Research Articles Fighting Back Against Substance Abuse Are Community Coalitions Winning? Denise Hallfors, PhD, Hyunsan Cho, PhD, David Livert, MS, Charles Kadushin, PhD 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 out- comes 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. Medical Subject Headings (MeSH): program evaluation, substance-related disorders, public health, organizations, primary prevention (Am J Prev Med 2002;23(4):237–245) © 2002 American Journal of Preventive Medicine Introduction F ederal policy continues to provide strong support for community antidrug coalitions. The federal government spent almost a half billion dollars during the 1990s to support local coalitions through the Center for Substance Abuse Prevention’s (CSAP) Community Partnership Program and subsequent Community Coalition Program. 1 Since 1997, the Office of National Drug Control Policy has funded 464 anti- drug coalitions with an additional $95 million, and the president’s 2002 budget request would double funding for community antidrug coalitions to $350 million over 5 years, including an $11 million increase in 2002. 2 The private sector has also invested heavily in antidrug coalitions. The Robert Wood Johnson Foundation (RWJF) launched Fighting Back, its largest demonstra- tion program ever, to reduce demand for drugs through community coalitions. 3 RWJF credits the Fight- ing Back concept as the origin of federal initiatives. Supporting the activities of local coalitions is both intuitively attractive (bringing the community together to address local problems) and politically popular (spreading the money around). What is not clear is whether coalitions actually reduce substance abuse. This article presents data on the Fighting Back pro- gram, including the strategies that the coalitions chose to develop, the degree to which they implemented these strategies, and evidence of their effects. It also provides conclusions and recommendations about ways to improve the efforts of antidrug coalitions. This study is unique in categorizing the strategies that communi- ties developed to reduce substance abuse and correlat- ing strategy dose with corresponding outcomes. Fighting Back followed several large-scale community trials for chronic disease prevention that had enormous From the Pacific Institute for Research and Evaluation (Hallfors, Cho), Chapel Hill, North Carolina; Social/Personality Psychology Program, Graduate Center, City University of New York (Livert), New York, New York; and Brandeis University (Kadushin), Waltham, Massachusetts Address correspondence and reprint requests to: Denise Hallfors, PhD, Pacific Institute for Research and Evaluation, 1229 E. Franklin St., 2nd Floor, Chapel Hill, NC 27514. E-mail: hallfors@pire.org. Information for full text of this article is available via AJPM Online at www.ajpm-online.net. 237 Am J Prev Med 2002;23(4) 0749-3797/02/$–see front matter © 2002 American Journal of Preventive Medicine • Published by Elsevier Science Inc. PII S0749-3797(02)00511-1