Title: 2000 Arrestee Drug Abuse Monitoring: Annual Report Series: Research Report Author: National Institute of Justice Published: April 2003 Subject: ADAM (Arrestee Drug Abuse Monitoring) Program, drug abuse, and drug testing 129 pages 309,000 bytes ---------------------------- Figures, charts, forms, and tables are not included in this ASCII plain-text file. To view this document in its entirety, download the Adobe Acrobat graphic file available from this Web site or order a print copy from NCJRS at 800-851- 3420 (877-712-9279 for TTY users). ---------------------------- U.S. Department of Justice Office of Justice Programs National Institute of Justice ANNUAL REPORT 2000 ARRESTEE DRUG ABUSE MONITORING ---------------------------- U.S. Department of Justice Office of Justice Programs 810 Seventh Street N.W. Washington, DC 20531 John Ashcroft Attorney General Deborah J. Daniels Assistant Attorney General Sarah V. Hart Director, National Institute of Justice Office of Justice Programs World Wide Web Site http://www.ojp.usdoj.gov National Institute of Justice World Wide Web Site http://www.ojp.usdoj.gov/nij ---------------------------- 2000 Arrestee Drug Abuse Monitoring: Annual Report April 2003 NCJ 193013 ---------------------------- NIJ National Institute of Justice Sarah V. Hart Director For their forthright and insightful comments on the draft, we are indebted to our colleagues at the Office of National Drug Control Policy, particularly Robert Eiss; at the National Institute on Drug Abuse, particularly Lynda Erinoff; and at the Executive Office for Weed and Seed, U.S. Department of Justice, particularly Robert Samuels. We would also like to acknowledge the contributions of ADAM's data management contractor, Abt Associates Inc, and the laboratory contractor, PharmChem, Inc. The National Institute of Justice is a component of the Office of Justice Programs, which also includes the Bureau of Justice Assistance, the Bureau of Justice Statistics, the Office of Juvenile Justice and Delinquency Prevention, and the Office for Victims of Crime. ---------------------------- Contents Executive Summary Part I: Drug Use and Related Behavior: Findings o Chapter I--Overall Findings and ADAM Redesign o Chapter II--Drug Dependence and Treatment o Chapter III--Alcohol Use and Alcohol Dependence o Chapter IV--Drug Markets o Chapter V--Drug Use Among Adult Female Arrestees o Chapter VI--Drug Use Among Juvenile Detainees Part II: 2000 Findings, by Site-Adult Male Arrestees Part III: Applying the New ADAM Method o Chapter VII--Implementing the New ADAM Study Design at the Local Level o Chapter VIII--"Calendaring" in ADAM: Examining Annual Patterns of Drug Use and Related Behavior o Chapter IX--Estimating Hardcore Drug Use in the Community Appendix Tables and Exhibits Tables Chapter 1 o Table 1-1: Number of Weighted Cases, by Site--Adult Male Arrestees, 2000 o Appendix Table 1-1: Drug Test Results, by Drug by Site--Adult Male Arrestees, 2000 o Appendix Table 1-2: ADAM Sample Sizes, Interviews, and Urinalyses, by Site--Adult Male Arrestees, 2000 Chapter 2 o Appendix Table 2-1: Drug Dependence and Treatment Status, by Site-- Adult Male Arrestees, 2000 o Appendix Table 2-2: Adult Male Arrestees at Risk for Drug Dependence, by Site--Adult Male Arrestees, 2000 o Appendix Table 2-3: Demographics and Sociodemographics of Adult Male Arrestees at Risk for Drug Dependence, by Site, 2000 o Appendix Table 2-4: Adult Male Arrestees Who Ever Received Drug or Alcohol Treatment, By Selected Drugs, by Site, 2000 o Appendix Table 2-5: Demographics and Sociodemographics of Adult Male Arrestees Who Received Drug or Alcohol Treatment in Past Year, by Site, 2000 o Appendix Table 2-6: Adult Male Arrestees at Risk for Drug Dependence Who Received Treatment, by Site, 2000 Chapter 3 o Table 3-1: "Heavy" Alcohol Use-ADAM Definitions o Appendix Table 3-1: Binge Drinking in Past Year and Past Month, by Site-- Adult Male Arrestees, 2000 o Appendix Table 3-2a: Binge Drinking, Past Month, by Age and Race, by Site--Adult Male Arrestees, 2000 o Appendix Table 3-2b: Binge Drinking, Past Month, by Demographic and Sociodemographic Characteristics, by Site--Adult Male Arrestees, 2000 o Appendix Table 3-3: Binge Drinking, Past Month, by Level of Drinking, by Site--Adult Male Arrestees, 2000 o Appendix Table 3-4a: Adult Male Arrestees at Risk for Alcohol Dependence, Past Year, by Age Group by Site, 2000 o Appendix Table 3-4b: Adult Male Arrestees at Risk for Alcohol Dependence in Past Year, by Demographic and Sociodemographic Characteristics, by Site, 2000 o Appendix Table 3-5: Adult Male Arrestees at Risk for Alcohol Dependence, Past Month, by Level of Alcohol Consumption, by Site, 2000 o Appendix Table 3-6: Proportions of Adult Male Arrestees at Risk for Alcohol or Drug Dependence, by Age When Drinking Began, by Site, 2000 o Appendix Table 3-7: Drug Use in Past Month, by Level of Alcohol Use- Adult Male Arrestees, by Drug by Site, 2000 Chapter 4 o Table 4-1: Method of Contacting Dealer to Obtain Selected Drugs on Cash and Noncash Basis--Averages Among Sites--Adult Male Arrestees, 2000 o Table 4-2: Reasons Attempts to Purchase Drugs Failed--Averages Among Sites--Adult Male Arrestees, 2000 o Table 4-3: Cash and Noncash Transactions, Most Active Drug Market Sites--Adult Male Arrestees, 2000 o Table 4-4: Number of Times Per Day Arrestees Obtained Drugs, Most Active Drug Market Sites--Adult Male Arrestees, 2000 o Table 4-5: Number of Days in Past Month When Arrestees Obtained Drugs, Most Active Drug Market Sites--Adult Male Arrestees, 2000 o Table 4-6: Number of Drug Transactions Per Month, Most Active Drug Market Sites--Adult Male Arrestees, 2000 o Table 4-7: Percentage of Arrestees Who Generated More Than Half the Drug Transactions, Most Active Drug Market Sites--Adult Male Arrestees, 2000 o Table 4-8: Market Size (in Dollars) of Past-month Cash-only Transactions, Most Active Drug Market Sites--Adult Male Arrestees, 2000 o Appendix Table 4-1: Drug Market Participation in Past 30 Days, by Drug by Site-Adult Male Arrestees, 2000 o Appendix Table 4-2: Drug Transaction Type (Cash, Noncash, or Combination), by Drug by Site--Adult Male Arrestees, 2000 o Appendix Table 4-3: Methods of Obtaining Drugs by Noncash Transactions, by Drug by Site-Adult Male Arrestees, 2000 o Appendix Table 4-4: Methods of Contacting Dealer to Obtain Marijuana, by Site-Adult Male Arrestees, 2000 o Appendix Table 4-5: Methods of Contacting Dealer to Obtain Crack Cocaine, by Site-Adult Male Arrestees, 2000 o Appendix Table 4-6: Methods of Contacting Dealer to Obtain Powder Cocaine, by Site-Adult Male Arrestees, 2000 o Appendix Table 4-7: Contacts with Multiple Drug Dealers for Cash Purchases, by Drug by Site-Adult Male Arrestees, 2000 o Appendix Table 4-8: Regularity of Relationship with Drug Dealer for Cash Purchase, by Drug by Site-Adult Male Arrestees, 2000 o Appendix Table 4-9: Use of Couriers/"Go-Betweens" for Cash Purchases, by Drug by Site-Adult Male Arrestees, 2000 o Appendix Table 4-10: Outdoor Drug Purchases, by Drug by Site-Adult Male Arrestees, 2000 o Appendix Table 4-11: Outside-Neighborhood Drug Purchases, by Drug by Site-Adult Male Arrestees, 2000 o Appendix Table 4-12: Failed Drug Purchases, by Drug by Site-Adult Male Arrestees, 2000 o Appendix Table 4-13: Reasons Attempts to Purchase Drugs Failed, by Drug by Site-Adult Male Arrestees, 2000 Chapter 5 o Table 5-1: Average Age of Adult Female Arrestees, by Site, 2000 o Table 5-2: Drug Transaction Types (Cash and Other) for Marijuana and Crack Cocaine, by Selected Sites--Adult Female Arrestees, 2000 o Table 5-3: Outdoor Cash Purchases of Marijuana and Crack Cocaine, by Selected Sites--Adult Female Arrestees, 2000 o Table 5-4: Outside-Neighborhood Cash Purchases of Marijuana and Crack Cocaine, by Selected Sites--Adult Female Arrestees, 2000 o Table 5-5: Failed Cash Purchases of Marijuana and Crack Cocaine, by Selected Sites--Adult Female Arrestees, 2000 o Appendix Table 5-1: Sample Size--Adult Female Arrestees, 2000 o Appendix Table 5-2: Drug Test Results, by Drug by Site-Adult Female Arrestees, 2000 o Appendix Table 5-3a: Drug Test Results for NIDA-5 Drugs and Cocaine, by Age by Site--Adult Female Arrestees, 2000 o Appendix Table 5-3b: Drug Test Results for Marijuana and Opiates, by Age by Site--Adult Female Arrestees, 2000 o Appendix Table 5-3c: Drug Test Results for Methamphetamine and PCP, by Age by Site--Adult Female Arrestees, 2000 o Appendix Table 5-3d: Drug Test Results for Multiple NIDA-5 Drugs, by Age by Site--Adult Female Arrestees, 2000 o Appendix Table 5-4a: Drug Test Results--Adult Females Arrested for Violent Offenses, by Drug by Site, 2000 o Appendix Table 5-4b: Drug Test Results--Adult Females Arrested for Drug and Alcohol Offenses, by Drug by Site, 2000 o Appendix Table 5-4c: Drug Test Results--Adult Females Arrested for Property Offenses, by Drug by Site, 2000 o Appendix Table 5-4d: Drug Test Results--Adult Females Arrested for Driving While Intoxicated, by Drug by Site, 2000 o Appendix Table 5-4e: Drug Test Results--Adult Females Arrested for Domestic Violence Offenses, by Drug by Site, 2000 o Appendix Table 5-4f: Drug Test Results--Adult Females Arrested for "Other" Offenses, by Drug by Site, 2000 o Appendix Table 5-5a: Drug Test Results by Race/Ethnicity by Drug by Site-- Adult Female Arrestees, 2000 (Whites and Blacks) o Appendix Table 5-5b: Drug Test Results by Race/Ethnicity by Drug by Site-- Adult Female Arrestees, 2000 (Hispanics and "Other") o Appendix Table 5-6: Age and Race/Ethnicity, by Site--Adult Female Arrestees, 2000 o Appendix Table 5-7: Demographics and Sociodemographics, by Site--Adult Female Arrestees, 2000 o Appendix Table 5-8: Drug Use, Past 12 Months and Past 30 Days, by Drug by Site--Adult Female Arrestees, 2000 o Appendix Table 5-9: Extent of Heavy Drinking, by Site--Adult Female Arrestees, 2000 o Appendix Table 5-10: Need for Treatment, as Measured by Risk for Dependence and Injection Drug Use, by Site--Adult Female Arrestees, 2000 o Appendix Table 5-11: Treatment for Drugs, Alcohol, or Mental Health Problems, by Site--Adult Female Arrestees, 2000 o Appendix Table 5-12a: Treatment for Drugs and Mental Health Problems Among Adult Female Arrestees Who Used Cocaine, by Type of Treatment by Site, 2000 o Appendix Table 5-12b: Treatment for Drugs and Mental Health Problems Among Adult Female Arrestees Who Used Marijuana or Heroin, by Type of Treatment by Site, 2000 o Appendix Table 5-12c: Treatment for Drugs and Mental Health Problems Among Adult Female Arrestees Who Used Methamphetamine, by Type of Treatment by Site, 2000 o Appendix Table 5-13: Drug Market Participation in Past 30 Days, by Drug by Site--Adult Female Arrestees, 2000 o Appendix Table 5-14a: Methods of Obtaining Marijuana by Noncash Means, Selected Sites--Adult Female Arrestees, 2000 o Appendix Table 5-14b: Methods of Obtaining Crack Cocaine by Noncash Means, Selected Sites--Adult Female Arrestees, 2000 o Appendix Table 5-15a: Reasons Attempts to Purchase Marijuana Failed, Selected Sites--Adult Female Arrestees, 2000 o Appendix Table 5-15b: Reasons Attempts to Purchase Crack Cocaine Failed, Selected Sites--Adult Female Arrestees, 2000 Chapter 6 o Table 6-1: ADAM Sites Where Juvenile Detainees Participated--2000 o Table 6-2: Drug Test Results, by Drug by Site--Juvenile Male Arrestees, 2000 o Table 6-3: Drug Test Results, by Drug by Site--Juvenile Female Arrestees, 2000 Chapter 8 o Table 8-1: Self-Reported Crack Use, Selected Sites, by Calendar Period-- Adult Male Arrestees, 2000 o Table 8-2: Arrest Rates in Past 12 Months, Selected Sites--Adult Male Arrestees, 2000 o Table 8-3: Adult Male Arrestees Not Included in Other Measures of Drug Use and Related Behavior, Selected Sites, 2000 Chapter 9 o Table 9-1: Estimated Number of Hardcore Drug Users in the ADAM Sites-- Adult Male Arrestees, 2000 Exhibits Chapter 2 o Exhibit 2-1: Percentages of Drug-using Adult Male Arrestees at Risk for Dependence in Past Year, by Drug, 2000 o Exhibit 2-2: Participation by Drug-using Adult Male Arrestees in Drug or Alcohol Treatment or Mental Health Treatment--Ranges Among the Sites, 2000 o Exhibit 2-3: Percentages of Drug-using Adult Male Arrestees Who Ever Received Inpatient Drug or Alcohol Treatment, by Drug--Ranges Among the Sites, 2000 o Exhibit 2-4: Percentages of Drug-using Adult Male Arrestees Who Ever Received Outpatient Drug or Alcohol Treatment, by Drug--Ranges Among the Sites, 2000 o Exhibit 2-5: Hispanic Adult Male Arrestees: Percentages at Risk for Drug Dependence and Percentages with Health Insurance, Past 12 Months, Selected Sites, 2000 o Exhibit 2-6: Percentages of Drug-using Adult Male Arrestees Who Received Drug or Alcohol Treatment, Past 12 Months, by Race, Selected Sites, 2000 o Exhibit 2-7: Percentages Who Lack Health Insurance: Drug-dependent and Drug-using Adult Male Arrestees and All Adult Male Arrestees, Selected Sites, 2000 Chapter 3 o Exhibit 3-1: Binge Drinking in Past Month Among Homeless and Nonhomeless Adult Male Arrestees, by Site, 2000 o Exhibit 3-2: Levels of Heavy Alcohol Use, Past Month--Ranges Among the Sites--Adult Male Arrestees, 2000 Chapter 4 o Exhibit 4-1: Extent of Drug Market Participation in the Past Month, by Selected Drugs-Ranges Among the Sites--Adult Male Arrestees, 2000 o Exhibit 4-2: Drug Transaction Types (Cash and Other), by Selected Drugs-- Ranges Among the Sites--Adult Male Arrestees, 2000 o Exhibit 4-3: Noncash Drug Transactions Involving Gifts, by Selected Drugs-- Ranges Among the Sites--Adult Male Arrestees, 2000 o Exhibit 4-4: Use of Two or More Drug Dealers to Make Cash Purchases, by Selected Drugs--Ranges Among the Sites--Adult Male Arrestees, 2000 o Exhibit 4-5: Most Recent Cash Purchase of Drugs from a Regular Source (Dealer), by Selected Drugs--Ranges Among the Sites--Adult Male Arrestees, 2000 o Exhibit 4-6: Outdoor Purchases of Drugs-Ranges Among the Sites, by Selected Drugs--Adult Male Arrestees, 2000 o Exhibit 4-7: Drug Purchases Made Outside the Neighborhood, by Selected Drugs--Ranges Among the Sites--Adult Male Arrestees, 2000 o Exhibit 4-8: Failed Purchases, by Selected Drugs--Ranges Among the Sites-- Adult Male Arrestees, 2000 Chapter 5 o Exhibit 5-1: Drug Test Results--Ranges Among the Sites--Adult Female Arrestees, 2000 o Exhibit 5-2: Extent of Drug Market Participation in the Past Month, by Selected Drugs--Ranges Among the Sites--Adult Female Arrestees, 2000 Chapter 8 o Exhibit 8-1: Annual Rates of Arrest, by Selected Drugs, by Selected Sites-- Adult Male Arrestees, 2000 o Exhibit 8-2: Percentages of Adult Male Arrestees Who Used Heroin or Cocaine in Past Year, by Level of Use, New York--Adult Male Arrestees, 2000 o Exhibit 8-3: Patterns of Heroin Use for 3 Adult Male Arrestees in Year Before Arrest, New York--2000 o Exhibit 8-4: Heroin Use by "User B" in Context of Treatment and Involvement in Criminal Justice System, New York--ADAM Data, 2000 Chapter 9 o Exhibit 9-1: Hardcore Drug Users Are Assumed to All Have the Same Arrest Rate o Exhibit 9-2: The Estimate Requires Creating a Model of the Arrest Process o Exhibit 9-3: The Basic Logic of the Estimation Model Illustrated o Exhibit 9-4: Introducing Measured Heterogeneity into the Estimation o Exhibit 9-5: Changing the Calculation to Accommodate Measured Heterogeneity o Exhibit 9-6: Introducing Unmeasured Heterogeneity into the Estimation o Exhibit 9-7: Average Annual Arrest Rate of Hardcore Drug Users in a County o Exhibit 9-8: Hardcore Users in the Community Per Hardcore User in the Booking Population ---------------------------- Executive Summary When the National Institute of Justice (NIJ) established the Drug Use Forecasting (DUF) program in 1988, it was the first time an objective drug testing method would be routinely used to assess the validity of self-reported drug use among people charged with crime. DUF demonstrated that it is possible to conduct research on drug use among arrestees in the jail setting, and for many years the program provided information to policymakers and practitioners about drug use in the at-risk population of arrestees. Evaluations of DUF led NIJ to decide to strengthen the program by making the sampling procedure more scientifically sound, standardizing data collection, and instituting other changes. After several years of development and testing, the restructured program was fully implemented in 2000 as Arrestee Drug Abuse Monitoring (ADAM). Probability-based sampling was adopted, the interview instrument (questionnaire) was enhanced to cover several new areas of drug use and related behavior, and the number of sites was increased. The 2000 annual report reflects these changes. That means it departs from previous years' reports in some ways. As in the past, it presents information about arrestees' drug use, both overall and site by site. This year the report also features a series of chapters that examine in depth some of the new topics that are now a routine part of the questionnaire. The emphasis is on adult male arrestees, because probability-based sampling is currently used only for this population. As in the past, the report includes a summary table of data from each site, but this year the tables also show risk for drug and alcohol dependence, admissions to treatment, and drug market participation. Another series of essays documents the new ADAM method and explores possible new ways to apply it. The "audiences" for ADAM data are the same as in the past. For policymakers, there is a broad overview of drug use among the population at risk for crime. For practitioners in the justice system who deal day-to-day with drug use and related crime, ADAM offers information useful for planning control strategies. Practitioners in the ADAM sites can compare the drug-use profile of their jurisdiction with that of other sites. For researchers, the ADAM data offer myriad possibilities for investigating the drug-crime link. Overall findings and ADAM redesign In 2000, drug use continued to be common among adult male arrestees, as in previous years. The ADAM redesign strengthens the reliability of the findings and makes it possible to explore new areas of drug use and related behavior. o In half the 35 ADAM sites, urinalysis indicated that 64 percent or more of adult male arrestees had recently used at least one of five drugs: cocaine (undistinguished between crack and powder), marijuana, opiates, methamphetamine, or PCP (phencyclidine). Marijuana was the drug most commonly used, followed by cocaine. o The transition from DUF to ADAM in 2000 completed a major redesign of the program. One component of the redesign included enhancing the data collection instrument (the interview questionnaire) to ask about alcohol use, risk for dependence on drugs and alcohol, substance abuse treatment, and drug market participation, including how and where drugs are obtained. The number of sites in the ADAM program increased from 23 to 35 (including two "affiliated" sites1). Arguably the most important change was the adoption, at all ADAM sites, of probability-based sampling for selecting adult male arrestees. Drug dependence and treatment As part of the redesigned program, adult male arrestees' risk for dependence on drugs is measured, and they are asked about their experiences with treatment. o Between about one-fourth and one-half of all adult male arrestees in the ADAM sites were found to have been at risk for dependence on drugs. o Although a large percentage of adult male arrestees had not only used drugs but also were at risk for drug dependence, few had received treatment. Among the ADAM sites, the range in the proportions who said they were treated on an inpatient basis in the year before their arrest for either drugs or alcohol was 4 percent to 17 percent, and the range of those who had received outpatient treatment was 2 percent to 15 percent. o With few exceptions, adult male arrestees who were treated for drug or alcohol use in the year before their arrest were more likely than not to have no health insurance. Alcohol use and alcohol dependence Alcohol abuse can be associated with behavioral problems, including crime. ADAM asks adult male arrestees about their use of alcohol and measures their risk for dependence on it. o Adult male arrestees drank heavily. Among the sites, the proportions who had five or more drinks on at least one occasion in the month before their arrest ranged from a low of 35 percent to a high of 70 percent. Drinking at the level defined as "heaviest" was not uncommon: The proportions who had five or more drinks on one occasion on 13 or more days in the month before their arrest ranged from 10 percent to 24 percent. o Risk for alcohol dependence was measured by a special set of questions, or "screen." By this measure, more than four in five of the "heaviest" drinkers were at risk. In half the sites, 85 percent or more were at risk, with the range among the sites 67 percent to 91 percent. o The heaviest drinkers were also likely to have used illicit drugs. On average, 71 percent of them had used at least one drug in the month before their arrest. Drug markets The ADAM redesign makes it possible to obtain information about drug markets from a large number of buyers at the local level in many sites nationwide. Adult male arrestees were asked about the extent of their participation in drug markets, how and where they acquired drugs, what difficulties they encountered trying to do so, how often they obtained drugs, and the dollar value of the drugs. o In the 23 sites analyzed,[2] the market for marijuana was the largest, as measured by percentage of adult male arrestees who participated. Much smaller percentages participated in the markets for crack cocaine, powder cocaine, heroin, and methamphetamine. o Many arrestees participated in one or more drug markets. The majority reported little difficulty completing a drug transaction, saying such obstacles as police activity and lack of drug availability were not a problem. o Fairly large proportions of adult male arrestees did not rely solely on cash to obtain drugs, whether marijuana, crack cocaine, or powder cocaine. These noncash exchanges most commonly took place at a social setting or at work. In many sites, when arrestees paid cash for marijuana, the most common method of obtaining it was by using a phone or pager, and for crack cocaine it was by approaching a dealer in a public place. o In four high-volume sites (Miami, Phoenix, Seattle, and Tucson), the number of transactions in the crack market was much larger than in the powder cocaine and marijuana markets. In these sites, the estimated size (measured in dollars) of the crack cocaine market in a 30-day period was 2 to 10 times larger than the size of the powder cocaine and marijuana markets. The range among these sites in the market size of crack cocaine was about $226,000 to $1,400,000. Drug use among adult female arrestees Although only about one in five people arrested in the United States is a woman, and the proportion of women who commit drug offenses is even smaller, the number of women charged with drug offenses is not inconsequential. Research on women's involvement in drugs has been relatively limited, but the ADAM redesign offers the opportunity to expand research on their drug use and drug-related behavior.[3] o As in previous years, urinalysis revealed that a large percentage of women arrestees had used drugs. Cocaine was the drug for which the proportion testing positive was highest, with marijuana coming in second. o Of the women arrestees who used drugs or alcohol, about half were found at risk for drug dependence. o Only very small percentages of women arrestees had been treated for drug or alcohol use the year before their arrest. The average among the sites was 11 percent. Drug use among juvenile detainees Data on drug use were collected from male and female juvenile detainees in 8 of the 35 ADAM sites (Birmingham, Denver, Los Angeles, Phoenix, Portland, San Antonio, San Diego, and Tucson). Data were also gathered in Cleveland, but for juvenile male detainees only. The samples were not probability-based, nor were the interviews conducted with the expanded ADAM questionnaire.[4] o Juveniles were more likely to test positive by urinalysis for marijuana than any other drug. o Cocaine came in a distant second; the percentages testing positive for methamphetamine were also low. Implementing the new ADAM study design at the local level Implementing the new, probability-based ADAM study design involved adopting standardized data collection procedures among 35 sites. This entailed redefining the catchment areas (the area from which arrestees are drawn to participate in the program) to make them uniform among the sites, and designing sampling plans at the county level and the level of each facility to ensure that all arrestees have some probability of being included among those participating in the program. o In DUF, the definition of the catchment area varied from site to site, and often consisted of a single jail. In ADAM the catchment area was redefined as the county for all sites. o Data collection was redesigned to account for variations among the sites in the structure and size of local criminal justice systems and processes. The county-level sampling model adopted was flexible enough to be applied to the specific counties/sites. o The transition from DUF to ADAM showed that standardized protocols and probability- based sampling can be implemented in the dynamic environment of the jail. o Within one year of introducing the new sampling method, almost all the ADAM sites had successfully implemented it. That means they can now develop reliable prevalence estimates for a variety of drug-related issues, including the proportions of arrestees who test positive for drugs and those who need treatment. "Calendaring" in ADAM: examining annual patterns of drug use and related behavior A new feature in the ADAM interview instrument in 2000 is "calendaring," which permits analysis of drug use and related behavior for the period of a full year. Through memory aids built into the questionnaire, arrestees' behavior is examined month by month for the entire 12-month period of the survey. The technique can increase accuracy in arrestees' recall of drug use and related behavior. o Data from selected sites, when broken down by different periods of time in the year, demonstrated that recent drug use is not always a good measure of longer-term, more typical use. o The annual rates of arrest for individual arrestees can vary by type of drug used. o The ADAM redesign permits the data to be "crosswalked" with other annually conducted national surveys of drug use and related behavior. Analysis indicates that some of these surveys do not cover the subpopulation reached by ADAM. o The proportions of arrestees who used heroin and cocaine at least 15 days a month in every month of the year were higher than the proportions who used them less frequently (for example 1 to 7 days a month in each month). Estimating hardcore drug use in the community ADAM is developing a method that can be used to estimate the prevalence of hardcore drug use in the sites. Made possible by the adoption of probability-based sampling, the method infers prevalence in the community from the count of adult male hardcore users who are arrested and booked at the ADAM sites. Arrest rates are therefore key to the calculations. o Preliminary estimates indicate that, in most ADAM sites, there are 750 arrests and bookings a year for every 1,000 hardcore drug users and that the number of hardcore users ranges from just over 1,500 (Minneapolis) to almost 126,000 (New York). For sites where sampling takes place in several jail facilities, the numbers are likely underrepresentations, by perhaps as much as half. o Once the method has been refined, the ADAM sites should be able to use it to make their own calculations. Notes 1. ADAM's two affiliated sites--so called because they are funded by sources other than NIJ--are Charlotte/Mecklenburg County, North Carolina, and Albany/New York Capital Area. 2. This analysis was confined to the 23 sites where the markets for all three heavily used drugs--marijuana, crack cocaine, and powder cocaine--were most active. 3. Because the number of women arrested is much lower than the number of men, fewer are available for participation in ADAM. Some ADAM sites do not include women arrestees. The expanded ADAM questionnaire was used to interview the women arrestees, but probability-based sampling does not yet include them. 4. Juvenile detainees are interviewed with the DUF instrument (questionnaire), but the program is considering designing a new interview instrument for them, to collect information about drug treatment and participation in drug markets. ---------------------------- Part I: Drug Use and Related Behavior: Findings I. Overall Findings and ADAM Redesign With this year's annual report, the transition from the Drug Use Forecasting (DUF) program to the Arrestee Drug Abuse Monitoring (ADAM) program is complete. The findings reported here are from the redesigned ADAM program. ADAM was changed to make it more scientifically rigorous and to generate more information. In 2000 the changes were fully implemented. The goal is the same as before: to track drug use and related behavior among arrestees in many of the Nation's largest cities. ADAM remains the only program that does so by using urinalysis as an objective and accurate measure. The transition to ADAM involved major changes. To select participating adult males, probability-based sampling was adopted, and all ADAM sites now use standardized procedures to collect data. Several new topics were added to the questionnaire, and although that was done before on an ad hoc basis, these new areas of inquiry will continue. Finally, the number of sites is now 38, up from 23. The changes make this annual report different from those of previous years. As in the past, the report updates findings on arrestees' use of drugs, but this year it also explains how the new ADAM method was used to analyze the 2000 data, and in a series of essays the report examines some of the new topics (Part I). Information about arrestee drug use is presented site by site, as in previous annual reports (Part II). Another set of essays documents the new ADAM method and explores possible further ways to use it (Part III). If ADAM has changed dramatically, the "audiences" remain the same. For policymakers, ADAM offers a broad overview of drug use by people at risk for crime. For the police and other criminal justice practitioners at the individual sites who deal with drug use on a day-to-day basis, ADAM offers data useful for planning control strategies; and they can compare their site with the others. For researchers, ADAM offers a wealth of topics for investigating the drug-crime link. Extent of drug use as detected by urinalysis As in previous years, the levels of drug use detected were high. The urinalysis test used in ADAM can identify any of 10 substances, but the analysis focuses on the "NIDA-5" drugs (cocaine, opiates, marijuana, methamphetamine, and PCP).[1] (See "ADAM Drug Testing--the Procedure, the Drugs" for details of these drugs.) In half the ADAM sites that reported data, 64 percent or more of the adult male arrestees[2] had recently used at least one of these drugs. Use ranged from 52 percent of arrestees (Anchorage) to 80 percent (New York) (See Appendix Table 1-1.) For each drug there were major variations among the sites and regions. These are explored here. In each site there were also distinctive patterns, examined in the section profiling the sites. An analysis that combined data from many regions of the country into a nationwide picture of drug use by arrestees would mask these differences. The differences revealed by ADAM suggest a one-size-fits-all approach to controlling drug use may not be the optimal one, and policies and strategies for enforcement and treatment are best tailored to specific user groups and locations. Of the 10 drugs analyzed by ADAM through urinalysis, four--cocaine (both crack and powder), marijuana, methamphetamine, and opiates (heroin, for example)--were the ones used most often by adult male arrestees in most sites. Of these, marijuana was most commonly used, followed by cocaine, opiates, and methamphetamine, in that order. In half the sites at least 40 percent of the adult male arrestees tested positive for marijuana. Use was lowest in Laredo (29 percent testing positive), with Oklahoma City at the top of the range (57 percent testing positive). Large percentages of adult male arrestees recently used cocaine (undistinguished here between crack and powder). In half the sites, at least 31 percent tested positive, with the range between 11 percent (Des Moines) and 49 percent (Atlanta and New York). Many sites where the proportions testing positive for cocaine were relatively low (under 20 percent) were on the West Coast and in the Pacific Northwest. These include Sacramento and Salt Lake City (both 18 percent), Honolulu (16 percent), Spokane and San Diego (both 15 percent), and San Jose (12 percent). For methamphetamine, the West is where the proportions of adult male arrestees who used this drug were highest. In several Midwestern States as well, substantial proportions of arrestees tested positive for this substance. Confirmatory urinalyses[3] indicated the highest methamphetamine use (20 percent or more of adult male arrestees) was in Honolulu (36 percent), Sacramento (29 percent), San Diego (26 percent), San Jose (22 percent), Portland (21 percent), and Spokane (20 percent). Double-digit rates also showed up in Phoenix and Des Moines (both 19 percent), Las Vegas (18 percent), Salt Lake City (17 percent), and Oklahoma City and Omaha (both 11 percent). In some sites, urinalysis indicated no recent methamphetamine use. These sites, 8 in number, are largely in the eastern part of the country (Albany/New York Capital Area, Chicago, Detroit, Fort Lauderdale, Laredo, Miami, New York, and Philadelphia). In nine other sites, only between one-tenth of 1 percent and 1 percent of adult male arrestees tested positive. These two groups of sites, 17 in all, where 1 percent or fewer arrestees tested positive for methamphetamine, lower the median for all the sites.[4] Although that midpoint is only 2 percent (in half the sites, 2 percent or fewer tested positive), it does not obscure the fact that in 12 sites more than 10 percent of the arrestees were positive for methamphetamine. Only in a few sites were opiates used extensively. In most sites, few adult male arrestees tested positive for these substances (in half the sites, the proportion was 7 percent or fewer). The range was 2 percent of arrestees (Charlotte-Metro, Fort Lauderdale, and Omaha) to 27 percent (Chicago). In addition to Chicago, sites with double-digit opiate-positive rates were New York (21 percent), New Orleans (16 percent), Portland (14 percent), Philadelphia and Albuquerque (both 12 percent), and Birmingham, San Antonio, Laredo, and Seattle (each 10 percent). This distribution suggests no geographic pattern. PCP was used by only a small percentage of arrestees in most of the sites (in half the sites, the proportion who used it was 0.3 percent or less). This low rate is consistent with the findings of earlier DUF and ADAM reports. In only two sites in 2000 did 5 percent or more of the adult male arrestees test positive for PCP (Cleveland, 8 percent, and Oklahoma City, 5 percent), and in 12 sites no arrestees tested positive. Most adult male arrestees tested positive for only one of the five drugs. In half the sites, 21 percent or more tested positive for polydrug use, with the sites ranging from 10 percent of arrestees (Anchorage and Albany) to 34 percent (Chicago). For polydrug use the evidence should be interpreted cautiously, because the test detects only recent use. Studies have consistently shown past year or past month polydrug use the norm,[5] with users substituting one drug for another when the drug of choice is scarce, or mixing drugs to counter or moderate the effects of one or the other. The ADAM interviews can add to the information from urinalysis and reveal whether arrestees are using different types of drugs in the period of a month[6] or a year (and how frequently they are used). The new ADAM method The redesigned ADAM program provides better estimates of drug use and related behavior than it did previously.[7] Data collection is now based on probability sampling. The sample of arrestees at any site is selected in such a way that the findings become an accurate estimate of the proportion of all arrestees in the county who would test positive for drugs had all of them been interviewed and tested. This also means data for use in research projects at each site are stronger. And because the sites will be able to place the numbers within confidence intervals, trend analysis (year-to-year comparisons) will be more reliable and more easily interpreted than in the past. The year 2000 was the first time these probability-based samples were obtained for adult male arrestees. Some sites were unable to implement the new procedures as quickly and effectively as others. But at most ADAM sites, beginning in 2000, the data collected constituted statistically reliable estimates of the proportion of all male arrestees in the area who had used drugs within a specified time period. Plans are to develop probability-based sampling plans for female arrestees as well. Ensuring a representative sample The new sampling procedure ensures a representativeness not possible under the DUF program and during the first years of the ADAM program.[8] In each city, data were generally collected at only one lockup facility--the largest--and interviews were conducted with volunteers who had been arrested no more than 48 hours previously. DUF and ADAM staff tried to gain access to the facilities at times during the day when there was a large number of arrests, though these times varied considerably from site to site. As a result, the representativeness of the time period of data collection and of the resultant sample was unknown, and standard errors for the samples could not be calculated. With the introduction of probability sampling in 2000, which refined the procedures for when and where data collection would take place, ADAM gained greater scientific rigor in estimating drug use. Sample sizes and weighting The findings reported here come from 35 of the 38 ADAM sites--those able to collect data during at least one calendar quarter in 2000. In general, the ADAM sites are very successful in convincing arrestees to participate. That was true in 2000, when at least 81 percent of adult male arrestees in half the sites agreed to be interviewed (Appendix Table 1-2). The refusal rate ranged from a low of 6 percent (Fort Lauderdale) to a high of 40 percent (Charlotte-Metro area). The vast majority of arrestees interviewed also agreed to provide a urine specimen for analysis. In half the sites, 89 percent or more agreed, with a low of 75 percent (Albany) to a high of 98 percent (Oklahoma City). (See Appendix Table 1-2.) In half the sites, 600 or more interviews were "complete" (that is, an interview was conducted and a urine sample obtained), with the range from 109 (Charlotte-Metro area) to 1,534 (Phoenix). A number of factors contributed to the variation in sample size (See "Why Sample Sizes Vary from Site to Site--and the Implications"), and when numbers were very small, they were not used in some analyses presented here. The number of adult male arrestees selected for inclusion in the sample averaged close to 300 per calendar quarter for each site. On the whole, these samples (the unweighted data) were more than adequate to allow data analysis and a reasonable interpretation of the results. With the adoption of probability-based sampling, the numbers can be converted by weighting to represent all arrestees in a given county/site--many more than in the original sample. The 2000 sample, when weighted, represents a large number of arrestees, from 921 in Laredo, Texas, to 18,037 in New York City. In more than half the sites the weighted sample size is more than 4,000. (See Table 1-1.) Refining the catchment area-where data are collected ADAM sites are typically named for the largest city in an area (the "primary city"). However, in most sites the catchment area has been redefined by ADAM to encompass a substantially larger geographic area than the urban center. The standard catchment area--the geographic region from which samples are drawn--is now the county in all the sites. The organization of booking facilities (jails), where arrestees are interviewed for the ADAM program, varies considerably by county. Some have a single, large facility where arrestees are brought by both city and county law enforcement agencies. Others have numerous smaller jails throughout the county. Generally, however, the jurisdictional reach of law enforcement agencies does not extend beyond county lines. Defining the sites by the county where a major metropolitan center is located (but does not necessarily encompass) means the primary unit of analysis for ADAM coincides with the standard government jurisdiction in which law enforcement's jurisdiction is generally defined. There are now 38 sites in 26 States and the District of Columbia. How the samples are now selected The sampling "frame" for ADAM data collection is now the total number of adult males arrested in a county in a two-week period, regardless of charge. The probability-based sampling has two stages: drawing samples of booking facilities and, within the facilities, drawing samples of arrestees. To allocate ADAM resources efficiently, a sampling simulation exercise is initially used to choose the optimal sampling design, select the booking facilities to be sampled, and distribute interviewer resources in each site. The overall goal of the design is to minimize the standard error of estimates for each site while recognizing the real-world constraints within which the program operates. The precision of estimates varies somewhat from site to site; it may be lower in some site where more than one facility is included. The specific goal is to generate estimates of drug use and related behavior that have no more than a .05 standard error overall for all sites. Selecting the booking facilities. In the first stage, a sample of booking facilities is drawn at each site from all facilities where people are arrested. The method of selection varies by site, depending on the number of facilities in the county and the number of arrestees booked into each. For sites that have only one booking facility, all cases are drawn from it. Sites with a small number of facilities (2 to 5) are stratified by size, and cases are sampled proportionate to the size of the facility. For sites having many facilities, the facilities are clustered, principally by size, and those in each cluster are sampled proportionate to size. In a few counties, a more complex sampling model that recognizes movement of arrestees within the county is required.[9] Selecting the arrestees. Once the facilities are selected, the second step is to draw a sample of arrestees from each. The sampling method in every facility is the same. An attempt is made to select cases systematically. Some arrestees are selected during the time of day when the volume of arrestees ("arrestee flow) is highest. In order to include a sample of arrestees booked when interviewers are not on site ("arrestee stock"), others are randomly selected during the rest of each 24-hour period. Arrestees who cannot be interviewed because they were released early are represented through statistical imputation. Sites are given a target number of interviews to complete each calendar quarter. It is based on an assumption of the number of interviews completed by one interviewer who works a regular shift each day of the week for a 1- or 2-week period. The probability of selection and the assignment of case weights are calculated by examining data on all arrestees booked at each facility in the two-week arrest/interview period. The new interview instrument The interview is a key component of the ADAM program--the source of information that cannot be obtained from official records or urinalyses. The interview process itself remains the same as in the past. Interviews are conducted among arrestees who volunteer to participate, and the process conforms to stringent Federal confidentiality regulations. Privacy is ensured because these regulations prohibit linking the interview to the arrestee's name and using the information for or against the arrestee during booking or adjudication. No record is kept of arrestees' names or other personal identifiers. Only a common ID number is assigned to the interview form and the urine specimen container so that these data can be linked. The interview-process and administration As in the past, interviews are conducted four times a year among male and female adult arrestees and juvenile detainees who have been in a booking facility less than 48 hours. They take place typically during a 4- to 8-hour period every day for one to two weeks. At each site, data collection proceeds on a staggered schedule, with collection periods for any single population (males, females, or juveniles) generally lasting one to two consecutive weeks. In most sites, more than 80 percent of the people asked to be interviewed agree. At each site, data collection is managed by a local team that includes a site director and site coordinator.[10] A pool of interviewers administers the interviews and collects the urine specimens. All interviewers must successfully complete a 3-day training course. At all sites, local data collection staff are trained in interview techniques and in administering the ADAM interview instrument. The same, standardized training materials are used at all sites. Training is conducted just before data collection so that new skills can be applied immediately to field conditions and so that interviewers can be observed by the trainers. All interviewers also must take enhancement training every quarter. The new design From 1987, the year the DUF program was established, through 1999, a relatively limited amount of information could be obtained during the interviews. It included the types of drugs arrestees used, arrestees' perceived dependence on drugs, and arrestees' perceived need for alcohol or drug treatment or both. Because the offense was known, the relationship between type of offense and drug use could be analyzed. Demographic and related information were also obtained during the interview. As part of the ADAM redesign, the interview instrument (questionnaire) has been enhanced significantly and a great deal more information is collected. The newly designed instrument, which takes about 10 minutes longer than previously (approximately 25 minutes) to administer, preserves the key measures of drug use and thus ensures comparability of data from year to year. The new features extend the usefulness of the information obtained: o Greater focus on the NIDA-5 drugs and patterns of use in the year before the arrestees were interviewed. o A screen for identifying arrestees' risk for drug dependence and clinically defined drug "abuse." o Questions about arrestees' participation in inpatient and outpatient drug and alcohol treatment and mental health treatment. o Questions about arrest history. o Questions about drug acquisition and recent use patterns. The latter feature offers insights into the dynamics of not only drug markets but also drug use and drug sharing. The new instrument is structured to permit crosswalks to other national datasets on drug use, such as the National Household Survey on Drug Abuse (NHSDA), the Treatment Episode Data Set (TEDS), the System to Retrieve Information from Drug Evidence (STRIDE), and the Uniform Crime Reports (UCR). All data are available for use by anyone who has a bona fide research project. (See "Availability of 'Raw' ADAM Data.") Notes 1. The ten drugs for which arrestees are tested in the ADAM program are cocaine, opiates, marijuana, methamphetamine, phencyclidine (PCP), methadone, benzodiazepines, methaqualone, propoxyphene, and barbiturates. The first five are the "NIDA-5," established as a standard panel of commonly used illegal drugs by the National Institute on Drug Abuse. 2. An adult is defined here as anyone brought to an adult lockup facility. 3. Urinalysis can detect drugs in the amphetamine group, but only a confirmatory test indicates whether the drug is methamphetamine. The confirmation is also necessary because several cold and diet medications contain amphetamines, which would produce false positives. 4. Unless indicated otherwise, all averages are expressed as medians. 5. U.S. Department of Health and Human Services, Office of Applied Studies, SAMSHA, National Household Survey on Drug Abuse--Main Findings, Washington, DC: 1998. 6. Throughout this report, "past month" and "past 30 days" are used interchangeably to refer to the 30 days before the arrestees were interviewed. 7. See Chapter 7 for an in-depth discussion of the ADAM redesign. 8. A detailed discussion of the method used to collect ADAM data is in Methodology Guide for ADAM, by D. Hunt and W. Rhodes. Prepared by Abt Associates Inc. in May 2001, it can be downloaded from the ADAM Web page (http://www.adam-nij.net) on the NIJ Web site (http://www.ojp.usdoj.gov/nij). 9. For more details, see Methodology Guide for ADAM. 10. Accountability from all data collection sites is ensured by the contractor that manages ADAM for NIJ. The contractor provides centralized oversight for such matters as fiscal management, rigorously standardized data collection procedures, and minimum requirements for interviewers. ---------------------------- Why Sample Sizes Vary from Site to Site--and the Implications In general, this report presents findings from all the ADAM sites. Of the 38 sites, findings are reported from all those (35 in number) where data were collected in at least one calendar quarter of 2000. Although the new procedure ensures representativeness of the sample, its adoption introduced complexities that affect comparability of findings from site to site. The findings should be read with an understanding that some data are missing and that in some cases changes were made to increase the representativeness of what data were available. Sampling difficulties Although 24 of the 35 sites were able to collect data in all four quarters, others were not. Six sites collected data in three quarters, 3 sites collected data in two quarters, and 2 sites collected data in only one quarter. (See Appendix Table 1-2.) In some sites, not enough data from arrestee case flow were obtained to permit weighting and thus these sites did not report data in the quarters when this information was missing. Some sites collected information from different populations from quarter to quarter. Findings reported here have not been adjusted for the missing quarters of data. A site-by-site breakdown reveals the difficulties: o Minneapolis and Philadelphia: Because they began data collection in the second quarter of the year, they reported data for only three quarters. o Los Angeles: After several years of collecting data at the Los Angeles Police Department's main facility, this site lost access in 2000. The site staff spent the year re-establishing authorization. Therefore, this report does not contain information about Los Angeles. o Albuquerque: Staffing problems in the jail prevented this site from collecting data in the fourth quarter. o Dallas: Data are presented for only three quarters, because the site team went on hiatus status to resolve sampling difficulties. o Houston and Fort Lauderdale: In these sites, staffing changes on the site team reduced to two the number of quarters when data were collected. o Miami: Here, staffing changes reduced to three the number of quarters in which data were collected. o Albany and Charlotte-Metro area: These two sites became part of the ADAM program as "affiliates" and did not collect data in all four quarters. Albany began collection in the second quarter and Charlotte-Metro in the fourth quarter. A few other sites encountered major obstacles to obtaining the census data needed to weight their samples, which in turn limited the number of quarters weighted data were available: o Chicago and Detroit: Data collection took place at these sites for more than one quarter, but both sites could provide adequate census data for only one quarter. o Atlanta: At this site it was impossible to obtain census data for all facilities in the sample. The findings are from Fulton County only, although data were collected from both Fulton and DeKalb counties. Making the data more representative As a result of these difficulties, changes were made to increase the representativeness of the data. As the examples of Houston, Dallas, and New York illustrate, in some cases the changes were dramatic. o Houston: In the first quarter, data were collected at the jails operated by the Houston Police Department and in the second quarter at a jail operated by the Harris County Sheriff's Department. This meant the first-quarter data reflect people arrested within the Houston city limits, while the second-quarter data reflect people arrested throughout Harris County. o Dallas: Collection had taken place in the main county jail, expanding to other booking facilities only in the fourth quarter (after a hiatus in the third quarter). As a result, fourth-quarter data are more representative of all arrestees in Dallas County than are first- and second-quarter data. o New York: Data collection, which had taken place in all five boroughs in the first quarter, was reduced to one borough--Manhattan--for subsequent quarters because of difficulties in sampling and obtaining census data from the other four. In some sites where there were several jails (Atlanta, Birmingham, Cleveland, Dallas, Des Moines, Detroit, Phoenix, San Antonio, and Seattle), the sampling plans used a stratified cluster model (explained in the Methodology Guide for ADAM. See note 8.) This required obtaining case flow data for all arrestees in the county. However, the data from these sites were weighted to the facilities in the site sampling plans--not to the county as a whole. Weights will be refined annually to reflect the countywide arrestee population; that is, the statistical inflation factor will be applied once all data are obtained. ---------------------------- Availability of "Raw" ADAM Data The ADAM data are both a research product and a resource to be used in future research. The National Institute of Justice recognizes the need to preserve and make available these and other machine-coded data collected with public funds. All archived ADAM data files are stored with the Inter-University Consortium for Political and Social Research (ICPSR), at the University of Michigan. Researchers who would like to obtain the raw data files may contact the ICPSR (by phone at 800-999-0960 or 734-998-9825 or on the Web at http://www.icpsr.umich.edu/NACJD/. NIJ's policy on use of ADAM data is on ADAM Web page (http://www.adam-nij.net), which can be accessed via the Web site of the National Institute of Justice (http://www.ojp.usdoj.gov/nij). In general, ADAM data for a particular year are available for public use after they have been presented in the ADAM annual report for that year. ---------------------------- ADAM drug testing--the procedure, the drugs Drug testing by urinalysis is a unique and important component of the ADAM program. ADAM uses an immunoassay (EMIT (Enzyme Multiplied Immunoassay Testing), to screen for the presence of drugs in urine. EMIT tests have been shown to be one of the most consistently accurate drug testing methods, with greater than 95 percent accuracy and specificity for most drugs. The procedure At the conclusion of the ADAM interview, arrestees are asked to provide a urine sample. Over the years of the program, approximately 80 percent agree to be interviewed, and of those more than 80 percent also agree to give a sample. Arrestees who have complete interviews (that is, they have been interviewed and have also given a urine sample) are given an incentive (for example, candy bars, gift certificates, or a soft drink). The urine specimens are removed daily from the ADAM site facilities. A positive result from the EMIT assay (or "screen") indicates that the drug for which the test is performed is present in the urine sample at a level above or equal to a specified cutoff point. A negative result means either there is no drug in the urine sample or the level is below the cutoff point. Because ADAM tracks the epidemiology of drug use over time, it is not necessary or cost-effective to take other steps to confirm the presence of drugs. A confirmatory test is performed only when it is necessary to detect a particular subclass of a drug. For instance, all amphetamine positives are confirmed by gas chromatography/mass spectrometry (GC/MS) to determine whether methamphetamine was used. Specimens from all the sites are screened at a central laboratory. The drugs detected by ADAM ADAM detects as many as 10 drugs, but the focus of the program is the "NIDA-5," so called because the National Institute on Drug Abuse has identified them as a standard panel of commonly used illegal drugs. They are cocaine, marijuana, methamphetamine, opiates, and phencyclidine (PCP). The other five are methadone, benzodiazepines, methaqualone, propoxyphene, and barbiturates. Amphetamines A positive EMIT screen result indicates the presence of one or more drugs in the amphetamine group. Drugs that produce an amphetamine-positive screen include: o d - Amphetamine o d - Methamphetamine o Methylenedioxyamphetamine (MDA) o Methylenedioxymethamphetamine (MDMA). When a test conducted to detect methamphetamine is positive, that means amphetamines are in the urine. In this country, most amphetamine use represents legal or illegal ingestion of manufactured products containing the substance. Several over-the-counter cold and diet medications, as well as drugs used to treat ADD, can trigger a positive EMIT result. By contrast, most methamphetamine use represents consumption of an illegal substance. To determine whether the substance detected is in fact methamphetamine, screens that indicate the presence of amphetamines are subjected to a confirmatory, GC/MS test. The percentage of a dose of amphetamine excreted from the body unchanged into a metabolite varies with the pH of the urine, with the range 2 percent (alkaline pH) to 68 percent (acidic pH). Typically, 20 to 30 percent of the substance is excreted as unchanged amphetamine and 25 percent as benzoic acid and a simple compound (hippuric acid). Methamphetamine is excreted primarily unchanged, with a small fraction as amphetamine (44 percent and 6 percent, respectively). Barbiturates A barbiturate screen detects drugs in the barbiturate group. A positive screen indicates the presence of any metabolites of the group. The EMIT screen process is most efficient at detecting secobarbital in the urine. However, depending on the concentration of drug, the screen will also detect other commonly encountered barbiturates, including butalbital, pentobarbital, alphenal, amobarbital, aprobarbital, barbital, cyclopentobarbital, 5-ethyl-5-(4-hydroxyphenyl) barbituric acid, butabarbital, phenobarbital, talbutal, and thiopental. Benzodiazepines Most benzodiazepines are metabolized extensively in the liver and excreted through the urine as metabolites. The EMIT assay is best at detecting oxazepam, a common metabolite of benzodiazepines. However, the assay can be positive for many other benzodiazepines and/or metabolites, such as the compounds alprazolam, bromazepam, chlordiazepoxide, clobazam, clonazepam, clorazepate, clotiazepam, demoxepam, N-desalkylflurazepam, N-desmethyldiazepam, diazepam, flunitrazepam (Rohypnol), flurazepam, halazepam (Halcion), a-hydroxyalprazolam, 1-N-hydroxyethylflurazepam, a-hydroxytriazolam, ketazolam, lorazepam, medazepam, midazolam, nitrazepam, norchlordiazepoxide, prazepam, temazepam, tetrazepam, and triazolam. Cocaine Cocaine is metabolized extensively by liver and plasma esterases,* and only 1 percent of the dose is excreted in the urine unchanged. The primary metabolite of cocaine, benzoylecgonine, is easily identified in a urine specimen. Therefore, the EMIT assay was specifically designed to detect benzoylecgonine. Marijuana Delta-9-tetrahydrocannabinol (THC) is the primary psychoactive ingredient in marijuana. THC is one of approximately 30 compounds known as cannabinoids. Almost no THC is excreted in the urine unchanged into a metabolite. The primary metabolite of THC is 11-nor-D9-THC-9-carboxylic acid. Other major metabolites detected by EMIT assay, and which indicate marijuana use, include: o 11-nor-D9-THC-9-carboxylic acid o 8-b-11-hydroxy-D9-THC o 8-b-hydroxy- D9-THC o 11-hydroxy- D8-THC o 11-hydroxy-D9-THC. Methadone The EMIT assay is specific to methadone. Unchanged methadone is detectable in the urine. Methaqualone Methaqualone is metabolized extensively. Less than 1 percent of the dose is excreted unchanged in the urine, while 25 percent is excreted as hydroxylated metabolites. The assay detects the following compounds: o Methaqualone o Macloqualone o 3'-hydroxy-methaqualone o 4'-hydroxy-methaqualone o 2'-hydroxymethyl-methaqualone. Opiates Opiates are a broad class of drugs that include heroin, morphine, codeine, and semisynthetic derivatives of morphine. Heroin is rapidly broken down in the body, first to 6-monoacetylmorphine, which is metabolized to morphine. Both heroin and 6-monoacetylmorphine disappear rapidly from the blood. Codeine is also metabolized to morphine. Because heroin and codeine break down to morphine, and the unique metabolite of heroin (6-monoacetylmorphine) disappears rapidly from the body, the EMIT opiate assay is designed to detect morphine and its metabolites. A positive screen on the EMIT assay indicates only that the substance might be heroin; use of other opiate drugs cannot be ruled out with the screen alone. Someone who has used morphine or codeine legally (morphine after surgery, for example, and codeine in a prescription drug, for example) might reasonably be expected to screen positive for opiates. The EMIT assay can detect the following common compounds in the that belong to the class of opiates: o Morphine o Morphine-3-glucuronide o Codeine o Dihydrocodeine o Hydrocodone o Hydromorphone o Levallorphan. Morphine is metabolized extensively, with only 2 to 12 percent excreted unchanged in the urine. Large amounts (60 to 80 percent) of the conjugated metabolites (glucuronides) are excreted. In terms of quantity excreted, the most important metabolite of opiates is morphine-3-glucuronide-67 to 70 percent of the dose is excreted in the urine. The pattern of urinary excretion of morphine from heroin is similar to that of pharmaceutical morphine: 7 percent is excreted unchanged and 50 to 60 percent as conjugated morphine (glucuronides). Codeine is metabolized extensively, primarily to conjugated 6-codeine-glucuronide, while 10 to 15 percent of the dose forms morphine and norcodeine. Phencyclidine (PCP) The EMIT assay for PCP is designed to detect the following metabolites: o Phencyclidine o N, N-diethyl-1-phenylcyclohexylamine (PCDE) o 1-(4-hydroxypiperidino) phenylcyclohexane o 1-(1-phenylcyclohexyl) morpholine (PCM) o 1-(1-phenylcyclohexyl) pyrrolidine (PCPy) o 4-phenyl-4-piperidinocyclohexanol o 1-(1-(2-thienyl)-cyclohexyl) morpholine (TCM) o 1-(1-(2-thienyl)-cyclohexyl) piperidine (TCP) o 1-(1-(2-thienyl)-cyclohexyl) pyrrolidine (TCPy). The body produces all these metabolites by consuming PCP. Only about 10 percent of a PCP dose is excreted unchanged in the urine. About 40 percent of the substances in a urine specimen containing PCP have not been identified by science. Propoxyphene Propoxyphene is classified as a narcotic analgesic, used for pain relief, that includes the trade name Darvon. The EMIT process detects the following compounds that indicate propoxyphene use: o Propoxyphene o Norpropoxyphene. * An esterase is an enzyme that speeds the splitting up of an ester--a molecule consisting of an acid and an alcohol. ---------------------------- Immunoassays and what they detect An immunoassay is a test that uses antibodies to detect the presence of drugs and other substances in urine. Each immunoassay is designed to detect one particular drug or drug class. In some cases, the EMIT assay used by ADAM detects the drug itself, while in other cases it detects the metabolites of the drug. Metabolites are compounds produced by the breakdown of a drug in the body. The drug-metabolite distinction is important. There is no specific EMIT heroin assay, for example. Instead, EMIT detects metabolites common to all opiates, including heroin and codeine. When a screen detects a class of drugs, such as opiates, a confirmation test can be performed to identify the specific drug. ---------------------------- II. Drug Dependence and Treatment by Christine R. Crossland and Henry H. Brownstein* DUF and ADAM have revealed that people who come to the attention of the criminal justice system by being arrested are more often than not users of drugs and/or alcohol.[1] What is not known is the extent to which they have become dependent on these substances.[2] Nor is it known to what extent they need treatment or even have access to treatment.[3] Nonetheless, dependence and access to treatment, particularly for this at-risk population, are serious social and public health problems[4] about which data are often limited. Many communities have historically lacked the data needed to identify arrestees' treatment needs, because such users are typically undercounted in drug-use surveys (for example, the National Household Survey on Drug Abuse). Two additions to the ADAM survey instrument were designed to promote understanding of arrestee dependence and treatment needs as a means to address the resultant public health problems. First, the instrument now includes a screening tool to assess risk for drug and alcohol dependence--a measure of need for treatment. Second, questions about arrestees' treatment history have been added in an attempt to determine whether arrestees have ever received drug or alcohol treatment and whether they received such treatment recently-- specifically, in the year before they were arrested.[5] With the redesigned ADAM program, many communities now have access to data on treatment and can use it to develop evidence-based policies that can help local and national policymakers acquire or target treatment resources. Measuring drug dependence/treatment need In response to the debate among researchers and policymakers about the distinction between physical and psychological dependence, sociologist Erich Goode has suggested that such distinction is "largely irrelevant."[6] He contends that chronic users of drugs that cause psychological dependence behave in much the same way as individuals who are addicted to drugs that cause physiological dependence. For example, while cocaine dependence is not the same as heroin addiction,[7] the profound psychological need felt by cocaine users produces similar behavioral outcomes. Because the behavioral effects of physiological and psychological addiction are similar, the emphasis in the ADAM screener for dependence is on behavior rather than on classic physiological markers, such as tolerance or withdrawal. (For details about the development of the screener and the screener itself, see "Screening Arrestees for Drug and Alcohol Dependence/Need for Treatment.") Arrestees at risk for dependence on drugs Overall, among all adult male arrestees in the ADAM sample, between 27 percent (Houston and San Antonio) and 47 percent (Chicago) were found to be at risk for dependence on drugs. (See Appendix Table 2-1.) While in no site were more than half the arrestees found to be drug dependent, neither was there any site where less than one-fourth were drug dependent. Risk for dependence by type of drug Among users of marijuana, crack, powder cocaine, heroin, and methamphetamine, more than half were found to have been at risk for dependence in the past year. (See Appendix Table 2-2.) The proportions at risk varied by drug. In general, heroin users were more likely than users of other drugs to be at risk for dependence. The figure was 88 percent or more in half the sites, with a range of 50 percent (Charlotte-Metro) to 100 percent (Birmingham, Des Moines, and Indianapolis). At 56 percent in half the sites, the proportion of marijuana users at risk for dependence was much lower than for all other drugs. The range was 45 percent of drug-using arrestees (Denver) to 69 percent (Des Moines). For users of the other drugs, the proportions at risk for dependence lay between the rates for heroin and marijuana. Thus, for crack cocaine, 80 percent of drug-using arrestees in half the sites were at risk; the figure for powder cocaine was 74 percent, for methamphetamine, 76 percent, and for other drugs, 74 percent. (Exhibit 2-1 shows these relative averages.[8]) Demographics and sociodemographics of those at risk Among drug-using arrestees at risk for dependence, there was some variation by site in age, race, ethnicity, employment status, level of education, marital status, and whether or not the arrestee had health insurance. (See Appendix Table 2-3.) For example, the proportion of arrestees who scored at risk for drug dependence and were under 21 ranged from less than 10 percent (Denver and Las Vegas) to more than 35 percent (San Antonio). Of arrestees at risk for dependence, in Atlanta, Birmingham, Chicago, Detroit, and New Orleans, more than 75 percent were black; in Albuquerque, Honolulu, Laredo, Phoenix, Salt Lake City, San Antonio, and Spokane, fewer than 13 percent were black. This breakdown may, of course, reflect the racial and ethnic composition of all adult male arrestees and all people living in the particular county.[9] Thus, in the same way, in a number of southwestern sites, the proportion of arrestees who were both drug-dependent and Hispanic was relatively high (for example, 64 percent in Albuquerque; 93 percent in Laredo; 71 percent in San Antonio; and 42 percent in Tucson). This reflects the high percentage of adult male arrestees in these sites who said they were of Hispanic heritage (Albuquerque, 60 percent; Laredo, 96 percent; San Antonio, 68 percent; and Tucson, 42 percent). Prevalence of treatment among drug users The adult male arrestees who said they used drugs were asked whether they had participated in inpatient and outpatient treatment for drugs or alcohol, both in the past year and in their lifetime. Fewer than one in ten said they had received inpatient drug or alcohol treatment (for example, in detox, rehab, a therapeutic community, or a hospital) in the past year (9 percent or less, in half the sites). The range was 4 percent (Birmingham) to 17 percent (Albany/New York Capital area). (See Appendix Table 2-1.) The proportion who had ever been in inpatient treatment was higher: In half the sites, at least 29 percent of drug-using arrestees said they had ever been treated on an inpatient basis. (See Exhibit 2-2 for a visual illustration of the comparative percentages.) This may reflect the large numbers who have participated in (inpatient) detox programs. Mental health treatment was much less common, with 10 percent or less in half the sites saying they ever received such treatment. The proportions ranged from 2 percent (Charlotte-Metro) to 20 percent (Spokane). Treatment by type of drug The proportion of drug users who ever received treatment varied by type of drug used. For inpatient treatment, marijuana was the drug for which the proportion of arrestees was lowest (28 percent or less in half the sites). (See Exhibit 2-3.) Among drug users who ever used marijuana,[10] the proportion who ever participated in inpatient treatment ranged from 16 percent (New Orleans) to 46 percent (Albany). (See Appendix Table 2-4.) The proportions who ever received outpatient treatment for this drug were somewhat lower, with the range 11 percent (New Orleans) to 42 percent (Albany). Arrestees who had used crack at some point in their lives were typically more likely than marijuana users to have ever received either type of treatment. In half the sites, 48 percent had received inpatient treatment and 31 percent outpatient treatment. For inpatient treatment, the range was 28 percent (New Orleans) to 73 percent (Albany); for outpatient treatment, it was 17 percent (New Orleans) to 66 percent (Albany). The proportions of arrestees who ever used the other drugs--heroin, powder cocaine, or methamphetamine--and said they had ever been in treatment were relatively high, with figures varying somewhat by site. In all sites except four (Atlanta, Chicago, Dallas, and New Orleans), half or more of all arrestees who ever used heroin also said they had received inpatient drug treatment at some point in their lives. Overall, at 61 percent, the proportion of heroin-using arrestees who had ever received inpatient treatment was higher than for those who used any of the other drugs. (See Exhibit 2-4.) The same was true of heroin users who received outpatient treatment, although the differences among the drugs were less dramatic. In nine sites (Albany, Anchorage, Des Moines, Detroit, Minneapolis, New York, Portland, San Diego, and Seattle), half or more of the arrestees who ever used powder cocaine said they had received inpatient treatment at some time in their lives. Because the proportions who received treatment were in some instances relatively high, they suggest overall that many adult male arrestees who used drugs have at one time or another availed themselves of treatment but remain drug users. Demographics and socio-demographics Among adult male arrestees who had participated in drug or alcohol treatment in the year before their arrest, there were few demographic differences by site. The average (median) age of those who had participated in inpatient treatment in the 12 months before their arrest was 34 years; among those participating in outpatient treatment it was 32. Among those who had participated in inpatient treatment, the proportion who did not have health insurance was high: In half the sites, at least 66 percent said they currently lacked health insurance. The range was 29 percent (Birmingham) to 85 percent (Indianapolis). The proportions who participated in outpatient treatment but lacked health insurance were also high: 64 percent or more in half the sites, with the range 31 percent (Omaha) to 91 percent (Charlotte-Metro). (See Appendix Table 2-5.) The situation of Hispanic arrestees is particularly notable. High percentages were at risk for drug dependence, and among them the proportions who had the health insurance coverage needed to address the problem were relatively low. (See Exhibit 2-5.) As with other demographic characteristics, race appears to make a difference in likelihood of being treated. Black arrestees were far more likely than whites and others to have said they had received treatment for drug or alcohol use in the year before they were arrested. (See Exhibit 2-6.) Drug-dependent arrestees--treatment needs The redesigned ADAM revealed notable proportions of adult male arrestees at risk for drug dependence and thus in particular need of treatment. Many had received treatment at some point in their lives, but the vast majority had not been treated recently (in the past year). (See Appendix Table 2-6.) In the year before their arrest, as few as 6 percent of drug-dependent arrestees (in Atlanta and Chicago) and rarely more than 20 percent (in Albany, Charlotte-Metro, Laredo, Minneapolis, and Portland) were treated on an inpatient basis, and in more than half the sites less than 10 percent received outpatient treatment. There may be a number of reasons that, despite an evident need, arrestees do not receive treatment. One barrier may be lack of health insurance. In half of the sites, at least two-thirds of these at-risk arrestees lacked any type of health insurance. (See Appendix Table 2-3.) The proportion lacking health insurance reached 50 percent in every site. For the most part, the proportion of drug-dependent arrestees who lacked insurance exceeded the proportions of drug-using arrestees who lacked insurance. (See Exhibit 2-7.) Toward more in-depth investigation ADAM has shown that not only is there considerable drug use among adult male arrestees, but there is also considerable risk for drug dependence--an index of need for treatment. As the ADAM program continues to expand and evolve, additional questions about drug dependence and treatment needs can be investigated. In addition to the new questions about need for treatment and types of services received (whether inpatient or outpatient), it may be possible to explore treatment settings, modalities, and types of interventions. In the near future, by adding to the interview instrument a more substantive module addressing treatment, the ADAM program will be able to offer practitioners, researchers, and policymakers more detailed information about arrestees' need for services. And it will be possible not only to identify treatment needs in particular areas at a particular time and to compare sites but, as data are collected from year to year, it will also be possible to track changes in specific sites. * Christine R. Crossland is a Program and Policy Analyst with the Drugs and Crime Research Division of the National Institute of Justice (NIJ); Henry H. Brownstein, Ph.D., is Director of the Drugs and Crime Research Division, NIJ, and Executive Director of the ADAM Program. Notes 1. See, for example, Arrestee Drug Abuse Monitoring Program, 1999 Annual Report on Drug Use Among Adult and Juvenile Arrestees, Research Report, Washington, DC: U.S. Department of Justice, National Institute of Justice, June 2000, NCJ 181426. 2. See Chen, H.T., et al., "Problems and Solutions for Estimating the Prevalence of Drug Abuse Among Arrestees," Journal of Drug Issues 27 (1997): 689-701; and Goode, E., Drugs in American Society, New York: McGraw Hill, 1993. 3. See Harrison, L., "The Revolving Prison Door for Drug-Involved Offenders: Challenges and Opportunities," Crime and Delinquency 47 (July 2001): 462- 484; and Hser, Y.I., D. Longshore, and M.D. Anglin, "Prevalence of Drug Use Among Criminal Offender Populations: Implications for Control, Treatment, and Policy," in Drugs and Crime-Evaluating Public Policy Initiatives, ed. D.L. Layton and C.D. Uchida, Thousand Oaks, CA: Sage, 1994:18-41. 4. Horgan, C., K.C. Skwara, and G.S., Substance Abuse-The Nation's Number One Health Problem, Princeton, NJ: The Robert Wood Johnson Foundation, 2001; and Office of National Drug Control Policy, The National Drug Control Strategy: 2001 Annual Report, Washington, DC: Executive Office of the President, 2001. 5. In this report, 12 months and one year are used interchangeably. 6. Goode, Drugs in American Society: 33. 7. U.S. Sentencing Commission, Cocaine and Federal Sentencing Policy, Washington, DC: U.S. Sentencing Commission, 1995: 22-28. 8. Unless indicated otherwise, averages are expressed as medians. 9. For most demographic characteristics, the proportions of adult male arrestees who scored as at risk for dependence mirrored the overall rates for the entire ADAM sample. When differences occurred, they were among sites rather than between arrestees who were drug-dependent and those who were not. 10. The arrestees were asked about each drug separately; thus a single arrestee could be included in each group of users of a specific drug. For example, an arrestee who used marijuana might also be among the cocaine and/or methamphetamine users. This overlap should be kept in mind in interpreting the findings. ---------------------------- Screening Arrestees for Drug and Alcohol Dependence/Need for Treatment As part of the redesign, ADAM added to the questionnaire a "screener" that generates information about risk for dependence on drugs and alcohol and consequent need for treatment. The screener was developed from a subset of questions derived from the Substance Use Disorder Diagnostic Schedule (SUDDS-IV), a clinical assessment based in turn on criteria for dependence in the American Psychiatric Association's DSM-IV.[a] This series of questions in the ADAM interview makes it possible to estimate the number of arrestees who are likely to be at risk for alcohol and/or drug dependence. The information from the new series of questions can also aid in responding to the problem. Examining the use of specific drugs can help promote the development of strategies and planning policies to address new or emerging problems. For instance, if the number of heroin users increases, if that increase was recent, and if the proportions found at risk for dependence have increased, this information can be used by providers to assess the need for resources (for example, whether more methadone treatment is needed). To measure substance abuse and risk for dependence, arrestees who said they used alcohol or drugs in the 12 months before their arrest are asked six questions. Pilot tests conducted in three cities[b] revealed these particular questions best predicted risk for dependence and abuse. o Have they spent more time drinking or using drugs than they intended? o Had they neglected their usual responsibilities because of drug or alcohol use? o Had they wanted to cut down on drinking or drug use? o Had anyone, during the past 12 months, objected to their use of drugs or alcohol? o How frequently had they found themselves thinking about using drugs or alcohol? o Had they had used drugs or alcohol to alleviate feelings such as sadness, anger, or boredom? Arrestees who answered yes to only one or none of the six questions were considered at no risk for either drug abuse or dependence. A combination of two affirmative responses indicated risk for abuse, unless the two responses were to the questions about using drugs and alleviating negative emotions. Risk for abuse was also indicated when an arrestee answered yes to three or more questions, as long as thinking about using drugs or alcohol or alleviating negative emotions was among the three. A combination of three or more affirmative responses indicated risk for dependence, provided that either thinking about using drugs or alcohol or alleviating negative emotions was one of the three. In addition, if both thinking about using either substance and alleviating negative emotions were the only two affirmative responses, the person was considered at risk for dependence. a. DSM-IV refers to the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders, compiled and published in 1994 by the American Psychiatric Association. It is used by psychiatrists for diagnoses and is widely used by others. See Hoffmann, N.G. and P.A. Harrison, SUDDS-IV: Substance Use Disorder Diagnostic Schedule-IV, St. Paul: New Standards, Inc., 1995; Hoffmann, N.G., et al., "UNCOPE: A Brief Substance Dependence Screen for Use with Arrestees," in Drug and Alcohol Dependence, forthcoming; and Hunt, D. and W. Rhodes, Methodology Guide for ADAM, Washington, DC: U.S. Department of Justice, National Institute of Justice, May 2001. The Guide can be downloaded from the ADAM Web page (http://www.adam-nij.net) on the NIJ Web site (http://www.ojp.usdoj.gov/nij). b. Hoffmann, et al., "UNCOPE." ---------------------------- III. Alcohol Use and Alcohol Dependence by Natalie Lu* As part of the redesigned ADAM program, arrestees are now asked about alcohol use. Since drug use is higher among arrestees than among the general population, it is no surprise that the same is true of alcohol use. About half of all Americans age 12 and older drink alcohol at least once a month and about 20 percent have five or more drinks on one occasion in a month.[1] By contrast, 61 percent or more of the arrestees, on average,[2] said they drank alcohol heavily in the past year, and 52 percent on average said they drank heavily in the past month.[3] Heavy alcohol use among adult male arrestees seems to be unrelated to most demographic indicators examined here. And large proportions of these arrestees who drink most heavily are at risk for dependence on alcohol and are more likely to have used drugs than those who are not heavy drinkers. Why measure heavy alcohol use Alcohol is the most widely used psychoactive drug in the United States.[4] It is legal and for most people does not cause health problems. Light or moderate alcohol use may even confer some health benefits, particularly for the cardiovascular system.[5] Some people, however, consume alcohol in quantities large enough to cause problems for themselves or others.[6] Chronic heavy drinking has been linked to brain damage, hypertension, stroke, certain cancers, and harm to the fetus during pregnancy;[7] it is a contributing factor in workplace and automobile accidents and increases the likelihood of homicide and suicide[8] and has been implicated in sexual assault and domestic violence.[9] Although alcohol is like illicit drugs in producing profound effects, it also differs in many respects.[10] Alcohol has more complicated effects on the brain. While most illicit drugs affect only a few brain neurotransmitters, alcohol affects many, and the outcomes differ from person to person. And unlike some illicit drugs, alcohol is toxic to most body organs. To enhance the understanding of alcohol use and alcohol-related behavior, ADAM asks arrestees[11] about alcohol use and their experiences with treatment[12] and also measures their risk for dependence on alcohol. Overall findings Alcohol is heavily used by arrestees. Various levels of "heavy" drinking are defined here, with the level depending on the number of days a month the arrestee had five or more drinks.[13] (Definitions are presented in Table 3-1.) Large percentages of arrestees drank heavily in the year and the month before their arrest. Past-year heavy drinking (defined as "binge drinking,") ranged from a low of 47 percent of arrestees (Philadelphia) to a high of 82 percent (Albuquerque). In half the sites, 61 percent or more said they engaged in binge drinking (that is, had five or more drinks on at least one occasion in a one-month period) the year before their arrest. Figures for past-month binge drinking ranged from a low of 35 percent (Philadelphia) to a high of 70 percent (Albuquerque). In half the sites, 52 percent or more engaged in binge drinking in the past month. (See Appendix Table 3-1.) Age and other demographic and sociodemographic characteristics Overall, there appear to be few differences between younger and older adult male arrestees in extent of binge drinking. Among the youngest (those under 21), at least 45 percent in half the sites said they had five or more drinks on one occasion at least once in the month before they were interviewed; among the oldest arrestees (over 35) the median was 53 percent--not that much greater. (See Appendix Table 3-2a). Within some age groups, however, there was considerable variation by site. Thus, among the youngest arrestees, the rates of binge drinking ranged from a low of 17 percent of arrestees (New Orleans) to a high of 66 percent (Albuquerque). Similarly, among arrestees ages 21 to 25, the range was 24 percent (New Orleans) to 75 percent (Albuquerque). In the overwhelming majority of sites (32 of the 35), more white arrestees than blacks said they had five or more drinks on one occasion at least once in the past month. Employment status, education level, and whether or not the arrestee has health insurance seem to play minor roles in explaining binge drinking. (See Appendix Table 3-2b.) The one factor other than race that made a difference was homelessness. (See Exhibit 3-1.) In 29 of the 35 sites, homeless arrestees were more likely to say they binged the month before they were arrested than those who were not homeless. In sites such as Fort Lauderdale, the difference was notable, with past month binge drinking among homeless arrestees approximately 92 percent, while for arrestees who were not homeless it was 51 percent. Levels of heavy alcohol use The proportion of adult male arrestees who were the heaviest drinkers (had five or more drinks on a single occasion on at least 13 days in the month before their arrest--or every other day of the month) ranged from 10 percent (Miami) to 24 percent (Tucson). (See Appendix Table 3-3.) In half the sites, 17 percent or more could be placed in this category of heaviest drinkers A relatively small proportion of arrestees (median 6 percent) were classified as heavier drinkers (had five or more drinks on a single occasion on 8 to 12 days in the month before the arrest), while the proportion classified as heavy drinkers (had five or more drinks on a single occasion on 1 to 7 days in the past month) was the largest (median 27 percent). There appears to be little middle ground in the drinking patterns of ADAM male arrestees who consume alcohol heavily. The proportions of arrestees who were heavy and heaviest drinkers were higher than the proportions who drank at the middle or heavier level. (See Exhibit 3-2.) Lowest and highest percentages for each category are represented by the "tails" of the box plot. Alcohol dependence The use of alcohol (or drugs) does not necessarily mean abuse or dependence. Level of alcohol consumption varies dramatically--from casual to frequent to very frequent, heavy use. For some moderate drinkers, even a small amount of alcohol can create problems, while for some people who drink heavily the social and/or health problems may not materialize right away. Because of these differences, clinicians are able to diagnose alcohol abuse and dependence only by determining whether they have resulted in health and/or relationship problems. This is done through an extensive series of questions based on criteria established by the American Psychiatric Association's DSM-IV.[14] The result is a clinical diagnosis of either alcohol abuse or alcohol dependence. Beginning in 2000, the ADAM interview instrument included questions that screen for drug and alcohol abuse and dependence. The screen consists of six questions from the Substance Use Disorder Diagnostic Schedule (SUDDS-IV), an instrument based on dependency criteria in the DSM-IV. The screen does not produce a clinical diagnosis, but rather an indication of risk for dependence.[15] (A more detailed discussion of this screen is in Chapter 2.) Risk for alcohol dependence is discussed here. In employment status, education level, and health insurance status, there were few differences in the proportions of adult male arrestees at risk for dependence on alcohol. (See Appendix Tables 3-4a and 3-4b.) There were differences by age. Among the youngest adult male arrestees, 23 percent on average were at risk for alcohol dependence; by contrast, among the oldest group the percentage was 35. The difference was even more notable in homelessness. Homeless arrestees were much more likely than those who were not homeless to report behavior that would classify them as at risk for alcohol dependence (46 percent, on average, compared to 30 percent). This mirrors the pattern for binge drinking by arrestees, noted above: Whether or not they were at risk for alcohol dependence, arrestees who were homeless were more likely than those who were not homeless to be binge drinkers. If alcohol dependence is not measured by level of use, is there any relation between level of use and dependence? An examination of the data reveals there is: Among arrestees who were the heaviest drinkers, on average more than four in five scored as at risk for alcohol dependence. (See Appendix Table 3-5.) The range among the sites was 67 percent (Omaha) to 91 percent (Charlotte), with 85 percent or more of the heaviest drinkers in half the sites at risk for dependence. The proportions at risk for dependence declined with the levels of drinking. Thus, among the heavier-drinking group, 72 percent on average were at risk, with the range 39 percent (Charlotte-Metro) to 89 percent (Cleveland). And among the heavy-drinking group (the lowest level), the average at risk for dependence was still lower, at 59 percent, with the range 39 percent (Omaha) to 72 percent (Spokane). Given the easy accessibility and low cost of alcohol, and the fact that drinking often precedes illicit drug use, alcohol is sometimes referred to as a "gateway drug" for young people.[16] That raises the question of whether there is a relationship between dependence on alcohol or drugs later in life and the age at which someone first starts drinking. Are people who become dependent on alcohol or drugs more likely to have started drinking at an early age? The ADAM data suggest they are. Compared to those who had their first drink after age 21, adult male arrestees who started drinking at 13 or younger were twice as likely to be classified as at risk for alcohol dependence. (See Appendix Table 3-6.) Similarly, if not more dramatically, compared to those who began drinking later in life, arrestees who had their first drink at 13 or younger were twice as likely to be at risk for drug dependence. To more definitively determine whether alcohol is a gateway drug would require an analysis beyond the scope of this report. The ADAM data are presented to suggest areas for further study. Is alcohol use related to use of illicit drugs? For some people, alcohol use is the primary substance abuse problem, while for others, it may be only one of several high-risk behaviors.[17] One of them may be drug use. This raises the question of whether for some people the two types of substance abuse are related. Perhaps not surprisingly, the heaviest drinkers were also likely to have used illicit drugs. Compared to arrestees who did not binge drink at all, those in the heaviest drinker category were more likely to say they used at least one NIDA-5 drug. In half the sites, 71 percent or more of the heaviest drinkers used at least one drug. (See Appendix Table 3-7.) (It should be kept in mind that arrestees could say they used more than one drug. Therefore, if an arrestee who was among the heaviest alcohol users also used marijuana, it is possible that he might also have used cocaine, heroin, methamphetamine, and/or PCP.) Overall, more than half the arrestees who were among the heaviest drinkers in the month before their arrest also reported marijuana use in the same period. And among the heaviest drinkers, the proportion who used crack cocaine was almost three times higher than among those who did not binge drink (28 percent compared to 10 percent). * Natalie Lu, Ph.D., is a Drug Testing Technology Specialist with the National Institute of Justice. Notes 1. Substance Abuse and Mental Health Service Administration, The 1999 National Household Survey on Drug Abuse, Rockville, MD: U.S. Department of Health and Human Services, 2000. 2. These percentages are medians. Unless otherwise indicated, averages are expressed as medians throughout this report. 3. "Month" and "30 days" are used interchangeably, as are "year" and "12 months." 4. Horgan, C., Substance Abuse--The Nation's Number One Health Problem, Princeton, NJ: Robert Wood Johnson Foundation, 2001. 5. Agarwal, D.P. and L.M. Srivastava, "Does Moderate Alcohol Intake Protect Against Coronary Heart Disease?" Indian Heart Journal 53 (March- April 2001): 224-30; Marques-Vidal, et al., "Relationships Between Alcoholic Beverages and Cardiovascular Risk Factor Levels in Middle-Aged Men: The PRIME Study," Atherosclerosis 157 (August 2001): 431-40; and Puddey, I.B., V. Rakic, S.B. Dimmitt, and L.J. Beilin, "Influence of Pattern of Drinking on Cardiovascular Disease and Cardiovascular Risk Factors: A Review," Addiction 94 (May 1999): 649-663. 6. Hoffmeister, H., et al., "The Relationship Between Alcohol Consumption, Health Indicators and Mortality in the German Population," International Journal of Epidemiology 28 (December 1999):1066-1072; and Muntwyler, et al., "Mortality and Light to Moderate Alcohol Consumption After Myocardial Infarction," Lancet 12, 352 (December 1998):1882-18825. 7. Iribarren, C., T. et al., "Cohort Study of Thyroid Cancer in a San Francisco Bay Area Population," International Journal of Cancer 93 (September 2001):745-750; Van Der Leeden, M., et al., "Infants Exposed to Alcohol Prenatally: Outcome at 3 and 7 Months of Age," Annals of Tropical Pediatrics 21 (June 2001):127-134; Hard, M.L., T.R. Einarson, and G. Koren, "The Role of Acetaldehyde in Pregnancy Outcome After Prenatal Alcohol Exposure," The Drug Monitor 23 (August 2001): 427-434; Ajani, U.A., et al., "Alcohol Consumption and Risk of Type 2 Diabetes Mellitus Among U.S. Male Physicians," Archives of Internal Medicine 160 (April 2000):1025-1030; and Berger, K., et al., "Light-to-Moderate Alcohol Consumption and Risk of Stroke Among U.S. Male Physicians," New England Journal of Medicine 341 (November 1999):1557-1564. 8. Martin, S.E., K. Bryant, and N. Fitzgerald, "Self-Reported Alcohol Use and Abuse by Arrestees in the 1998 Arrestee Drug Abuse Monitoring Program," Alcohol Research and Health 25 (2001): 72-79; Parker, R.N. and K. Auerhahn, "Alcohol, Drugs, and Violence," Annual Review of Sociology 24 (1998): 291-311; and Spunt, B.J., et al., "Alcohol and Homicide: Interviews with Prison Inmates," Journal of Drug Issues 24 (1994):143-163. 9. See Aldarondo, E., and G.K. Kantor, "Social Predictors of Wife Assault Cessation," in Out of Darkness: Contemporary Perspectives on Family Violence, ed. G. K. Kantor and J.L. Jaswiski, Thousand Oaks, CA: Sage, 1997; Kaufman Kantor, G., and J.L. Jasinski, "Dynamics and Risk Factors in Partner Violence," in Partner Violence: A Comprehensive Review of 20 Years of Research, ed. J.L. Jasinski and L.M. Williams, Thousand Oaks, CA: Sage, 1998; Leonard, K., and M. Senchak, "Prospective Prediction of Husband Marital Aggression within Newlywed Couples, Journal of Abnormal Psychology 105 (1996): 369-380; Pan, H.S., P.H. Neidig, and D.K. O'Leary, "Predicting Mild and Severe Husband-to-Wife Physical Aggression, Journal of Consulting and Clinical Psychology 62 (1994): 975-981; Woffordt, S., D.E. Mihalic, and S. Menard, "Continuities in Marital Violence," Journal of Family Violence (1994):195-225. and Ullman, S.E., G. Karabatsos, and M.P. Koss, "Alcohol and Sexual Assault in a National Sample of College Women, Journal of Interpersonal Violence 14, 6 (1999): 603-625. 10. See Horgan, C., Substance Abuse. 11. ADAM does not use urinalysis to confirm arrestees' self-reported alcohol use, because alcohol can be detected in the urine for only a short time. All information on alcohol use was obtained from the self-reports. The new ADAM interview instrument also incorporates many cross-link variables that make it feasible to compare ADAM data with other national survey datasets such as the National Household Survey on Drug Abuse (NHSDA) and the Treatment Episode Data Set (TEDS). 12. Treatment is discussed in Chapter 2. 13. In the preliminary report of the 2000 ADAM findings, the NHSDA definition of heavy drinking (five or more drinks on five or more occasions in a month) was also used. See Taylor, Bruce G., et al., ADAM Preliminary 2000 Findings on Drug Use and Drug Markets--Adult Male Arrestees, Research Report, Washington, DC: U.S. Department of Justice, National Institute of Justice, December 2001:16 (NCJ189101). 14. DSM-IV refers to the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders, compiled and published in 1994 by the American Psychiatric Association. It is used by psychiatrists for diagnoses and is widely used by others. 15. See also Hoffman, N.G., et al., "UNCOPE: A Brief Substance Dependence Screen for Use with Arrestees," Drug and Alcohol Dependence, forthcoming. 16. Horgan, C., Substance Abuse. 17. Paniagua Repetto, H., et al., "Tobacco, Alcohol and Illegal Drug Consumption among Adolescents: Relationship with Lifestyle and Environment," Anales Espanoles de Pediatria 55 (August 2001):121-128; and Carol, G., et al., "Alcohol and Drug Abuse: A Preliminary Investigation of Cocaine Craving Among Persons With and Without Schizophrenia," Psychiatric Services 52 (August 2001):1029-1031. ---------------------------- IV. Drug Markets by Bruce G. Taylor and Michael Costa* Law enforcement agencies often base their strategies for controlling drug markets on tactical or anecdotal information and the experience of their officers. That approach is useful but limited. Aside from the DEA's monitoring systems, which track only a small number of communities, there are few other information resources. The ADAM redesign makes it possible for the first time to obtain information about drug markets from a large number of buyers at the local level. This information, on a wide variety of topics related to drug markets, can help criminal justice and law enforcement policymakers and practitioners to design better strategies. (For discussion of the DEA drug market monitoring systems, see "Drug Market Monitoring by the DEA.") Much previous research on drug markets was carried out as single, stand-alone studies, and include a rich tradition of ethnographic studies,[1] but the ADAM redesign makes possible multiple-site studies and analysis of trends. ADAM offers the opportunity to examine larger samples of drug markets than are available in single-site studies; systematic analysis is possible because all the ADAM sites have a uniform data collection procedure. The opportunity to explore drug markets was the result of a cumulative process that began with the addition of questions about market participation to the interview instrument fielded in 1995 in six DUF (Drug Use Forecasting program) sites.[2] Areas of focus The ADAM redesign generates information about extent of participation in drug markets, method of acquisition (whether cash or noncash), place of purchase (on the street or indoors), neighborhood of purchase, and difficulties in locating and buying drugs. The analyses presented here focus on two areas: buyer behavior and transaction dynamics. The first analysis covers the activities of buyers in the environment of the drug market. The second analysis covers the specific drugs obtained, the quantities obtained, the frequency of transactions, and the amount of money exchanged. Previous research on drug markets suggests that while they all operate according to the same general market principles,[3] the dynamics are likely to be somewhat different for each drug.[4] This necessitates examining each one separately. In most of this chapter the emphasis is on crack cocaine, powder cocaine, and marijuana because, of the drugs analyzed by ADAM, these are the ones used by the largest proportion of arrestees at the ADAM sites.[5] Extent of drug market participation Adult male arrestees were asked whether they had obtained crack cocaine, powder cocaine, marijuana, methamphetamine, and heroin in the past 30 days. (See "Asking about Drug Market Participation" for an explanation of the development and phrasing of the question.) As measured by percentages of arrestees who participated, the marijuana market was the largest among the five drugs. It is a finding consistent with earlier ADAM data. Among all sites, 44 percent of arrestees, on average (median),[6] participated in the market for this drug in the month before their arrest. The range was 31 percent (Laredo) to 51 percent (Cleveland). In every site except one (Laredo), the percentage of marijuana market participants was higher than for any of the other four drugs. (See Exhibit 4-1.) Market participation for the other drugs was much lower. An average 15 percent of adult male arrestees participated in the crack cocaine market, with the range 5 percent (San Antonio) to 26 percent (Atlanta). For powder cocaine, an average 15 percent participated, with a range of 4 percent (Sacramento) to 35 percent (Laredo). Heroin attracted 5 percent of adult male arrestees as market participants, with the range zero (Charlotte) to 24 percent (Chicago). And for methamphetamine, 3 percent of adult male arrestees participated in the market, with the range zero (Fort Lauderdale) to 32 percent (Honolulu). (See Appendix Table 4-1, which presents weighted and unweighted numbers of participants as well as percentages.) Paying for drugs The dollar value of a drug transaction can be difficult to calculate. When questions about drug acquisition were field tested by ADAM in focus groups of arrestees, the answers confirmed what ethnographers have often reported: a substantial portion of the drug trade at the street level consists of combinations of goods and services exchanged in addition to or in place of cash. For example, to buy heroin, someone might pay $25 plus a radio for five "dime bags." If only the cash part of this transaction were taken into account, the assumption would be that five bags were worth $25. In fact, they were sold for the equivalent street value of about $50 (that is, $25 plus the cash value of the radio). Other focus group participants said they received a specified amount of drugs in exchange for sexual favors or services, such as transporting drugs or messages and steering customers to the seller. The "value" of the drugs on the market remains the same; it is simply paid for differently. Because the value of goods and services must be taken into account, ADAM examines cash and noncash transactions, as well as transactions that combine the two.[7] Fairly large proportions of market participants did not rely solely on cash to obtain marijuana, crack cocaine, or powder cocaine.[8] (See Appendix Table 4-2.) This was particularly true for marijuana. Marijuana market participants at most of the sites were more likely to have used noncash only transactions than to have paid cash. In half the sites, 43 percent or more used noncash means to obtain this drug, while 34 percent, on average, used combination (cash and noncash) transactions, and 23 percent used cash-only transactions. (See also Exhibit 4-2.) Conversely, cash-only transactions were more common in the crack and powder cocaine markets. For both these drugs, the proportions who paid cash were higher than the proportions who paid cash for marijuana (in half the sites, some 40 percent or more of arrestees paid cash). The proportion of arrestees who obtained crack by noncash means was on average 17 percent among the sites. By contrast, for powder cocaine, the proportion who obtained the drug by noncash means was almost twice as large--33 percent among the sites. Cash-only transactions The marijuana market was the one least likely to involve cash-only transactions. The proportion of arrestees who paid cash for this substance was lower than the proportions who did so for crack or powder cocaine. In the marijuana market, the proportion of arrestees who paid cash exceeded one-third in only 6 of the 23 sites analyzed. (See Appendix Table 4-2.) In both the crack and powder cocaine markets, the proportions paying cash for these drugs exceeded one-third in almost all sites (17 of the 23 sites and 18 of the 23 sites, respectively). Noncash-only transactions Among the various types of noncash transactions, the most common was receiving it as a "gift" (that is, paying nothing for it). Examples of gifts are marijuana joints given or shared at a party or sharing crack. Gifts dominated noncash transactions for all three drugs. For crack, the proportions of arrestees who said they received this drug as a gift was at least 56 percent in half the sites. (See Exhibit 4-3 and Appendix Table 4-3.) Gift-giving was even more pronounced in marijuana and powder cocaine transactions. Of noncash marijuana transactions, 76 percent on average involved receiving the drug as a gift. The proportion who received marijuana as a gift was greater than 60 percent in all sites. Powder cocaine was received as a gift by about two-thirds (68 percent) of arrestees who used noncash transactions to obtain this drug. In almost all sites (20 of the 23) the proportion exceeded 60 percent. After gifts, the next most common method of obtaining drugs was to buy on credit and pay cash later.[9] It was not a close second, however. For crack, in half the sites 11 percent of the noncash transactions involved credit with cash paid later. The figures for powder cocaine and marijuana were 7 percent and 5 percent, respectively. Cash and noncash combined ADAM measures three types of "combination" drug transactions. One consists of two separate transactions, one cash and one noncash. The second combination consists of a single transaction in which the buyer simultaneously pays in both cash and noncash (for example, $5 and a watch). The third consists of two transactions, one involving noncash payment and the other both cash and noncash together.[10] Of the markets for the three drugs, crack and marijuana were those in which the proportion of arrestees who used combination transactions was highest. In the crack cocaine market, 41 percent or more of arrestees in half the sites used a combination of cash and noncash, with the range 9 percent (New York) to 53 percent (Anchorage). (See Appendix Table 4-2.) In 17 of the 23 sites, the proportion who obtained crack this way exceeded one-third. For marijuana, the proportion who obtained the drug by combination transactions was similar to crack cocaine, averaging 34 percent among the sites. In 13 of the 23 sites, more than one-third of marijuana market participants obtained the drug this way. In the powder cocaine market, the proportions who used combination transactions were generally lower than for the other two drugs. Just under one-fourth of arrestees on average obtained powder cocaine this way, with the proportion barely surpassing 30 percent in only 3 sites. The type of dominant transaction varied by site. In New York City, for example, cash-only transactions dominated the markets for all three drugs (in the crack and powder cocaine markets, 90 percent of arrestees paid cash only, and 79 percent paid cash only in the marijuana market). The same was true of three other sites--Cleveland, Fort Lauderdale, and Miami--though not by margins as wide as in New York. Noncash exchangers dominated the markets for all three drugs in only one site--Spokane. Combination exchangers did not dominate all three drug markets in any of the 23 sites. Method of contacting drug dealers Arrestees were asked how they contacted dealers to obtain drugs. The methods of contact varied, and for each of the three drug markets, there were also differences between cash and noncash exchanges. (See Table 4-1 for the averages of the sites.) Among arrestees who paid cash for marijuana, the largest proportion used a phone or pager, with the next largest proportion going to someone's house or apartment. The averages among the sites for these two types of dealer contacts were 36 percent and 25 percent, respectively. By contrast, among arrestees who used noncash exchanges to obtain this drug, the proportion who contacted the dealer at work or in a social setting was by far the largest among the various methods of contact. In half the sites, 48 percent or more contacted the dealer this way, while for the other types of contact the proportions were much lower. (See Appendix Table 4-4.) For cash purchases of crack cocaine the picture was somewhat different. In contrast to marijuana, for crack the most common method was to approach a dealer in a public place. The proportion of arrestees who paid cash for crack cocaine this way was 43 percent or more in half the sites--more than double the proportion who bought marijuana this way. The second most popular way to obtain crack with cash was by contacting a dealer by phone or pager. The average was 30 percent among the sites. Ways to contact dealers for noncash crack transactions resembled those for marijuana: Contacts were most often made at work or in a social setting, with the next most frequent method of contact approaching a dealer in public (averages were 30 percent and 23 percent, respectively, among the sites). (See Appendix Table 4-5.) Much as in the cash marijuana market, cash purchases for powder cocaine tended to be made by phone or pager. In half the sites, almost half the arrestees said they used a phone or pager to buy powder cocaine in cash transactions. Noncash transactions of powder cocaine resembled those for marijuana and crack cocaine, with the largest proportion of arrestees (44 percent among the sites, on average) saying they obtained the drug at work or social settings. (See Appendix Table 4-6.) Whereas large proportions of arrestees obtained drugs by noncash means at work or in social settings, this was not the case for cash purchases. Overall, only small proportions of arrestees paid cash for any of the three drugs at work or in social settings. (See Appendix Tables 4-4, 4-5, and 4-6). And only small proportions of arrestees engaged in noncash transactions by going to someone's house or apartment to obtain any of the three drugs. The findings on noncash methods suggest they have two identifiable characteristics. First, the noncash events were, in most cases, opportunistic; that is, they occurred when someone happened to be at a social setting or at work. In other words, they may not have been planned. Second, the arrestees who obtained drugs through noncash transactions were acquainted with those who supplied them, suggesting they may be connected to other drug market participants. The cash methods suggest a well-structured network of contacts that include knowledge of dealers, as well as their beeper numbers, phone numbers, and addresses. Some sites diverged from the patterns noted above. For example, although marijuana cash purchases were most often made by phone or pager in most sites, in some this was not the case. In eight sites, the most common method used by arrestees who paid cash for marijuana was approaching a dealer in a public place. These sites were Atlanta, Cleveland, Denver, Fort Lauderdale, Miami, Minneapolis, New Orleans, and New York. Also, while cash purchases for powder cocaine were most often made by phone or pager, this was not the case in Atlanta, Cleveland, Fort Lauderdale, Miami, New Orleans, New York, and San Jose. In these cities, approaching a dealer in a public place was the most frequent way to contact dealers. And while cash purchases of crack cocaine were most commonly made by approaching dealers in public places, in Albuquerque, Anchorage, Denver, Indianapolis, Portland, Salt Lake City, and Spokane, the most common method was to use a phone or pager. In four southwestern sites (Dallas, Oklahoma City, Phoenix, and Tucson), going to someone's house or apartment was the most common method of buying crack with cash. Relationship of buyers to sellers[11] Do arrestees who obtain drugs have a regular dealer? Do they have only one dealer or several? Does the number of dealers vary with the drug obtained? With the ADAM redesign, these and other questions about the relationships between buyers and sellers are being explored. Crack cocaine was the drug whose purchase in cash was most likely to involve two or more dealers. In half the sites, 65 percent or more of adult male arrestees said they bought crack from two or more dealers in the month before their arrest. The figures for marijuana and powder cocaine were 42 percent and 34 percent, respectively. (See Appendix Table 4-7. Exhibit 4-4 presents the proportions of arrestees who made cash purchases from two or more dealers.) This pattern is particularly evident in sites like Houston (where 70 percent of arrestees used two or more dealers to buy crack, compared to 37 percent who did so when buying marijuana and 9 percent who did so when buying powder cocaine), Phoenix (where 59 percent of arrestees used two or more dealers to buy crack, compared to 19 percent for powder cocaine), and San Jose (where 71 percent used two or more dealers to buy crack, compared to the 15 percent who did so to buy powder cocaine). The large proportions of arrestees who used two or more dealers to buy crack help explain why the average number of dealers used by crack cocaine market participants was the highest among all three drugs. On average, crack market participants used 3.2 dealers, a figure higher than the 1.9 dealers used by marijuana market participants and the 1.8 used by powder cocaine market participants. The ADAM data reveal that particularly for crack cocaine purchases made in cash, arrestees often had more than two dealers, but they also show that arrestees commonly had a regular source, rather than either someone they dealt with occasionally or a new dealer. (See Exhibit 4-5.) This was the case in the markets for all three drugs studied. In the powder cocaine market, 61 percent or more of arrestees bought from a regular source. The range was 41 percent (Minneapolis) to 75 percent (Phoenix). In the crack cocaine market, the proportion who had a regular source was 49 percent or more in half the sites, with the range 19 percent (San Jose) to 62 percent (Tucson). In the marijuana market, the proportion having a regular source was 46 percent or more in half the sites, with the range 36 percent (Salt Lake City) to 69 percent (New York). (See Appendix Table 4-8.) For all three drugs, the percentage who obtained drugs from a regular source exceeded the percentage who obtained them from an occasional source, suggesting a certain stability in the markets. The percentages of arrestees who made their most recent cash purchase from a new source were fairly similar for all three drugs studied. On average, 19 percent used a new source for crack; for marijuana the figure was 16 percent, and for powder cocaine it was 13 percent. Drug markets often have go-betweens or couriers who facilitate purchases and also serve as "layers of protection" to preserve the seller's anonymity. The ADAM analysis revealed that in none of the three drug markets studied was there extensive use of these facilitators by arrestees. On average, in the marijuana market, 3 percent of arrestees used couriers, in the crack cocaine market 3 percent used couriers, and in the powder cocaine market, 4 percent did so.[12] (See Appendix Table 4-9.) In the crack cocaine market, the use of drug couriers ranged from none (Houston) to 12 percent (Denver). In the marijuana market, the range was none (Fort Lauderdale) to 7 percent (Salt Lake City and San Diego). And in the powder cocaine market the range was none (Albuquerque, Cleveland, Minneapolis, New York, and San Diego) to 12 percent (Salt Lake City). Are outdoor purchases the norm? The emergence of crack cocaine markets in urban areas of the United States in the late 1980s and early 1990s brought the environmental context to the forefront as an important variable in drug market dynamics. Before the crack cocaine epidemic, drugs were typically sold indoors. But in many cities crack was sold in open air markets. The media was quick to report on the high levels of violence attendant on the emerging trafficking in crack cocaine.[13] Researchers who subsequently documented the violence saw it as related to the characteristics of the substance itself, the nature of the market, and the marketing of the product.[14] When violent crime in urban areas began to decline in the early 1990s, some observers suggested it was to some extent related to the changing nature of the crack markets. One change was that open air sales were being replaced by indoor transactions, which were considered safer for buyers and sellers.[15] With ADAM now collecting information about drug markets, it is possible to assess the extent to which particular drugs in particular places at particular times are sold outdoors or indoors. Extent of outdoor sales For crack, the image of the open air market is confirmed in many sites. The proportion of arrestees who bought crack outdoors was 50 percent or more in 10 of the 23 sites. (See Appendix Table 4-10 and Exhibit 4-6.) In half the sites, 44 percent or more of arrestees bought crack this way, and the range was wide: 19 percent (Spokane) to 88 percent (New York). For marijuana, by contrast, the proportion who made outdoor purchases was 50 percent or more in only three sites. In half the sites, 31 percent or more bought marijuana outdoors. For powder cocaine, the proportion making purchases outdoors was as low: In only four sites did it exceed 50 percent. The average among the sites was about the same as for marijuana. These findings may reflect differences in the operations of the market for the various drugs and differences within specific sites. In New York and Cleveland, for example, outdoor purchasing dominated the markets for all three drugs. At the other end of the continuum were several sites where the proportion of arrestees who bought drugs indoors exceeded 70 percent for all three drugs. (These are Albuquerque, Anchorage, Dallas, Oklahoma City, Phoenix, Salt Lake City, Spokane, and Tucson). Thus, irrespective of type of drug, in some sites high proportions of arrestees buy drugs outdoors and in others high proportions buy drugs indoors. These differences also illustrate the value of ADAM's focus on individual sites--differences that would be obscured in nationwide or regional analyses of drug use patterns. The drug-market neighborhood The role of the drug trade in promoting neighborhood instability has not been studied often or systematically. Community activists have noted that outsiders (people who do not live in the neighborhood) come into the community to buy drugs. The ADAM data confirm their observations and bring to light new information about drugs as a destabilizing force. For all three drugs studied here, about half of all market participants said that at least one transaction took place outside their own neighborhood.[16] (see Exhibit 4-7. Appendix Table 4-11 presents site-by-site findings.) What makes a purchase attempt fail? Considerable law enforcement resources have been spent on making it more difficult for drug users to find and obtain illicit drugs.[17] According to the ADAM data, a surprisingly high percentage of arrestees have no difficulty completing a drug transaction. (See Exhibit 4-8 for the ranges and averages and Appendix Table 4-12 for site-by-site data).[18] Marijuana is the drug for which the percentage of arrestees reporting one or more failed cash transactions was highest. In half the sites 39 percent or more said they failed in an attempt to buy marijuana, with the range 12 percent (New York) to 53 percent (Indianapolis). Crack cocaine was a close second in failed transactions. In attempting to buy this drug, 37 percent or more of arrestees in half the sites said they failed. Failure rates for crack ranged from a low of 9 percent (New York) to a high of 59 percent (Oklahoma City). In attempting to buy powder cocaine, 29 percent or more of arrestees in half the sites failed, with the range 11 percent (New York) to 39 percent (Denver). Further research is likely to reveal more insights into these failed transactions, particularly with respect to the differences among the sites and among the various drugs. Not only did relatively few transactions end in failure, but when they did, police activity was rarely cited as the reason. (See Appendix Table 4-13.) The proportion of arrestees who said the presence of the police had deterred them from buying drugs was generally low. For marijuana, 6 percent or fewer of arrestees in half the sites cited the police as a deterrence; for both crack and powder cocaine the figure was 11 percent. (See Table 4-2.) There are a few notable exceptions to the evident ease with which drugs are obtained. In Miami, for example, where more than one-fourth of the arrestees said their transactions for powder cocaine had failed, a fairly large proportion (just under one-third--32 percent) ascribed their failure to police presence. (See Appendix Table 4-13.) There are similar exceptions for crack purchasing. In Houston, more than half (52 percent) the crack market participants said their transactions failed, and of these, 28 percent attributed the failure to police activity. In New York, attempts to buy any of these drugs ended in failure for relatively small proportions of arrestees, but even here the police role was notable. For crack cocaine, 9 percent of arrestees said the transactions failed, with police cited as the reason by 45 percent. For powder cocaine, the figures were 11 percent and 39 percent, and for marijuana,