Another way to reduce access to alcohol and drugs is to build coalitions of community organizations to develop local solutions.

RWJF supported four national programs—Fighting Back®, Free to Grow, A Matter of Degree and Reducing Underage Drinking through Coalitions—that helped communities build local coalitions of government, health care providers, schools, businesses and community groups to address the problem of substance abuse.

Coalitions worked together to reduce access in their communities to alcohol, illegal drugs and other mind-altering substances.

(For more information on how RWJF has used coalitions for to bring about social change, see "Engaging Coalitions to Improve Health and Health Care," by Laura C. Leviton and Elaine F. Cassidy.)

Highlights
Fighting Back. A $72.6-million program that ran from 1989 to 2002, Fighting Back helped mid-sized cities address drug problems through a community-wide approach. Coalitions of businesses, health care organizations, public schools, government agencies, police, community groups, local media and clergy worked together to develop local solutions to substance abuse.

Programming in the 14 funded communities varied, but included elements such as:

• Community policing
• Workplace programs
• Public awareness campaigns
• Youth alternative recreation
• Neighborhood graffiti clean-up
• Code enforcement

An evaluation of the program after 10 years found that it supported pre-selected community coalitions with ample technical assistance and direction from top-notch people. Still, the evaluation found that the program did not produce robust results in terms of decreasing substance abuse. One conclusion is that community coalitions alone are not a sufficient solution to the substance abuse problem.

At the same time, Fighting Back did demonstrate some positive results: The program effectively built coalitions. And residents of Fighting Back communities displayed greater awareness of substance abuse treatment options.

The Fighting Back evaluation also found that substance abuse problems in the inner-city sites were not dramatically worse than in the suburbs. Illegal drug supply is high in urban neighborhoods, but much of the demand comes from outside. (See Program Results on Fighting Back.)

Free to Grow: Head Start Partnerships for Substance-Free Communities. RWJF's Free to Grow program leveraged the infrastructure of federal Head Start preschool program to develop community-based substance abuse and child abuse-prevention programs in low-income communities. The program began in 1994 and ended in 2006.

Though coordinated through Head Start sites, Free to Grow was not a curricular intervention. It built community partnerships between Head Start and school districts, police departments, municipalities and other community organizations to develop targeted solutions for communities. Program strategies targeted the young child's overall environment, not the child.

With technical assistance and guidance from the national program office, individual Free to Grow communities developed and implemented their own projects. For example:

• Barre, Vt. Free to Grow provided services to families in the low-income Highgate housing complex-. Barre has high rates of alcohol and drug abuse, in part due to the isolation of the community and long winter months. Free to Grow emphasized the development of social networks. Bringing parents together on Free to Grow committees and in special training sessions and support groups increased their sense of community engagement. Free to Grow's Family Service Center within the Highgate community worked with families on issues such as economic self-sufficiency, literacy and substance abuse. (See a profile of Barre Free to Grow.)
• New Britain, Conn. This Free to Grow coalition implemented a three-tiered system to identify families with risk of substance abuse, domestic violence or mental health problems. Families in the highest-risk group were referred to a case management team that followed up with the families regularly. (See a profile of New Britain Free to Grow.)

An evaluation of the first phase of Free to Grow found that participants showed improved parenting skills and bonding between children and their parents. There were small changes observed in reducing domestic violence and the use of drugs and alcohol; the time period was too short to determine long-term outcomes. An evaluation of the second phase will be completed in December 2007. (See Program Results on Free to Grow and additional profiles of Free to Grow in Wausau, Wis. and St. Mary's Parish, La.)

A Matter of Degree. Ten universities are developing coalitions with their communities to reduce alcohol abuse among college campuses with assistance from A Matter of Degree, an $8.6-million, seven-year program supported by RWJF. These university-community coalitions are identifying and addressing the environmental factors that converge to encourage alcohol abuse, such as alcohol advertising and marketing, institutional policies and practices, local ordinances, and social and cultural beliefs and behaviors. Preliminary evaluation results suggest that the more environmental interventions are used at participating universities, the more likely they are to see reductions in alcohol consumption and its related harms. (See the Anthology chapter and the evaluation report.)

Reducing Underage Drinking Through Coalitions (RUDC) addressed the problem of underage drinking by developing statewide coalitions that advocated for a variety of policies and activities to reduce youth access to alcohol. The program funded projects in 10 states, plus Puerto Rico and Washington, D.C. (See Program Results on RUDC.)

The coalitions sought to:

• Improve enforcement of laws prohibiting alcohol sales to minors.
• Reduce the availability of alcohol at sporting and community events.
• Build support for statewide keg registration laws that hold keg purchasers responsible if minors are served.
• Tighten ID checks, train alcohol beverage servers, and reduce the use of special pricing that encourages over-consumption.
• Train youth leaders, who served as media spokespersons and testified before state legislatures about the harm of underage drinking.
• Build support for ordinances to increase the distance of billboards advertising alcohol from schools, churches and rehabilitation centers.

An evaluation of the program found that the coalitions made an impact on underage drinking in their communities. Successes included:

• Media coverage. Coalition states showed significant increases in media coverage of underage drinking.
• Social access policies. Coalitions effectively fought for social access policies, which reduce access to alcohol in social situations. Examples of social access policies are beer keg registration, alcohol use restrictions on public property, alcohol restrictions at community events and holding adults liable for serving minors alcohol.
• Alcohol policy measures. The coalitions had no significant effect upon alcohol policy measures in other areas: commercial access, alcohol marketing, policies addressing youth alcohol consumption, alcohol pricing/taxes and other alcohol issues.
• Youth drinking. Some youth drinking measures showed statistically-significant greater declines in coalition states than in non-coalition states. Coalition and non-coalition states began at almost the same levels of youth drinking and the frequency of youth drinking decreased at a faster rate among coalition states than non-coalition states.
• Drinking and driving. The decline in the number of times that a youth drove a car after drinking in the past two weeks was significantly larger in coalition states than non-coalition states. Other measures of alcohol-related driving and car crashes showed similar declines in the coalition and non-coalition states.

Other Relevant Program Results
Other coalition-building prevention projects

• The Urban Health Initiative, which is helping five cities implement systemic changes to improve the lives of children. (See the Urban Health Initiative Web site.)
• Three projects that provided technical assistance to community coalitions. (See Program Results on ID# 020021, ID# 023195 and ID# 040938.)
• Two community coalitions, in Pennsylvania and Arizona. (See Program Results on ID# 029558 and ID# 040553.)
• A national effort to build a parent drug prevention coalition. (See Program Results on ID# 028819.)
• A national center offering assistance to colleges and communities fighting substance abuse on campus. (See the center's Web site.)

Lessons Learned

• Community coalitions can effectively unite to conduct substance abuse-prevention programs and influence prevention policy. Successful coalitions included Latino community organizations in San Jose, Calif., and a coalition in Baltimore that advocated for and won city ordinances banning alcohol and tobacco billboards. (See Program Results on ID# 020021 and ID# 032190.)
• Communities were much more likely to rally for issues surrounding quality of life and economic development than alcohol and drug use. The most successful coalitions demonstrated clear links between the problems surrounding alcohol and tobacco, and the community's quality of life and opportunities for economic development. (See Program Results on ID# 020021.)
• Community coalitions need to measure their results in reducing drug use. Some community collations have tracked and documented local results, including reductions in underage drinking and illegal drug use. Other coalitions, however, need training and technical assistance in strengthening their outcome and measurement systems. (See Program Results on ID# 036494.)
• Collaborations between advocacy groups and government agencies pose special challenges. An advocacy group is often able to work quickly and flexibly to meet changing needs while government agencies are typically much more bureaucratic and slower to move forward. (See Program Results on ID# 034123.)
• Community coalitions alone are not a sufficient solution to the substance abuse problem. Evaluators of Fighting Back found evidence that attention to community coalition formation actually inhibited actions in pursuit of the main goal of the program-reducing substance abuse. (See Program Results on Fighting Back.)
• A specific set of partners is necessary for sites to implement a community-wide program and analyze its effects. Specific public and private agencies-such as local government, schools and hospitals-must collaborate to implement anti-drug programs and measure their effects. It is important, however, not to have too many people at the table. (See Program Results on Fighting Back.)
• Coalitions with diverse membership must find ways to surmount pre-existing mistrust of establishment-based organizations. "Given the serious schisms and rifts between white, middle-class-based organizations and African-American, working-class and underclass organizations and leaders that are prevalent" in most of the Fighting Back sites evaluators studied, "an approach that ignores social class divisions and ethnic mistrust is unlikely to be successful." (See Program Results on Fighting Back.)
• Effective coalitions share certain characteristics. The Fighting Back evaluators found that a coalition's ability to respond to a community problem (such as substance abuse) is related to factors such as its financial resources, lead agency, governance and leadership. (See Program Results on Fighting Back.)
• Enlist the support of agencies by offering to help them. Healthy Nations projects made inroads with other agencies and community organizations by consistently showing up at their meetings and offering assistance. As a result, Healthy Nations easily gained support from that organization when conducting activities. (See Program Results on Healthy Nations.)
• Maximize available resources by coordinating efforts across agencies and disciplines. More linkages among concerned agencies would foster improved collaborations. (See Program Results on ID# 030076 and ID# 039287.)
• Ensure that coalitions receive assistance early on to learn about policy change and advocacy work. Some coalition members are more accustomed to working directly "on the ground" rather than at the level of public policy and advocacy. (See Program Results on RUDC.)
• Pick a few policies (three or less, if possible) and focus on getting results in those areas. Coalitions that focused on just a few policies and were disciplined about not getting drawn into every alcohol-related issue showed more results than coalitions that had a long laundry list of hoped-for changes. (See Program Results on RUDC.)
• Involve target audiences-such as youth, parents, minorities-in project strategy and planning. Some coalitions in the Reducing Underage Drinking through Coalitions program involved youth but they did not allow them to participate in developing project strategy and planning. As a result, youth often felt like they were being used. (See Program Results on RUDC.)