Subtle changes are taking place in Baltimore's struggle against drug abuse, and the trend seems to be going toward prevention, as opposed to treatment of hard-core abusers.
Dr. Nollie Wood is the Baltimore City Health Department's assistant commissioner for the Division of Human Behavior and Community Psychiatry.
"Somewhere between 1 in 10 and 1 in 15 people are affected by substance abuse in the city, and that's including alcohol, heroin, cocaine and so on," he says. "The positive mirror of that is that about 9 in 10 to 14 to 15 have very positive challenges going on in their lives, have very strong families, are not affected by substance abuse and are working, strong citizens of Baltimore."
Tom Davis is the director of the Health Department's Substance Abuse Bureau. Both Dr. Wood and Mr. Davis are members of the health department's Substance Abuse Prevention Unit. This unit's goal, according to its literature, is to create a drug-free community by working with community organizations, churches, schools and other agencies to implement its community empowerment, parenting, senior citizens and AIDS prevention programs.
"Substance abuse before age 15 greatly increases the risk of sustained use in the future. Therefore, the majority of Baltimore City prevention efforts address youth," states a description of the unit.
"Our treatment modalities include education, peer-oriented models and mentor programs," Dr. Wood says.
"It's just recently that there has been a real focus on prevention," Mr. Davis says. "The federal Office for Substance Abuse Prevention has only been around for about five years. These prevention efforts are having some impact."
A Baltimore organization of black physicians, the Monumental City Medical Society, has committed itself to the struggle against substance abuse. In November, with assistance from the city health department and funding from Baltimore Substance Abuse Systems, the society will sponsor a conference, "The African-American Perspective on Substance Abuse."
"What we're trying to do is get health care providers to play a role beyond identifying the 'usual' medical problems," says Dr. Bannister Lee Raines Jr., who will be master of ceremonies of the conference. Dr. Raines is medical director of Glenwood Life and Counseling Center, a hard-core substance abuse treatment facity in Baltimore.
"What we're talking about is not just hard-core drugs, but sleeping pills, alcohol, cigarettes, any substance that can adversely affect health," Dr. Raines says.
"What we are finding out is that our treatment systems are basically designed for the severe abuser," says Gail Williams-Glasser, a health analyst for the health department.
Early diagnosis of substance abuse-related disease is important not only to the patient but the health care system as a whole, she says, because the costs of treating substance abusers are threatening to overwhelm the system.
"One of the unusual aspects of the conference is that one of the workshops will be on substance abuse treatment systems. So we'll have drug prevention and treatment persons there mingling with physicians. It will be an excellent opportunity for dialogue and networking," she says.