High Stakes

kpeters@govexec.com

Will was 13 when he smoked marijuana for the first time. It made him feel so much better than he usually felt that by the end of eighth grade he was smoking it nearly every day. Like many of his friends, he used other drugs as well: LSD, mushrooms, crystal meth, Ecstasy.

For a while, his drug of choice was Ritalin, which is commonly prescribed for hyperactive children. "You crush it up and snort it," he explains. "It was really cool. My friend was on it. It wasn't that hard to get. After I started liking it, I found out what to say to my doctor so I could get put on it. I just told him that I had trouble in school, that I couldn't pay attention, that I couldn't keep focused."

Will doesn't fit the stereotype of a drug abuser: His grades are better than average, he was a state champion wrestler and he has had the benefit of attending some of the best public schools in the country, growing up with his parents in an affluent Washington suburb.

He was arrested last winter after police raided a party he was hosting at home one evening when his parents were out. Tipped off by his former girlfriend, the police found an ounce of marijuana, a stash of methamphetamines and a set of scales in his bedroom. Now 17, Will has been "excluded" from school in the middle of his junior year-a penalty short of expulsion, since school officials could not prove the drugs confiscated from his bedroom were his. He's now on probation and required to carry a restricted drivers' license that allows him to drive to and from a drug and alcohol counseling program in which he is now enrolled.

"I know I'm not as bad as some of the other kids," Will says of the recovering drug abusers he has met in counseling. "I've heard their stories and seen where they have been, and I don't want to go there." While he's determined to stay drug-free, he realizes the verdict on his future is still out-the lure of drugs and the high they produce has proved extremely hard to resist.

Will's struggle against addiction is at the heart of a very public problem. An increase in drug offenders accounted for nearly three-quarters of the growth in the federal prison population between 1985 and 1995. The number of inmates in state prisons for drug-law violations increased by 478 percent over the same period, according to statistics compiled by the White House. Federal officials estimate the costs of illegal drug use, as measured in crime and health-care expenses, exceed $68 billion per year. Reaching kids like Will is key to driving those costs down, federal officials say.

"The whole battle is [reaching] the eighth grader through eleventh grader," says retired Gen. Barry McCaffrey, director of the White House Office of National Drug Control Policy (ONDCP). "If you can get them through this gateway development period without smoking a lot of pot, abusing alcohol or smoking cigarettes, then you have an excellent opportunity to keep them from joining the 13 million Americans who are addicted to illegal drugs."

But McCaffrey has learned that fighting the battle against drugs involves navigating a bureaucratic and political minefield. First ONDCP had to convince dozens of agencies to come up with a coordinated federal plan that sets specific, measurable and realistic goals. And when ONDCP finally released a plan in March that would halve the number of drug users by 2007, Republican leaders on Capitol Hill immediately denounced it as insufficiently aggressive.

Strategic Planning

Federal officials estimate about 6 percent of the population regularly uses illegal drugs. That's considerably lower than the 14 percent who reported using illegal drugs in 1979, the high-water mark of drug abuse nationwide. But national surveys cited by ONDCP show that between 1991 and 1996, drug use among eighth graders increased 156 percent. Every day, on average, 6,488 kids try marijuana for the first time, 1,786 try cocaine and 386 try heroin, and by the time they are seniors in high school, half say they have used drugs.

"We'll go right back to where we were before [in 1979] if we can't pick up these eighth graders and get them through high school without [using drugs]," says McCaffrey.

Drug abuse prevention, especially among teen-agers, is central to ONDCP's mission as the coordinating authority in the national campaign to eliminate drug abuse. Under McCaffrey, the Clinton administration has developed a 10-year strategy to cut drug use and availability in half, and cut associated crime and violence by one-third. The strategy is supported by a five-year budget plan-the first in history, and an elaborate performance measurement plan that details 94 specific performance targets to be met by 2002 and 2007.

ONDCP's goals include reducing drug use by 50 percent, cutting the number of projected drug users by 8 million. That would bring the rate of Americans who use drugs to 3.1 percent-the lowest since the federal government began tracking such data in 1971.

While ONDCP was not one of the agencies required to produce a performance plan under the 1993 Government Performance and Results Act (GPRA), its plan clearly was influenced by GPRA and the pressure Congress is putting on agencies to demonstrate the effectiveness of their programs.

"We're spending $17 billion [a year] on the drug problem. We need to see results," says Robert Charles, staff director for the House Government Reform and Oversight Committee's subcommittee on national security, international affairs and criminal justice.

ONDCP's performance plan is a step in that direction, says Norman Rabkin, director of administration of justice issues at GAO. "GPRA calls for agencies to focus on results. This plan does that. Each agency knows what it is responsible for. I think it's an excellent plan. I've looked at other performance plans and I think other agencies have a long way to go to match ONDCP," says Rabkin.

The 116-page document is designed to support the national drug control strategy's five major goals: educating youth to reject drugs, reducing drug-related crime, reducing the health and social costs of drug abuse, protecting U.S. borders, and breaking drug supply sources at home and abroad. Called the Performance Measures of Effectiveness, the plan links the efforts of 54 federal agencies; state, local and foreign governments; and the private sector. Developing it was an enormously complicated task, bureaucratically and politically, say those involved.

"There was a lot of heavy lifting through the interagency process to build this performance measurement system, to identify the impact targets and figure out where we wanted to go," says John Carnevale, director of ONDCP's Office of Programs, Budget, Research and Evaluation.

To be effective, the performance measurement system will have to hold the federal government accountable for its anti-drug efforts, while at the same time recognize the role of state and local governments, private citizens and foreign governments, who also contribute to the outcome. "That's what makes this system complicated," Carnevale says.

Holding People Accountable

The performance plan was established to provide a link between spending and results, although it is not "a resource document, in terms of trying to get money out of Congress," Carnevale says. "In an annual budget cycle, it's tempting to take the easy way out and go for the resources. I think a lot of agencies were threatened by the resource question, that this system would somehow preclude them from getting resources in other areas because of the demands made by the system. But we made it clear this is not a budget document."

The plan serves three functions, Carnevale says. It works as a measurement tool, by allowing administrators to clearly track the progress of the drug control strategy; as a management tool, by showing where results are not being achieved, allowing ONDCP to adjust programs and shift resources; and as a policy tool, by gauging the effectiveness of the strategy.

Hundreds of people participated in 20 interagency working groups ONDCP formed to hammer out the details of measuring progress toward the 94 performance targets. Inevitably, some were unhappy with the results and in some cases, agreement was achieved only at the eleventh hour after intense negotiation, says one participant.

Developing the performance plan "produced enormous levels of anxiety on the part of good people," McCaffrey says. "No one really welcomes being held accountable for achieving results. The implication of the Performance Measures of Effectiveness is that programs that don't work will lose resources and programs that do work will get more. It also implies there's no grade for style. The energy, the wit, the political acumen you bring to bear won't [matter as] much as: Do we get drug abuse to go down? Do we provide treatment and therefore reduce the number of people behind bars? Are we going to achieve results or not?"

The performance plan exposes ONDCP and federal agencies to new criticism, says James McDonough, ONDCP's director of strategy: "You're saying, 'Well, if I don't make this performance measurement, I've failed, haven't I?' There's not an agency in town that wants to do that. When you set up a measurement standard, you allow the funding to shift. You don't reinforce failures." Federal agencies will spend $17.1 billion on counter-drug programs in 1999, the largest amount in history and $3.6 billion more than counter-drug spending in 1996, the year McCaffrey took over as drug czar.

To complicate things further, the success of drug-control efforts is in many cases in the hands of local communities, where prevention and treatment and law enforcement all reside, McCaffrey says.

"I'm not in charge of local prevention and treatment programs, but somehow, all of us-the Attorney General, Secretary [of Health and Human Services Donna] Shalala, Secretary [of Education Richard] Riley, I and others have got to get resources and policy that allow greater achievement by local agencies," McCaffrey says.

Bill Modzeleski, director of the Safe and Drug Free Schools Program at the Education Department, which provides about half a billion dollars a year to schools' education and prevention programs, says it is very difficult to measure the effectiveness of individual approaches when so many factors can affect an outcome. "This is not about one particular program. It is about a whole series of things being done," Modzeleski says. Federal dollars have to be a catalyst for change, he says.

Because Education funds programs that are executed at the state and local levels, it has imposed new standards on organizations that receive funding. Beginning this month, states and local education agencies will have to do four things to qualify for money: conduct an assessment of the drug problem; work with community and school officials to set measurable goals and objectives; use research-proven programs and practices; and conduct periodic evaluations.

"This is a major change in our program. It's tightening up accountability quite a bit," Modzeleski says.

Measuring Results

As difficult as it was for ONDCP to come up with a strategy and a [performance measurement] plan, that was the easy part, says GAO's Rabkin. "The real challenge will be coming up with reliable data to measure results, and then adjust [the plan] accordingly, setting new resource priorities."

Data reliability has long been a problem in measuring production and use of illegal drugs. Much of the information available about drug abuse is not universally accepted. The stigma associated with drug abuse and the illicit nature of using and selling drugs contributes to the difficulty researchers face.

Federal officials rely heavily on household surveys to measure demand, but there are no official government estimates of the available supply of illicit drugs in the United States. While various agencies have estimated drug cultivation, production and transit, including ONDCP, the State Department, the Drug Enforcement Administration and the intelligence community, the figures are not universally accepted. ONDCP is now leading an interagency effort to develop acceptable estimates of the flow of cocaine, heroin, marijuana and methamphetamines into the United States to serve as a baseline for measuring progress in reducing the availability of drugs.

"One of the biggest challenges with [ONDCP's performance plan] was the intellectual challenge of deciding what could be measured and how to measure it," says McDonough. Measuring attitudes and people's propensity to use drugs can be highly subjective, and tying trends in attitude changes to particular policies or actions is even tougher. McDonough believes it will take at least two years before attitude changes that stem from actions ONDCP has taken can be measured.

One of the most significant actions ONDCP will take is to spend $1 billion over the next five years on anti-drug advertising. The marketing campaign, combined with anti-drug education and prevention programs is intended to reverse drug-use trends among youth.

To better measure those trends, ONDCP is working with agencies to improve data collection. Beginning in 1999, the National Household Survey on Drug Abuse, sponsored by the National Institute on Drug Abuse and the Substance Abuse and Mental Health Services Administration (SAMHSA) of the Department of Health and Human Services, will be expanded. The survey, which interviews people age 12 and older, is one of the most widely used sources of data. To improve its reliability, the survey population will be increased from 25,000 people to about 70,000, with interviews spread across all 50 states. Sampling error will be much smaller and researchers will be able to measure changes from year to year, says Joseph Roerer, director of population surveys at SAMHSA.

In addition, NIDA is conducting a new study, to be updated annually, to determine the social costs of drug abuse, now estimated to be about $68 billion per year. This is a particularly difficult figure to estimate. It includes costs related to corruption, prostitution, money laundering, domestic violence, embezzlement and weapons violations. It also tries to take into account the costs of drug-related health problems, such as infant mortality, birth defects and premature death, along with the spread of infectious diseases, such as tuberculosis, AIDS and hepatitis.

The relationship between reductions in drug supply and demand and the social costs of drug abuse has not been quantitatively measured before now. At this point, ONDCP officials believe they can expect a 30 percent reduction in social costs when they achieve a 50 percent reduction in supply and demand. However, better data will allow officials to develop a more precise model for setting future goals in reducing the consequences of drug use.

Donnie Marshall, acting deputy administrator of the Drug Enforcement Administration, says measuring results in law enforcement activities on the supply side is much more difficult than many people realize. "For example, how do we show the disruption of criminal organizations statistically or empirically to the layman or the program person that deals with performance measures?" he asks. When drug enforcement officials were able to disrupt the supply of heroin coming into the United States from Southeast Asia a few years ago, Colombian drug cartels simply took over the heroin traffic. The new suppliers didn't need as many middlemen and the purity of heroin hitting the streets of U.S. cities increased dramatically, posing an even greater threat.

"Our challenge is to really come up with performance measures that show we have identified the right organizations, the right individuals within those organizations and that we are making progress toward immobilizing, building cases against and taking to prison the right individuals within those organizations," Marshall says.

Revamping the intelligence system to support anti-drug efforts is a major challenge, say ONDCP officials. "It's not adequate," says McCaffrey. "How do we get the intelligence system we have to rapidly cue law enforcement officers-federal, state and local-and assist them in their job? That's what we've got to do better."

Generation Gap

While better research tools will certainly help bureaucrats measure progress toward goals, many aspects of the drug trade and its consequences will continue to defy empirical measurement. Influencing teen-agers' attitudes and raising awareness among parents may be the biggest hurdle federal officials face.

Most adults, even those who work with kids, are essentially "clueless" about the extent of the availability of drugs and the intensity of drugs being used, says Tom Minnick, director of the Northern Virginia Counseling Group, the largest private treatment program in Northern Virginia. "It always amazes me that even professionals who are trained and who have been involved with alcohol and drug education seem to be unaware of the involvement and availability of drugs in the community today."

"People who were teens in the 1970s and experimented with marijuana and found it to be not that big of a deal don't realize that the drugs being used today are much more potent and serious than the drugs they used," he says.

Finding and buying drugs is easy, say several teen-agers interviewed by Government Executive. For some, it's easier to buy drugs than to buy alcohol. And selling is almost as easy as buying, for those who are organized and don't let their own consumption cut into profits, says one 17-year-old, who found he smoked more marijuana than he sold when he tried to get into dealing.

Will also sold marijuana for a while. "It's not hard," he says. "It was kind of like a business. Once you saved up enough money, you'd buy, like, an ounce, [break it down into smaller amounts] and sell it. I did that a few times, until I could buy two ounces at a time, sometimes three ounces. I worked through one person who knew somebody who knew somebody."

When Minnick began working in Northern Virginia in 1986, the average age kids started using drugs was about 16, he says. Now, it's not uncommon for him to see 12- or 13-year-olds. "By the time they're 14, they're usually trying drugs other than marijuana. LSD is more widely used. What's happening is teen-agers are getting hooked on drugs at a younger age. There's a wider combination of drugs being used and we're seeing more violent activities among juveniles. Everyone in this business is struggling with how to work with younger teen-agers who are more drug involved," he says.

So has Minnick's business. Last year, his client population grew 75 percent. In 1996, it grew 140 percent. He believes a big factor in the increase of drug use among teen-agers is a permissive attitude toward drugs that pervades American culture.

"The president of the United States admitted smoking marijuana but not inhaling it. When that happened I asked eight of my teen-age groups if they believed that the president did not inhale, and every group, every client I had at the time, thought that he was lying. Every single client. And, they thought it was no big deal."

Political Pitfalls

Republicans have been highly critical of what they say is the Clinton administration's ambivalent message about drugs. House Speaker Newt Gingrich, R-Ga., has pledged to launch a "World War II-style campaign" against drugs and make the increase of drug use among young people under Clinton's watch an issue in the November mid-term elections. Gingrich has introduced a package of anti-drug legislation that would increase penalties for drug criminals, beef up protection of U.S. borders against smugglers, and provide more funding to communities, schools and employers that adopt anti-drug programs.

ONDCP's plan to cut drug use in half by 2007 is not ambitious enough, and by establishing goals for 2002 and 2007, it fails to hold the administration accountable, says Gingrich. He has proposed cutting drug use in half by 2002.

Officials at ONDCP and other agencies bristle at the suggestion their plan is not ambitious, and suggest some Republicans are more interested in battling the administration than combating drugs. Adm. Robert Kramek, who retired as commandant of the Coast Guard in May, told the Washington Post just before leaving his command that, despite the rhetoric, politicians lack the will to win the war on drugs: "I don't think we have the will yet. We don't have the will between the administration and Congress to win this thing." The Coast Guard, he noted, has experienced severe budget and personnel cuts in recent years and is struggling to balance its anti-drug efforts with other agency missions.

"I want to see the [Republican] plan that gets us to a 50 percent reduction by 2002," says one ONDCP official. "How are [they] going to make that happen?"

McCaffrey says he welcomes other ideas for fighting drugs, but notes the hundreds of people who put thousands of hours into developing ONDCP's strategy and performance measurement plan over the last two years. "I'm going to be pretty hard to fight with on this," he says. "I'm going to stand behind these documents."

"I think the time for all this balderdash arguing about one's viewpoint ought to stop and we ought to look at measurable results," McCaffrey says. "Having said that, these problems don't lend themselves to year-in, year-out analysis. We ought to see trend lines, but if we're going to make substantial progress it's going to take a bunch of years of hard work and then we need to go at it again. A new generation of kids will have shown up, asking about drugs and the intense pleasure they bring."

McCaffrey has proved a formidable force in furthering ONDCP's mission since his appointment in 1996. He's been as quick to take on members of Clinton's Cabinet as he has been to criticize GOP leaders. Earlier this year he clashed with Defense Secretary William Cohen, demanding the Defense Department increase its funding for anti-drug efforts. After a public battle, DoD ponied up more money. McCaffrey fought for renewing Mexico's certification for its participation in the drug war against the strong recommendation of DEA Administrator Thomas Constantine. After much wrangling, Congress approved Mexican certification. And most recently, McCaffrey battled HHS Secretary Donna Shalala over federal support for needle-exchange programs. Under pressure from McCaffrey, funding was banned.

McCaffrey downplays the disputes. "Every one of those questions, while important, while they deserve a reasoned answer, they are peripheral to what we're doing. I personally think we're probably achieving much more consensus than many people would really understand."

Carnevale is no stranger to political and bureaucratic pressures-he's worked for three presidents and four drug czars. "Clearly, the views of each administration have not been identical. That's part of the structure we have to work with," he says. One of the features of ONDCP's performance measurement system that should appeal to members of Congress of both parties is that it can be used to analyze anybody's drug strategy, Carnevale argues.

Part of the reason is that ONDCP is not just concentrating on near-term goals. "We quickly discovered people couldn't [set one-year goals], because you immediately start thinking about all the constraints around you-the current budget, the budget on the table, what's going to happen before Congress, current rules and regulations, current infrastructure, current levels of drug use," Carnevale says.

ONDCP officials decided a better approach would be to get agencies to think about what progress they could make in 10 years. After months of debate, the 50 percent reduction in supply and demand was generally agreed upon as a realistic goal. Based on that figure, the five-year, 25 percent goals were established.

The performance measurement plan was the beginning, McDonough says. This year ONDCP will establish annual performance measures, as well as action plans for reducing specific drugs.

Federal officials would do well to listen to Will as he tries to secure his own drug-free future: "Right now, I'm just taking it one day at a time."

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