the title of the session remained intact, but SAMHSA officials seemed unaware of the oppressive nature of marginalizing or erasing the names of the groups actually targeted. Mark Weber, SAMHSA spokesperson, is quoted as ominously saying the name change was only a suggestion but the conference organizers “do need to consider their funding source” (Washington Post, 2005).

What motivated SAMHSA’s effort to change the name of the session? Was it an attempt to whitewash the stigma of homosexuality from the session, even though it was specifically about tailoring prevention programs to an at-risk group that suffers from its mar-
ginalization? Was it motivated by political savvy ... to slide past the watchful eye of an anti-gay administration? Who can say?

Whatever the motivation, substance abuse counselors can often find themselves in politically sticky situations. Our fundamental ethical principle of justice demands that we fight against the societal oppression that leads to addiction and other terrible outcomes. We must use our policy-making power to create services that are effective and respect the dignity of our clients and communities. We cannot hide behind our counseling role as though we don’t have a broad responsibility given to us by our expertise and profession.

But how does a person or agency live out that mandate? Aren’t we sometimes faced with the need to present our programs in language and images that are carefully crafted to highlight the fundable and non-stigmatized aspects of our work? Many of us have changed the name of a program — essentially hiding the stigma — in order to shore up support for important work. Is it true, that as long as it avoids overt dishonesty, putting on the most acceptable face is sometimes the savvy thing to do? Making that choice seems to be strengthened by a desire to maximize the benefits (respecting our fundamental principle of beneficence). But there are costs, and not just in an abstract devotion to justice.

In this particular situation, the dynamic of stigma is the central force that makes lesbian, gay, bisexual and transgender people at risk for abuse of all kinds. SAMHSA and all of us should be careful not to deepen the shame in the name of “being smart”, “being acceptable” and “being respectful” of the cultures that are most anti-gay. We are the experts in risk and resiliency, and we are the ones who can walk those difficult lines even in polarized political environments. We are the ones who do the research and can show that social isolation, shame and internalized homophobia (as well as sexism, racism, ageism, etc.) contribute to addiction, depression and suicide. By showing courage and forthrightness we are responding to our principle of justice, and working for the day when there will be no stigma toward people regardless of the politics involved. SPRC seemed to believe that naming the session honestly and clearly is the best way to provide the right education to the right people. And they exemplify a degree of courage in not bowing to pressure to sanitize their event topics by marginalizing a community in need of open support.

So what is our responsibility if we think our own federal agency or any governmental agency has acted unethically? And did SAMHSA act unethically? I would like to invite your thoughts on this issue. Please send your ideas about this situation to Counselor. We will review them and consider publishing what you think is the right thing to do.

Adam Robinson, MA, CSAPC is associate director of Program Services at Wake AHEC in Raleigh, NC, and former chair of the NC Substance Abuse Professional Certification Board Ethics Committee.

References
National Clearinghouse of Alcohol and Drug Information, (2005). Substance Abuse Prevention and Treatment Issues (Gay and Lesbian), accessed at http://www.health.org/features/lgbt/keyfacts.aspx on March 28, 2005.
Weiss, R. (2005, February 16). Request to Edit the Title of Talk on Gays, Suicide Stirs Ire: HHS is Being Accused of Marginalization. The Washington Post, p. A17, accessed at http://www.washingtonpost.com/wp-dyn/articles/A27202-2005Feb15.html on March 28, 2005.