Working to Change Attitudes on a National Scale

Stigma toward IDUs and other drug users results from individual experiences with drug use or drug users, but it is also generated in large measure from broader societal attitudes toward drug use. Changing social attitudes is one way to affect change on an individual level. The National Institute on Drug Abuse (NIDA), a component of the National Institutes of Health (NIH), supports over 85 percent of the world's research on the health aspects of substance abuse and addiction and it is working on a number of fronts to disseminate the results of its research. This dissemination effort is helping to improve the nation's understanding of addiction and, as a result, change attitudes about drug addiction and people who use drugs.

These various activities include:

• Being clear on the terminology. NIDA carefully crafts the language it uses to talk about addiction and individuals who use drugs so that it reflects current scientific knowledge and is clearly understandable. These words and phrases-"addiction is a brain disease," for example-are used repeatedly and in multiple contexts so that, eventually, they can become a permanent part of the way that society talks about this issue.

• Fostering dialogue with communities. Since 1996, NIDA has hosted a series of 1-day Town Meetings in communities across the country to help bridge "the great disconnect"-the dichotomy between the public's perception of drug addiction and the scientific facts. These meetings, which are tailored to meet local interests and needs, give NIDA the chance to provide communities with the latest findings from drug abuse prevention and treatment research. They also give communities-local civic leaders, health care providers, parents, teachers, concerned citizens-a chance to tell NIDA what kind of information they need to better deal with drug problems in their community."

• Taking information to the people. If research findings and scientific facts are to have an impact and be useful, they need to be used. A big focus of NIDA's information dissemination effort, therefore, is creating a wide range of publications and other materials that are appealing, user-friendly, and pragmatic. For example, NIDA's recent publication, Principles of Drug Abuse Treatment: A Research-based Guide synthesizes 25 years of research into a series of practical principles that communities can use to develop effective substance abuse treatment programs. NIDA has also produced numerous educational booklets, slide shows, and other materials for parents, youth, and teachers.

• Harnessing the power of partnerships. NIDA has developed collaborative relationships with many different organizations and agencies, from Hollywood's Entertainment Industries Council, to the American Medical Association and other professional associations, to other federal agencies such as the Department of Justice and the Office of National Drug Control Policy (ONDCP), to community coalitions such as Join Together and Community Anti-Drug Coalitions of America (CADCA). NIDA works through these partnerships to promote wide distribution of information, ensure that depictions of drug use and addiction are accurate, and create a better and more thorough understanding of drugs and their effects on the brain and body.

For more information: National Institute on Drug Abuse (NIDA), Bethesda, MD, www.nida.nih.gov.

Overcoming Stigma Through Investing in Human Capital

The ARRIVE Program of Exponents, Inc. is designed to improve the quality of life of traditionally underserved minorities affected by drugs, HIV/AIDS, incarceration, and poverty. Serving clients from the entire New York City area, Exponents' programs intervene with detainees, recently released inmates, people living with HIV/AIDS, and substance users and their families. The ARRIVE curriculum covers harm reduction, relapse issues, HIV care and prevention strategies, health education, infection control, and nutrition. HIV counseling, referrals to much-needed services, and peer-led support groups reinforce classroom information and help clients amplify their strengths and resources to meet their health and social challenges.

Communications and presentation classes help clients transform personal experience into marketable skills.

ARRIVE is based on a "corporate social work model," says deputy executive director, Maria (Sam) Josepher. "It was begun by people who were corporately aware as well as people who had been in the substance abuse field for more than 30 years. We used a lot of what we learned from the business world to teach addicts-the importance of information, communication skills, respect, cleanliness-all of this is given to the client. On the social work side, the clients receive a lot of therapeutic peer support. We acknowledge the incremental steps that people make. We notice when people are dressing better, acting better, making more out of their lives."

Started in 1988, ARRIVE now trains over 900 substance users a year, 60 percent of whom are HIV-positive. It has maintained an 83 percent retention rate over the last decade. As Ms. Josepher explains, the program is based on the premise that investing in human capital not only works, but is cost-effective. "We see people go through a transformation within 2 months," she says. ARRIVE costs about $1,000 per person for more than 60 hours of education, support groups, and counseling. For $1,000 you have a person who is literally transformed, motivated, and renewed."

Ms. Josepher illustrates this with the following story: "One of my staff is a woman who was in and out of prison for prostitution, for drugs, for burglary. She would get off drugs but couldn't stay off. She didn't have that ability. She was a heroin IDU for 20 years and on methadone for two. She came into the ARRIVE program. She saw people like herself training, counseling, and becoming part of the solution. Then we put her on a computer. She just started soaking it up like a sponge. She became a volunteer, our first part-time employee. She never went back to drugs. The last time she was in prison was about 9 years ago. Two years ago she bought a house. When she announced this at a staff meeting, there wasn't a dry eye in the place."

For more information: The ARRIVE Program of Exponents, Inc., New York, NY, 212/243-3434 www.exponents.org.