Drug Use in Metropolitan America

367 Pages·1998·17.435 MB·English

by  Robert M. Bray

DRUG USE in
METROPOLITAN
AMERICA

DRUG USE ,N
METROPOLITAN
AMERICA
ROBERT M. BRAY
MARY ELLEN MARSDEN
Editors
SAGE Publications
International Educational and Professional Publisher
Thousand Oaks London New Delhi
Copyright © 1999 by Sage Publications, Inc.
All rights reserved. No part of this book may be reproduced or utilized in any form or by any
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Library of Congress Cataloging-in-Publication Data
Main entry under title:
Drug use in metropolitan America / Robert M. Bray and Mary Ellen
Marsden, editors,
p. cm.
Includes bibliographical references and index.
ISBN 0-7619-0374-7 (cloth: acid-free paper)
ISBN 0-7619-0375-5 (pbk.: acid-free paper
1. Drug abuse—United States. I. Bray, Robert M.
II. Marsden, Mary Ellen.
HV5825.D77ff736 1998
362.29Ί2,0973—ddc21 98-19675
99 00 01 02 03 04 10 9 8 7 6 5 4 3 2 1
Acquiring Editor: Peter Labella
Editorial Assistant: Renee Piernot
Production Editor: Diana E. Axelsen
Editorial Assistant: Denise Santoyo
Typesetter I Designer: Janelle LeMaster
Cover Designer: Candice Harman
Contents
List of Tables xiii
List of Figures xvii
Acknowledgments xix
1. Impact of Drug Use in Metropolitan America 1
Robert M. Bray, Mary Ellen Marsden,
and Amy A. Vincus
1.1 Effects of Drug Abuse 3
1.1.1 Drug Abuse and Crime 3
1.1.2 Drug Abuse and Health 4
1.1.3 Drug Abuse and Youth 5
1.1.4 Drug Abuse and the Workplace 6
1.2 Drug Use in Metropolitan America 7
1.2.1 Developing Estimates of Drug Use in a Metropolitan
Area 9
1.2.2 Needed Studies 10
1.3 The DC^MADS Project 12
1.4 Overview of This Book 13
References 14
2. The Washington, DC, Metropolitan Area Drug Study
(DC*MADS) 17
Robert M. Bray
2.1 Overview of DC*MADS and the Issue of Generalizability 18
2.2 Population Studies in This Book 22
2.2.1 Household Populations Study 25
2.2.2 Homeless and Transient Population Study 26
2.2.3 Institutionalized Study 26
2.2.4 Adult and Juvenile Offender Studies 27
2.2.5 Current Treatment Client Characteristics Study 28
2.2.6 Drug Use and Pregnancy Study 28
2.2.7 Comparing Findings Across Populations 29
2.3 Demographic Characteristics 30
2.4 Questionnaire Development and Key Substance Use
Measures 34
2.4.1 Questionnaire Development 34
2.4.2 Key Substance Use Measures 38
2.5 Overview of Sampling and Data Collection Methods 39
2.5.1 Sample Design 39
2.5.2 Data Collection 40
2.5.3 Response Rates 43
2.5.4 Methodological Challenges 43
2.6 Analytical Approach 47
2.6.1 Weighted Analysis Through SUDAAN 47
2.6.2 Survey Errors and Low Precision Rule 47
2.7 Study Strengths and Limitations 49
Note 51
References 51
3. Drug Use Among Household and Nonhousehold Populations 55
Mary Ellen Marsden and Robert M. Bray
3.1 Substance Use Prevalence and Trends in Household
and Nonhousehold Populations 56
3.1.1 Findings From Household Populations 57
3.1.2 Findings From Nonhousehold Populations 62
3.2 Overview of the Study 63
3.3 Drug Use Among Household Members 64
3.3.1 Prevalence and Number of Users 64
3.3.2 Comparisons With Large Metropolitan Areas 67
3.3.3 Comparisons Within the DC MSA 69
3.3.4 Demographic Correlates of Use 72
3.4 Comparisons of Drug Use Among All Populations 73
3.5 Targeting Drug Abuse Treatment and Prevention Services 76
References 77
4. Drug Use and Homelessness 79
Michael L. Dennis, Robert M. Bray,
Ronaldo lachan, and Jutta Thornberry
4.1 Multiple Faces of Homelessness 80
4.1.1 Concept and Definitions of Homelessness 80
4.1.2 Substance Use Among Homeless People 83
4.2 Overview of the Study 85
4.3 Population Size and Characteristics 86
4.3.1 Size of the Homeless Population 86
4.3.2 Characteristics of the Homeless and Transient
Population 89
4.4 Drug Use Prevalence and Correlates 94
4.4.1 Prevalence 94
4.4.2 Demographic and Homeless Correlates 96
4.4.3 Symptoms of Dependence 98
4.5 Co-Occurring Problems and Service Utilization 98
4.5.1 Drug- and Alcohol-Related Problems 99
4.5.2 Mental Health Problems 103
4.5.3 Physical Health Problems 104
4.5.4 Illegal Activity 105
4.5.5 Employment and Income 106
4.5.6 Drug User Group Profiles 108
4.6 Discussion and Implications 109
4.6.1 Epidemiology and Surveillance of Homelessness 110
4.6.2 Epidemiology and Surveillance of Substance Use 112
4.6.3 Implications for Program Planning 113
4.6.4 Implications for Welfare Reform 114
4.6.5 Implications for Local Policymakers 115
4.6.6 Reprise and Conclusions 117
References 119
5. Drug Use Among the Institutionalized Population 125
Gregory H. Gaertner and Linda }. Keil
5.1 Drug Use and Institutionalization 125
5.1.1 Rates of Drug Use Before and During
Institutionalization 126
5.1.2 Contributions From Studying Drug Use in
the Institutionalized Population 127
5.2 Overview of the Study 132
5.3 Understanding the Institutionalized Population 133
5.3.1 Size and Demographics of the Institutionalized
Population 133
5.3.2 Patterns of Institutionalization 135
5.4 Drug Use Prevalence and Correlates 137
5.4.1 Prevalence of Drug Use Among the
Institutionalized Population 138
5.4.2 Demographic Correlates of Drug Use 140
5.4.3 Drug Use by Type of Institution 142
5.4.4 Characterizing Drug Use Prior to
Institutionalization 144
5.5 Substance Abuse Problems, Treatment, and Primary
Care Utilization Among Institutionalized People 147
5.5.1 Alcohol- and Drug-Related Problems 147
5.5.2 Substance Abuse Treatment 148
5.5.3 Primary Care Utilization and Insurance Coverage 152
5.6 Discussion and Implications 155
5.6.1 Prevalence of Drug and Alcohol Use Among
the Institutionalized Population 155
5.6.2 Effectiveness of Institutions in Regulating
Drug Use Among Residents 155
5.6.3 Effects of Drug Use on Becoming Institutionalized 156
5.6.4 Interactions Between Substance Abuse and
Other Physical and Psychological Problems 157
5.6.5 Treatment Needs and Resources 157
Notes 159
References 159
6. Drug Involvement Among Offender Populations 161
David Cantor
6.1 Relationship of Drug Use and Offending 161
6.1.1 Nature of the Relationship 162
6.1.2 Data on the Drug-Crime Link 164
6.1.3 Remaining Issues 166
6.2 Overview of the Studies 168
6.3 Drug Use and Offending Patterns 168
6.3.1 Patterns Among Adults 169
6.3.2 Patterns Among Juveniles 173
6.3.3 Types of Crime Committed by Adult and
Juvenile Offenders 177
6.4 Links Between Drug Involvement and Predatory Crime 179
6.4.1 Drug Use at the Time of a Violent or Property
Crime 179
6.4.2 Linking Drug Involvement to Violent and
Property Offending 182
6.5 Frequency of Drug Trafficking and Reasons for
Involvement 185
6.6 Discussion and Implications 188
6.6.1 Drugs and Crime 188
6.6.2 Limitations of Findings 189
References 191
7. Patterns of Use Among Drug Treatment Clients 195
Patrick M. Flynn, James W. Luckey, and Sara C. Wheeless
7.1 Value of Epidemiological Studies of Drug
Treatment Populations 196
7.1.1 Multiple Problems of Drug Abusers 196
7.1.2 Characteristics of the Treatment Population 197
7.2 Overview of the Study 199
7.3 Prevalence of Drug Use Among Treatment Clients 200
7.3.1 Drug Use During the Past Year and Past Month 201
7.3.2 Demographic Correlates of Users 207
7.3.3 Patterns of Drug Use 208
7.3.4 Frequency of Use and Components of Dependence 211
7.3.5 Needle Use 213