FROM MANHATTAN TO MAIN STREET

The rate of drug, alcohol and nicotine use among young teens in rural
America is now higher than in the nation's large urban centers. The rates
of drug, alcohol and nicotine use among adults are about the same in rural
towns and mid-size cities as in large urban centers. At the start of the
21st century, there is no place to hide from the scourge of substance abuse
and addiction in America.

These troubling conclusions come from an assessment of the incidence of
substance abuse and addiction in population centers that the National
Center on Addiction and Substance Abuse at Columbia University recently
conducted.

Eighth-graders living in rural America are much likelier than those living
in urban centers to use illegal drugs, alcohol and tobacco. Compared with
those in urban centers, rural eighth-graders are: 83 percent likelier to
use crack cocaine and 50 percent likelier to use cocaine; twice as likely
to use amphetamines; 34 percent likelier to smoke marijuana; 29 percent
likelier to drink alcohol (and 70 percent likelier to get drunk); more than
twice as likely to smoke cigarettes; nearly five times likelier to use
smokeless tobacco.

Among 10th-graders, rates of use in rural areas exceed those in large urban
areas for every drug except Ecstasy and marijuana. Among high school
seniors, the rates in rural America exceed those in large urban areas for
cocaine, crack, amphetamines, inhalants, alcohol, cigarettes and smokeless
tobacco.

Drugs are now as available on Main Street as they are in Manhattan. The
proportion of individuals surveyed in rural towns, small cities and large
urban centers who find drugs "very easy" or "fairly easy" to obtain is
essentially the same: around 60 percent for marijuana, 40 percent for
cocaine and crack, 30 percent for heroin.

From 1990 to 1998, the average annual increase in per-capita drug law
violations in cities with populations of 50,000 to 100,000 was more than
double that of cities of 250,000 or more; in cities with fewer than 10,000,
it was six times as much.

In 1988 the White House Office of National Drug Control Policy began
identifying High Intensity Drug Trafficking Areas - centers "of illegal
drug production, manufacture, importation or distribution" - that need
additional federal resources to fight the problem. Originally used to mark
giant urban centers such as New York, Los Angeles and Miami, the
designation was applied to Iowa, Kansas, Nebraska and South Dakota in 1996
and to Kentucky, Tennessee and West Virginia in 1998.

According to the U.S. Centers for Disease Control and Prevention, from 1994
to June of 1999, AIDS cases in rural areas increased by 82 percent compared
with a 59 percent rise in metropolitan areas with populations above 500,000
- - largely because of intravenous drug use. A 1998 report from the
SmithKline Beecham Drug Testing Index, based on tests of some 5 million
employees in various regions of the eastern United States, revealed that
the proportion of workers in rural areas of Tennessee, Indiana and Florida
who tested positive for drugs was twice that for the three largest
metropolitan areas.

From 1994 to 1998, Drug Enforcement Administration seizures of
methamphetamine labs jumped from 263 to 1,627 - a sixfold increase
concentrated largely in less populated areas of the West and Midwest. In
1998 state and local police seized another 4,132 illegal drug labs, almost
all producing meth, largely centered in rural areas and smaller cities.

Thirty-five years ago, when I was on the White House staff, President
Lyndon Johnson had difficulty mustering interest in the nation's first Drug
Rehabilitation Act, with an annual appropriation of only $15 million,
because Americans viewed drug addiction as an affliction of the urban poor,
largely confined to black ghettos. The nation's failure to deal with the
drug problem then - based in no small measure on the assumption that it was
"their" problem, not "ours" - gave drugs time to seep into every
neighborhood in every large city across America.

Parents with the money and freedom fled first to the suburbs and then to
rural towns. But drugs did not respect geographic boundaries, and today the
sores of drug abuse and addiction that we allowed to fester in our urban
ghettos infect every hamlet in America.

Battling drugs only in one place is like pushing down on a pillow: They
will just pop up somewhere else. With Mayor Rudy Giuliani's success against
drug dealers in New York City has come increased drug activity in
Westchester County and eastern New Jersey. It's time to recognize that we
can no more deal with the scourge of drugs in one city or section of the
nation than we can cure leukemia in only one part of the bone marrow.

The writer is president of the National Center on Addiction and Substance
Abuse at Columbia University. He was secretary of health, education and
welfare from 1977 to 1979.