Tobacco Documents Online

Center On Addiction and Substance Abuse - Newsroom 3/1 1/01' 3:33 PM ghettos infect every hamlet in America. Battling drugs in only one place is like pushing down on a pillow. They will just pop up somewhere else. With Mayor Rudy Guiliani's success against drug dealers in New York City has come increased drug activity ir Westchester County and eastern New Jersey. We can no more deal with drug abuse and addiction in one city or section of the nation than we can cure leukemia in only one part of the bone marrow. And we can no more deal with the problem j ust by local law enforcement or just by public health measures, or just by interdiction, or just by education, orjust by incarceration, orjust by treatment, or just by religio or just in the family, or workplace or union hall or school, or neighborhoc or community. That is the central point of this meeting. There is a role for each of us. Ta the clergy, for example: Teens who do not consider religion an important part of their lives and who do not attend religious services regularly are much more likely to smoke, drink and use illegal drugs. Defining that role--establishing responsibilities, setting appropriate mixes and boundaries, finding cost effective ways to prevent and treat the problem- what we are all searching for. That search will not be helped by platitudes, by standing pat, or by pointing to the other guy. That search will not be concluded successfully simply by expressing good intentions. A look in the mirror will reveal that each us can do a lot better. Certainly„ the tobacco companies can be more forthcoming. The beer and cigarette , o sellers who don't want their own children and grandchildren to smoke or , o abuse alcohol can do a much better job of keeping their stuff out of the -i hands of our children and grandchildren. But before the physicians here ' N simply nod agreement with that, think about this: Presented with classic W symptoms of a 60 year old female alcoholic, only one per cent of 00 physicians with significant geriatric patient populations even mentioned alcoholism as a possible diagnosis. Our search over these few days while you are here will require each of yc to endure the agony of thinking through the problem and, hopefully wher you leave here, will inspire in each of you the exhausting tenacity it takes for effective action. Each"of us has to face hard questions: • Despite the saturation barrage of public health pronouncements and education programs, the same percentage of teens smoke tod as were smoking when we started the anti-smoking campaign in 1978. Why? http://www.casacolumbia.org/newstetter1457/newsletter_show.htm?doc_id=27104 Page 6 of 11

Center On Addiction and Substance Abuse - Newsroom 3/11/01 3:33 PM • Thanks to substance abuse and addiction, prisons and Medicaid the budget busting components of state public spending. • 23 per cent of Medicare hospital costs are attributable to substar abuse, largely cigarette smoking. • Some $6 billion in Social Security Disability payments are made individuals disabled by smoking-related diseases. • Most 12 to 17 year olds say drugs are used, kept and sold at thei schools. Teens whose middle and high schools are not drug free a three times likelier to smoke nicotine and marijuana cigarettes anc twice as likely to know someone who uses cocaine or heroin. A recent analysis that CASA conducted of drug, alcohol and nicotine use by population centers makes clear that there is no place to hide from the scourge of substance abuse in America. Eight graders living in rural America are more likely to use illegal drugs, alcohol and tobacco. Compared with those in urban centers, rural eighth graders are-- • 83 percent likelier to use crack cocaine. • 50 percent likelier to use cocaine. • Twice as likely to use amphetamines. • 34 percent likelier to smoke marijuana. • 29 percent likelier to drink alcohol and 70 percent likelier to get drunk. • More than twice as likely to smoke cigarettes and nearly five tim likelier to use smokeless tobacco. Thirty-five years ago, when I was on the White House staff, President Lyndon Johnson had difficulty mustering interest in the nation's first Dn Rehabilitation Act, with an annual appropriation of $15 million dollars, because Americans viewed drug addiction as an affliction of the urban po~ something largely confined to black ghettos. The nation's failure to deal with the drug problem then-based in no small measure on the assumption that it was "their" problem, not "our" problem-gave drugs time to seep in every neighborhood in every large city across America. Parents with the money and freedom fled first to the suburbs and then to rural towns. But drugs did not respect geographic boundaries. Today the sores of drug abuse and addiction that we allowed to fester in our urban http://www.casacolumbia.org/newsletter7457/newsletter_show.htm?doc_id=27104 Page, 5 of 11 I

Center On Addiction and Substance Abuse - Newsroom 3/11/01 3:33 PM J~jml1}!& 1'outh FnI'rirrna#ieiri • s;~ Opening remarks from CASA's conference by Joseph A. Califano, Jr. March 2000 It's Substance Abuse, Stupid! Opening Address by Joseph A. Califano, Jr. At Substance Abuse in the 21st Century: Positioning the Nation for Progress Ronald Reagan Presidential Library Simi Valley, California March 1, 2000 Welcome to this unprecedented national conference. Holding this conference at the Ronald Reagan Presidential Library is another example c Nancy Reagan's commitment to helping America's children develop the w and skills to say no to drugs. At CASA, we are proud to have Mrs. Reag: as a member of our board of directors. At the outset let me express our deepest appreciation to all of our spons< who have made this conference possible: American Airlines, California Healthcare Foundation, The Charles A. Dana Foundation, Conrad N. Hilton Foundation, The Henry J. Kaiser Family Foundation, The J.M. Foundation, The National Institute on Alcohol Abuse and Alcoholism, Primerica Financial Services, Psychemedics Corporation, Ronald McDonald House Charities, and Schering-Plough Corporation. For the first time, a series of panels and presentations cutting across law enforcement, brain research, religion, public and private schools, the practice of medicine, business, the entertainment industry, the treatment community and the legal drugs--alcohol and nicotine--as well as the illegal ones--is being held as part of the same conference on substance abuse and addiction. The panelists, presenters and audience participants are individuals who c do something about this. You come from all over the nation--from Florida to Oregon, from New York and New Jersey to Texas and Arizona. You a treatment providers; law enforcement officials; public health officers and child welfare providers; clergy; entertainment media representatives and critics; state, county and municipal executives and legislators; program officers and scholars at foundations, think tanks and universities; representatives of alcohol and tobacco companies; the president of Mothers Against Drunk Driving (MADD) and the President of the Wine Institute; representatives of governors and mayors, Washington lobbyist: federal, state and local alcohol, tobacco and drug prevention, treatment an _..ti __..._.._ ..a-:_:.~.....__ http'//www.casacolumbia.org/newsletter7457lnewsletter_show.htm?doc_id=27104 Page 1 Ot 11

Center On Addiction and Substance Abuse - Newsroom 3/ 1 1/01 3:33 PM other drugs. CASA's teen surveys have repeatedly shown that parents ha far more influence over their teens substance use than they think, that parent power is the most underutilized weapon in the war on drugs. Too many parents are not engaged in their teens' lives, are in denial about then children's exposure to these substances, or are resigned to their teen smoking and using drugs. There are some promising signs that illegal drug use is leveling off among teenagers, but binge drinking has been rising among high school students and college women. More than three times as many college women as 15 years ago drink just to get drunk. If marijuana use among teens has dropp by 42 percent since peaking in 1979, the percentage of teens who smoke nicotine cigarettes is about the same today as it was in 1978 when the aggressive anti-smoking campaigns started. The human misery addiction and abuse cause can't be calculated-the brok homes; teenage mothers and absent fathers; lives snuffed out in their twenties; mothers and fathers dying of smoking related lung cancer and heart attacks while their children are still young; women victimized by violence and rape; babies deformed by a mother's smoking, drinking and using drugs during pregnancy; children molested by a father hopped up o beer, pot or cocaine; children and teens committing suicide in the grip of alcohol or drug aggravated depression. If we can't repair the broken hearts, we can measure some costs of substance abuse. This year the bill is expected to top half a trillion dollar: rJ • 80 percent of the nation's 1.9 million adult prison inmates are tha 00 for drug or alcohol related crimes: they either violated drug laws, CD stole money to buy drugs, were high on alcohol or drugs at the th N of their violent crime, or are drug and alcohol addicts and abusers w Alcohol is implicated in more violent crimes than any other drug. m • Alcohol and drug abuse causes or exacerbates seven out of ten of the more than 3 million cases of child abuse and neglect that have overwhelmed the nation's child welfare systems to the point of chaos. More than $600 million of the $800 million New York Ck spent on child welfare last year was due to alcohol and drug abusing parents. • More than one in four children under 18--some 19 million children--are exposed to family alcohol addiction or abuse. 9 Teens who drink or use drugs are likelier to have sex, initiate it at younger ages and have multiple partners. • Most teen pregnancy occurs when one or both the parties are hig at the time of intercourse. • Two thirds of illegal drug users work full or part-time. http://www.casaco{umbia.org/newsletter1457/newsletter_show.htm?doc_id=27104 • Page 4 of 11

Center On Addiction and Substance Abuse - Newsroom 3/11/01 3:33 PM • Virtually everyone who smokes is hooked before they are 21,-mc in their early teens. Pushing drugs--whether nicotine, heroin or marijuana--requires the addictive component and marketing to children. Given these facts, is it reasonable to think that anyone who is charged by law to make a profit for shareholders by sellin. cigarettes will put their energies into getting rid of the addictive component and discouraging children from buying? • With cigarettes and illegal drugs, the public health message is clea Don't use at all. With alcohol, for most Americans the message i; use in moderation. How do we make the distinction clear to kids and discourage underage drinking? • Why can't we motivate more addicts to enter treatment-and renk there? Why can't we make treatment more available and effective' • With so many treatment dropouts, so many relapses and so man physicians and psychiatrists unable to diagnose the disease, and help their patients, is it reasonable to expect insurers to provide full parity to treatment for drug addicts and alcoholics? • It takes every carrot and stick available to get individuals into treatment and to stay the course. Mandatory sentences take awa the carrot of early release as an encouragement to enter treatment while in prison. They also remove the stick of revoking parole th -- can provide the motivation to continue treatment or aftercare upc N release. Why do so many Americans support such sentences? ~ • If 20 percent of the drinkers consume 88 percent of the alcohol, (D can we reasonably expect those charged with making a profit on ' N beer, wine and liquor sales not to focus their sale efforts on such : 01 lucrative segment of their market? W (D • Will the American people pay the costs and accept the consequences of the kind of iron curtain that would have to come down on our shores and borders to make interdiction far more effective? If not, then what? • Is' it reasonable to expect the entertainment media-television, movies and music-to stop exhibiting smoking, drinking and drug use (or in the case of music, singing the praises of drugs) when Americans keep viewing the shows and buying the theater ticket: and CDs? • Why do parents raise hell and keep their kids out of school if the discover asbestos there, but send their children, day after day, to schools infested with drugs? • Is brain and genetic research going to provide a silver bullet, or wi we still have to make choices: whether to smoke, drink or use dn in the fir st instance, and whether to quit if we get addicted? • We demand that foreign countries go after their Escobars and sen them to us for punishment, and we help find them. Why don't w fmd the Escobars in our own country? • We go after Mexican and other bankers laundering drug money. E what about money laundering by our own bankers? • Does business have a responsibility to do more than test employees for drug use? To provide smoke-free workplaces? To help prevent drug use and provide coverage for treatment of http://www.casacolumbia.org/newsletter1457/newsletter_show.htm?doc_id=27104 ^ Page 7 of 11

Center On Addiction and Substance Abuse - Newsroom 3/11/01 3:33 PM icxaicu }rwui.uu ttuuuui,uawi5. 1i hy attempt such a conference? CASA--The National Center on Addiction and Substance Abuse at Columbia University--is founded on these propositions: • Substance abuse and addiction lurks in the background ofjust about evety social, health and criminal justice problem the nation faces. We must take manv actions to deal with these problems, b we will never solve them until we confront substance abuse and addiction, o Combating this epidemic requires a wide varietv of skills, an atta• on abuse of all substances-tobacco, alcohol. illegal and prescriptic drugs, and the engagement of even sector of societ.~. This undertaking is all about children. N m' The most important lesson of eight years of intensive research at CASA ,0" this: a child who gets through age 21 without smoking, using illegal drugs , N abusing alcohol is virtually certain never to do so. W ~ Especialh for children_- all substances are related The younger and more often a child smokes and drinks. the likelier that child is to use mariiuana- The vrounger and more often a child uses marijuana, the greater the risk th child will use cocaine, heroin and other drues like LSD. The statistical relationships are powerful, manc times stronger than those that initialh_ related cigacette smoking to lung cancer and high cholesterol to heart disease_ In recent vears, scientists have found evidence that all these substances-nicotine- alcohol. mariiuanai heroin and cocaine-affect le\ els o dopamine (the substance that gives pleasure) in the brain. Almost everv b that smokes marijuana cigarettes first learned how to smoke with nicotine cigarettes. lndividuals addicted to nicotine have a more difficult time shaking addiction to drugs like heroin and cocaine. Most patients in treatment are polv-addicted; addiction to only one substance is increasin, the exception, not the rule. As we assemble this morning, presidential candidates of both parties are claiming that they offer the best way to stem rising health care costs: reduce erime; curb child abuse, domestic violence and teen preenancy; anc the spread of AIDS and other sexually transmitted diseases; reclaim publi schools; help the homeless; increase worker productivity and product quality; and save Social Securitv and Medicare. They talk of the internet, the revolution in biomedical science, tapping th surplus to fund Social Security and Medicare, reforming the corrupt campaign finance system, paying public school teachers more money to instruct smaller classes, making health care delivery more efficient, puttin additional cops on the street, http://www.casacolumbia.org/newsletter1457/newsletter_show.htm?doc_id=271 04 Page 2 of 1 1

Center On Addiction and Substance Abuse - Newsroom 3/1 1/01 3:33 PM But they never talk about the impact of substance abuse and addiction on every one of the problems they promise to solve. Our political leaders can soft peddle the gravity of the addiction epidemic because so many individuals are content with their own denial. Yet it is hard to find an American that substance abuse has not touched directly. The anecdotal evidence is everywhere: in the addiction to alcohol and pill of mega stars like Elizabeth Taylor and Liza Minelli; the 1986 death of Maryland college basketball star Len Bias from a cocaine overdose and th drug and alcohol addiction problems of a host of professional athletes; th( destructive cocaine and heroin dependence of Eugene Fodor, the first American to win the Tchaikovsky violin competition in Moscow; the life threatening alcohol and drug addiction of Robin Williams, and the overdo: deaths of Williams' friends, John Belushi and Chris Farley; the premature deaths of Humphrey Bogart, Nat King Cole and Mary Wells from nicotir addiction; Kurt Cobain and the long line of rock stars whose lives have be shattered by drug use. The toll on the nation's political wives has been fearful: Cindy McCain's addiction to pills; the alcohol and pill addictions of Betty Ford and Kitty Dukakis; the nicotine addiction of Pat Nixon who got down on the floor c the President's limousine to smoke during parades. -- The statistical evidence gives substance abuse its sinister status as Public--and Public Health--Enemy Number One: • 60 million Americans are hooked on cigarettes. • 17 to 20 million are addicted to alcohol or regularly abuse it. • More than 6 million smoke marijuana at least once a week. • Some 1.8 million use cocaine at least monthly and at least half a million are addicted to crack. • More than 10 million abuse psychotherapeutic drugs like tranquilizers, amphetamines and sleeping pills. • One and a half million regularly use hallucinogens like LSD. • 1.8 million women age 60 and over abuse or are addicted to alcoh. 2.8 million abuse or are addicted to psychoactive prescription drugs, and 4.4 million smoke nicotine cigarettes. No one knows with any precision how many teens use methamphetamin or ecstasy; snort aerosol cans, felt markers and glue; or experiment with other dangerous substances. What we do know is that all teens, and man) preteens, are adrift in a sea of substances--cigarettes, alcohol, marijuana ai http://www.casacolumbia.org/newsletter1457/newsletter_show.htm?doc_id=27104 Page 3 of 11 N 0 00 0 ~ cn N ~ w rn I

Center On Addiction and Substance Abuse - Newsroom 3/11/01 3:33 PM - alcothot, nicotine ano drug abuse and aaotctton7 This conference is not going to-answer all those questions. But we can at least face them. We can begin a candid national dialogue on these issues tl can be repeated in every state and city in the nation. In this sense you are part of an extraordinary and special experiment. Thi conference--these panels and presentations in which you will each have a opportunity to participate by your questions and comments--can set an important precedent and example. It is our hope that by your participatic here you will show the way for every state, city and county to conduct similar events. Think about it. What it will mean for our nation if we can get each state, city and county in America to begin a dialogue among their schools, clerg; businesses, workers and labor unions; medical practitioners, universities, news and entertainment media, police and sheriffs, child welfare workers, politicians and public officials, stores selling tobacco and alcohol, treatme providers, public health officials. We will then have in one place, togethet the essential ingredients to combat all substance abuse in all segments of our society. We will be able to make the kind of progress that will return us to a natio where teen smoking and binge drinking is socialh• unacceptable, cocaine i, only a line in a Cole Porter song, marijuana is not a cash crop, meth labs r longer scar the open spaces of the mid-west and west, and parents will nc longer have to worrv about whether their children's friends are pushing drugs. Thank you for beine here and for what you are already doing. I look forward to learning a lot from each of you and I hope you will leave here better able to deal with the nation's number one problem-substance abuse and addiction. Sections of Newsroom Other Articles From News Releasesj S ,QC-ieAS°v - C--aJA kilt"ff' &-hIIilai3t7Pc C;o-Fa C.aS?. Plo-,..lin! :niu Fr,nr.r t'lL\1` Sotrclan. - Ctuffnno - ta `. ~<i [ Nct lnnctor, Hcr=ht~ ~in ?.Isr~ h -t=:-lS:;` f~alcn>e. R.eo~vt. 1.ndtrikrRrt•: SuG,taa ~ - . ahrut ur~i' !he tidnrrr Il ornar. Cah;`~nr.=ul~!re«e. tieri,asc F'~atnd.~Lyu _ C~ASA leailic'=Bcf•.,rc \lriu'san II~.m~eaiKerr~~cntari~c.c C? 9A Releasr, 1 y`iS Li.uP In S<'hw.r( feeu Sun~ CASA S_auncFc~ GmunJbreajn_.v.diiInal Pru_re Tt.,, Se_-;,nd G.m.:ert uI n~>r.k CAS a-t'~ru" ?re-,cne,L[t i'r, ~~~ram \k'lin Densrtmen http://www.casacolumbia.org/newsletter1457/newsletter_show.htm?doc_id=27104 PaCJe 8 of- 11