Fighting back against substance abuse: are community coalitions winning?
OBJECTIVE
Federal initiatives continue to provide strong support for community antidrug coalitions, but whether this approach actually reduces substance abuse is not clear. This paper examines the strategies that coalitions in a large national demonstration program (Fighting Back) chose to develop, the degree to which they implemented these strategies, and evidence regarding their effects.


METHODS
Coalition strategy implementation was coded and ranked for 12 Fighting Back sites. Effect sizes (intervention over time) for outcomes related to substance use, alcohol and other drug treatment, and community/prevention indicators were also ranked by site. Using rank order correlation, three directional hypotheses compared strategy dose to outcomes.


RESULTS
None of the hypotheses were supported. Strategies aimed at either youth or community/prevention outcomes showed no effects, while strategies to improve adult-focused outcomes showed significant negative effects over time, compared to matched controls. Coalitions with a more comprehensive array of strategies did not show any superior benefits, and increasing the number of high-dose strategies showed a significant negative effect on overall outcomes.


CONCLUSIONS
Comprehensive community coalitions are intuitively attractive and politically popular, but the potential for adverse effects must be considered. Efforts to evaluate implementation processes as well as to correlate strategies with theoretically corresponding outcomes are a critical but neglected aspect of prevention research.
Hallfors
Denise
D
Pacific Institute for Research and Evaluation, Chapel Hill, North Carolina 27514, USA. hallfors@pire.org
Cho
Hyunsan
H
Livert
David
D
Kadushin
Charles
C
D000293:Adolescent; D000328:Adult; D003256:Community Participation; D006801:Humans; D016015:Logistic Models; D010043:Outcome and Process Assessment, Health Care; D011322:Primary Prevention; D015397:Program Evaluation; D011634:Public Health; D018709:Statistics, Nonparametric; D019966:Substance-Related Disorders / Q000517:prevention & control*; D014481:United States