Overview of the Evaluation of "Fighting Back" and Introduction to This Issue
Winick, Charles, Journal of Drug Issues
During the last few decades, community coalitions have increasingly emerged as program vehicles for coping with alcohol and other drug problems. The Robert Wood Johnson Foundation supported "Fighting Back," a community coalition program between 1992 and 2002 that was developed at each community and operated at 15 sites in 11 states. The program's goal was the reduction of alcohol abuse and illegal drug use through coalitions. An outside interdisciplinary evaluation of the Fighting Back and matched comparison sites concluded that the program had no significant effect on substance abuse. Various aspects of the evaluation are discussed. For the last 15 years, the federal government has supported hundreds of anti-substance abuse coalitions. In the articles that follow, different features of the evaluation dealing with results, treatment of substance abusers, community structure, correlative factors, research methodology, bibliography, and a funder's perspective are set forth.
"Fighting Back" was a national demonstration program to explore the impact of community coalitions in dealing with the use and abuse of alcohol and other drugs. The articles in this special issue were written in order to convey the approach, contents, and other dimensions of the evaluation of Fighting Back, conducted by a team from the City University of New York (CUNY) Graduate Center and Brandeis University between 1994 and 2002. All but one of the articles were written by members of the evaluation staff.1
The authors present findings or other aspects of their participation in the evaluation that are important but had not been treated in earlier reports and publications. The publications of the evaluation team can be found in Tighe's (2006) listing of the Fighting Back national evaluation bibliography 1995-2005 in this issue.
Fighting Back was the most substantial nongovernmental program of its kind. It was supported by the Robert Wood Johnson Foundation (RWJF), the country's largest philanthropy exclusively concerned with health matters. The foundation's mission since 1972 has been "to improve the health and health care of all Americans." The evaluation is the most extensive assessment of the community coalition approach to coping with substance use and abuse.
RWJF's selection of substance use and abuse as a target goal in 1990 was important for a number of reasons. American foundations had not previously addressed substance abuse on a level commensurate with the problem's importance.
Partly in response to complaints about foundation inaction toward drug abuse, four other national foundations had at least joined in 1972 to establish the Drug Abuse Council as an independent source of needed research, public policy, and program guidance. Although the council published a series of valuable monographs and handbooks, it gradually became less active after the creation of the National Institute on Drug Abuse (NIDA) in 1973. The establishment of NIDA led many foundations to assume, probably erroneously, that there was less need for a private sector initiative in coping with drug abuse.
There had been scattered efforts to encourage community-based action to deal with substance abuse as early as the 1950s, when the Federal Bureau of Narcotics was the government's lead agency dealing with the problem and the National Institute on Mental Health had few available resources for it. Law enforcement was the major institutional concern, with little large scale public or private program activity in prevention and treatment.
As heroin use increased during the 1960s, community action to deal with it began to be discussed. Some leadership was provided by the American Social Health Association (ASHA), a national voluntary health agency that had been primarily concerned with the control of venereal disease and commercialized prostitution since 1912.2 The association (1972) suggested guidelines and established some community programs to reduce drug abuse. …