by Don Matteson, Chief Program Officer
"One generation plants a tree, another gets the shade." - Chinese Proverb
During a site visit a few weeks back, I was talking with a grantee about how it seems to be easier to get funding for substance abuse treatment than it is for prevention. Talk to any number of experts on substance use disorders, and they'll tell you that prevention is critical. While we know that people need treatment now, we also believe that we can (eventually) reduce the demand for treatment services if we implement effective prevention strategies.
The economic argument is clear: money spent in prevention now saves us a disproportionate number of treatment dollars in the future. For instance, the Substance Abuse and Mental Health Services Administration's 2008 cost-benefit analysis indicates that a dollar spent on school-based prevention programs can potentially save $18 in costs associated with problems later in life. So why is it that our inclination is to dump money into treatment while giving prevention short shrift?
It seems like there are two main reasons for this: the desire to see results and the desire to see results quickly. When we look at treatment, there are lots of concrete metrics to work with: (e.g., treatment completion, readmission within 12-months of program completion). Seeing prevention's results is trickier; we can't readily measure what didn't happen. Sure, we can look at community metrics (e.g., decreasing age at first use of drugs, lower drug-related arrest rates), but it's still nearly impossible to draw a straight line between the prevention activity and the improved community-wide measures.
Along the same lines, results from treatment can be assessed pretty quickly -- often within a year or two. Prevention takes longer, and it's hard to nail down results in a satisfying causal fashion. We'll need to look at population-level data in five or six years (maybe longer) to know whether today's school-based prevention programs had an effect. Even then, we won't know for sure whether it was the prevention programming or some other independent factor. These qualities taken together are a recipe for treatment programs to get funding preference over prevention programs.
Culturally, we're impatient. We have a need for immediate gratification. We want programs that will show us results on a very short time horizon. Treatment gives us outcomes pretty quickly -- either the program "worked" or it didn't. Prevention simply doesn't operate that way; it requires us to take the long view. We need to be more patient as a society if we want to see any change that's more than cosmetic.
Politically, elections are won by pointing to the results of (or promising to implement) programs and projects that demonstrate benefit. Election cycles are too short for us to see results from prevention. Further, because their results are difficult to measure, politicians can't point to a prevention program that they backed and say definitively, "I did that, and it moved the needle." We need to get more comfortable with ambiguity, and -- perhaps most important -- we need to stop worrying about trying to take credit for change and acknowledge that we "win" or "lose" as a team.
Like the proverbial tree, prevention is an investment in the next generation's well-being. The seeds of prevention are planted today by community groups, service providers, funders, and government to benefit the next generation of adults -- today's children.
What will you do to promote substance abuse prevention efforts in your community? How can philanthropy support those efforts?
Photo by William Murphy
Flickr: Trees, Bushes And Parkland (St. Annes Park) / 6838561151
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