For the majority of its 50-year history, the National Council on Alcoholism and Drug Abuse (NCADA)-St. Louis has leveraged the power of primary prevention to improve the odds for individuals at risk for substance use problems. Since that mission took hold in the 1980s, the organization's leaders have resisted taking opportunities to branch in other directions.
“We always chose not to get into treatment,” says associate executive director Dan Duncan. “We wanted to be a hub for the community, and not compete with other organizations.”
In St. Louis—also the site of this year's National Conference on Addiction Disorders (NCAD)—the NCADA organization is celebrating its 50th anniversary. And leaders are also celebrating the fact that in the last academic year, NCADA reached 75,000 students in more than 270 schools with a prevention message. Its growth has been steady but in some ways, it's relatively unknown in St. Louis's greater community—a reality that its current executive director has been working hard to change.
Howard Weissman, having replaced longtime executive director Ed Tasch nearly two years ago, saw his first priority as not messing up what a beloved executive had built before him. After that, “I wanted NCADA to no longer be the best-kept secret in St. Louis,” Weissman says. Letting the secret out has involved taking a couple of risks, including the airing of a controversial public service announcement during this year's Super Bowl to highlight the community's heroin problem.
The ad launched conversations, and Weissman says that in general the community seems more willing to address substance abuse issues in a less stigmatizing way. “Things are improving marginally, because the [opioid] epidemic has reached a point where you can't have four adults in a room without someone having lost someone,” he says. “It's now killing people of means.”
A group of individuals in recovery met with recovery movement pioneer Marty Mann in the mid-1960s to form a St Louis affiliate of the organization that is now the National Council on Alcoholism and Drug Dependence, Inc. (NCADD); NCADA-St. Louis decided not to change its name subsequent to the national organization's most recent name change. “For a long time it was a two- or three-person operation,” says Duncan. “In the early days they were about talking with AA groups and helping the recovering.”
Later, the organization helped companies such as Anheuser-Busch in establishing employee assistance programs (EAPs), and contracted with some entities to provide EAP services. Eventually the decision would be made to get involved with individuals in the community earlier, in seeking to prevent costly substance use problems from occurring. “At the time, there wasn't much information on what you do,” says Duncan. “We started to look at the science of it.”
Today, NCADA-St. Louis has more than 50 employees and a budget of around $4 million, with a geographic reach that includes the city of St. Louis, St. Louis County and seven surrounding counties. Among its paid staff are counselors who assist residents via a telephone helpline with available assessment and referral services.
An example of the organization's efforts to intervene early exists with a transitional counseling program supported by two area funders (including one that is using sales tax revenue to fund the effort). Weissman says many of the students who are targeted in this program would not meet criteria for dependence, as they are at the early stages of substance use problems and may have seen the first consequence of that in a suspension from school, for example. “For kids like that, treatment arguably does as much harm as good,” he says.
The program offers motivational assistance and academic support to students. An independent six-month evaluation of the program showed improvement on a range of variables, from sobriety to academic performance to life satisfaction, Weissman says.
Duncan adds that a summertime teen institute that instills prevention skills and builds positive peer influences also has had a profound effect in the community. “We have adults come to us and say it was the single most important influence in their life,” he says.
Slowly but surely, NCADA-St. Louis is helping the community believe in prevention's potential. “It reminds me of race relations—we've come a long way, but we have a long way to go,” Duncan says. He adds that “legislators are a reflection of the general public. They want to think prevention is a good idea, but there is still a good deal of doubt about whether it can work.”