Editors’ Note

Joseph Anthony Califano, Jr. has held many posts in the United States Government including United States Secretary of Health, Education, and Welfare from 1977 until 1979. He has been Adjunct Professor of Public Health (Health Policy and Management) at Columbia University’s Medical School (Department of Psychiatry) and School of Public Health and is a member of the Institute of Medicine of the National Academy of Sciences. His 12th book, How to Raise a Drug-Free Kid – The Straight Dope for Parents, was published in August 2009 and his 11th book, High Society: How Substance Abuse Ravages America and What To Do About It was published in 2007. Califano received his Bachelor of Arts degree from the College of the Holy Cross in Worcester, Massachusetts, in 1952, and his LL.B., magna cum laude, from Harvard Law School in 1955. Upon graduation, Califano enlisted in the Navy as an officer candidate. He was commissioned an ensign in November 1955, served three years in the Office of the Judge Advocate General in Washington, D.C., and was released to inactive duty as a lieutenant in October 1958. He associated with the law firm of Dewey Ballantine in New York City from October 1958 until April 1961. In April 1961, Califano became Special Assistant to the General Counsel of the Department of Defense. In July 1962, he was appointed Special Assistant to the Secretary of the Army. On July 1, 1963 he was appointed General Counsel of the Army. He also served as Special Assistant to the Secretary of the Army for Civil Functions, supervising the Corps of Engineers’ Civil Works Program, and was a member of the President’s Appalachian Regional Commission. In recognition of his work as General Counsel of the Department of the Army, Califano was awarded the Distinguished Civilian Service Medal, the highest civilian award of the Army. On April 1, 1964, Califano was appointed Special Assistant to the Secretary and Deputy Secretary of Defense. He had special responsibilities for Department of Defense liaison with the Office of the President of the United States. He also acted as Executive Secretary of the President’s Advisory Committee on Supersonic Transport, as the Department of Defense representative on the President’s Committee on the Economic Impact of Defense and Disarmament, and as a member of the Federal Radiation Council. Califano was appointed Special Assistant to President Lyndon B. Johnson on July 26, 1965. He served in this position until January 20, 1969. Califano was a member of the Washington law firm of Arnold & Porter from March 1969 until May 1971. He was a member of the Washington law firm of Williams, Connolly & Califano from June 1971 until January 1977. In January 1977, Califano became Secretary of Health, Education, and Welfare. He served in that Cabinet post until August 1979. In January 1980, Califano formed the law firm of Califano, Ross & Heineman in Washington, D.C. From 1983 until 1992, he was senior partner and head of the Washington office of Dewey Ballantine. He was Founding Chairman of the Board of the Institute for Social and Economic Policy in the Middle East at the Kennedy School of Government at Harvard University. Califano is a director of CBS Corporation and Willis Group Holdings, Ltd. Califano is admitted to practice before the Supreme Court of the United States.

Organization Brief

The National Center on Addiction and Substance Abuse at Columbia University (www.casacolumbia.org; CASA Columbia) was created to inform Americans of the economic and social costs of substance abuse and its impact on their lives; assess what works in prevention, treatment, and law enforcement; encourage every individual and institution to take responsibility to combat substance abuse and addiction; provide those on the front lines with the tools they need to succeed; and remove the stigma of substance abuse and replace shame and despair with hope. Founded in 1992 by former U.S. Secretary of Health, Education, and Welfare Joseph A. Califano, Jr., CASA remains the only national organization that assembles under one roof all of the professional skills to examine the impact of abuse and addiction of all substances (tobacco, alcohol, illegal and prescription drugs) in all sectors of society and to develop proven, effective ways to prevent and treat the disease of substance abuse and addiction.

In 1992, what made you feel it was the right time to create CASA and what was your vision for the organization?

During the Johnson Administration, the first Surgeon General’s report on smoking came out in 1964. We did nothing about it, because we were trying to pass the Civil Rights Act of ’64, the Voting Rights Act of ’65, and the Fair Housing Act of ’68 and we did not want to further antagonize the states in the south.

When I went to HEW (Health, Education, and Welfare) in 1977, President Carter wanted a disease prevention program. I interviewed more than 100 doctors for jobs and every one of them told me that you can’t have a serious program in health promotion and disease prevention unless you go after smoking.

So we did a survey and found out that 90 percent of adults hooked on cigarettes were hooked before they were 21 and that half the people who smoked had tried to quit within the past year but most didn’t make it. So that led to the national anti-smoking campaign that I started in January 1978.

Mercedes McCambridge, an Academy Award-winning actress, came to see me later that year and said, “Joe, all you do is talk about smoking; alcohol is an even bigger problem. I know because I’m an alcoholic. You should do something about this.”

So we put a program together and I announced it in May of 1979. As I was rolled out at HEW over the smoking issue, in August of that year, nothing happened.

In 1980, Governor Hugh Carey was running for re-election in New York and I was practicing law in Washington, D.C. Heroin was a big issue in New York City and the governor asked if I would put a program together on heroin.

So I went to Harlem and Bedford-Stuyvesant and saw men and women hooked on heroin. It was awful. That had an enormous impact on me.

Jim Burke, head of Johnson & Johnson and a client of mine at that time, told me he was retiring and going to start the Partnership for a Drug-Free America. He told me there was no good public policy center in this field and urged me to start working on that.

I knew the issue was addiction, not any particular substance, and that addiction was a disease and I knew that our people didn’t understand what substance abuse and addiction was doing to our society. I also knew that we needed not just doctors and lawyers to focus on this scourge, but businesspeople, sociologists, statisticians, public health professionals, labor leaders, educators, and communications experts.

So the concept for CASA was to assemble under one roof all the different skills to look at all substance abuse in all parts of society.

How challenging was it in the early days of developing CASA with such a stigma attached to this issue?

There is still a lot of stigma but we are working tirelessly to eliminate it and get people to understand that this is a disease, a complex neurological, psychological, physical, and spiritual disease driven by genetics, as well as psychological and environmental influences. It most often results from the use of addictive substances in adolescence when the brain is still developing.

The tough part was to get enough financial support so I could recruit the bright people and demonstrate that we had the staying power to tackle this vexing problem. That came from the Robert Wood Johnson Foundation and its then-president Steve Schroeder, as well as other foundations like Carnegie and Ford, and from corporations that were willing to make five-year commitments to this enterprise.

Early on, we issued reports on the gateway theory, demonstrating statistically that kids who smoked and drank were more likely to use pot, and that kids who smoked, drank, and used pot were more likely to use other drugs.

Those statistical studies were followed by scientific research at Scripps in California, and in Italy and in Madrid, which showed that all these addictive substances – alcohol, cocaine, heroin, nicotine – affect dopamine levels in the brain through common pathways. Dopamine gives you pleasure. When your dopamine goes up, you’re happy. So the scientific relationship explained the statistical relationship.

Then we set about trying to systematically identify the impact of all these substances, first on the health care system. We found that about a third of the costs of health care, including the costs of Medicare and Medicaid, are attributable to smoking, drinking, drug use, and alcohol abuse.

Then we looked at the criminal justice system. Our analyses of prison systems showed that roughly 80 percent of the people in prison are either alcoholics, drug addicts, or abusers, or stole money to buy drugs, or committed their crime of violence while they were high on alcohol or drugs, or violated the alcohol and drug laws.

We then studied social service systems and found that 70 percent of the children in this country – three million kids – are there because of drug and alcohol abusing parents.

We did the early studies on substance abuse in colleges. In 1994, we pointed out that binge drinking on college campuses was a major problem, particularly among women, and we did a second study a few years ago that showed that virtually nothing has been done about it. We found that each year on college campuses, thanks to alcohol abuse, approximately 2,000 students are killed, 100,000 girls are raped and sexually assaulted, and about 700,000 students are injured.

We did an analysis of government costs that we called “Shoveling Up” to answer the question: How much of government spending is attributable to substance abuse and addiction? How much of the criminal justice costs, juvenile justice costs, health care costs, social service costs, special education costs, and vandalism and property damage from fires is there? We were appalled not only by the billions spent on such costs, but by this fact: Of the billions spent by federal and state government on substance abuse and addiction, 96 cents of every dollar goes to shovel up the consequences and only three or four cents is spent on prevention and treatment.

Today, at CASA Columbia we have more than 60 professionals and we are the premier operation in this field.

We have been trying hard to remove the stigma that clings to this disease. We’ve made some progress but we have a long way to go. Addiction is a chronic disease, like hypertension or diabetes. Individuals with high blood pressure have to take their pills each day; those with diabetes have to take their insulin each day. Many addicts and alcoholics need to go to AA or NA each day. If a man doesn’t take his hypertension pills because they are hurting his sex life or a diabetic woman goes off her diet, no one condemns them. We recognize that they are fallible, imperfect human beings, as we all are, and we help them get back on track. If an alcoholic or addict slips, condemnation for failure is almost guaranteed. We must stop this, shed the stigma, and give substance abuse and addiction the same respect we accord other diseases.

To me the greatest failure of the medical and public health professions is their failure to educate our people about this disease. In a matter of a few years, those professions taught the American people that AIDS was not a social curse, but a disease. Their failure to do the same for substance abuse and addiction is inexcusable.

Are you primarily focused on teens or are you trying to reach all age groups?

Over time, the most important thing we have learned is that this problem is all about kids – if you can get a child to age 21 without smoking, abusing alcohol, and using illegal drugs, that child is virtually certain to be home free for his or her life. So we are very much focused on adolescents.

The most recent report we put out was on adolescents. In that study, we found that 90 percent of the adults who are alcoholics and 90 percent of the adults who are drug addicts used those substances when they were teenagers. Prior to that study, we only knew that 90 percent of adults hooked on cigarettes were hooked as teens.

That’s why we have put so much focus on parents, because parents have more influence over their kids – for better or worse – than anyone else.

It seems much work has to be done inside the home with the parents having an open dialogue. It’s hard to control that. Will success be reaching the parents and getting them to understand their role in this?

Success is a lot of things. There is no question that parents have the greatest influence on kids, more than peer pressure. It’s also no question it’s a much more difficult time to raise teenagers than it was 30 years ago. What kids see on the Internet and films and TV, and what they hear in music, so often glamorizes drinking and drug use. Kids can learn how to get high by going online.

We also need a fundamental acceptance in our society of the reality that substance abuse is a disease and that starts with getting doctors to realize this is a disease. They now tell you not to smoke, but they don’t ask about drinking or how you’re using your pills. When the health care system takes this seriously, we’ll have a big change in this country.

Then it will start to affect the other systems: the prison system, the education system, the faith systems, the social service systems, and the family systems.

How much can be done within schools and universities?

A lot. Schools can educate kids and engage parents. A lot of high schools ask parents to sign an agreement saying if they have parties for teenagers, they won’t serve alcohol to them.

At universities, however, many kids calibrate their university life to maximize party time. No Friday or weekend classes and no classes Monday until afternoon. So the party is four nights a week. And it’s the professors as well as the kids who don’t want Friday classes – they want a long weekend.

Many sororities and fraternities run wild, and universities are getting sued by parents. So universities are moving the fraternities off campus so they’re not liable for what happens. Universities have to take far more responsibility and work to change the college culture.

For CASA, is there a focus outside the U.S.?

We have remained focused in the U.S. but the time will come when we’ll go outside. We in the U.S. are roughly five percent of the world’s population, but we use more than half the world’s illegal drugs.

Is the funding and awareness there at the public level and are we moving in the right direction?

No, there are some serious mistakes being made.

We have our best scientific minds working in cancer. That wasn’t true until Lyndon Johnson and Richard Nixon came along and said there’s going to be at least $1 billion a year in research money for cancer – now it’s over $3 billion.

The largest causes and exacerbators of cancer, heart disease, AIDS, and lung diseases are smoking, drinking, and drug use. Yet, they get less than one-tenth the research dollars applied to those other diseases at the National Institutes of Health.

So at the research level, we have to make a basic research commitment. We need a president that is going to say that there is going to be three billion dollars available every year. Then we’ll start to attract more attention and talent. There are a lot of dedicated people but we need more and better scientists in this field. Here the stigma really hurts.

Looking back over your career, what are some things you’re very proud of?

Those years with Lyndon Johnson; passing 100 bills a year, we did change the country: the first environmental laws, Medicare, Medicaid, civil rights laws, all the consumer legislation like auto safety, consumer protection agencies, truth in lending and packaging, the immigration reform, aid to elementary and secondary education, Head Start, college loans, grants and work study programs, Public Television and Broadcasting – so much that changed this nation for the better and opened opportunity to millions of individuals and families.

From the years at HEW, the only thing that will be on my grave will be the smoking campaign. But there were also Title IX, where we opened athletics up for women, the disabled regulations that opened up opportunity for the disabled, curbing excessive radiation by the medical profession, and revoking the long-standing public health regulation that defined homosexuality as a disease, thus enabling the immigration authorities to keep gays out of the United States.•