Fighting back against substance abuse - Are community coalitions winning?

Denise Hallfors, Hyunsan Cho, David Livert, Charles Kadushin

Research output: Contribution to journalArticlepeer-review

147 Scopus citations


Objectives: 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.

Original languageEnglish (US)
Pages (from-to)237-245
Number of pages9
JournalAmerican Journal of Preventive Medicine
Issue number4
StatePublished - Nov 2002

All Science Journal Classification (ASJC) codes

  • Epidemiology
  • Public Health, Environmental and Occupational Health


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