Foot soldiers in combating the opioid crisis withstand challenges

Federal Drug-Free Communities (DFC) funding is the lifeblood of substance use prevention in many communities, offering 120 grant awards of $125,000 each per year aimed at curbing the opioid epidemic and other drug problems locally. Each grant lasts for up to five years. Grantees are allowed to apply for a second round at any time, but they apply as a new applicant, with no special standing to get a renewal. No DFC recipient can earn more than two grant cycles. The basis for all of this is sustainability—keeping the program going in the community after the federal grant has run out.

In general, the DFC program has been a success, because it is based on the concept of the hometown’s responsibility of dealing with its drug issue. Community buy-in from the start is essential to achieving sustainability. In order to apply for a DFC grant, a local anti-drug coalition must have been in existence for six months prior to applying, and must have communitywide involvement from groups ranging from schools to businesses to health professionals to everyday citizens. Local grantees also must match every federal dollar up to $125,000 a year.

The program has grown from $10 million at its start in 1998 to $95 million in 2016. However, there has been enough funding for only 32.7% of those who have applied since the beginning of DFC. And while many of the more than 2,000 DFC recipients have achieved sustainability, some have not. Poorer and more remote areas have tended to struggle the most.

About DFC

The Drug-Free Communities Support Program, administered through the Office of National Drug Control Policy (ONDCP) and with grantees trained by Community Anti-Drug Coalitions of America (CADCA), advances evidence-based prevention programming. Grantees are selected by ONDCP and the Substance Abuse and Mental Health Services Administration (SAMHSA). Included in the grantee training is how to implement seven strategies to change communities and achieve reductions in youth drug use. Examples of the strategies include enhancing skills, changing consequences with incentives and disincentives, and modifying or changing policies.

The model is to “change the culture across the community about drugs in general,” says Sue Thau, public policy consultant for CADCA. Thau tells Addiction Professional that some communities that once couldn’t find workers because nobody could pass a drug test are now thriving because of DFC-funded coalitions' efforts.

Every DFC grantee must have a sustainability plan in year one. “We have a full-time technical assistance manager” who can help with developing such a plan, says Thau. Sustainability does not have to be at the full $125,000-a-year level, she notes.

It’s important to point out that the program has a rigorous outcomes management and evaluation system, says Thau. “Every grantee gets their data back, so they can show population-level outcomes,” she says.

In a random sample of DFC grantees conducted in 2013, it was found that of 182 coalitions, 82% were still in existence 10 years after the first grant.

Rural challenges

But sustainability has been proving difficult in some rural areas. Nancy Hale, president and CEO of Operation UNITE, a Kentucky not-for-profit started in 2003 by U.S. Rep. Harold “Hal” Rogers, knows her state's successes and its needs. Bell County in eastern Kentucky had a DFC grant that was not renewed for a second cycle.

“They were doing tremendous things, there was a lot of programming, but when the grant cycle ended, there was no way for them to sustain it,” Hale says.

Even though Bell County had only one DFC cycle, much good was accomplished, and the effects lasted long after the grant ran out, says Donnie Caldwell, who headed up the local effort for UNITE Bell County. “The lasting results were there,” says Caldwell. “I’m thankful because it did save lives.”

Without the consistent source of funding, however, the community work must be done by volunteers, and many times volunteers don’t have the time, he says. “Once we don’t have funded, paid individuals out doing it because they’re taking on other jobs and have other responsibilities, we lose the commitment,” he says.

Caldwell adds, regarding the federal support, “$125,000 a year doesn’t pay for a lot of people. But it helps for securing facilities like the gym and the movie theater and the ad promotion. We did a movie commercial—a trailer, with local kids.”

With the declines in the local coal industry, financial support from the community is minimal, says Caldwell. Over the last 10 to 15 years, local fundraising from banks is almost impossible to secure.

The First Tee program, a partner of Operation UNITE, is the coalition vehicle in Bell County. It has an annual budget of $60,000, and as of February, there was only $3,000 in the bank. “Folks don’t have the checkbook available,” Caldwell says.

Couldn't the coalition simply apply for another DFC grant? “We can,” says Caldwell. “But sadly, it takes someone basically full time to be able to put up a competent product.” The application would take someone working diligently for “weeks and months,” he says, adding, “I don’t see a volunteer being able to do this.”

And there are financial loose ends from the community's original DFC grant. “There’s a $5,500 hiccup,” Caldwell says. “They say we owe $5,500 back.”

Still, Caldwell has no regrets about the five years spent with the DFC. “We saved hundreds if not thousands of lives here, because we educated the young people,” he says. “I feel very good about the work we did for those five years.”

But he sounds ambivalent about going back to that work. “It wears on you—not the dealing with the kids, that was great. But there’s no down time. You’re getting a phone call when you’re putting your kids to bed, and you have to talk someone through suicide,” he says. “You can’t say, ‘Can I call you back in the morning?’”

Another rural community in eastern Kentucky did manage to achieve sustainability, but misses the DFC funding. “Our DFC grant ended a few years ago,” says Glenda Shrum of the Knott Drug Abuse Council, based in Hindman in Knott County. “We have sustained our coalition and have built a good community network among partners.”

That said, the coalition did lose one full-time employee, with its other employee working only two days a week through the Kentucky Agency for Substance Abuse Policy (ASAP). “This has hindered us in many ways,” Shrum says. “We could do so much more with a little more money. We have many local partners who work alongside and support us. We partner with the local health department, board of education, community action agency, law enforcement and the ministerial association.”

Successes in Knott County have included helping families seeking treatment, collecting unused medications, holding community events such as recovery rallies and town hall meetings, and helping to develop county ordinances related to substance use.

View from UNITE

Some Kentucky communities have been able to get county government to give them several thousand dollars a year to keep coalition efforts going, says Debbie Trusty, education and treatment director for Operation UNITE, which has 32 of its own anti-drug coalitions throughout the state. “But in the poorer counties, everyone is strapped, including law enforcement,” she says. “When the funding stops, they don’t have the money to do what they did before.”

Hale says UNITE is proud of being able to bring law enforcement, treatment and education together. “Hal Rogers definitely was a pioneer in this,” she says. “We’ve been contacted by several states to look at how we started, replicating some of our programs.”

In addition to The First Tee, other programs crafted in Kentucky include the National Archery in the Schools Program and Hooked On Fishing—Not On Drugs. “You don’t have to start from scratch,” says Dale Morton, UNITE's communications director. “The value of community coalitions is you can spread the awareness of the changing patterns of drug use and try to get out ahead of it. If you don’t have that good network, you can’t get ahead of it.”

Morton adds, “If you’re talking about sustainability, the one piece of advice I would give a DFC recipient is not to wait until the end of your funding cycle to start thinking about it. It’s not something that can be done overnight. In the early stages of having a grant, in addition to focusing on the specific mission, you need to be bringing your partners on board and looking at ways these programs can continue at the end of the grant.”

Also, it is important to make sure “you have a leader who is very passionate about the issue, because that leader will make sure that things get done,” Morton says.

Finally, Hale says coalitions are needed even when improvements have occurred.

“Just because things are going well, that doesn’t mean you don’t need a coalition anymore,” she says. Different drugs start trending. “You always have to be prepared,” she says. “Yes, we want youth use to go down. But we also want our young people to never use drugs, whether it’s tobacco or marijuana or abuse of prescription drugs. Prevention is ongoing. You don’t just stop when things get better.”

Alison Knopf is a freelance writer based in New York.

Coalitions can overcome challenges

Despite the challenges outlined by some of the leaders interviewed for this article, it is possible for low-income, rural communities to have sustainable Drug-Free Communities coalitions. Here are three examples:

• Jackson County, W.Va. Under the leadership of Amy Haskins, the Ripley-based Jackson County Anti-Drug Coalition has conducted initiatives that included a multifaceted media campaign on prescription drug use, a pill identification training for law enforcement officers, and advocacy efforts to promote wider use of the state's prescription drug monitoring program.

• Carter County, Ky. Run by Shelly Steiner in Ashland, Ky., the Carter County Drug-Free Coalition has helped bring about a rise in college- and career-readiness scores from 23% in 2010 to 76.5% in 2016. Initiatives have included health professional training in polypharmacy and addiction, and a communitywide drug-free workplace initiative.

• Scioto County, Ohio. Lisa Roberts, program director of the Scioto County Coalition, credits her coalition's success to the National Coalition Academy run by CADCA. The coalition's initiatives have included implementing an adult and caregiver education effort on prescription drug misuse and piloting Ohio's first community-based naloxone education and distribution program.