National Center on Addiction & Substance Abuse
It has been over 70 years since alcohol prohibition was swept off the books in the United States, but the mindset behind it is definitely alive and kicking.
Since the 1950s, when research into substance abuse and addiction formally became part of the Public Health field, an enormous amount of financial and human resources has been poured into investigating the “whys and wherefores” of substance abuse. The vast majority of this work is truly scientific, pursued by conscientious researchers whose findings are based on careful inquiry, and confirmed by the stringent process of peer review.
As with any scientific discipline, however, not everyone in the field respects this time-honored recipe for scientific progress. While most scientists recognize that their primary mandate is to work out reliable explanations for how nature — or, in the case of addiction and substance abuse, human nature — works, there always seem to be a few bad apples in the research corps who insist on faking data, “cooking” the books, or otherwise crafting results to fit their prejudices. Their motives are almost always political, and they tend to complement their deceit with slick public-relations skills.
Such high public profiles and strong political acumen also tend to attract huge amounts of money from like-minded and deep-pocketed sources. In the case of the National Center on Addiction and Substance Abuse (CASA) at Columbia University, this financial confluence is compounded by the degree to which local and federal government agencies continue to pile on their support, often sending good money chasing after bad.
The CASA that Joe built
CASA’s fearless leader is Joseph A. Califano, Jr., a long-time policy wonk who, as chief domestic policy advisor to LBJ, was regarded as one of the key architects of the “Great Society” programs. Califano also served in President Jimmy Carter’s cabinet as Secretary of Health, Education, and Welfare. Cater fired him in 1979, largely because, according to Washingtonian magazine, his “blunt, high-profile, self-promoting approach cost Carter too many political allies.”
After more than 12 years in private law practice, and a stint on the board of the Chrysler Corporation, Califano was approached by former Johnson & Johnson CEO James Burke (then in charge of the executive-branch Office of National Drug Control Policy, or ONDCP) with the idea to found CASA. Califano jumped at the chance, telling reporters that he was bored with practicing “commercial law,” and that he “wake[s] up every morning ready to roar.”
On May 18, 1992, the birth of the National Center on Addiction and Substance Abuse (CASA) was announced to the press, along with prominent mention of its sources of startup funding. United Press International reported that “more than $2 million” would come from the Carnegie Corporation of New York, “more than $5 million” from the Pew Charitable Trusts and the Rockefeller Foundation, and a single five-year, $8 million grant from the Robert Wood Johnson Foundation. This latter windfall represented the single largest grant in that foundation’s history (a $13-million-plus grant to CASA in 1998 would later raise the bar even higher).
The fact that CASA came about as the result of a request from the ONDCP director (a White House official) didn’t turn many heads in 1992, but perhaps it should have. At the time, a combination of private and public donors were already pouring $400 million per year into substance-abuse and addiction studies, mostly in long-standing university research programs. This new organization, with its initial endowment of over $15 million, promised to spread those resources even thinner. Furthermore, the appointment of Califano — a political firebrand, not a scientist — as CASA’s director was viewed with remarkably little suspicion.
While the press also noted that CASA’s new Medical Director, Dr. Herbert Kleber, had been ONDCP’s deputy director only two years before, nobody at the time asked about the propriety of ONDCP chairman James Burke using his office to drum up high-prestige work for a former colleague. It’s not clear whether CASA’s association with Columbia University had much to do with Kleber’s tenured position on Columbia’s psychiatry faculty, but it probably didn’t hurt.
Since CASA opened its offices in New York City, Califano has played a dual role as both rainmaker and spokesman. His boardroom contacts at Chrysler have yielded CASA corporate donations from the likes of CBS, Walt Disney, Citigroup, Bristol-Myers Squibb, American Express, and Travelers Insurance. His presumed gravitas as a former cabinet official has translated into the highest profile imaginable for just about any pronouncement his organization’s “research” dictates, no matter how baseless or logically contorted.
During the years of the Clinton Administration, Califano parlayed his Democratic Party credentials into a pair of multi-million-dollar fundraisers, titled “Concerts of Hope.” Featuring stars like Natalie Cole, En Vogue, Kenny G, Tim McGraw, and Wynnona, these events were televised by CBS and expressly honored then-First Lady Hillary Clinton for her (unspecified) efforts to combat substance abuse in children.
Remarkable, but true: Califano’s enormous political clout and the $150 million dollars that he has raised since 1992, have brought about a “think/action tank” (in the words of CASA’s web site) that is widely considered a laughingstock among mainstream social scientists. The 2002 release of a CASA report, entitled “Teen Tipplers: America’s Underage Drinking Epidemic,” provides an explanation of why.
With the release of this report, Califano declared on February 26, 2002, that “underage drinkers account for 25 percent of all the alcohol consumed in the U.S.” It was a truly shocking, incendiary finding, aimed directly at America’s brewers and distilled spirits marketers. With teen drinking “out of control,” the CASA report argued, America had an obligation to quickly ban all alcohol advertising. Issued only weeks after NBC’s controversial decision to re-open its airwaves to liquor ads, CASA’s pronouncement was political opportunism at its worst.
The most shocking information about “Teen Tipplers,” though, was yet to come. Within 24 hours, it emerged that CASA’s central finding was just plain wrong. The New York Times, in an article entitled “Disturbing Finding on Youth Drinkers Proves to Be Wrong,” reported the following morning that the real proportion of alcohol consumed by American teens was less than half CASA’s published figure.
How did CASA’s “experts” come to publish such a falsehood? “Teen Tipplers” was based on a 1998 government project called the Household Survey on Drug Abuse, in which 25,500 people were interviewed in their homes. For a variety of legitimate reasons, the federal survey’s architects decided to “oversample” teenagers. While 38 percent of those surveyed were in the 12-20 age group, they make up only 13 percent of the American population.
CASA’s researchers, to say nothing of its leaders, managed to ignore this important distinction. The result was a headline-ready statistic that overstated the truth by over 200 percent. In the days following the release of “Teen Tipplers,” the Substance Abuse and Mental Health Administration (SAMHSA), the very same federal agency that produces the Household Survey on Drug Abuse, issued a scathing news release announcing that CASA had misinterpreted its data. The real percentage of alcohol consumed by underage Americans, it announced, was just 11.4 percent.
The only remaining question was whether CASA’s error was an unintentional blunder or a willful deception. CASA president Joseph Califano provided the answer almost immediately. In an incredible show of hubris, Califano tried to justify his organization’s faulty statistics. One typical news report (out of over 200), written in the Baton Rouge Advocate, noted that Califano “defended his group’s decision not to make the [appropriate statistical] adjustment.”
Getting it 100 percent wrong
While this particular boneheaded arithmetical gaffe led to the most astonishing mistake in “Teen Tipplers,” it was by no means the report’s only ridiculous statement. Another of the report’s key findings was that “82.8 percent of adults who drink had their first drink of alcohol before age 21.” Here is another made-for-TV headline that says absolutely nothing of value. A majority of today’s adults grew up in an era when the minimum legal drinking age was 18 (most states raised the drinking age to 21 during the 1980s). In addition, the United States is remarkably puritanical when compared to other nations, very few of which set the legal drinking age so high. So millions of American “adults who drink” could easily have had their first tastes of alcohol — quite legally — before reaching their twenty-first birthday. CASA’s “82.8 percent” number presumably also includes Christian youngsters who are given wine with communion (an increasingly common phenomenon) as well as any college student who has visited Europe, Mexico, South America, or Canada.
It gets worse for CASA’s scientific integrity. A front-page New York Times account of CASA’s misdeeds noted that “alcohol consumption by teenagers dropped sharply in the 1980s” (when the drinking age rose to 21). Furthermore, the Times said, “the proportion of teenagers who engage in binge drinking has declined… In 1998, 6.6 percent of girls and 8.7 percent of boys 12 to 17 reported binge drinking, compared with 11 percent of the girls and nearly 19 percent of the boys a decade earlier” (emphases added).
So the real news was that teen drinking was becoming less of a problem. Yet CASA chose to twist reality in an attempt to convince Americans that teen drinking was “an epidemic.” And even as CASA’s “results” were being retracted by one television network after another, Califano never followed suit himself. Instead, CASA issued a second press release, insisting that “America has an underage drinking epidemic” and arguing that the real proportion of alcohol consumed by minors in America was probably even higher than it estimated, a number approaching “30 percent or more.” Instead of conceding that their numbers didn’t add up, CASA threw even more fuel on the fire.
Indeed, CASA remains unapologetic to this day. The original “Teen Tipplers” report can still be found on CASA’s web site, unchanged, and without the slightest hint that anything went wrong. Americans with $20 to spare can order a bound copy of the report, which comes without any mention that its central finding was flat wrong and thoroughly debunked.
The damage continues to pile up. Putting sensationalism before science, an April 1, 2002 TIME magazine cover story cited the CASA “Teen Tipplers” study in order make the point that the binge-drinking gap between teenage boys and girls had narrowed. TIME, like CASA, didn’t bother noting that teen binge-drinking rates for both sexes had drastically declined.
A “Serial Abuser of Statistics”
The “Teen Tipplers” episode was not the first time CASA has been exposed for factual distortion. In 1997 William London, the long-time Public Health Director of the American Council of Science and Health, told The Chronicle of Higher Education that CASA “is a group that is interested in painting the most alarming picture possible.”
Other scientists who study the effects of drugs and alcohol, normally not the most venom-tongued people in the world, are often unabashed in their condemnation of the goings-on at CASA. Craig Reinarman, a noted UC Santa Cruz sociologist, told Washingtonian magazine in 1998 that Califano is “not playing by the same rules that all other faculty and research centers have to play by.” Reinarman’s advice to Califano: “Don’t pretend you’re a Columbia University scholar when you’re not.”
Professor David J. Hanson, who has spent over 25 years studying drinking patterns among young people, told reporters that CASA’s “Teen Tipplers” report was “a political report, not a scientific study,” and declared that its research standards and methods “aren’t even acceptable at the undergraduate level.” He added that CASA has a tendency to “misinform the public, and diminish the credibility of all research in the field.”
And Joseph D. McNamara, a former Kansas City and San Jose police chief who now studies drug control policy at Stanford, told Washingtonian that “what CASA does is present information in a kind of hysterical-crisis mode… It’s a propaganda war.”
It’s a well-funded propaganda war, too. At the end of 2000, CASA had $44.9 million in the bank and was paying 6-figure salaries to at least 10 people. Califano took home the biggest chunk, with a personal salary over $375,000. And the Office of National Drug Control Policy — the White House department that first lured Califano to Columbia — has certainly taken care of CASA. In 2000 alone, ONDCP contributed $5.75 million.
The National Center on Addiction and Substance Abuse (CASA) at Columbia University has a track record that makes absolutely no one in the public health field the least bit envious. A long line of questionable pronouncements, based on equally questionable science, have been issued from this well-to-do political advocacy group over the years:
- Through some remarkably transparent statistical sleight-of-hand, a 2002 CASA report entitled “Teen Tipplers” willfully overstated the proportion of alcoholic beverages consumed by underage drinkers in the United States. This despite the fact that CASA’s own numbers showed that underage binge drinking fell sharply during the previous 20 years. Under CASA’s interpretation of the facts, every American who drinks between ages 12 and 20 would have to consume over 4 drinks every day Unrepentant, CASA has stuck by its original claims, despite the fact that every respectable news outlet has roundly denounced the “Teen Tipplers” report.
- A 1994 CASA report alleged that one in four women on welfare (25 percent) were “abusing” alcohol or other drugs. The U.S. Department of Health & Human Services (HHS) quickly debunked this claim, announcing that the very studies CASA used in its report put the number at only 4.5 percent. Government researchers at HHS called the CASA report “seriously flawed” and blasted CASA for repeating one of its most common errors: mistaking use for abuse. CASA had arbitrarily decided that adults who have five drinks twice in any given month could be labeled “alcohol abusers.” Similarly, anyone who used illicit drugs during the previous year – even one experiment with marijuana – counted as a “drug abuser” in the CASA study. In a scathing press release, HHS urged Americans to “read the fine print” and noted that CASA’s work was “susceptible to serious misuse by people who take it out of context.”
- Another CASA report focused on college binge drinking, calling it a problem of “epidemic proportions.” CASA’s key finding, that binge drinking among college women had tripled, made national headlines. But the CASA-of-cards came tumbling down when Forbes MediaCritic, a now-defunct news journal, found that CASA’s conclusions were completely unjustified. It turns out that binge drinking at college campuses had remained steady for decades. A closer look at CASA’s research standards told the rest of the story: MediaCritic senior editor Kathy McNamara-Meis found that many of the “statistics” cited by CASA were merely conjecture by health educators at various universities. One number even came from a student handout that was “not intended to reflect any kind of original research.” Another statistic came from a misquote published in a student newspaper. McNamara-Meis concluded that CASA’s numbers were either outdated, “not credible,” or simply “pulled from thin air.”
- In 1997, CASA published a report on pre-teen drug use that concluded “the percentage of 12-year-olds who said they knew a friend or classmate who used ‘acid,’ cocaine, or heroin more than doubled between 1996 and 1997.” But just one week earlier, the U.S. government had published results stating that rates of teen drug use were unchanged. In some cases, they were actually on the decline. In an interview on PBS’s News Hour with Jim Lehrer, Califano was asked whether any of the kids in his survey might have been referring to “an older, very much older friend, or sibling” who used drugs. Did CASA break down its data to at least distinguish friends and classmates from older siblings? Califano’s reply: “Unfortunately, we didn’t.”
- One of CASA’s more remarkable numerical contortions caught the notice of UC Santa Cruz sociologist Mike Males, who wrote about it in the April 2002 issue of Youth Today. Males notes that a CASA study financed by the Kaiser Family Foundation concluded that a whopping 89 percent of teens who used drugs or alcohol were “at risk” of having unprotected sex. A look at the original survey data, however, reveals that only five percent of high school seniors had actually engaged in unprotected sex after using drugs or alcohol. This, off course, was before CASA and Kaiser cooked the books. In order to inflate its statistics by 1,790 percent, the 15-17 age group was lumped together with those between 18 and 24. In making this “adjustment,” they also included married couples! Lastly, they made allowances for student’s vague guesses about whether “people my age” just might mix drinking and sex. The result: the five percent of 15-17 year-olds who actually engaged in high-risk behavior were ignored in favor of the 89 percent of 15-24 year-olds who thought someone in their age group “might” do so. Guess which number made the evening news?
Even more troubling than CASA’s results, though, is its methodology. CASA’s institutional refusal to participate in the academic peer-review process has made it the butt of jokes at Columbia. Peer review, normally an integral part of publishing scholarly documents, involves a neutral party selecting a fixed number of an author’s colleagues (without regard to ideology) in order to verify the legitimacy of a study’s methods and conclusions.
This is the way that real science works, and it’s the best tool we have to make sure that half-baked and ill-informed conclusions stay out of the mainstream of scientific thought. CASA has consistently chosen to avoid this process like the plague, leading some in the public health field to suggest that its findings would never survive such concentrated scientific inquiry. Dr. Herbert Kleber, CASA’s medical director, has written that the length of CASA’s monographs “does not readily lend itself to the format of an academic peer-reviewed journal.” Accordingly, Kleber says, CASA has “chosen to issue these documents ourselves.”
CASA would obviously garner tremendous prestige if even a short paper were accepted for publication by the likes of Nature, JAMA, or the New England Journal of Medicine. All it would take is an acknowledgement that CASA’s work should be subject to the same scrutiny as everyone else’s at Columbia University. The fact that they’ve chosen not to try speaks volumes.
Immediately following the “Teen Tipplers” debacle, Dr. David J. Hanson, a 25-year veteran of teen-alcohol-abuse research at the State University of New York, asked the operative question: “Did the staff of highly-trained Ph.D.s and other graduate-degree specialists [at CASA] make a fundamental error that few undergraduates would make, or was a decision knowingly made to present clearly untrue statistics as fact in order to grab media and public attention?”
In an opinion column read by few outside Hanson’s sphere of influence in Potsdam, New York, he suggested that CASA — like many organizations claiming to operate for the public good — had become dependent on the big money required to promote its agenda. “It’s hard to raise money to save the endangered bald eagle,” Hanson reasoned, “if people realize that its population is growing. So some activists promote false beliefs about the bird for their own organizational and personal gain.”
The Hoover Institution’s Joseph McNamara has a different take: “It’s a propaganda war,” he says, “and the motivation, I think, is that the ends justify the means.”
We’ve seen the means in action, but what ends does CASA strive for? Dr. Ethan Nadelman has an idea.
“Califano is essentially a reincarnation of the old temperance warriors,” Nadelman told The Chronicle of Higher Education in 1997. “It’s ‘demon alcohol’… It’s Carry Nation and the old anti-alcohol warriors, given a gloss by his association with Columbia University and this ‘sophisticated’ research center.” Nadelman is a former Princeton professor who now runs the New York-based Drug Policy Alliance.
Evidence of Califano’s prohibitionist tendencies winds through most of “Teen Tipplers,” which, like most of CASA’s output, fails to distinguish between use and abuse. This may be a useful tactic when the subject is crack cocaine, but applying it to alcohol tends to favor zero-tolerance over moderation. “Individuals who do not drink before age 21,” CASA writes, “are virtually certain never to do so.” This is only a worthwhile goal if you’re interested in removing alcohol from the marketplace entirely.
In a 1996 Washington Post op-ed, Califano tipped his hand somewhat by arguing that 1920s Prohibition resulted in a 50 percent drop in per capita alcohol consumption in the United States (“from 1.96 gallons per person in 1919 to .97 gallons person in 1934”). He also reminded readers that Prohibition cut the death rate for liver cirrhosis among men by 64 percent, and reduced admissions to mental health institutions for “alcohol psychosis” by 60 percent. With Prohibition, Califano said, “arrests for drunk and disorderly conduct went down 50 percent” and “welfare agencies reported significant declines in cases due to alcohol-related family problems.”
In the following paragraph, of course, Califano insisted that he “strongly opposes” reinstating alcohol Prohibition. But at a minimum — even if you take him at his word — CASA’s policy recommendations seem targeted at reducing per capita alcohol consumption in all segments of the U.S. population.
We’ve seen this strategy before, from the very same federal Department of Health and Human Services (HHS) that keeps CASA’s gravy train running. Take a look at the “Healthy People 2010” report put out by HHS in 2000. This federal plan sets ten-year targets for a variety of public health goals. Healthy People 2010 explicitly calls for a 9 percent across-the-board cut in alcohol consumption. Its predecessor, “Healthy People 2000,” demanded a cut in consumption by over 24 percent. Not just in underage drinking: the feds want less alcohol consumed, period.
This lines up well with CASA’s examination, in “Teen Tipplers,” of various strategies ostensibly targeted at “reducing underage drinking.” The policy options that CASA chose to explore include (in their own words):
- Increase Alcohol Taxes
- Restrict the social and commercial availability of alcohol
- Ban alcohol advertising on television
- Limit [the] numbers, locations, and hours of alcohol establishments
- Require prominent warning labels in all alcohol advertising
The subtlety of this approach may have been lost on the mass media — who could blame them, when the report was already a scandal in the making? — but the strategy in use here is obvious. In addition to recommending policies that specifically target underage drinkers (such as school-based prevention programs and expanded addiction treatment options), CASA is arguing for measures that would effectively limit the options of adults, regardless of how responsibly they drink or how well they hold their liquor.
In a recent study funded by a $250,000 grant from the Robert Wood Johnson Foundation (CASA’s single biggest funder), Deborah Cohen of the RAND Corporation wrote that “alcohol consumption by any individual is, in part, a function of the overall distribution of consumption of the community.” She argues that “[the] magnitude of alcohol-related health problems in a population is directly related to per capita consumption.” What to do about this? Cohen declares that individual alcohol consumption “is associated with various factors affecting the physical and social availability of the product.”
In other words, the social engineering in play here calls for reduced “availability” of alcohol, leading to lower rates of consumption by responsible adults. Only by controlling the many, Cohen argues, can you reduce alcohol abuse by the few. Cohen, by the way, has also launched an effort to apply the same product-control tactics to obesity by shutting down restaurants. In a pronouncement that would undoubtedly make Joseph Califano proud, she told the Dallas Morning News: “It’s easier to control the providers than it is the consumers.”