The Chairman’s Corner

I have great news about The National Center on Addiction and Substance Abuse at Columbia University (CASA Columbia):  The board of directors has elected Jeffrey B. Lane to be its new Chair beginning February 1, 2012.  Since joining the board last year, Jeff has been co-chair of our investment committee.

Jeff has enjoyed a distinguished career in the financial field and maintains a deep interest in health care.  He is a director of the North Shore-Long Island Jewish Hospital System (which includes Lenox Hill Hospital in Manhattan) and co-chair of its investment committee.  His career includes positions as Chairman and CEO of Neuberger Berman, President and Chief Operating Officer of Shearson Lehman, and Vice Chairman of Lehman Brothers and of Travelers Group.  He is a graduate of New York University and holds an MBA from Columbia University’s Graduate School of Business.

Jeff is enthusiastic about taking on this task and the board and I are even more enthusiastic that he will be chair of CASA Columbia.  I will become Chairman Emeritus and at Jeff’s request remain on the board.  I look forward to helping him.

This is a major step forward for CASA Columbia as it moves to build on its reputation as the premier institution that brings together all the skills needed to research and combat all substance abuse in all sectors of society, continues to seek effective means to prevent and treat this devastating disease, maintains its interest in helping kids grow up healthy and drug free, and expands its influence in the field.

A recent survey of 7th through 11th graders in the Connecticut gold coast town of Westport, Connecticut, nails the importance of targeting alcohol use among teens for parents, teachers, pediatricians and public health professionals who seek to prevent teen substance abuse and addiction.

The survey by the Governor’s Prevention Initiative for Youth revealed that 25 percent of the town’s 9th graders, 37 percent of 10th graders, and 60 percent of 11th graders had been drinking alcohol in the previous 30 days. Translated from substance abuse statistical jargon to plain English, this means that these high school freshman, sophomores and juniors are current drinkers, likely drinking regularly.

Marijuana use is a distant second as a drug of choice among these teens, but it also deserves some attention. Seven percent of 9th graders, 17 percent of 10th graders and 37 percent of 11th graders use marijuana.

But the contrast with nicotine makes it clear that tobacco is NOT a drug of their choice. Only two, three and 11 percent, respectively, of 9th, 10th and 11th graders smoke cigarettes.

Four percent of 7th graders and eight percent of 8th graders drink alcohol, one percent use marijuana and 0.5 percent smoke cigarettes.

Over the past decade, the changes in alcohol and marijuana use were modest (slightly lower for alcohol, slightly higher for marijuana), but smoking was down sharply. For 7th through 10th graders, the Governor’s survey found that smoking was down 90 percent from what it was a decade ago.

Place these findings against what we know about substance abuse and addiction in America and the message could not be any clearer for prevention buffs and those who want to reduce health care costs.

First, the 800 pound gorilla, the King Kong, of adolescent substance abuse is alcohol—beer, wines, alcopops like Mike’s Hard Lemonade, Seagram’s Sweet Tea Vodka and Bacardi Breezer. Use of drugs like heroin, meth and cocaine command time on the airwaves and space in the tabloids. And parents tremble at the thought that their child might experiment with such horrific substances and get hooked on them. But it’s alcohol that should be the main drug of concern for parents, schools, churches, pediatricians and the public health community, with attention paid to marijuana as well. This is especially true as we learn more and more about the threat alcohol and marijuana pose to the adolescent brain.

Second, our kids are getting the message about smoking—and they’re acting on it. The decline in cigarette smoking among these affluent, well-educated Westport teens is dramatic and signals the success of our antismoking campaigns. Indeed, as the person who started the nation’s first antismoking campaign in 1978 while U.S. Secretary of Health, Education, and Welfare, I am astonished and enthralled by what has happened. That’s not to take credit, for many others from Surgeon General Everett Koop in the Reagan administration, to President Bill Clinton, to scores of state, city and county officials, Congressmen like Henry Waxman and Senators like Frank Lautenberg, and hosts of teachers and private citizens deserve the acclaim.

But the overarching point is critical: when the public health message is trumpeted not just by the conductor, but by everyone in the orchestra, the entire audience starts humming the same tune.

Third, the lesson from the success with smoking is, “Yes we can keep our kids from drinking alcohol.” And it is critically important to do so. We’ve known for some time that 90 percent of adults hooked on cigarettes were hooked when they were teens.

CASA Columbia’s recent report on adolescent substance use finds, for the first time, that 90 percent of those addicted to alcohol and other drugs started using them before they were 18. Moreover, we have learned a lot about the adolescent brain in the past several years. One of the most important things that we have learned is that drinking, particularly binge drinking, can stunt the development of a teen’s brain and in some cases do permanent damage. So in addition to helping individual teens, getting the alcohol message across will reduce health care costs (people with alcohol abuse and addiction problems cost a lot more in medical services) and help more of our kids grow up drug free and become productive citizens, in turn contributing to our country’s economic growth and global competitiveness.

The message about smoking is simple and absolute: It’s NO—No for everyone FOREVER—for boys and girls, men and women of all ages throughout their lives.

The message about drinking alcohol is more complex: It’s no for those under 21, no for adults who have a genetic predisposition or are alcoholics; but yes, in moderation, for others who choose to drink.

This means that teens are likely to see their parents drink, to see other adults drink and to be exposed to all sorts of advertising designed to glamorize and sell beer, wine, sweet drinks and hard liquor. It makes it more difficult to deliver the prevention message to our teens. But not less important.

And there are all sorts of things we can do to deliver this message and begin to change the teen drinking culture. We can start by educating younger children to the dangers of drinking way before they are 21 or even teens—teach them about the potential damage to their brains, their lower level of impulse control, the threat that excessive drinking has in terms of crippling and fatal accidents, risky and criminal sexual activity. We can also, as a society, put some serious restrictions on alcohol advertising, eliminating it during television programs and in publications that attract significant proportions of children and teens. And we can educate our kids about drinking in the same health classes where we teach them about the dangers of smoking and obesity and the benefits of exercise and healthy diets.

Most importantly, we must change the culture of drinking for teens so that it is just as uncool for them to drink as it is for them to smoke. That may seem impossible today. But remember this: When in 1978 as HEW Secretary I declared the HEW building to be smoke free, the following morning the employees demonstrated against my decision and demanded that they have the right to smoke in their offices. And no other cabinet officer or agency head followed my lead. Who would have thought then that 30 years later there are virtually no public buildings or private offices in our nation where you can smoke today!

So, let’s stop accepting teen alcohol use as an inevitable rite of passage, and start down this road of cultural change. Any ideas you have on preventing kids from drinking and making it “cool” for teens not to drink, please send them along in your comments and together we can begin to change the culture.

With the death of Betty Ford, our nation loses one of its great First Ladies, those committed to the battle against substance abuse and addiction lose one of our most courageous leaders, CASA Columbia loses one of its Founding Directors and I lose a dear friend and committed partner.

I first met Betty Ford at a White House dinner during the 1960s when I served as President Lyndon Johnson’s aide for domestic affairs.  Those were the days when Democrats and Republicans, who fought like hell over public policies day after day during the week, sat down with each other at drinks, dinner and parties in the evenings and on the weekends.  Even though LBJ could get mighty angry at Gerald Ford’s opposition to his Great Society programs, he would tell me, “You treat Ford [then Minority Leader of the House] with the same respect you give McCormack [then Democratic Speaker of the House].  If he needs help, try to give it to him.  That’s how we get things done.”

Betty Ford will always be remembered for her courage in facing up to her addiction to alcohol and pills and her years of abusing those substances.  In a day when even more shame attached to alcoholics and addicts, Betty Ford not only openly discussed her problems, but started the Betty Ford Center, now one of the world’s premier rehabilitation facilities.  I always admired her for that.  (She and her husband were a courageous couple. I respected the bravery of President Ford when he pardoned Richard Nixon in order to heal divisions that had wracked our nation—and would have continued to do so if criminal proceedings dragged on.  I believe President Ford and Betty knew that action would likely cost him his election something he dearly desired, to be elected President on his own name).

I saw the Fords periodically thereafter when the President and I were on a corporate board together.

In 1992, when I announced that I was founding The National Center on Addiction and Substance Abuse at Columbia University, Betty’s Ford’s eye caught the announcement in a trade journal. She wrote me offering her “support and assistance,” calling “substance abuse and addiction the most harmful component of today’s society,” and the establishment of CASA “an important step forward [that] can achieve great success.”

I called to thank her for her letter.

She said, “Joe, this is as important as anything you’ve ever done.  Let me know if I can do anything to help you.”

“Come on our founding board.”

“Done, if we can work out the schedule.”

“We’ll do that.”

“Then it’s done.”

Betty Ford served on the CASA board for six years.

At the first meeting the board established CASA’s missions.  I had proposed four, which the board adopted: to inform Americans of the costs of substance abuse and addiction, assess what works in prevention and treatment, encourage everyone to take responsibility, and provide those on the front lines with tools to succeed.

Betty Ford then said, “There’s something very important missing.  We should commit to attack the stigma that attaches to the disease of substance abuse and addiction.”

After a brief discussion, she suggested, “Let’s add this mission: To remove the stigma of substance abuse and replace shame and despair with hope.”  The board quickly agreed and Betty said, “If we can achieve that, we will be a great success!”

Betty Ford was a most active board member.  She conducted press conferences with me and helped promote a series of reports—the nation’s first—on substance abuse and women.  Those reports led to the first CASA book—and the first book ever written on this subject–Women under the Influence, published by the Johns Hopkins University Press in 2006.

We honored Betty Ford at a Concert of Hope in Los Angeles which was CBS-TV broadcast on November 29, 1995.  It was a gala event with Tony Bennett, Liza Minnelli, Patti LaBelle and other great performers. But Betty was the star of the evening.

In 1998, Betty Ford called me. “The doctors don’t want me to fly anymore [she had a problem breathing] so I won’t be able to get to your board meetings in New York,” she said.  “I’m only going to make one trip east each year, for Jerry’s annual reunion with his staff. I hope you understand.”

Though she continued to support our work, we lost a founding board member.

Now, the world has lost a great woman.  But Betty Ford will always be an inspiration to all of us at CASA and to me.  As part of our recognition of the former First Lady and founding board member, we are recommitting ourselves to strip the shame from this disease, replace despair with hope and convince our people and institutions to accord substance abuse and addiction the same respect they accord other diseases, and to prod our public health and medical professions to devote the same energy and attention to preventing substance abuse and addiction that they devote to other preventable and treatable chronic diseases like diabetes and hypertension.

That will be our enduring response to the charge Betty Ford gave us at our first board meeting in 1992 and the inspiration the memory of her courage and commitment continues to give us.

Since my book, How to Raise a Drug-Free Kid: The Straight Dope for Parents, was published in late 2009, I’ve made dozens of speeches to parents across the country–from San Francisco to Miami, Boston to Houston, and many points between–and thousands of books have been purchased. I often wonder how well the book is fulfilling its purpose: to help parents raise healthy, drug-free children.

The book, based on research by many professionals over two decades, was written by me as a result of CASA Columbia’s finding that A child who gets through age 21 without smoking, using illegal drugs, or abusing alcohol or prescription drugs is virtually certain never to do so.  That fact makes raising drug-free kids first and foremost a Mom and Pop operation.

My conversations around the country with thousands of parents have confirmed my belief in the ingenuity of informed American parents. Indeed with the help of our book, parents have devised all sorts of creative and effective ways to help their children negotiate the dangerous decade from 10 to 21 drug free.

Well, I’m now asking parents to send us their ideas about protecting their kids from today’s culture of availability, advertising, media and peer pressure that so easily can lead to smoking, drinking and using illegal and prescription drugs. Then we can share them with other parents across the country. Experts say that students who go to top professional schools of law, business or medicine learn more from each other than from the teachers. Well, I believe parents can learn more from other parents than from all the experts in the world on raising drug-free kids. Here are a few examples of how parents and communities across the country help one another raise healthy, drug-free kids.  I hope those of you who are doing things like this will send them to me.

Robert Curry of New Canaan
After speaking to parents of middle and high school students in New Canaan, Connecticut, at an occasion where every parent who attended received a copy of my book, the event organizer Robert Curry joined with others to seek ways to build on the evening’s momentum.

They created workshops to “give parents the tools to take what’s in the book and learn how to implement it.” With Active Parenting Publishers, creator of video education programs, Curry signed up 100 parents to take a six session course. Parents were divided into small groups, some for those with children age 5 to 12, others for those with children over 12. Parents met each week to discuss subjects like alcohol, drugs, sexuality, communicating with their children, and learning how to discipline their children and redirect errant behavior. The sessions used a workbook, with parents given homework and practice tools.

Diane Hobbs, one of the workshop program leaders, said, “I went to hear Joe Califano speak and I was so moved by what he had to say. It was very hopeful to hear that as a parent I had a lot more importance in the teen years than I had realized. I got very worried about drugs and alcohol in the teen years and his talk made me feel like, ‘Wow, they really care about what I have to say about these things.’”

Because of the program’s success, Robert Curry will conduct spring parenting classes in Fairfield County, Connecticut. For anyone interested in taking the class or following Bob’s lead by starting their own course, email him at RobertC@TurningPointForLeaders.com or call him at 203-972-9400.

United Way in Norman, Oklahoma
In Norman, Oklahoma, United Way created Operation Parent Power using How to Raise a Drug-Free Kid. The parents involved said they knew more about parenting strategies as a result of the book and planned to use those strategies in their parenting. Each committed to pass the book on to another parent.  The United Way program engaged 15 Parent Teacher Associations in Norman.

Greater Omaha Healthy Communities Youth
Last fall in Nebraska the Greater Omaha Healthy Communities Healthy Youth Initiative designated How to Raise a Drug-Free Kid its community book read. It gave the book to interested parents along with study guides in English and Spanish. After reading the book, one father posted a book review for other parents to read on his son’s school’s website.

Tonka CARES
In April I will speak to parents in Minnetonka, Minnesota. Tonka CARES, a community coalition which aims to reduce underage drinking and substance abuse in the Minnetonka School District, designated How to Raise a Drug-Free Kid a community read, and created their own facilitator’s guide for weekly book discussion forums. Participants exchange ideas about advice in the book. Tonka CARES encourages teacher groups, book clubs, and faith organizations to hold their own discussion forums.

The book is beginning to do what we hoped–give parents of children and teens ideas, information and tools to raise healthy, drug-free kids who can reach their full potential and be all that God gave them the talent to be. 

I stress beginning. We can build on this momentum. We can spread the word to other parents and use your ideas to make the next edition even more valuable than this beginning. Send me your ideas. Let me know of your struggles, successes and mistakes by sharing them in the comment section below.  The best way to help parents is for parents to help each other. That’s what Parent Power is all about.

There are two fiscal gluttons gobbling taxpayer dollars, threatening to starve other public needs like education, and creating budget crises for at least 46 states: Medicaid and prisons.

And there is one common tapeworm that spawns this ravenous appetite for state funds: substance abuse and addiction.

New York, California, Illinois and New Jersey make the headlines for their huge budget deficits and whopping Medicaid and prison costs, but in fact most every state faces budget deficits due to the same culprits. 

The reaction of governors to Medicaid’s explosion in costs tends to be to eliminate coverage of services such as hearing and vision care, transplants, and obesity surgery, and to reduce payments to doctors, hospitals, and ambulance services. To cut prison costs, most governors appear to favor releasing inmates early to trim the size of the prison population and, as New York City is doing, reduce things like the size of food portions that prisoners get.

Such tactics are short term and short sighted. They assure that in the long run (on somebody else’s watch) the need for public services and the burden on law abiding, taxpaying citizens will increase.

Here’s a proposal for any governor who can see beyond getting through his or her term, or winning re-election or election to some other office, and who has the courage to do what any business executive in the private sector would do: Make an investment that will solve, not simply postpone or paper over the problem. If small business owners want to increase their business, or lawyers or doctors want to add to their practice, or large corporations want to get into new markets — or if any of them want to reduce costs by modernization or eliminating inefficiencies — they make additional investments in order to make more money in the future, over the long haul.

Is there a governor with the courage to apply this simple concept to permanently reduce Medicaid and prison costs? 

If there is, here’s how.

First, Face the Facts:

• Some 30 percent of Medicaid health care dollars are spent to treat the injuries from violence and accidents and the 70 plus diseases caused or aggravated by substance abuse and addiction. Medicaid patients with drug and alcohol problems cost $5,000 to $10,000 a year more in health care costs than those without such problems. Most Medicaid hospital patients readmitted within 30 days are those with drug and alcohol problems. In New York, Governor Andrew Cuomo estimates that on average each such patient costs Medicaid $100,000 a year.
• Some 80 percent of inmates are incarcerated for violent and other crimes committed while they were high on alcohol or other drugs, stole to get money to buy drugs, violated the alcohol or drug laws, or are alcohol or drug addicts or abusers.
• Of all state substance abuse related expenditures, 94 percent goes to shovel up the burden of substance abuse and addiction in crime, health care, education and social services, while only 2.4 percent is spent on prevention, treatment or research. (3.6 percent is used to regulate alcohol and tobacco sales, collect taxes and operate liquor stores.)
• For each dollar that states collect in tobacco and alcohol taxes and liquor store revenues, they spend more than seven dollars on the health care and criminal justice consequences of smoking and alcohol abuse and addiction.

Then, Act on the Facts: Invest resources in the prevention and treatment of substance abuse focused on these populations:

• For all Medicaid patients, provide screening for drug and alcohol abuse and addiction and then intervene to put those with this disease into treatment.
• For all in prison who need it, provide treatment and the carrots and sticks likely to get inmates into treatment, like early release for those who remain clean for at least six months. Then condition early release and probation of these inmates on their entering and staying in programs like Alcoholics or Narcotics Anonymous. CASA studies have demonstrated that if only 10 percent of inmates treated remain sober, crime free and employed for a year after release, the economic benefits and reduced criminal activity will pay for the treatment of all inmates who need it.
• Pay for these investments in the short term by increasing cigarette and alcohol taxes, which offer the added bonus of discouraging smoking and excessive drinking and deterring initiation of smoking and binge drinking by underage teens.

Long term, systemic control of state budgets requires a serious effort to prevent and treat the disease of drug and alcohol abuse and addiction, which in turn requires Governors and state legislators to have the guts to make short term investments to attack this fundamental problem. Otherwise, taxpayers will end up paying more and more for less and less.

Is there a governor and state legislature with the courage to face the facts and act in a way that will solve the problem, rather than postpone or paper over it during their term in office? That’s the multi-billion dollar “to be or not to be” question in American politics today. Our states desperately need governors with the guts to be problem solvers rather than problem postponers.

With President Barack Obama’s eloquent speech at the Tucson memorial, Speaker John Boehner’s emotional reminder to his Democratic and Republican colleagues and all Americans that “an attack on one of us is an attack on all of us,” and the thousands of pundits, left and right, arguing about the meaning of the tragedy in Arizona, it might seem that there is nothing more to say or learn about the horrific incident that killed six, wounded 13, and put a bullet through the brain of Congresswoman Gabrielle Giffords.

But there is - and it is as important as any other lesson to come out of this tragedy.

It’s about the relationship of marijuana use to psychotic illnesses.

There has been plenty of media and talking head attention to the weak gun laws that allow purchase of automatic weapons and super size ammunition clips. There has been story upon story, and comment upon comment, bemoaning how easy it was for this mentally deranged young man to buy such a gun and ammunition clip. And the reporting about the twisted mind of Jared Lee Loughner and his erratic behavior has been extensive.

But I haven’t seen press reports or talking heads discuss their concern about how easy it has been for this mentally ill young man to get marijuana. And there has been no mention of the potential of marijuana to spark latent psychosis and exacerbate schizophrenia and other mental illnesses.

In 2007, the British Medical Journal Lancet concluded that an exhaustive review of cannabis use and mental health “leads us now to conclude that cannabis use could increase the risk of psychotic illness.” Since then, there has been more research on the relationship of marijuana use and psychosis.

Scientists at the Albert Einstein College of Medicine in New York City conducted a study of individuals who suffered from schizophrenia, half of whom used marijuana. They found that among marijuana users, three fourths had begun smoking pot before the onset of their mental illness and their schizophrenia appeared two years earlier than it did in those who did not smoke pot.

Marie-Odile Krebs, a psychiatrist at the National Institute of Health and Medical Research in France, found that among a group of 121 patients who used cannabis, 44 either developed schizophrenia within a month of beginning to smoke pot or significantly intensified their existing psychosis with each successive use of the drug. Schizophrenia appeared some three years earlier in these 44 than in the other marijuana users.

From CNN and other press reports, we know that Loughner was turned down by the Army because of his admitted regular marijuana use. His childhood friend Kylie Smith tells us that after Loughner’s sophomore year in high school, “he got involved with marijuana, and he was really into psychedelics.” Smith described how Loughner got more and more involved with marijuana and alcohol during his high school years and how he began hanging out with potheads.  In his short stay at Pima Community College, one professor described Loughner’s “hysterical kind of laugh, laughing to himself, and his bright red complexion, and his kind of shaking and trembling, as if he was under the influence of drugs.”

The question that not enough people are asking - and the one that should be answered - is this:  Was Loughner under the influence of drugs at the time of the shooting?

If the police have any of the hair shaved from Loughner’s head, they can easily find out if marijuana was in his system at the time of the shooting. They may even be able to do so from hair that grows back in.

So as we continue to think about this killer and his deranged mind, we should be asking this question:  Is Jared Loughner an individual whose psychosis was prompted or exacerbated by the use of marijuana?

Whether or not he is, it is important for the press and parents to see this horrendous incident not only as a teaching moment about the easy availability and dangerous potential of automatic weapons, but also as a teaching moment about the easy availability and dangerous potential of marijuana to spark and exacerbate psychosis and schizophrenia in individuals with latent mental illnesses.

The missing story line in existing news reports and television chatter shows is about the terrible trinity of easy availability of guns, easy availability of marijuana and mental illness.

The question for all of us, especially parents of teenagers, to ask is this:  Is the media’s failure to acknowledge this tragic trinity due to its tendency to overlook or underplay the dangers of marijuana use?

The New Year is a time for resolutions and here are my suggestions for some of those responsible for curbing drug and alcohol abuse and addiction:

For doctors: Resolve to take responsibility to treat substance abuse and addiction with the same medical professionalism devoted to other diseases.

For medical schools: Resolve to give more than the usual two or three hours to teach the subject of substance abuse and addiction.  Then medical students won’t have to wait until their clinical training, residencies and fellowships to learn how alcohol and other drug abuse and addiction cause and exacerbate most ailments and accidents they will confront as family doctors, general surgeons or cancer or other specialists.

For public health professionals: Resolve to mount against underage drinking and teen drug experimentation the same kind of intensive, relentless and persuasive campaign that they have mounted against cigarette smoking and AIDS.

For the media: Resolve to require health reporters to become educated about and conversant with the subject of substance abuse, to have obituaries report when the decedent who dies of lung or other cancers was a smoker, to cover the dangers of marijuana to our children with the same energy they devote to covering the social acceptance of the drug, which is now 10 times the strength it was in the 70s, and to include in coverage of assaults, rapes, murderers and robberies whether the accused was high on alcohol or other drugs at the time of the offense.

For mayors, school boards and education officials: Resolve to report the number of kids who drop out because of their drug and alcohol abuse or that of their parents.

For college presidents and provosts: Resolve to end their see, hear, speak-no-evil attitude about campus alcohol abuse, which each year accounts for the deaths of 2,000 students, the rapes and sexual assaults of 100,000 college women, and the hundreds of thousands of student injuries, many paralyzing and life altering.

For the governors and states worried about Medicaid costs: Resolve to screen beneficiaries for drug and alcohol problems and intervene with those who have them because treating such problems will save states billions of dollars since patients with drug and alcohol problems incur $5,000 to $7,000 per year more in health care costs than substance-free beneficiaries.

For the Obama Administration, which wants to hang on to Obamacare, and the Republicans who want to dismantle it: Resolve to find common ground to recognize the phenomenal health care cost savings potential in reducing smoking, and alcohol and illegal and prescription drug abuse, and join together to take action to prevent and treat it.

For parents: Resolve to be engaged in your children’s lives, to talk to them about the dangers of underage drinking and drug use, and to demand drug-free schools.

For all of us: Resolve to remove the stigma that clings to drug addiction, to recognize that this is a complex neurological, emotional, psychological and spiritual disease, to help those trying to shake their addiction (have you ever tried to lose weight and keep it off?  Multiply that difficulty by a thousand to appreciate how hard it is to shake a drug addiction), and to demand that our health practitioners and researchers accord this malady the same respect they accord other chronic, relapsing diseases like hypertension and diabetes.

If we maintain our resolve in 2011, millions of our children and families will have a much happier New Year.

NOTE: In my Chairman’s Corner on May 10, 2010 I noted that the death of Yeardley Love, the University of Virginia lacrosse player, was likely another consequence of alcohol abuse on our nation’s campuses.   It appears from news reports that Ms. Love had a blood alcohol content of .14 and she had Adderall in her system at the time of her death.  How many college women have to die and be raped and sexually abused before the college administrations take this problem seriously?  The University of Virginia should resolve to lead the way on this issue.

If we are serious about educating our children at every level from elementary school through college, we’d better recognize that money alone will not solve the problem.  We can fill our schools with all the modern gadgetry — computers, great graphics, television screens in every classroom, internet tutoring — and we can pay teachers, principals, professors and college presidents more and more money.  That’s the easy stuff.

The tough stuff is revamping communities, strengthening parents and families, and getting rid of the drugs and the alcohol abuse that infect so many schools and campuses.  If we don’t tackle the tough stuff, these high ticket investments are not likely to have more than a marginal impact and we’ll still be “Waiting for ‘Superman’”.

Failure to face up to that truth is why school reform so often has little effect on our kids’ education. There is only so much high tech tools and high paid teachers can accomplish.

Overall, only 71 percent of American students graduate from high school; in most urban centers, the number is no more than 50 percent.  And usually, those graduation rates are calculated only from the kids that enter high school.  If we started counting from first grade in elementary school, the drop out rates would be much higher.

According to the NBC News Education Nation summit, among 30 other industrialized countries American students rank 25th in math and 21st in science. Seven out of 10 of our eighth-grade students can’t read at their grade level.

To what extent are low reading and math scores and high drop out rates attributable to the failure of schools to have more modern plants and equipment?  Or to teachers unions?  And to what extent are they due to drug and alcohol use by teenagers in high school and their parents use or neglect?

About half the students who drop out are involved with alcohol and other drugs or have parents abusing such substances.  We know from years of surveys that drugs and alcohol are commonly used, kept, or sold at most high schools and many middle schools.

Congress has appropriated $4.35 billion for schools in the 10 states that won the Race to the Top school reform contest. That same Congress eliminated $295 million in funding for the state grants to fund drug and violence prevention programs.

Take a walk around the outside of the schools in your community. Is there a sign that says Drug-Free School Zone?  Have you ever thought about whether that sign is telling the truth?  At The National Center on Addiction and Substance Abuse at Columbia University we have.  We have talked to thousands of middle and high schoolers in small towns, medium-size cities and major urban centers all over the country.  Most of them tell us that the words on that sign aren’t worth the paint they’re printed with.

Drugs and alcohol threaten our children’s academic performance.  Research shows that adolescents who smoke, drink or use other drugs have poorer grades, higher levels of truancy, cognitive impairments at school, and higher rates of suspension or expulsion.  They are less likely to graduate from high school or to obtain a college or post-graduate degree than teens who remain substance free.

For the past 16 years CASA Columbia has been asking 12 to 17 year-olds about the presence of drugs in the corridors, classrooms and grounds of their schools.  Their consistent responses are these:

• Responding to an open ended question, the largest percentage of teens say that their number one problem is drugs.
• Eight of 10 high school students and 4 of 10 middle school students say that they see schoolmates possessing, using or dealing drugs, or getting high or drunk, at school.
• One in 3 middle schoolers and 2 out of 3 high schoolers report that drugs are used, kept, or sold at their schools, continuing a steady increase in drug-infected high schools since 2006.

And what about those kids that do graduate high school and head to college?  America now ranks 10th in the world in the percentage of young adults who graduate from college — we used to be first.

There are many reasons why college students do not graduate, especially in these difficult economic times.  But here’s one you may not be aware of:

Half of our nation’s college students binge drink and abuse prescription and illegal drugs, and almost one-quarter of college students meet the medical criteria for the disease of addiction, compared to 10 percent of the general population.

Among the college students who never graduate are these:

• The 2,000 students who die each year from alcohol poisoning or alcohol related accidents and violence on college campuses.
• Some of the 100,000 college women who each year are victims of sexual assault or rape due to alcohol abuse.
• Some of the 700,000 college students who each year are injured as a result of alcohol related accidents or violence.

Don’t get me wrong.  I’m all for the reforms that Education Secretary Arnie Duncan, state education officials, and mayors like Mike Bloomberg are seeking.  I’m for all kinds of competition, from Race to the Top to charter schools, parochial schools, vouchers, for profit and not-for-profit private schools.  I recognize that we must do lots of things to repair our broken elementary, middle and high schools and get our colleges to be more than a four- or five-year alcohol drenched party for millions of students.  But if America wants to get serious about improving the education of our children in schools and colleges, all of the big bucks spent on other stuff will be for naught or of only marginal value unless we find the Superman to deal with the problem of alcohol and other drug abuse and addiction that undermine the education of our children.

Parents of tweens and teens:  CASA’s 15th Annual Back-to-School Survey indicates that the odds are increasing that the middle or high school your children are going to is drug infected (a place where drugs are used, kept or sold), especially if it is a public school.

Are you going to do something about it or just accept it as an inevitable experience your child has to go through because “that’s just the way things are today”?

If you heard that your child’s classroom and school building were infected with asbestos, wouldn’t you demand that the school authorities certify that the asbestos was cleaned out before you sent you child to school for five or more hours each day?

Are you more concerned about your child breathing asbestos dust than you are about your child drinking, smoking, popping pills, using marijuana, or experimenting with drugs like acid, ecstasy, meth, cocaine, and heroin?

That’s the question you’ve got to answer because here’s what CASA’s 2010 Survey reveals:

• Twenty-seven percent of public school children attend schools infected with gangs and drugs.  Compared to teens at gang- and drug-free schools, the 5.7 million teens at these schools are five times likelier to use marijuana, three times likelier to drink, twelve times likelier to smoke, and five times likelier to be among friends and classmates who use illegal drugs like acid, ecstasy, meth, cocaine and heroin.
• One in three middle schoolers say that their schools are drug infected, a 39 percent jump over the past couple of years.  Ten percent of the kids at these drug-infected middle schools admit they smoke pot, while none of those surveyed at drug-free middle schools use marijuana.
• Sixty-six percent of high school students say their schools are drug infected; continuing a steady increase in drug-infected high schools since 2006, when 51 percent of high school students said they attended drug-infected schools.

These increases in the number of drug-infected schools is a trajectory for tragedy for millions of 12- to 17-year olds in our nation because kids in drug-infected schools are much likelier to smoke, drink, get drunk, and use drugs than those in drug-free schools.

Hopefully these dismaying survey results will change the hear-see-speak-no-drugs mentality of so many public school administrators, from the U.S. Department of Education down through state school commissioners to local school board members.  They all bemoan the number of dropouts and the low graduation rates, but they never mention that the bulk of those dropouts are kids with drug and alcohol problems or whose parents have such problems.

Indeed, if you want to know one of the reasons why so many public schools are failing our children, consider the difference the CASA survey reveals between public schools and private and religious schools: 46 percent of teens at public schools say there are gangs at their schools compared to only 2 percent of teens at private and religious schools.  In other words, public schools are 23 times likelier to be gang infected than private and religious schools.

Where there are gangs, there are likelier to be drugs.  Not surprisingly, 47 percent of public school students said their school was drug infected compared to six percent of private and religious school children.

The drug-free school gap between public schools and private and religious schools is up sharply from its narrowest point in a decade.  In the 2001 CASA teen survey 62 percent of public schools and 79 percent of private and religious school students said they attended drug-free schools; in this year’s survey, 43 percent of public school students and 78 percent of private and religious school students say they attend drug-free schools, widening the drug-free school gap from 17 points to 35 points.

Most adults do not encounter gangs and drugs at work each day.  Why do we force millions of our children to encounter gangs and drugs at school each day?  If adults faced gangs and drugs in their factories and offices they would protest, call the police, and if that failed, change jobs.  Yet we expect millions of our children to return to the same school, day after day, and face the menace of gangs and drugs.

Placing our young teens and pre-teens in an environment where drinking and drugging are common is state sanctioned child abuse, since we know that the earlier a child begins to smoke, drink or use drugs, the likelier that child is to become addicted.  States require parents to send their children to school; in some states it is a crime if parents fail to do so.  These states have an obligation to provide safe and drug-free schools.  Requiring parents to send 12- to 17-year olds–and even younger children–to drug- and gang-infected schools is an outrageous misuse of government power–and a mandate that no parent should be forced to respect.

The greatest and most costly failure of the medical profession and public health community is their failure to explain to the American people that addiction to alcohol and other drugs is a disease.

Against the scientific knowledge we now have, physicians’ refusal to give alcohol- and other drug-addicted patients the same medical care and attention they provide individuals with other chronic illnesses like hypertension and diabetes is inconsistent with their Hippocratic oath to “prescribe regimen for the good of my patients…and never to do harm to anyone.” The harm due to this long term failure of the medical profession and public health community is measured in untold lives lost and ruined and the incalculable human misery of families, friends and colleagues of alcoholics and drug addicts.

Why has this happened?

When I started CASA in 1992, former First Lady Betty Ford, one of the founding directors, said, “Joe, if you do nothing else, if you can only get the stigma off this disease, we will have accomplished a great deal.”

At the time I didn’t realize how prescient the former First Lady was.  As many will remember, Betty Ford revealed her own addiction to mood altering prescription pills and alcohol in an effort to put an end to the stigma that clings this disease.

Well, today I like to think that we’ve achieved a great deal over these past two decades at CASA, educating our people and policy makers about how drug and alcohol addiction causes and exacerbates just about every social problem the nation faces–crime, health care costs, lousy public schools and besotted college campuses, domestic violence, child abuse, teen pregnancy, homelessness–and developing effective prevention and treatment programs for the most vulnerable in our society, like high risk children and mothers on welfare.  But we haven’t peeled the stigma off this disease of addiction.

I now believe we won’t be able to do that until the medical and public health professions accord addiction to alcohol and other drugs the respect they pay to other chronic illnesses.  Addiction ranks as the nation’s most prevalent ailment.  Indeed, if ten percent of our people had the flu or measles, we’d all call it a monstrous epidemic and pull out all the stops to confront it.  Yet that many people in our country–some 30 million–are likely addicted to alcohol, prescription and illegal drugs and steroids, and we ignore this elephantine epidemic.

Why?

Because so many Americans don’t consider addiction to alcohol or illegal or prescription drugs a disease.  They think it’s just a personal indulgence or a moral failing that the addicted individual ought to be able to shed like a winter coat in warm weather.

Well, I hold the medical and public health professionals responsible for that gross misunderstanding and the havoc it wreaks.

Remember AIDS?  Most Americans considered AIDS a social curse for homosexuals.  Then the doctors and the public health pros mounted an all fronts education campaign, and in just a few years Americans accepted the fact that AIDS was a serious disease–and acted on that fact raising money for research and volunteering to help afflicted individuals.

Remember when smoking was a common practice everywhere?  Well, it took a little longer, but the public health community organized a relentless education campaign and doctors urged their patients to quit-and now all except the hard-core nicotine pushers like Altria (nee Philip Morris) and Brown and Williamson accept that nicotine addiction can be cured with pharmaceuticals and attentive physician care.  And the smoker who once said, “Would you like a cigarette?”, now asks, “Do you mind if I smoke?”, and most people respond, “You bet I do!”

Well the time has come for physicians and public health professionals to say to the American people, “Addiction to alcohol and other drugs is a disease and we are going to accord it the same medical attention we accord other chronic diseases.”  Setting that example in their own practices, the doctors will have the credibility needed to support a massive public health campaign to get our people to understand that addiction is indeed a disease and a preventable and treatable one.

It will take years, perhaps a generation as it did with smoking (I started the national anti-smoking campaign in 1978), but eventually as we curb this disease we will sharply reduce the consequential crime, health care costs and other social ills, shut down the huge market for illegal drugs that exists in our nation and spawns so much violence in other nations like Mexico, and save millions of lives and the related misery for the families and friends of those who suffer from the disease of addiction.