Dane County Initiative on Alcohol Abuse Reduction

Executive Summary

September, 2008

We have to face up to the reality that Wisconsin has the worst record in the nation on the abuse of alcohol; we are no better in Dane County. Alcohol abuse here has many complex facets; its harm is massive. The immensity of the challenge can be daunting and even discouraging. However, we have worked to identify key leverage points for the next phases of work that will not only let us begin to go to the next positive level in dealing with our problem, but to gain the critical momentum to achieve the kinds of change that’s needed. We cannot sit back and accept the status quo.

We know that a critical mass of committed individuals can achieve major change; that’s what we are about.

Our task over the past seven months has been to consider all reasonable possibilities to help reduce this harm. No ethnic group or age is spared the ravages of alcohol abuse. From the research and discussions done and the past experiences analyzed, it is clear that the issue of alcohol abuse is complex. That is, there is no single strategy that will make the progress long needed in our county and state. A convergence of varying strategies along with policy, attitudinal, and cultural changes will be required to effectively address the problems posed by alcohol abuse. It will take the work and commitment of a wide range of partners for any efforts to be successful.

Since early February, we have read over 200 science-based research articles, interviewed over 80 experts and attended numerous group sessions or conferences addressing alcohol misuse and abuse. A number of these meetings were with medical and human services professionals well versed in successful prevention and treatment strategies.

We met with police chiefs and law enforcement officials from across the county. They indicated a high prevalence of alcohol related incidents nights and weekends that require significant time and attention of on-duty deputies and officers. Their observation was consistent with what we witnessed during our visit to Central Booking in the Dane County jail on a Friday night/Saturday morning. Almost all of the individuals booked during our observation where there for alcohol related criminal offenses.

The leverage themes identified represent our best judgment of the most practical and effective means of accomplishing change. We will be announcing the resulting initiative in three phases. Some of the changes can be accomplished through policy changes in county government while others need a more community-based approach. Others require changes and additions to state law, necessitating the attention of state policy-makers. Our recommendations include the need for:

1)Focus on the early years and parents: One of the areas that clearly needs further attention and action is that of middle school youth and their parents. Research shows that young people who drink alcohol before the age of 15 are four times more likely to have serious problems in later life than those who do not.

A 2005 Youth Survey of Dane County revealed that one in three 7th and 8th graders had drank alcohol in the last year. Nearly 10% reported having five or more drinks on one occasion in the past month.

Given the key role of parents and the fact that middle school is a critical turning point for kids and their initial alcohol use, education and support for parents of these adolescents is needed. The role of parents for early-teen youth is challenging – many do not know about brain development. They may be vaguely aware of the stages of growing independence, but information and support in negotiating these complex waters (including really knowing the warning signs of developing trouble) can make all the difference. Parents of adolescents who have already started to flash warning signals need special support and connection. For maximum effectiveness, this strategy would work with the schools to note early signs of truancy/disengagement from school as an indicator of coming problems and then offer targeted support for parents of these students. It could also be a way to provide intervention for parental alcohol abuse, a dynamic that has been shown also to have a major impact on youth alcohol use and abuse. This aspect of the Alcohol Abuse Reduction Initiative is new; we have not focused on middle school youth and their parents in this way before now.

2)Improved Mental Health/Long Term Treatment and Recovery: The scientific findings regarding the efficacy of the technique of brief motivational interviewing are both exciting and challenging. Of all the strategies for dealing with alcohol and other drug abuse, brief motivational interviewing has shown amazing, cost effective results. This process (which includes a short initial assessment by the individual of his/her use) makes possible a very individualized and focused subsequent conversation with those who indicate problems. This conversation focuses on the person’s goals, how alcohol interferes with those goals, ending with steps that can be taken to assure that alcohol abuse doesn’t interfere with achievement of those goals and, finally, connection to help/support. This approach has proven effective in emergency rooms, primary health care settings and other venues. The training for those doing the interviewing is intensive; the costs are significant, but the outcomes are worth considering. In many cases treatment courses can be shorter because individuals engage sooner.

Both supervisors and staff must be trained and then engage in a period of review/follow-up. Other venues for which this approach would be beneficial: central booking at the jail, juvenile justice reception and all other intake points at which alcohol abuse might be a problematic facet. The Human Services system has begun to learn about brief motivational interviewing and to do some early implementation. Based on the findings, greater use of this clinical approach is in order.

This approach could be used in the parent program discussed above, in the juvenile justice system and in a host of other intake/treatment venues. It will also be important to be able to have a timely treatment response for individuals who demonstrate that they are motivated to make major changes in their abuse of alcohol. This means that we need dedicated treatment slots to respond at the point that individuals are motivated to make needed change.

3)Partnerships to Coordinate Community-Based Culture Change: Culture is a powerful determinant of values and behavior. Culture plays a major role in those aspects of drinking behavior that are responsible for the greatest risk and ultimate harm. The underlying role of cultural images and expectations is too often overlooked in our efforts to reduce the effects of alcohol abuse. As a result, we are derelict if we don’t work intensively on substantively changing our negative drinking messages; they have especial influence on youth who are formulating their life decisions.

There is currently no county-wide coalition that addresses alcohol abuse. The point of a citizen coalition is to drive major change that will not be achieved in any other way. It draws on a source of caring energy that can make all the difference. The kinds of needed policy change that can be achieved include: outlet density reduction and stiffened drunk driving penalties. This broad coalition would seek to connect existing local organizations such as the UW-Madison PACE Coalition and Capital Neighborhoods, Inc. and will stimulate new interest and involvement from those who care about this issue, but have had no structure within which to work on their concerns. This coalition will be invaluable in educating the public, sponsoring social marketing messages and helping to educate/mobilize Dane County residents .

The impact of a citizen-driven partnership would be significant; it would move action and engagement beyond “the usual suspects”. The coalition would be able to push for improved policies and laws and have access to policy advice and must consciously include partners from business, communities across the county, the University of Wisconsin-Madison, and youth. This organizing process has the potential to create new desperately-needed revenue streams for prevention, intervention, treatment and after-care.

We know that significant changes can be achieved by working in broad partnership to change the negative aspects all levels of cultural dynamics. We know that the challenges are great, but it is important to begin the work. We will be announcing the specifics of this effort in October.

4)Strong, effective laws work; market signals change behavior: Wisconsin has some of the weaker alcohol laws in the country and some of the lowest costs for alcohol. Research has shown that policy changes and tougher laws result in needed behavioral change. Changes in legislation at city, county and state levels are needed.

Stiffer penalties can make a difference. For example, 90% of those arrested for operating while intoxicated (OWI) are first time offenders. Additional research has shown that some first time OWI offenders drove under the influence up to 200 times before they were arrested. Research also shows first time OWI offenders are responsible for the majority of alcohol-related fatal and injury crashes.

Limiting alcohol outlet density, the use of ignition interlocks, reduction in access through pricing strategies are just a few examples of many good ideas have all been shown to make a positive difference in the harmful effects of alcohol abuse. Pricing increases can affect youth use of alcohol and other substances. Cigarette tax increases resulted an estimated drop in youth smoking when first implemented. These are examples of the kinds of policy changes coupled with appropriate enforcement for which further research is in order. In November, we will be proposing a set of law changes that will move us forward.

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