Title: I-ADAM in Eight Countries: Approaches and Challenges Series: Research Report Author: Bruce Taylor (ed.) Published: National Institute of Justice, May 2002 Subject: More issues in criminal justice: criminal justice system 170 pages 417,066 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 I-ADAM in Eight Countries Approaches and Challenges RESEARCH REPORT ------------------------------ 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 ------------------------------ I-ADAM in Eight Countries Approaches and Challenges Editor Bruce Taylor Contributing Authors Vicknasingam Balasingam, Trevor Bennett, Henry H. Brownstein, Luis Caris, Willemijn Garnier, Doug Johnson, Peter Klerks, D. Locke, Antoinette Louw, Toni Makkai, Neil McKeganey, Visweswaran Navaratnam, Hilal Hj. Othman, Charles Parry, Janine Plaisier, Andreas Plddemann, Bruce Taylor, Elna van Niekerk, and Gina Weir-Smith May 2002 NCJ 189768 ------------------------------ National Institute of Justice Sarah V. Hart Director Points of view or opinions stated in this document are those of the authors and do not represent the official position or policies of the U.S. Department of Justice. 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. ------------------------------ Foreword James O. Finckenauer James O. Finckenauer is director of the International Center of the National Institute of Justice. He is on leave from the Rutgers University School of Criminal Justice, where he is a professor of criminal justice. The International Arrestee Drug Abuse Monitoring (I-ADAM) program began just over 2 years ago. I-ADAM in Eight Countries: Approaches and Challenges is the first look at the general results of this international experiment. The compendium provides an update--a kind of status report-- on the state of I-ADAM's implementation. It also provides an opportunity to address the broader subject of international comparative research. Research purporting to examine crime and justice issues across national boundaries, while occasionally lauded, has been relatively rare. This rarity is attributable in part to the great difficulties faced by any would-be comparativists; some of these difficulties are of sufficient gravity to call into question the very worth of any such undertakings. Skeptical questions often raised about comparative research include: What is its value? What are its contributions to our body of knowledge about crime and criminals? What are its pitfalls? And perhaps most important, are those pitfalls so potentially damaging to research credibility as to render any findings and conclusions from international comparative studies meaningless? Although this initial and modest effort by the I- ADAM program can serve as a useful case example, it will obviously not definitively answer the criticisms and questions. It will, however, permit us to begin to address a number of issues subsumed within some of the questions. Before turning to cross-national research in general and the I-ADAM studies in particular, let us first consider the issue of the overall worth of any research information that is "comparative." Findings and results of research can be grouped into three types of information: descriptive, comparative, and explanatory. Although any research results must begin with descriptive information, mere descriptions, by themselves, tell us very little. For example, let us say we find that 30 percent of arrested drug users recidivate. What are we to make of this isolated piece of information? Is that figure high, low, or average? Is it increasing or decreasing? Without some basis for comparison, we do not know. Thus, we see the need for comparative information--literally, an answer to the question, "Compared with what?" Before/after studies, multisite studies, and experimental/control studies, for instance, all introduce a comparative frame of reference. Of the three information types, explanatory information is of the highest order in facilitating understanding. But to obtain explanatory information, one must have rigorous research designs that enable testing causal assumptions so as to actually explain the phenomenon in question. Such designs are quite expensive and difficult to maintain in criminological studies. As the above discussion implies, comparative research can occur in many forms. Only one of these--albeit the one most thought of as "comparative research"--involves cross-national work. Cross-national comparative studies introduce cultural and national diversity into the research design. They enable us to address questions about the universality of crime and criminal behavior, the criminal justice system response, the offender and community reactions to that system response, and the universality of the interactions among these factors. With respect to drug abuse, the focus of the research reported here, we can ask about differences across countries in drugs, drug use markets and prices, or the age and gender of users. We can further ask about differences in the relationship between drug use and criminal offending, the type of crimes committed, and, again, offender age and gender. As the introduction to this compendium points out, comparing the prevalence of drug use among arrestees in different countries is valuable to help identify invariant factors that predict drug use across countries and general patterns of human behavior that are not culturally specific. I-ADAM has considerable potential for creating a research-based policy platform. The value in having answers to questions such as those just mentioned lies in finding cross-national differences that lend themselves to policy interventions. For example, if specific criminal justice responses or prevention strategies are shown to be effective in particular instances, they can be replicated and tested in other jurisdictions, which is one of the motives behind the I-ADAM initiative. Pitfalls of Comparative Research Some words about a few of the pitfalls in cross-national work, alluded to earlier, are in order. A major barrier to be overcome is that of language. Except where research sites share a common language, translation is necessary. Written instruments require not only translation from the original into the second language, but also translation back to the original to verify accuracy. Despite the utmost efforts of the researchers, differences in meaning often creep in that can change the results. Because roughly half of the countries in the I-ADAM project are English speaking, this was not a problem. Nevertheless, it was an issue for the sites in Chile, Malaysia, and the Netherlands. For example, the Chilean report indicates that the interview schedule was translated into Spanish and then given "minor edits and adaptation to the Chilean idiom." It is this kind of adaptation that can introduce imprecision and differences in responses. Language will become an even greater problem if and when countries such as Russia and Ukraine are added as sites, as planned. Cultural differences in research traditions and methods also have to be reconciled in cross-national studies. The scientific method does not govern everywhere. Sampling can mean different things in different countries. The same is true of access to data, protection of human subjects, and policies with respect to publication of research findings. The Chile report is again a case in point. Referring to the questionnaire, the report says "it was deemed necessary to add as well as remove a few questions on the basis of cultural applicability." Similarly, Australia's report indicates that "changes were made to the instrument based on feedback from local sites, interviewers, and interviewees"--in part because "terminology did not translate." Introducing differences also introduces variability that can threaten validity. Comparative research is also made difficult by the variation in data reliability and validity across countries. Crimes and criminal justice practices (such as arrests, prosecutions, and convictions) are defined and recorded differently. These difficulties both challenge and discourage researchers and lead to skepticism with respect to the credibility of cross-national research. These potential problems confronted the I-ADAM project and required the existence, at the outset, of a very compelling argument and rationale for the program, which is stated quite succinctly in the Introduction and Overview chapter. Drug use and the crimes attendant to drug use are global problems. They infect both developed and developing countries. Drugs devastate individual abusers and their families. Drug money feeds transnational organized crime, corrupts governments, and finances civil wars and terrorism. To develop effective policies for confronting these problems, we obviously need to know and learn as much as possible about them. Unfortunately, for many of the reasons outlined earlier, existing drug research makes cross-country comparison difficult or impossible. In many cases, no research existed. The report from Malaysia indicates, for example, that there had never been a study conducted in that country to determine the level of drug and alcohol use among the arrestee population. It was hoped that the ADAM method and protocols could help fill the gaps and overcome incomparability. Method and Protocols I-ADAM has systematically attempted to deal with the host of potential problems that are common to comparative research and to ensure uniformity in its approach. The research in the eight countries has proceeded in a parallel way to avoid any history effects. As with the original ADAM, I-ADAM employs two data collection methods: individual interviews and urinalyses. One of the first issues for comparability is the uniformity of the sampling procedure for choosing those subjects from whom to collect data. In accordance with ADAM practice, arrestee participation must be voluntary. Adult male and female arrestees (individuals booked and processed by the police) who are detained long enough to be interviewed, but less than 48 hours, make up the pool from which the sample of volunteers is to be drawn. Sites use probability sampling methods, or if the population is small enough, they interview the entire universe. Alternatively, some sites use convenient sampling methods to reduce the cost of data collection. A second comparability issue is the need for uniformity with respect to the interviewers and the interview environment. The ADAM protocol stipulates that interviewers should not be law enforcement personnel to avoid any coercion or biasing of responses. All interviewers are carefully trained in the administration of the interview schedule. The interviews themselves are conducted in private or semiprivate settings to encourage confidentiality. A major issue for uniformity is the interview schedule itself. Dropping and adding questions obviously works against uniformity. The effect of changes is not itself uniform, however. Because all questions in the schedule are not created equal, as long as "core" questions are retained and changes are on the margins, a condition of relative uniformity can be maintained. One effect of alterations in questions is to limit the comparative analyses to just those items that appear in the same manner in all forms. With respect to urinalysis, many comparability problems are avoided. Assuming the sample has been properly chosen, there is less room for human variation and error in collecting and analyzing urine samples than in conducting the interviews. Five common drugs are tested for all I- ADAM sites: marijuana, cocaine, opiates, amphetamines, and benzodiazepines. Drug testing is a highly reliable method of ascertaining whether a subject has recently used drugs and what drug (or drugs) has been used. With this background, but also with the reminder that I-ADAM is both limited and in its early stages, we can make some observations about the experiences to date. These observations are, of necessity, impressionistic and suggestive. Assessment and Observations The I-ADAM effort described in these pages represents a rare and, in some senses, unique research effort. Because it was adapted from the ADAM foundation, it starts with a tried-and-true methodology. It is also relatively narrowly focused and well defined, thus reducing the risk of incomparability. Unlike other comparative research projects, no considerable time needed to be spent in designing the research (e.g., formulating research questions, sample designs, or data collection and analysis strategies). With the research design already in place, individual country projects could begin as soon as such practical issues as funding and political support were addressed. The first observation deals with the samples in the different countries. These samples, including those in the U.S., tend to be regarded and even treated as nation specific, when this is clearly not the case. As is pointed out in the U.S. chapter, within-country variability makes any assumptions about population homogeneity untenable. It is generally accepted that due to the variability among and between the 35 sites in the United States, results cannot be generalized to any larger population. This is even a greater problem when results are compared across international borders. Thus, any results will need to be specific and treated with caution. Considering the sample limitations and variations in the interview schedule, the report from the Netherlands takes what is perhaps the most appropriate perspective on the comparability of data collection at this stage. The Dutch say that "comparisons with I-ADAM data from other countries should perhaps be restricted to hypothesis-forming impressions and should not be used to form conclusions about the drug situation in the Netherlands." This is wise advice. The value of using these reports to develop testable hypotheses and glean other heuristic effects should not be dismissed or downplayed. There are numerous possibilities to be explored here. For example, South African data show that nearly 80 percent of the offenders arrested for housebreaking tested positively for drugs. Furthermore, the number of housebreakers in South African sites using cocaine was four times that of those committing other crimes. In Australia, the strongest correlation with respect to drug use and offending was between property offenses and opiate use. Scotland found relatively high levels of opiate use among the arrestees tested but much more so among females than males. The U.K. found that many of the measures of drug use correlate strongly with many of the measures of crime. What might be made of all these findings? What are the general patterns of relations between drug use and offending? What is the particular connection here between drugs and housebreaking, and opiates and property offending? Why the gender distinction in Scotland? What are the differences in these respects across countries? These and other questions are stimulated by the current research. This compendium illustrates that a reasonable beginning has been made. There are problems and there are corrections to be made. Nevertheless, the potential value is clear. The report from England/Wales sums up rather nicely the ultimate value of I-ADAM. Pointing out that these data add to our fundamental knowledge about drug abuse and crime and the way they are linked, the report says, "The data generated by the I-ADAM partnership can be used to compare international trends in drug misuse. The program allows for monitoring changes in drug misuse across countries and over time. This evidence can then be used to inform national and international drug policies." ------------------------------ Table of Contents Foreword James O. Finckenauer, National Institute of Justice, Washington, DC, USA Executive Summary Introduction and Overview Bruce Taylor, National Institute of Justice, Washington, DC, USA Australia Toni Makkai, Australian Institute of Criminology, Canberra, Australia Doug Johnson, Australian Institute of Criminology, Canberra, Australia Chile Luis Caris, Chief, Alcohol, Tobacco, and Drug Unit, Ministry of Health, Santiago, Chile Bruce Taylor, National Institute of Justice, Washington, DC, USA England and Wales Trevor Bennett, Institute of Criminology, University of Cambridge, Cambridge, England Malaysia Visweswaran Navaratnam, National Centre for Drug Abuse Research, Universiti Sains Malaysia Vicknasingam Balasingam, National Centre for Drug Abuse Research, Universiti Sains Malaysia Hilal Hj. Othman, National Centre for Drug Abuse Research, Universiti Sains Malaysia The Netherlands Peter Klerks, Dutch Police Academy Janine Plaisier, WODC, Ministry of Justice, The Hague, the Netherlands Willemijn Garnier, Ministry of Justice, The Hague, the Netherlands Scotland Neil McKeganey, University of Glasgow Centre for Drug Misuse Research, Glasgow, Scotland Clare Connelly, University of Glasgow School of Law, Glasgow, Scotland John Norrie, University of Glasgow Robinson Centre for Biostatistics, Glasgow, Scotland Janusz Knepil, Department of Biochemistry, Gartnavel General Hospital, Glasgow, Scotland South Africa Elna van Niekerk, CSIR, Division of Roads and Transport Technology, Pretoria, South Africa Charles Parry, Medical Research Council, Cape Town, South Africa Andreas Plddemann, Medical Research Council, Cape Town, South Africa Antoinette Louw, Institute for Security Studies, Pretoria, South Africa Gina Weir-Smith, Human Sciences Research Council, Pretoria, South Africa D. Locke, Crime Information Analysis Centre, Pretoria, South Africa United States Bruce Taylor, National Institute of Justice, Washington, DC, USA Concluding Thoughts Henry H. Brownstein, National Institute of Justice, Washington, DC, USA Appendix A: Model I-ADAM Survey Instrument Appendix B: Demographic, Economic, and Drug Information by Country ------------------------------ Executive Summary This publication is primarily a progress report on the implementation of the International Arrestee Drug Abuse Monitoring (I-ADAM) program in eight countries and on the challenges they faced. Those countries are Australia, Chile, England, Malaysia, Netherlands, Scotland, South Africa, and the United States. Although some research findings are presented, the principal purpose of this report is to describe the experiences of the countries as they engaged in the process of launching I-ADAM. Providing the first review of the early stages and status of I-ADAM in participating nations, this volume attempts to identify common problems in developing an I-ADAM site and approaches to surmounting implementation barriers. As noted toward the end of the Introduction and Overview chapter, the sequence of subtopics in each of the eight country chapters is the same, ranging from general information to such issues as obtaining funding, creating a survey instrument, developing research methods, and training. This report documents that, overall, reasonable progress has been made in implementing the I-ADAM experiment. Problems remain; some adjustments are needed. I-ADAM's impressive potential, however, is undiminished. International ADAM Program in Brief I-ADAM is an outgrowth and extension of the Arrestee Drug Abuse Monitoring (ADAM) program, developed and operated by the National Institute of Justice, U.S. Department of Justice. Its origin dating back to the mid-1980s, ADAM tracks trends in the prevalence and types of hardcore drug use--such as cocaine, heroin, marijuana, and methamphetamine--among booked arrestees in 35 sites across the United States. Obtained through a standardized methodology and protocol governing arrestee interviews and urine specimen testing, ADAM provides a series of localized assessments about the U.S. drug abuse problem in the arrestee population that are a central component in studying links between drug use and crime and other social problems. Aspects of ADAM can be customized to address specific needs at the community level. Thus, data collected through ADAM can also provide a fundamental research and evaluation tool that local analysts, policymakers, and practitioners can use to target drug-related issues of particular interest to the locality, such as evaluations of drug treatment and pretrial diversion programs. In 1998, the ADAM concept began expanding internationally as the I- ADAM program, envisioned as a research partnership among criminal justice organizations worldwide. Like its namesake, I-ADAM serves the twin functions of research and policy guidance. The program's major goal is to develop a standardized international drug surveillance system-- similar survey instruments, sampling, training, and other protocols--that facilitates cross-country comparisons of the prevalence of drug use among arrestees and permits an assessment of the consequences of drug abuse within and across national boundaries. To the extent that its data identify similar drug problems across national borders, I-ADAM can promote a standard basis for nations to coordinate drug control policies and resources and to improve multilateral cooperation. I-ADAM identification of a growing substance abuse problem in a country's arrestee population can help forecast a potential hot spot for international drug trafficking. Researchers may also use I-ADAM data in some cases to develop such estimates as the following: the relationship between drugs and crime, sources of illegal income for arrestees, drug dependency, use of substance abuse treatment, drug market dynamics, and certain public health-related consequences of drug abuse. I-ADAM can address topics of local interest (e.g., domestic violence) and international concern (e.g., drug prices). Comparing Drug Use Across Countries I-ADAM is a network of researchers from various nations working together to address problems in each of their countries that are unique in some ways yet common in others. One of the themes that emerges from I- ADAM data is that drugs are a global issue. All eight countries have problems. Marijuana in one form or another is the drug that is most commonly used by arrestees throughout the world. In Australia, 50 to 66 percent of all arrestees tested positive for cannabis. In Chile, 30 percent of arrestees tested positive. In South Africa, 36 to 44 percent tested positive. But some drug problems are unique to particular countries. In South Africa, for example, 19 to 25 percent of arrestees tested positive for mandrax, a blend of methaqualone and antihistamine that is rarely, if ever, found being used by arrestees in other nations. The most serious problem in each country differs: England and Thailand report that opiates are the main problem. Scotland has a serious problem with injection drugs. In addition to the similarities and differences in drug use among nations, the nations also report similarities and differences in terms of the problems they have in implementing I-ADAM. For example, in all countries people commit crimes and are arrested and booked daily, night and day. Yet in all countries, it is not possible to conduct interviews 24 hours every day. The researchers report that in those nations where I-ADAM programs have been implemented or planned, policymakers and practitioners in criminal justice and public health generally express high levels of interest in the program. At the same time, most are experiencing problems identifying and securing adequate funding to support an ongoing program. All must deal with collecting data in a hectic environment, and all must work with local law enforcement and correctional officials to ensure that the program operates in a way that benefits the community without disrupting the ongoing operation of the local jail. Ultimately, I-ADAM is a fragile multinational network of people who share a common interest in the problems of drugs and are trying to work together to do something about it. ------------------------------ Introduction and Overview Bruce Taylor, National Institute of Justice Nations are increasingly recognizing a shared interest in better understanding the causes of crime and drug problems. The problem of drug use and related crime is a global phenomenon. No longer can the drug/crime problem be thought of in isolation or strictly in national terms. The drug trade affects most nations of the world, and the problems that arise because of drugs can be quite severe. In both developing and industrialized countries, problems related to drug abuse include crime, sexually transmitted diseases, accidents, deaths, poverty, unemployment, and decreased productivity. Illicit drugs can be devastating not only at the individual level; they can also corrupt governments and undermine international relations. Despite the growing nature and globalization of the drug problem, the quality and extent of research on this subject has not kept pace. Most drug abuse research to date has been done independently by dozens of countries using different research methods. Unfortunately, the results have not been comparable across countries. In response to this dearth of international comparative drug research, the National Institute of Justice (NIJ) launched the International Arrestee Drug Abuse Monitoring (I-ADAM) program in 1998, with the first annual I- ADAM conference in Miami. I-ADAM was designed to provide an international research platform to study the relationship between drugs and crime and other social problems. By attempting to identify invariant factors that predict drug use across countries, I-ADAM has the potential to broaden the research community's understanding of the nature of the drug epidemic. More important, I-ADAM is designed to provide a data-driven framework for informing and coordinating global drug control policy. Many recommendations that are made regarding global drug control policy are made without the benefit of empirical research. A fundamental element in designing and planning effective drug control strategies is the presence of extensive and reliable data, which are not available in many countries around the world. I-ADAM is being designed to meet the needs of policymakers by providing a base from which data-driven policy recommendations can be generated. I-ADAM data should make it easier for drug control policies to be coordinated across nations, and improved coordination of drug-control policies could improve the international community's ability to combat the pernicious effects of the global drug trade. One of the most significant barriers to drug policy research has been funding. Most countries do not have the resources to collect data that are representative of their entire population. However, I-ADAM is an established monitoring system for focusing on the areas of a nation with the worst drug problems (the largest cities), and where people using the most drugs (arrestees) can be found. Also, I-ADAM can provide prevalence estimates for low-base-rate drugs not typically used in the general population (e.g., heroin and cocaine). Finally, the drug use patterns of arrestees are often a good indication of future problems. For example, the U.S. program documented high prevalence rates for cocaine long before the epidemic was detected by drug treatment centers. Historical Background In 1987, NIJ created the Drug Use Forecasting (DUF) program to serve as one of the U.S. Government's primary sources of information on drug use among arrestees in cities. DUF became one of the primary research tools on drug use, crime, and related social indicators. In 1997, the DUF program was redesigned and renamed ADAM (Arrestee Drug Abuse Monitoring) to reflect the geographic expansion and increased methodological rigor of the program and its development as both a research and policy platform and a system for locally initiated research on topics identified by sites. At its core, however, the ADAM program preserves DUF's simple concept: interviewing and drug testing arrestees. A component of the new ADAM program was the development of an international drug surveillance system among arrestees. The international element to NIJ's work is relatively new; in the past, NIJ has worked mostly with U.S. Federal, State, and local officials. In 1997, the NIJ International Center was launched as the central organizing body of NIJ's international efforts. Its mission is to stimulate, facilitate, evaluate, and disseminate national and international criminal justice research and information. With the transition from DUF to ADAM, the development of the I-ADAM program became an important goal. Prior to the formal launching of the I- ADAM program, two countries--Chile and England--started collecting ADAM-like data in 1996. In April 1998 in Miami, I-ADAM held its first annual conference for representatives from eight nations (Australia, Chile, England, the Netherlands, Panama, Scotland, South Africa, and Uruguay), two international organizations (The Organization of American States and the United Nations International Drug Control Programme), experts in the field of drug surveillance systems, NIJ staff, and other U.S. Federal representatives (the Drug Enforcement Administration and the National Institute on Alcohol Abuse and Alcoholism). In July 1998, officials from England's Home Office announced the second phase of development for the New England/Wales ADAM program (named NEW-ADAM), which added several new sites and began a time-series design in revisited sites. The second wave of NEW-ADAM data collection began in August 1998; two locations were surveyed in that year (South Norwood in London and Copy Lane in Liverpool). With the exception of England (1996) and Australia (March 1998), most countries represented at the first I-ADAM meeting in Miami did not have funding for I-ADAM work. In August 1998, Chile and Scotland secured funds for I-ADAM data collection, and in November 1998, South Africa secured funds for I-ADAM work. Also during 1998, NIJ began conducting field assessments (in Scotland and England in September 1998, Australia in October 1998, Chile in December 1998, and South Africa in January 1999) and training for interviewer staff (in Australia in January 1999 and Chile in January 1999). In the fall of 1998, the infrastructure for I-ADAM started to take shape, with the development of the core survey and an I-ADAM training program. At the beginning of 1999, Chile and Australia started data collection; I- ADAM held its second strategic planning meeting in April in Chicago. In addition to those who attended the first meeting, representatives from Malaysia and Taiwan were present at this meeting. In April 1999, NIJ released Comparing Drug Use Rates of Detained Arrestees in the United States and England,[1] which represented the first comparative analysis of arrestee drug use rates across two countries and the first publication of the I-ADAM Program. In mid-1999, three more sites started collecting data (the Netherlands, Scotland, and South Africa), and another country (Spain) contacted NIJ and expressed interest in I-ADAM. NIJ visited Madrid in October 1999 and participated in the Seminarios Internacionales Complutenses. NIJ also participated in an international meeting held by the World Health Organization in Vancouver, Canada, in December 1999 to generate interest in I-ADAM. In November 1999, NIJ met with other Federal agencies involved in drug policy work, research, treatment, and law enforcement. The dual purposes of the meeting were to inform interested parties about the status, goals and objectives, costs, and future rollout plans for I-ADAM and to start a dialogue among potential Federal or international funding partners and NIJ. One important issue discussed at the meeting was the wisdom of expanding I-ADAM from the eight self-funded countries currently involved to a second generation of I-ADAM sites. At the end of the meeting, a number of representatives expressed interest in I-ADAM on behalf of their organizations and their desire to collaborate with NIJ on developing a program. In December 1999, the Medical Research Council of South Africa released its first I-ADAM report containing data from three metropolitan sites, and in 2000, a number of countries began publishing the results of their I- ADAM work. Australia released two I-ADAM publications in January and two more in March. Additional publications were released by the Medical Research Council of South Africa in May. Scotland released its first publication in June, and England released its second program publication in July. Early in 2000, a number of innovative developments occurred in I-ADAM. In February 2000, the first international comparison study of two drug testing kits was completed. This study demonstrated the similarity in results between different drug testing kits; the fact that England is using a different urinalysis kit than the United States does not appear to affect results. In March, data collection for the first-ever national probability sample of arrestees started in South Africa, and the program's first Asian country (Malaysia) began collecting I-ADAM pilot data in May. In early to mid-2000, a number of important I-ADAM-related meetings were held. First, an I-ADAM section was added to the U.S. ADAM annual meeting, and the third annual I-ADAM conference was held in September in Washington, D.C. The third conference was the largest I-ADAM meeting to date (double the size of the second conference); its more than 50 attendees included 15 representatives from 11 countries (Australia, Chile, England, Malaysia, Russia, Scotland, South Africa, Taiwan, Thailand, Ukraine, and the United States), more than a dozen officials from other U.S. Federal agencies, and researchers and policymakers from a variety of other organizations. The year 2000 also contained some setbacks. In June, the Netherlands I- ADAM group stopped collecting I-ADAM data. Early 2001 involved a fair amount of I-ADAM activity. In Australia, three reports were released, and additional funding was approved.[1] In announcing funding of $1.8 million to continue the Australian I-ADAM program, known as DUMA, for a further 2 years, the Honorable Chris Ellison, Minister for Justice and Customs, said: "DUMA testing for the first time provides the criminal justice system with quality data on the drugs-crime link and demonstrates the Government's commitment to evidence-based policy making." In England, a summary report on the NEW-ADAM program covering July 1999 and April 2000 data collection was issued.[2] The Honorable Bob Ainsworth, Home Office Minister responsible for coordinating the Drugs Strategy, welcomed the publication of the study by saying: "The NEW- ADAM research reveals that the first point in the criminal justice system is picking up a group of particularly prolific drug using offenders. In 1999- 2000, this group represented 15 percent of arrestees. Our target is to reduce the size of this group by one quarter in 2005 and by a half in 2008." The summary report presents results of drug use and offending among adult arrestees in eight locations in England and Wales. It sets baselines for the "Communities" component of the national antidrug strategy. In South Africa, the I-ADAM group published a report on the third phase of data collection for their Three Metros Study, and held a workshop to discuss ADAM findings and implications for policy.[3] A panel of South African experts from justice, corrections, drug research, social services department, offender rehabilitation and police was invited to the workshop to give their views on the drug-crime situation and what was learned from the data. In the United States, the first release of data collected under the new ADAM sampling scheme and revised survey instrument was made publically available, and ADAM published the "Methodology Guide" and "Data Analytic Guide" by posting the reports on the ADAM Web site. Also, a number of international participants attended the 2001 ADAM Annual Conference held in Miami in June 2001. Data collection has also proceeded as scheduled in the other I-ADAM participating countries. In 2001, a few other countries (Barbados, Nigeria, and Venezuela) expressed interest in joining the I-ADAM effort. Representatives from Thailand who attended the third I-ADAM annual meeting began preparations to collect I-ADAM data in late 2001 in Chiang Mai city. The three studies are: 1. Makkai, T., and K. McGregor, "Drug Use Monitoring in Australia (DUMA): Annual Report for 2000," Research and Public Policy Series, No. 37, Canberra: Australian Institute of Criminology, 2001; Johnson, D. "Age of Illicit Drug Initiation," Trends and Issues in Crime and Criminal Justice, No. 201, Canberra: Australian Institute of Criminology, 2001; Makkai, T., "Drug Use Amongst Police Detainees: Some Comparative Data Testing," Trends and Issues in Crime and Criminal Justice, No. 191, Canberra: Australian Institute of Criminology, 2001. 2. Bennett, T., K. Holloway, and T. Williams, "Drug Use and Offending: Summary Results From the First Year of the NEW-ADAM Research Programme." Home Office Research, Development and Statistics Directorate Research Findings 148. London: Home Office, 2001. 3. Parry, C., A. Louw, and A. Plddemann, "Drugs and Crime in South Africa: The MRC/ISS 3 Metros Arrestee Study (Phase 3)." Research Brief. Pretoria: Medical Research Council and Institute for Security Studies. Description of Program The I-ADAM Program is an international partnership of government-sponsored research organizations. All participating countries/jurisdictions are being operated through local/national funds. Countries participate in I-ADAM to stay current on the latest scientific methods of arrestee drug surveillance survey work, take part in comparative data analytic projects on cross-national differences in drug use, and receive technical assistance on the basic operation of a data collection system. I-ADAM's development is important because the existing drug surveillance systems around the globe, in many cases, are not compatible. Therefore, post-hoc comparisons across countries with independently designed systems are very difficult. The existing general population household surveys found in some countries use very different measures of drug use and were not designed for multinational comparisons. From its inception, I-ADAM has been designed to be a standardized international surveillance system (with similar instruments, sampling, training, and other protocols). I-ADAM serves two functions: research and policy guidance. Research might show, for example, that certain market conditions must exist for particular drug epidemics to thrive. The findings could then be used by countries that are not experiencing the epidemic to plan prevention efforts. It is hoped that, in the future, I-ADAM can help form a standard basis for nations to coordinate drug control policies. A growing substance abuse problem in a country's arrestee population can help forecast a potential hot spot for international drug trafficking. Through development of addendums, I-ADAM can be used to help estimate the characteristics of drug markets around the world; such data should prove useful for coordinating international drug control efforts. I-ADAM is a standardized international drug surveillance system that for the first time provides researchers with a platform to compare the prevalence of drug use among arrestees in different nations and allow them to assess the consequences of drug abuse within and across national boundaries. I-ADAM has three main components: voluntary, anonymous, and confidential interviewing; similar data collection methods; and standardized measures. Voluntary, anonymous, and confidential interviewing At I-ADAM data collection sites, trained interviewers (who are not in law enforcement) conduct individual interviews with detained arrestees and collect voluntary and anonymous urine specimens from interviewees. Every I-ADAM site provides a private or semiprivate interview environment that is conducive to open, valid, and reliable responses by participants. Similar data collection methods Each I-ADAM site uses similar eligibility criteria for selecting study participants. Site staff collect data from male and female booked/processed arrestees detained long enough to be interviewed (but less than 48 hours). Study participants are generally interviewed before they have seen a magistrate or judge, but they have access to legal counsel if they wish to ask about the voluntary nature of the study. Data collection from juvenile males and females is optional. Each I- ADAM site attempts to obtain a sample size large enough to provide a reasonable level of statistical precision where all the main age and gender groups are represented in sufficient numbers. Typically, the site schedules about 2 to 3 weeks of quarterly interviewing at the jail/lockup. Most I- ADAM sites collect data from 150 adult male and 75 adult female arrestees each quarter to reach a total of 900 arrestees annually. I-ADAM sites aim to use a definable study/catchment area and to understand the representativeness of their data. Ultimately, probability-based sampling methods will be adopted at each I-ADAM site. At I-ADAM sites in England and Scotland, the entire universe of eligible arrestees is interviewed at selected study sites during a selected time period. When the universe of cases is interviewed, the problem of complicated sampling schemes is avoided, but the cost of data collection increases dramatically. The sites that have adopted population-based data collection schemes have used this method because of the small number of arrests made in their jurisdictions. By interviewing all of the eligible cases, these sites are able to maximize the number of interviews that can be conducted in the shortest period of time, thereby reducing the burden of data collection to a few weeks per quarter. Standardized measures In collaboration with NIJ, international sites determine the type and number of drugs in the drug test panel. Currently, at least five common drugs (marijuana, cocaine, heroin/opiates, amphetamines, and benzodiazepines) are being tested by all the I-ADAM sites. Also, NIJ has developed a core I-ADAM survey instrument in consultation with the other I-ADAM sites, and the agreed-on core survey is being implemented by all the active sites. The development of a revised core I-ADAM survey, which might include such new topical areas as drug dependency, criminal history, and drug markets, is under consideration. At a later point, common addendum surveys will be developed for special topical areas (e.g., domestic violence). Organization of This Compendium The chapters in this report provide a review of the developmental stages of I-ADAM in participating countries, barriers to development, national stakeholders involved in the development of I-ADAM, research methods used in I-ADAM, and analytic results (if data are available). This report does not involve direct statistical testing of differences across countries; instead, it is intended to be descriptive. The report attempts to identify common problems across countries in developing an I-ADAM site and approaches to resolving those problems. Each country provides a summary of its I-ADAM results and likely policy implications or applications of its data. Also, site description tables covering sociodemographic characteristics, economic information, and drug use data are included in the appendix for each I-ADAM country. All country chapters follow the same basic outline. The first three sections of each chapter provide some broad information about the participating countries. Here, the attempt was made to provide some context for I- ADAM work in terms of the general sociodemographic conditions present in each country, the basic operation of the criminal justice system within which I-ADAM needs to fit, and the status of drug control policy. Section I covers national census information on each country. A basic demographic profile is provided, including statistics on population size; geographic size; ethnic, gender, and age distribution; unemployment, poverty, and literacy rates; income; gross national product; percent living in urban conditions; birth rate; life expectancy; population growth; mortality rates; and gender composition. Section II provides a description of the country's criminal justice system, the arrest process, and the detention system. Prior research with DUF (and now ADAM) has shown that the study of arrestees is important because they typically represent the hardcore population of drug users and are the group consuming the majority of illicit drugs. Section III examines the general policies in place to deal with drugs in each participating country. A fair amount of variability exists within I- ADAM on the issue of drug control policy. For example, the Netherlands has a policy of harm reduction, or a medical model. Therefore, consumption of certain small amounts of drugs is tolerated by law enforcement in the Netherlands. Malaysia, however, has a strict zero-tolerance policy for drugs, and the death penalty exists for certain drug offenses. The overview of a country's drug control policy helps to explain the drug use of its population. Section IV covers the developmental history of I-ADAM in each country. For most participating countries, this history is fairly recent--beginning around 1998--and the programs have developed quite rapidly. Section V examines the goals and objectives of I-ADAM. It is important to understand the local/national focus of I-ADAM and that, without the achievement of local goals, little room for international work exists. Most participating countries have not formally stated their goals and objectives, but the authors identify at least some of the broad aims of the program. Section VI documents the difficult work of getting an I-ADAM site operational and is meant to help interested countries start a program. Issues reviewed in this section include: o Obtaining funding. o Deciding to conduct in-house research or to contract it out. o Negotiating access to the lockup facilities where arrestees are held. o Learning about the catchment area for the project and how arrestees are processed therein. o Handling urine specimens. o Creating a survey instrument that is culturally applicable for the local arrestee population. o Designing a survey that conforms to I-ADAM core standards but retains its utility for local purposes. Section VII reviews the numerous barriers that exist to conducting this type of work, such as obtaining adequate funding and obtaining a large enough sample to allow sufficient statistical precision. Given the importance of securing political support for I-ADAM to sustain the program, section VIII discusses the national stakeholders involved. Section IX reviews the site-specific research methods used in the program. This section pays special attention to detailing the sampling scheme and related data collection protocols. Section X reviews training issues. NIJ has developed a training curriculum and related materials and made it available to all participating I-ADAM jurisdictions. NIJ and its contractors have also visited each of the countries to assist and/or participate in the development of local training programs. This section identifies difficulties that have been encountered in training I-ADAM interviewers and areas that need to be focused on in the future. The final sections review the main data analytic results of I-ADAM in each country (Malaysia did not have findings at the time this compendium was written), the policy implications of I-ADAM, and various examples of I-ADAM data applications. Note 1. Taylor, B., and T. Bennett, Comparing Drug Use Rates of Detained Arrestees in the United States and England, Washington, DC: U.S. Department of Justice, National Institute of Justice, 1999, NCJ 175052. ------------------------------ Australia Toni Makkai Doug Johnson Toni Makkai is director of research at the Australian Institute of Criminology and program director of the Drug Use Monitoring in Australia (DUMA) project. She has held university teaching and research appointments in England and Australia. Doug Johnson is currently a project officer with the Commonwealth Attorney General. Prior to this, he was a member of the DUMA project team at the Australian Institute of Criminology. DUMA is funded under a 3-year grant from the Commonwealth's National Illicit Drug Strategy. The data used here were collected for the Australian Institute of Criminology's Drug Use Monitoring in Australia project by the National Drug Research Institute at the Curtin University of Technology, Hauritz & Associates Pty Ltd, and Forsythe Consultants Pty Ltd, with the assistance of the Queensland, New South Wales, and Western Australian Police Services. Neither the collectors nor the police services bear any responsibility for the analyses or interpretations presented here. The opinions expressed here are those of the authors and do not necessarily reflect those of the Australian Institute of Criminology. I. Overview of Demographic Profile of Nation Australia has one of the most stable and conservative democracies in the world. The official Head of State, the Queen of England, and the Westminster style of government are evidence of its British heritage. Parliament consists of two chambers, the House of Representatives and the Senate. Voting is along party lines, and the party that captures a majority of seats in the House of Representatives--or that can assemble a coalition with a majority of seats--is given the opportunity to form a government. The majority party's leader becomes the Prime Minister. The Australian political system is a federal system in which the States have significant power relative to the Commonwealth Government. The country comprises six States and two Territories. Each State has its own Parliament and Premier, and each guards its sovereignty jealously. The Territories also have their own Parliaments and Chief Ministers, but they have less sovereignty over their own internal affairs. Australia is at once one of the world's most sparsely populated countries and one of its most urbanized. A population of 19.1 million, 1/14th that of the United States, occupies a landmass of 7,692,030 square kilometers, nearly the size of the United States. At the same time, 80 percent of Australia's population is clustered in a few large coastal cities at the edge of an otherwise virtually uninhabited continent. Characteristics of the population, including population growth, life expectancy, birth and death rates, and literacy (see exhibit 1) are in keeping with those of other industrialized, Western countries.[1] Australia's population enjoys a high standard of living, as shown in exhibit 2. Besides its geographic distribution, the other distinguishing feature of Australia's population is the role that immigration has played in its growth. Although Australian-born individuals contributed two-thirds of the increase in population between 1901 and 1998, by June 1999, 24 percent of the population was born overseas. Moreover, although the population is still heavily Anglo-Celtic in background, the sources of immigration have diversified since World War II. Drug and Crime Statistics The primary sources of drug statistics in Australia are the National Drug Strategy Household Survey on Drug Use, school-based surveys, and the annual Illicit Drug Reporting System (IDRS), which includes surveys of injecting drug users (IDUs). The household and school surveys are random samples conducted every 2-3 years and are based on self-report data.[2] The most recent surveys show upward trends in the use of illicit drugs. As shown in the drug arrest statistics (see exhibit 3), cannabis remains the most popular illicit drug, followed by heroin and amphetamines. IDRS is conducted annually; IDU surveys are convenience samples that use self-report data. The IDU surveys show that heroin and amphetamines are the most popular illicit drugs among IDUs. The Australian Bureau of Criminal Intelligence collects annual data on drug-related issues (exhibit 3), price, and purity. The average drug purity in 1998-99 was 65 percent for heroin, 51 percent for cocaine, and 17 percent for methamphetamines.[3] Prices vary across jurisdictions. In January-March 1999, the price of a cap (0.1-0.3 g) of heroin was estimated to range from $A25 in parts of New South Wales to $A100[4] in the Northern Territory. The last national crime victimization survey was undertaken in 1998. Data from this collection found that the prevalence rate for all offenses against households was 9.0 percent and for all offenses against persons was 4.8 percent. The most common crime was breaking and entering, with a prevalence rate of 7.6 percent. The survey found that those who were assaulted during a 12-month period were more likely to be repeat victims than were victims of other crimes. Forty-six percent of assault victims had experienced two or more assaults during the previous 12 months. Since 1993, national crime statistics have been collected on seven major crimes recorded by police in Australia: homicide, assault, sexual assault, robbery, unlawful entry with intent, motor vehicle theft, and other theft. The most common crime recorded by police is "other theft," which includes pickpocketing, bag snatching, and stock stealing. This category accounts for slightly less than half of the total recorded crimes. The rates of assaults increased from 1993 to 2000. The rates of property offenses and robberies also increased from 1993 to 1998, decreased in 1999, and appear to have increased again in 2000. In 1999, 342 murders were recorded, which represented a rate of 18 per 1 million population; murders decreased by 12 percent in 2000 to 302.[5] II. Description of Criminal Justice System, Arrest Process, and Detention System Australia's federal system of government has implications for its criminal justice system. The States and Territories administer criminal justice, but "the components and processes of criminal justice are essentially the same across Australia."[6] Australia is served by eight police forces: one in each State and the Northern Territory, and the Australian Federal Police, which also polices the Australian Capital Territory. The Drug Use Monitoring in Australia (DUMA) project operates in three States: Queensland, Western Australia, and New South Wales. Exhibit 4 illustrates the usual arrest process for offenders. Once an offense comes to the attention of the police, the officer can decide whether to investigate further. If the officer proceeds with the investigation, three options are open: The suspect can be issued a "notice to attend" or its equivalent, given a summons, or arrested. A notice to attend is usually given for relatively minor offenses. A summons is given for civil offenses such as traffic incidents or tax matters. In both these instances, the offender is usually not brought to the police station. If the matter is more serious, the officer can either arrest the suspect immediately and bring him or her to the police station or ask the suspect to accompany him or her to the station for further investigation. Once at the police station, the arresting officer can decide to continue with a formal charging process or release the suspect from custody. If the suspect is charged, the seriousness of the charge will determine whether the suspect is to be held in custody for a magistrate's hearing. If the charge is not serious, the suspect is released on bail following completion of formal charges. In the magistrate's court, the suspect can either be given bail and released or refused bail and remanded into custody. DUMA staff cannot interview a detainee until the arrest process is complete. In some sites, if the offender is refused bail, he or she is then transferred to corrective services. DUMA personnel must interview the detainee before the transfer. Some sites also have a maximum detention time. In New South Wales, the police can detain a suspect for up to 4 hours for investigative purposes (an application can be made for another 8 hours). After that time, the suspect must be charged or released. DUMA staff must gain access to the detainee before this deadline. There is a last window of opportunity to interview those people charged and then remanded into custody by the court; if remand is within 48 hours after arrest, then data collection can proceed. Australia has State and Federal courts. Seventy-nine percent of court hearings in 1996-97 were for criminal matters, which State and Territory magistrates' courts usually handle. These courts have no jury and normally cannot impose a sentence longer than 2 years. Most defendants in the magistrates' courts are found guilty; the majority of defendants are male. The district or higher court hears more serious criminal matters. Defendants who cannot afford their own solicitors can apply for legal assistance, but they have no constitutional right to representation. On conviction, the courts can impose a range of measures, including a fine, suspended sentence, community-based supervision order, home detention, periodic detention, and incarceration. In 1997-98, 74,810 persons were sentenced in Australia. Of these, 25 percent were placed in a community corrections program, 25 percent were given a prison sentence, and 2 percent were given periodic detention.[7] The rate of imprisonment in Australia of persons older than age 16 has increased significantly in the past two decades, rising 52 percent from 91.6 per 100,000 population in 1983 to 139.2 per 100,000 population in 1998. III. Status of National Drug Policy The drug of choice in Australian society is alcohol, and, although the country's temperance movement was active in the late 19th and early 20th centuries, alcohol was never prohibited.[8] Before Federation in 1901, opium and cocaine were legal and as widely available as alcohol and tobacco. At the turn of the 20th century, considerable concern grew about the use of opium, particularly by ethnic Chinese. A combination of factors caused the States to introduce legislation to ban opium use. During the early 1900s, laws were passed to ban over-the-counter medications, including heroin. Those drugs no longer could be sold without a doctor's prescription. A policy of drug maintenance under the control of general practitioners continued until the early 1950s. Concurrently, an international outcry about high levels of legal heroin use led to a Federal ban on the importation of heroin, and Australian States banned the manufacture of heroin within their jurisdictions. By the early 1980s, the first cases of AIDS were diagnosed, civil liberties were increasingly being eroded, the profits from organized crime were growing exponentially, and public officials were being corrupted by large sums of money from the drug trade. In 1983, the Federal Government introduced a national harm minimization strategy that was most clearly defined in the 1993-97 National Drug Strategic Plan: Harm minimization is an approach that aims to reduce the adverse health, social, and economic consequences of alcohol and other drugs by minimizing or limiting the harms and hazards of drug use for both the community and the individual without necessarily eliminating use.[9] Successive governments have continued to endorse this policy, but at first, law enforcement was not supportive. By the 1990s, law enforcement agencies were committed to harm minimization, at least at the policy level. Throughout the 1990s, a range of drug and crime indicators suggested that illicit drug use and related criminal activity were increasing. The Federal Government responded in 1996 with the launch of the National Illicit Drug Strategy (NIDS), which allocated more money to both supply and demand reduction strategies. IV. Background History to DUMA Throughout the 1990s in Australia, deaths due to opioid overdose increased at an alarming rate; illicit drugs, particularly heroin, were widely available; and open drug markets started to appear in some cities. Crime, particularly property crime, was increasing. In 1997, the Federal Government reinvigorated its commitment to a national drug policy by allocating more money for law enforcement, treatment, and education. Given the severity of the problem and the link between illicit drugs and crime, the Australian Institute of Criminology (AIC) successfully applied for funds to conduct the Drug Use Monitoring in Australia (DUMA) pilot project. The project began collecting data in January 1999 and continued under current funding arrangements until December 2001. V. Goals and Objectives of DUMA As a pilot study, DUMA's primary purpose is to apply the U.S. Arrestee Drug Abuse Monitoring (ADAM) methodology and questionnaire to Australia; its secondary purpose is to begin collecting credible data on drugs and crime. The project specifically aims to determine whether the ADAM methodology can provide the following: o Reliable drug prevalence data on detainees. o Aggregated data to local and national law enforcement and treatment agencies for monitoring, evaluation, and assessment purposes. o Timely and high-quality data to inform policy on drugs and crime.[10] VI. Getting Started A. Obtaining Funding NIDS provided new funds for drug policy, half of which was directed toward supply interdiction efforts. AIC obtained $1.6 million in funding for DUMA over 3 years from NIDS's supply-side funds, which represents 0.76 percent of the total money allocated to supply-side intervention strategies. B. Contracting for Data Collection AIC does not collect DUMA data itself. Instead, a partnership with local police and local universities or research companies operates at each site. Memorandums of understanding govern the working relationship between AIC and the data collectors. Each site has its own advisory or steering committee that deals with local strategic issues. Participating State police services are well represented on the local committees. C. Facility Access Facility access must be obtained at two levels. At the higher level, the State police commissioner in the relevant jurisdiction must give permission for access. At the second level, local watchhouse personnel must cooperate with the data collection team. Interviews take place at each site usually over a 3-week period every 3 months. Fieldwork began in January 1999 at the Queensland (Southport watchhouse) and Western Australia (East Perth lockup) sites and in the third quarter of 1999 at the two New South Wales sites in Sydney (Bankstown and Parramatta). Exhibit 5 shows the periods when fieldwork was undertaken. Start dates at each site varied according to local conditions, but they were generally within a few weeks of each other. The collection of data at the two New South Wales sites--one after the other rather than at the same time-- complicated matters. Only adult males were interviewed in the first quarter of 1999 in the Queensland and Western Australia sites. Collection was expanded to include adult females in Queensland in the second quarter of 1999 and in Western Australia in the third quarter of 1999. In New South Wales, adult males, adult females, and juveniles were interviewed from the start. The legal definition of an adult is age 17 in Queensland and age 18 in Western Australia and New South Wales. DUMA interviewers cannot be law enforcement officers or court personnel. Given Australia's size, interviewers must be recruited locally. Thirty-one interviewers were used across all sites in 1999. The average age of interviewers was 33. Twenty of the 31 interviewers were female, and 23 were Australian born. Interviewers were often postgraduate students enrolled in psychology, drug research, or criminal justice programs. All interviewers were required to undergo training before each data collection. As part of the training, they engaged in role playing and discussed their error reports from the previous collection. After police processing, DUMA interviewers approached detainees and asked them to participate in a confidential and voluntary research project. Detainees were shown a statement describing the study; interviewers read the statement to those with reading difficulties. Interviewers pointed out that the detainees did not have to take part in the interview if they did not want to, they did not have to answer any questions that they did not want to, and they could stop the interview and leave at any time. Detainees were then asked whether they agreed to take part in the study. In 1999, seven people started the interview and chose not to complete it. Detainees could also choose to complete the interview but not provide a urine specimen. Three hundred and fifty detainees (25 percent) who completed interviews in 1999 chose not to provide urine specimens; another 66 (5 percent) tried to produce a specimen but could not. At some sites, detainees were offered food or coffee or tea to thank them for taking part. D. Knowing the Catchment Area Although the sites are referred to by the name of the area where the site is located, the catchment area may not necessarily reflect the city boundaries. A number of differences were observed among the four sites. The size of the population in the catchment areas varies greatly (see exhibit 6). This reflects the nature of each site. The East Perth site is a large, old facility designed to take detainees from a large portion of the city. Many police stations in the city have the capacity to handle only a few detainees; the East Perth facility accommodates detainees who are to be held overnight if a local police station is not open 24 hours a day or does not have a holding cell available. Sydney has no large central facility for detainees. Local police stations handle their own detainees and take them from other parts of the city only in emergencies. It is rare for detainees to be held for longer than 4 hours in these facilities; if they are to be held overnight, they are transferred to Corrective Services. The Southport watchhouse caters to the entire southeastern region of Queensland. It is a modern facility with the capacity to hold detainees overnight and serves the local magistrate's court. Police districts do not always overlap with census districts, so it is difficult to determine the precise characteristics of the catchment areas using census data. Postal codes and local census districts were used to match the police districts as closely as possible. Exhibit 6 provides basic census data on each catchment area. East Perth, Bankstown, and Parramatta differ little in terms of the mean age of the population, the percentage of males, and the percentage of Australian-born people. The catchment population in Southport has a slightly smaller proportion of people with jobs, and both Bankstown and Southport have a higher percentage of people who left school at age 14 or younger. The percentage who have never married ranges from 28 to 32 at all sites. E. Drug Testing Issues All drug testing for the DUMA project was conducted at Pacific Laboratory Medical Services, Northern Sydney Area Health Service, in Sydney. The laboratory is accredited to the Australian Standards AS3408- 1995, and it consistently seeks to improve the sensitivity of its tests. In 2000, the EMIT[TM] (enzyme multiplied immunoassay testing) assay for methadone and amphetamines will be changed to CEDIA[R]. CEDIA shows fewer false positives due to proprietary medications, and its reagent is more sensitive to MDMA (Ecstasy or XTC) and methylamphetamine. Urine is routinely tested for six classes of drugs: cannabis, opiates, methadone, cocaine, amphetamines, and benzodiazepines. A test is deemed positive when the drug or its metabolites are detected at the cutoff levels prescribed in Australian Standard AS3408-1995.[11] Confirmatory tests are undertaken when a sample tests positive for opiates, amphetamines, or benzodiazepines. F. Instrument Issues Cultural applicability DUMA has attempted to keep the core questionnaire as close as possible to the U.S. ADAM questionnaire. Throughout 1999, however, changes were made to the instrument based on feedback from local sites, interviewers, and interviewees. In some cases, terminology did not translate or distinctions (i.e., summary/indictable) were not appropriate for some sites. As a result of interviewer complaints about the length of the drug grid, it was broken down into separate grids. In addition, interviewers reported that they were skeptical about detainees' responses to questions related to money earned from illegal activities. As a result, these questions have been moved toward the end of the questionnaire in the hope that initial doubts about the confidentiality of the process will recede as rapport develops between the interviewer and the interviewee. Standardization versus local utility Each site has local concerns, and the pressure to include other questions is always present. The means of overcoming this pressure is to encourage sites to develop local addenda that can be used in their jurisdictions to answer specific policy questions. VII. Barriers to Developing DUMA Although AIC secured money for the DUMA pilot project, ongoing funding is by no means certain. The five potential barriers to the long-term development of DUMA are-- o Securing ongoing funding and cultivating greater support at the policy level. o Further promoting cooperation and dedication of resources by police at the local site. o Maintaining a well-trained interview team when the work is intermittent. o Recognizing and solving ethical problems when dealing with a vulnerable population. o Addressing legal issues in which neither the interviewer nor the detainee has protections such as those provided by the statutory and regulatory confidentiality requirements stipulated under U.S. legislation.[12] VIII. National Stakeholders Involved in the Development of DUMA DUMA is a partnership among AIC, local police, and researchers. Exhibit 7 indicates the general arrangements by which the DUMA project is overseen. The project has been funded by NIDS to run pilot sites in three jurisdictions (Queensland, Western Australia, and New South Wales) over 3 years. It is affiliated with the International Arrestee Drug Abuse Monitoring (I-ADAM) program and has a scientific advisory committee with whom AIC consults concerning technical and methodological issues. Each site has a local steering or advisory committee that supports local data collectors, monitors the local progress of the study, suggests ways of improving the project, and ensures that information is disseminated to relevant local agencies. The committees are made up of a cross-section of people that includes representatives from local law enforcement and researchers. IX. Research Methods No attempt was made to sample within the available pool of detainees. The selected sites were regarded as having a high volume of detainees relative to other possible sites. Even these sites, however, processed considerably fewer detainees than comparable U.S. sites. Maintaining 24-hour coverage would not have significantly increased the number of detainees interviewed and would have been prohibitively expensive. Interviewers entered the sites when the number of detainees was expected to be highest. The major eligibility criterion was that the detainee had not been held in custody for more than 48 hours. Approximately 10 percent of detainees were deemed ineligible by local police, usually due to an assessment that there was a risk to the interviewer. Thus, the sample was not a random sample of all detainees brought to the police station or of all persons detained by the local police. In all three jurisdictions--Queensland, Western Australia, and New South Wales--police are increasingly using notices to attend court or the equivalent that are issued on the spot rather than bringing people to the police station for questioning. Normally, these notices are for minor offenses when the person has no prior criminal record. DUMA has no access to these people. Because the study is anonymous, interview subjects cannot be tracked across interview periods. Given that a substantial number of detainees self-reported that they had been arrested in the previous 12 months, it is likely that some detainees appeared in more than one quarter of interviews. Strictly speaking, the sample is one of detentions rather than detainees. X. Training Issues AIC has developed a training protocol manual for each site based on the U.S. National Institute of Justice protocols for the ADAM program and adapted to local conditions. Sites are required to train staff before each data collection. In addition, AIC produces a report for each site that details question-by-question errors by the interviewers to assist in the training process. XI. National Data Analytic Results The data represent four quarters of interviews for the Queensland and Western Australian sites and two quarters for the two New South Wales sites.[13] As a result, the total sample size for 1999 was much smaller for the New South Wales sites than for the other two sites (see exhibit 8). In 2000, each site was monitored every quarter. Because fewer women than men are detained by the police, the sample size for women was considerably smaller, which should be borne in mind when examining the data for females. In 1999, the program interviewed 1,402 detainees, 1,366 of whom were defined as adults in their relevant jurisdiction. Urine specimens were collected from 978 adult and juvenile detainees. Both the interview and the provision of a urine specimen were voluntary; detainees could choose to complete the interview and not provide a specimen. Approximately 70 percent of both men and women who agreed to an interview also provided a urine sample. Only data from adults are presented in this section. Across all four sites, detainees of both sexes were usually younger than age 30. The largest concentration by age tended to be in the 21- to 25-year-old group, as shown in exhibit 9. Detainees were asked if they had been arrested (excluding their current arrest) and if they had spent time in prison in the previous 12 months. These data are presented in exhibit 10. The pattern is similar across the four sites: approximately half of detainees reported at least one prior arrest in the previous 12 months, and more than 15 percent had spent time in prison during the previous 12 months. Parramatta had a slightly higher rate of prior imprisonment for males than the other sites, and it had the highest percentage of detainees self-reporting a prior arrest in the previous 12 months. These data indicate that many detainees are cycling through the system and that interventions are needed to break this cycle. During the DUMA pilot project, all detainees were interviewed regardless of the charge. Exhibit 11 shows what was determined to be the most serious charge at arrest for the detainees interviewed. The most serious charge was not always obvious from the charge sheet; interviewers recorded up to three charges. Information from all three charges was considered when determining the most serious charge: Violent offenses were assigned the most serious charge, followed by property, then drug, then traffic (including drunk driving) offenses. All remaining offenses were classified in the "other" category. The charge profiles varied among the sites. Southport had the lowest percentage of adult male detainees charged with a violent offense and the highest proportion charged for traffic offenses (many for drunk driving). Almost half of the adult male detainees in Parramatta were charged with property offenses, as were approximately three-quarters of adult female detainees. Drug arrests across the four sites varied for adult males from 7 percent in Parramatta to 15 percent in Bankstown. East Perth had the highest percentage of "other" charges, many for outstanding warrants. Exhibit 12 shows the percentage of detainees who tested positive for drugs by gender and site. Drug use among detainees was common among the sites; approximately three-quarters of adult male detainees across all sites tested positive for any drug. There were, however, significant variations among the sites for individual drugs. A higher percentage of both male and female detainees tested positive for cannabis in Southport and East Perth than in the two Sydney sites. By contrast, a much higher percentage of detainees in the two Sydney sites tested positive for opiates; the rates for adult males in Sydney were almost double those in East Perth and triple those in Southport. Virtually no detainees tested positive for cocaine, except in Bankstown, where 12 percent of adult females tested positive for the drug. Only 4 percent of adult males tested positive for amphetamines in Bankstown, compared with between 12 and 14 percent in the other three sites. Multiple drug use is common. It was highest overall among arrestees in Bankstown and Parramatta--the two sites with the highest rates of opiate use--although the single group with the highest prevalence rate was female arrestees in East Perth, 47 percent of whom used more than one drug. Exhibit 13 shows that, consistently across all sites, adult male detainees tested positive for a range of drugs regardless of the charge for which they were detained. Males detained for minor offenses up to the most serious violent offenses tested positive for cannabis, opiates, and amphetamines. The positive test rates for cannabis were higher than for other drugs, in part because the test could detect cannabis use for up to 30 days, whereas it could detect use of opiates and amphetamines only within the previous 2 to 4 days. Opiates were detected in similar and significant proportions across all offense categories in all sites except Southport. In Southport, 32 percent of property offenders tested positive for opiates, but among those charged with other offenses, relatively few (less than 12 percent) tested positive for opiates. In the other three sites, a significant percentage of detainees charged with a range of offenses tested positive for opiates; 23 percent of violent offenders in East Perth, 46 percent of those charged with "other" offenses in Bankstown, and 46 percent of those charged with traffic offenses in Parramatta. The strongest correlation in all sites was found between property crimes and the use of opiates. It was particularly strong in Bankstown, where 78 percent of property offenders tested positive for opiates. As with opiate use, amphetamine use occurred across all offense categories. This applied less to the Sydney sites, which had a relatively small pool of detainees who tested positive for amphet-amines. The correlation between violent offending and amphetamine use was nowhere near as strong as that found between opiates and property offending. In Bankstown, none of the violent offenders tested positive for amphetamines, but the sample size was small (15 offenders charged with a violent crime). At the other three sites, from 11 to 15 percent of those charged with violent offenses tested positive for amphetamines. XII. Policy Implications and Applications of Data A key goal of policing is to reduce crime. Given that certain criminal activities are closely associated with illicit drug use, monitoring the use of drugs by detainees is of key importance to law enforcement. DUMA provides for the first time a reasonable and independent indicator of drug-related crime in specific areas in Australia. Australian law enforcement has not had a systematic monitoring system to track drug use among people who come into contact with criminal justice agencies. Much of the discussion on the links between drugs and crime has been based on anecdotal evidence or localized studies. More rigorous national collections are required for evidence-based policymaking. DUMA's goal is to overcome a significant limitation in Australia's national surveillance of illicit drug use by undertaking ongoing monitoring of detainees' involvement in drugs and crime. Law enforcement concerns itself with both the demand for and the supply of illicit drugs. To enact successful policies to intervene in illicit drug markets, long-term monitoring of these markets is required. As with all commercial markets for major products, local markets are inextricably tied to global markets; one cannot be understood without the other. To understand supply, one must understand where, how, and when demand occurs and changes. The purpose of DUMA is to improve understanding of the supply and demand for illicit drugs among detainees at the local level while providing comparable data across sites to facilitate the aggregation of national data. DUMA represents a research platform in the criminal justice system that can enable monitoring of supply and demand for illicit drugs at the local, national, and international levels. DUMA data are now being used in three ways. First, local watchhouse personnel use the data to ensure a high standard of care for detainees. Appreciation of the types and amounts of drugs used by those coming into the watchhouse helps watchhouse staff better prepare for any medical situations they might face. Second, strategic law enforcement analysts at the State and local levels use the data to improve their understanding of drug consumption patterns and related criminal activities. Finally, local health agencies use the data to plan new drug treatment options. Notes 1. Australia's literacy rate compares favorably with those of the United States and the United Kingdom. According to the International Adult Literacy Survey, 17 percent of Australian adults ages 16-65 are at the lowest level of literacy, compared with 23 percent in the United Kingdom and 24 percent in the United States. In contrast, 17 percent of Australian adults ages 16-65 are at the highest level of literacy, compared with 19 percent in both the United Kingdom and the United States. Organisation for Economic Cooperation and Development, Education at a Glance 2000, Paris: Organisation for Economic Cooperation and Development, 2000: table A2.3a. 2. Makkai, Toni, Linking Drugs and Criminal Activity: Developing an Integrated Monitoring System, Trends and Issues in Crime and Criminal Justice Series No. 109, Canberra: Australian Institute of Criminology, 1999. 3. Purity levels are calculated only on those seizures that have been analyzed at a forensic laboratory. See Australian Bureau of Criminal Intelligence, Australian Illicit Drug Report 1998-99, Canberra: Australian Bureau of Criminal Intelligence, 2000: tables 11.11, 11.13, and 11.14. 4. Ibid., tables 11.11, 11.13, and 11.19. 5. Australian Bureau of Statistics, National Crime Statistics/Recorded Crime, Australia, 1993-2000, Canberra: Australian Bureau of Statistics, 1994-2001, ABS 4510.0. 6. Wimshurst, Kerry, and Arch Harrison, "The Australian Criminal Justice System: Issues and Prospects," in Crime and the Criminal Justice System in Australia: 2000 and Beyond, ed. Duncan Chappell and Paul Wilson, Sydney: Butterworths, 2000. 7. For more detailed information, see Makkai, Toni, "Crime in Australia," in Sociology of Australian Society, ed. Jake Najman and John Western, Melbourne: Macmillan Publishers, 2000. 8. Makkai, Toni, "Harm Reduction in Australia: Politics, Policy, and Public Opinion," in Harm Reduction: National and International Perspectives, ed. James A. Inciardi and Lana D. Harrison, Thousand Oaks, California: Sage Publications, 2000: 171-192. 9. Ministerial Council on Drug Strategy, National Drug Strategic Plan 1993-1997, Canberra: Australian Government Printing Service, 1993: 4. 10. A more detailed outline of DUMA is provided in Makkai, Toni, Drug Use Monitoring in Australia (DUMA): A Brief Description, Research and Public Policy Series No. 21, Canberra: Australian Institute of Criminology, 1999. 11. More detailed information on urinalysis testing is provided in Australian Institute of Criminology, DUMA: Drug Detection Testing, Research in Public Policy Series No. 25, Canberra: Australian Institute of Criminology, 2000. 12. 42 U.S. Code 3789g and 28 Code of Federal Regulations Part 22. 13. This section of the chapter draws from data presented in Australian Institute of Criminology, DUMA: 1999 Annual Report, Research in Public Policy Series No. 26, Canberra: Australian Institute of Criminology, 2000. ------------------------------ Chile Luis Caris Bruce Taylor Luis Caris is a psychiatrist and professor at the School of Public Health, University of Chile, where he directs the drug prevention program. He also is chief of the Alcohol, Tobacco, and Drug Unit, Ministry of Health; a short-term consultant to the Pan American Health Organization; and a consultant to the Organization of American States-CICAD. Bruce Taylor is the deputy director of the Arrestee Drug Abuse Monitoring (ADAM) Program at the National Institute of Justice (NIJ). I. Overview of Demographic Profile of Nation Chile is a long, thin country in the extreme southwest of South America. Its closest neighbors are Argentina to the east and Bolivia and Peru to the north. Chile is more than 2,650 miles long but only about 300 miles wide at its widest point. Chile is as geographically isolated as it is diverse. To the south, it reaches into the Antarctic zone; to the west, the Pacific Ocean; to the north, the Atacama Desert; and to the east, the Andes. Chile exhibits many of the traits that characterize Latin American countries. Its colonization by Spain began in the 16th century. The culture that evolved was largely Spanish; the influence of the aborigines is negligible. The country has a relatively homogenous, primarily mestizo population with a strong cultural unity (see exhibit 1 for demographic information). Chile has no sizable minority groups. During its history, a small elite has controlled most of the land, wealth, and political life. Chile did not depend as heavily on agriculture and mining as other Latin American countries; it also developed a manufacturing economy. Chile is one of the more urbanized Latin American countries, with a substantial middle class. More than 85 percent of the total population is urban; the metropolitan area of Santiago, the capital, has a population of more than 5 million. The Republic of Chile was established in 1821. It is divided politically into 13 regions (Regions I-XII and the Santiago Municipal Region), 51 provinces, and 300 municipalities. Chile has a long history of representative democratic government and political freedom, with only a few short-lived exceptions. From September 1973 to March 1990, a military junta headed by General Augusto Pinochet Ugarte presided over the longest period of authoritarian rule in the country's history. Chile is governed in accordance with the Constitution of 1980,[1] approved by a plebiscite called by General Pinochet to change the Constitution of 1925. The 1980 Constitution places state administration in the hands of the President, who appoints the state ministers. The regions are headed by an intendente (intendant), provinces are headed by a gobernador (governor), and municipalities are headed by an alcalde (mayor). In towns with fewer than 10,000 inhabitants, the mayor is appointed by the municipal council; in towns and cities with more than 10,000 inhabitants, the mayor is appointed by the President of the Republic.[2] Chile is one of Latin America's most economically developed countries, with a diversified free- market economy characterized by a high level of foreign trade (see exhibit 2). According to the human development index, Chile leads all Latin American countries in terms of development and is categorized as having high development in a world context, ranking 38th overall.[3] Although Chile's crime rates in the early 1990s remained far below those of the United States, the notion that common crime was rare in Chile until the 1970s and 1980s is a myth. Chile's rural areas were plagued with outlaw gangs in the early 19th century. Attempting to analyze the crime situation under the military regime in the 1970s and 1980s is confusing because the government and media tended to lump ordinary criminal behavior together with dissident violence. Figures on crime and criminals released by the Instituto Nacional de Estad'sticas (National Statistics Institute--INE) are not enlightening as to the true prevalence of crime in the country. Neither juvenile nor adult crime rates are broken down by gender, and no statistics are provided on prison populations. Few, if any, published sources provide general crime statistics, with the main exception of figures for arrests, which are readily available in INE's Compendio Estadstico.[4] Chile's reported crime rate of about 1,300 crimes per 100,000 people is low compared with the reported U.S. rate of about 4,615 crimes per 100,000 people.[5] Chile long remained relatively unaffected by either drug trafficking or extensive drug abuse. Small increases in both occurred during the late 1960s and early 1970s, reflecting an international trend.[6] By the early 1970s, Chile had become an important regional center for cocaine processing. Drug trafficking has been growing in Chile since the early 1980s, not only because of its geographic configuration and location bordering on the world s two leading producers of coca--Peru and Bolivia- -but also because of its economic stability. With its open-market economy and bank secrecy laws, Chile is an attractive haven for money laundering. By 1992, Chile's most serious drug-related problem involved illicit drug transit along the northern corridor to Africa. In early 1993, a new cocaine/cocaine paste drug route reportedly came from Bolivia through the Azapa Valley. After 1989, drug-related crime increased dramatically, particularly in the north of the country. In 1990, the police estimated that 20 percent of Africa's population aged 15 to 34 were habitual drug users. Of 385 homicides (0.3 per 10,000) in Chile during 1990, nearly 77 (20 percent) were classified as drug related. II. Description of the Criminal Justice System, Arrest Process, and Detention System Criminal Code The Criminal Code of Chile, first drafted in 1870 after two unsuccessful attempts, was promulgated in 1874 and modified in 1928 and again in 1930. Its models were the criminal codes of Austria, Belgium, France, and Spain. The death penalty, abolished in 1930, was reinstated for certain crimes in 1937 and abolished again in 2001. The Criminal Code is divided into general and special sections. The general section enumerates general principles of criminal law relating to jurisdiction, the concept of crime, attempted crime, second-party participation in the commission of crime, habitual criminals, penalties, and circumstances that exclude or extinguish criminal responsibility. The special section defines specific offenses and their appropriate penalties. The courts are charged with ensuring that the penalty is appropriate not only to the crime but also to the criminal's culpability.[7] Classification of Crimes Crimes are divided into three basic categories: crmenes (serious crimes), delitos (minor crimes), and faltas (misdemeanors). A crime is defined as a voluntary act or omission for which the law imposes punishment. Criminal responsibility is specifically excluded in cases in which the defendant is insane or younger than 10. Minors 10 to 16 years old are not held criminally responsible unless it can be proven that they acted with full understanding of their acts. Criminal responsibility is also excluded for violent acts committed in the defense of one's own person, property, or rights; those of one's spouse; or those of a third party. Other excluded violent acts are those committed-- o Accidentally in the exercise of a legal act. o In the exercise of public duty. o Under duress or fear. o Resulting in the killing or wounding of the accomplice of an adulterous spouse. Criminal responsibility is also excluded for crimes of omission owing to a legal or irresistible cause. Suicide and attempted suicide are specifically decriminalized.[8] Arrest Procedure The Chilean Constitution states that no one may be arrested or detained unless on the order of a public official empowered by law. The police may detain someone caught in the act of committing a crime or based on suspicion. On detention, an arrestee must be brought before a competent judge within 24 hours. The Constitution allows civilian and military courts to order detention for up to 5 days without arraignment and to extend the detention of suspected terrorists for up to 10 days. The law affords detainees 30 minutes of immediate and subsequent daily access to a lawyer and to a doctor to verify their physical condition. The law does not permit a judge to deny such access. The Constitution allows judges to set bail.[9] Trial by jury is not provided for, and heavy reliance is placed on police evidence in criminal cases. The Courts The founders of Chile drew from the example of the United States in designing the institutions of government, and from Roman law and Spanish and French traditions, particularly the Napoleonic Code, in designing the judicial system. The 1925 Constitution introduced reforms aimed at depoliticizing and improving the judicial system by guaranteeing judicial independence. The organization and jurisdiction of Chile's courts were established in the Organic Code of the Tribunals (Law 7,241), adopted in 1943. This law has been modified on several occasions, mostly recently by Organic Constitutional Law 18,969 of March 10, 1990, and Law 19,124 of February 2, 1992. Chile's ordinary courts consist of juzgados de letras (local courts), major claims courts, the cortes de apelacin (appellate courts), and the Supreme Court. There is also a series of special courts, such as the juvenile courts, labor courts, and military courts in peacetime. The local courts consist of one or more tribunals specifically assigned to each of the country's communes, Chile's smallest administrative units. In larger jurisdictions, the local courts may specialize in criminal or civil cases, as defined by law. Chile's 16 appellate courts each has jurisdiction over 1 or more provinces.[10] The Penal System Chile's penal system has been standardized since 1930, coming under the jurisdiction of the Minister of Justice. The system emphasizes rehabilitation of the offender. The degree of confinement is reduced progressively throughout the prisoner's sentence and ends, subject to good behavior, in conditional release for periods up to 50 percent of the total sentence. Chile has approximately 140 penal institutions with a total capacity of approximately 15,000 inmates; in 1990, however, the estimated number of prisoners was larger than 25,000. During the third quarter of 1990, for example, Santiago's San Bernardo Prison, designed to hold 800 prisoners, housed 3,300 inmates.[11] III. Status of National Drug Policy In 1999, a comprehensive revision of Chile's 1995 counternarcotics law was undertaken and proposed strengthening changes were drafted. The changes focus on authorizing flexibility in sentencing (currently, the minimum sentence is 5 years regardless of severity of the offense), combating money laundering through mandatory reporting of transactions and creation of a financial intelligence unit, and harmonizing the drug code with Chile's ongoing legal reform.[12] The Chilean Government's coordinating body for drug policy and demand reduction activities is the Consejo Nacional para el Control de Estupefacientes (National Drug Control Council--CONACE). CONACE's 2001 annual budget of approximately $15.2 million represents a real increase of more than 30 percent from its 2000 budget. Of CONACE's 2001 budget, $8.2 million is earmarked for demand reduction programs-- $3.1 million for community-based prevention programs, $2.6 million for prevention targeted at schools, and $2.5 million for drug treatment. Resources to be channeled to school- and community-based programs will double under the 2002 budget.[13] In a major drug policy initiative in 1998, CONACE decentralized its national project bank for drug prevention, education, and rehabilitation. As a result of the decentralization, regional councils and local municipalities gained more input in projects that account for approximately 90 percent of the national project bank's funds. Individual projects also can be proposed and implemented by nongovernmental organizations, local governments, universities, and other institutions.[14] Chile is not considered a center of production of illegal drugs. Partly because of its geographic isolation, it has until recently avoided many of the problems created by illegal narcotics in other South American countries.[15] As a consequence of the expansion of drug trafficking and narcotics abuse during the late 1960s and early 1970s, Chile's first antinarcotics law had been passed by 1973. Later, the Government formed a special narcotics unit and began a highly effective crackdown, bringing the narcotics problem under control within a year. Government antidrug forces also pioneered a youth education program against narcotics. The dismantling of a large drug-trafficking and money-laundering ring in May 1998 demonstrates the Government's continued efforts to counter drug smuggling and related criminal activity.[16] Chile is a party to the 1988 United Nations Drug Convention. Government and private organizations support drug-abuse prevention and rehabilitation programs. Chile continues to play a leading role in the Organization of American States' Comisin Interamericana para el Control del Abuso de Drogas (Inter-American Drug Abuse Control Commission--CICAD), including its efforts to create a multilateral evaluation mechanism to combat illegal drug trafficking and abuse. Chile worked closely with CICAD in the area of money laundering in 1998 and sponsored public- and private-sector seminars on the topic.[17] Chile has joined the Grupo de Accin Financiera de Sudamrica Contra el Lavado de Activos (South American Financial Action Task Force on Money Laundering-- GAFISUD), created in December 2000. In addition, in August 2000, the U.S. and Chile signed an umbrella agreement to share information, strategies, and resources to continue joint efforts against narcotics.[18] Chile has several ongoing data collection systems that help inform drug policy. I--ADAM will serve as another indicator of drug use in Chile. Currently, the Chilean Government conducts a door-to-door household drug survey of a representative sample of the population every 2 years, a school-based drug survey, a study of emergency rooms similar to the Drug Abuse Warning Network program in the United States,[19] and various treatment facility surveys. IV. Background History of the I-ADAM Program in Chile In 1994, the Ministry of Health set up an alcohol and drug surveillance/monitoring system aimed at assessing alcohol and drug abuse in Chile. Monitoring was conducted in several cities and data were gathered on drug type, drug and alcohol abuse, and health outcomes. Public school students and people entering hospital emergency rooms, jail detention centers, and treatment centers answered self-administered questionnaires about the health risks associated with alcohol and/or drug use, protective behaviors, prevention, and consumption. Data were analyzed to assess the magnitude of alcohol and drug abuse, and an early warning system against the use of alcohol and/or drugs was set up. As previously mentioned above, the Government conducts a door-to-door drug survey of a representative sample of the population every 2 years. Although research has been done in Chile on the relationship between health and drugs/alcohol, the relationship between drugs and crime has yet to be explored. In 1998, Chile implemented an I-ADAM project to explore this relationship and to serve as an indicator of drug use in the country. As a precursor to its participation in the I-ADAM project, Chilean health authorities conducted a 10-day study of drug abuse among detained arrestees in March 1997. Five hundred forty-nine arrestees (499 men and 50 women) from six police stations in the Santiago municipal region participated in the research. The police stations were located in Santiago city, Renca, Nuoa, Pealoln, San Miguel, and Conchal. Chilean police bring all persons arrested for nontraffic offenses to the police stations for booking. During this 10-day period, researchers attempted to interview all arrestees: 75 percent of the arrestees approached by the research staff agreed to take part in the study, and 75 percent of those who participated agreed to provide a urine specimen. Because of budget restrictions, urine testing was done only for cocaine and marijuana. The study instrument and a report of this study are available only in Spanish. V. Goals and Objectives of I-ADAM in Chile The primary aim of I-ADAM in Chile is to generate drug abuse surveillance/monitoring data. Program objectives include the following: o Testing the applicability of the I-ADAM research methodology. o Assessing the applicability of the I-ADAM instrument. o Describing the types and forms of drug use in detention centers. o Generating information concerning the magnitude of substance abuse in the arrestee population. VI. Getting Started A. Obtaining Funding The Ministerio de Salud (Ministry of Health) funds and operates the I- ADAM program in Chile. The Ministry of Health has five divisions, one of which is the Divisin de Salud de las Personas (Division of the People's Health). This division has three components: the Departamento de Programas de Las Personas (People's Health Program), Departamento de Epidemiologa (Department of Epidemiology), and Departamento Odontolgico (Department of Odontology). I-ADAM in Chile is operated as a research program of the People's Health Program; its name is Vigilencia Epidemiologica Drogas en Chile (Drug Epidemiological Surveillance in Chile). Because Chile's I-ADAM program is administered by employees of the Ministry of Health, nearly all the costs associated with this research are absorbed as part of employees' salaries. The only extra costs incurred by the I-ADAM program are for the laboratory costs of urine testing and overtime pay for the field site director and the team of interviewers to conduct the research interviews. I-ADAM management aimed for two data collection points per year at each site. Funds were allocated for one data collection point in 1998 and for two data collection points in 1999. Efforts are under way to seek funding from the Ministries of Health and Justice and from foreign and multinational agencies and foundations operating in Chile. B. Contracting for Data Collection As indicated above, this project was conducted in house by staff of the Ministry of Health. Hiring a contractor to conduct this work was considered cost prohibitive. C. Facility Access Access to the lockup facilities was secured through a partnership between the Ministry of Health and the Carabineros (the national uniformed police). The mayors (commanders) of the comisaras (police stations) gave research staff written permission to conduct the study and gain access to the jails. Because police were not accustomed to having research conducted in their jails, they were briefed in detail about the scope of the project. D. Knowing the Catchment Area The 1999 I-ADAM study was conducted in select comisaras in three municipalities of the capital city of Santiago: the First Police Station of Santiago, the Fifth Police Station of Conchal in the northern part of the city, and Lo Espejo in the southern part of the city. Data collection sites were selected based on their case flow and neighborhood characteristics. One site is in the heart of a thriving downtown commercial area that has arrestees from all socioeconomic levels; another site is an active drug-trafficking area; the third site has many drug addicts. Future research sites will include police detention centers in either Valparaiso or Inquinque. Collaboration among the Ministry of Health, the director general of the Carabineros, and police station commanders made access to selected research sites easier. E. Drug Testing Issues Because of the relative scarcity of high-volume drug-testing equipment in Chile, drug testing is expensive in the country. After a search, it was determined that PharmChem, the U.S. laboratory that conducts the U.S. ADAM drug testing, offered the most affordable option for the I-ADAM group in Chile. PharmChem used the EMIT[TM] (enzyme multiplied immunoassay testing) system--the same system used by the U.S. ADAM program--to screen for the presence of drugs in urine. Samples were tested for alcohol, amphetamines, barbiturates, benzodiazepines, cocaine, marijuana, methadone, methaqualone, opiates, PCP, and propoxyphene. F. Instrument Issues The questionnaire used in the I-ADAM Chile study was based on the early Drug Use Forecasting (DUF) questionnaire.[20] The National Institute of Justice (NIJ) translated the DUF questionnaire and sent it to the Chilean research team for review. Minor edits and adaptation to the Chilean idiom were made, and it was deemed necessary to add as well as remove a few questions on the basis of cultural applicability. Several drug market questions were dropped, and the list of drugs to be queried on the drug grid was revised. The self-report survey includes the following drugs: alcohol, marijuana, coca paste, crack cocaine, powder cocaine, heroin/opiates/dilaudid, amphetamines, methamphetamines, inhalants, and tranquilizers. Some housing questions, illegal income questions, and the ethnicity question were removed. Cultural applicability Spanish is the official language of Chile, and virtually everyone is conversant in Spanish. Therefore, it was decided to use only one questionnaire designed in Spanish. Arrestees who could not speak Spanish were deemed ineligible and were excluded from the survey. Standardization versus local utility The same questionnaire is used across all sites in Chile. It was not found necessary to adjust the questions for local cultural differences. Because cultural standardization is particularly relevant when making comparisons across countries, the I-ADAM Chile survey includes a series of core questions that are used in the ADAM surveys in the United States and other I-ADAM participating countries. VII. Barriers to Developing I-ADAM To date, the development of the Vigilencia Epidemiologica Drogas en Chile has run smoothly. Nonetheless, barriers arose at the onset of the program. The primary barrier to establishing I-ADAM in Chile has been obtaining funding and establishing the legitimacy of the research. Full government support and funding is needed to implement the program. Although the Ministry of Health earmarked funds for the program in 1999, 2000, and 2001, long-term funding has not yet been obtained. As noted earlier, program managers are soliciting the Ministry of Health, the Ministry of Justice, and foreign sources of funds such as CICAD, the United Nations Drug Control Programme, and the American Embassy in Chile. VIII. National Stakeholders Involved in the Development of I-ADAM The key players involved in developing and implementing I-ADAM in Chile are the Ministry of Health (the minister and undersecretary), the Ministry of Justice (the Ministry's representative to CONACE, the acting undersecretary, and the division directors), and the Carabineros (the director of the Departamento Control Drogas y Prevencin Delictual-- Department of Drug Control and Crime Prevention). A cooperative relationship has been established among representatives of these Government agencies. The Ministries of Health and Justice have expressed an interest in ADAM as a platform for developing policy-relevant research pertaining to drug control activities and the health consequences associated with drug use. The director of the Department of Drug Control and Crime Prevention has expressed a special interest in international research, especially the potential for comparative data applications. IX. Research Methods The I-ADAM program in Chile has two fundamental components: a questionnaire administered in a booking facility by a trained interviewer to an arrestee within 48 hours of the arrest and a urine specimen collected from the respondent that is used to corroborate statements about recent drug use. Each of Santiago's 49 municipalities has its own police force. Chile has a uniformed police force (Carabineros) and a nonuniformed police force (Policia de Investigaciones) similar to the U.S. Federal Bureau of Investigation. Nonuniformed officers work at the federal level and deal with national issues. A judicial order must be issued before nonuniformed officers can initiate an investigation. Uniformed officers staff comisaras and make arrests. Only persons arrested by uniformed officers are eligible for inclusion in the I-ADAM study. Anyone arrested for a crime, including the least serious nontraffic offense, is brought to the municipal police station for at least 1 hour. The arrest information is entered in a logbook and recorded electronically. All persons arrested are eligible to be interviewed by I-ADAM research staff. Using the police station's computer, a list of all cases for any time period can be easily reproduced and used for sampling. Given that the 1999 I-ADAM Chile study was a pilot test, the main purpose of which was to resolve implementation issues, nonprobability-based sampling methods were used. The three sites were selected intentionally because of their locations and neighborhood characteristics; they do not represent the population of arrestees in the nation or in Santiago. As mentioned earlier, some effort was made to choose a varying group of catchment areas. At the site level, all cases that met the study eligibility criteria were interviewed. Interviews were done from 8 a.m. to 10 p.m.; no provision was made to compare cases that were not sampled from 10:01 p.m. to 7:59 a.m. The eligibility criteria for I-ADAM in Chile are the same as in the other I- ADAM participating countries. Data were collected from adult booked/processed arrestees detained long enough to be interviewed (but less than 48 hours). Study participants generally were interviewed before they saw a magistrate or judge, but they had access to legal counsel to ask about the voluntary and confidential nature of the study. Arrestees who did not speak Spanish or who were deemed too intoxicated, violent, or mentally unstable did not participate. The 1999 Chile pilot study included only men. X. Training Issues The goal of the I-ADAM training in Chile is to convey to a team of interviewers the practices and procedures required to conduct scientific research surveys. The training curriculum for the Chilean I-ADAM data collection team was based largely on the U.S. ADAM training manual. The development of the curriculum was a joint effort between NIJ and the Chilean Ministry of Health. Each Chilean interviewer received training using a standard curriculum and manual that addressed basic and advanced interview skills and site operating procedures. Training was conducted 2 to 3 days before actual data collection. The training curriculum covered the roles and responsibilities of key site personnel, a question-by-question review of the survey, the handling and shipping of urine specimens, paired mock exercises, editing exercises (e.g., editing the survey instrument for proper skip-pattern usage during the interview), interviewer safety, and a review of the concept of informed consent. Interviewers were required to complete and demonstrate competence in basic interviewing skills and an understanding of project operating procedures. NIJ staff met with staff from the Ministry of Health in November 1998 to visit the facilities, develop a data collection plan, and meet with stakeholders from the Ministries of Health and Justice. In January 1999, shortly before data collection started, a U.S. training team was sent to Chile to help implement the first training of the Chilean field staff. Nurses from the Ministry of Health conducted the I-ADAM interviews. The group of nurses selected for I-ADAM Chile had extensive experience with arrestees, having been involved in an earlier study of drug use among detainees. Using nurses to conduct inter-views had advantages and disadvantages. Arrestees are reluctant to trust the police and to participate in a research project that looks as if it is sponsored by the police. Using nurses clearly shows the arrestees that the program is sponsored by the Ministry of Health and the information will not be used against them. The Ministry of Health is seen as nonrepressive and has a positive image as a healing organization. One belief was that if the research team did not use uniformed nurses, few arrestees would participate and give honest responses. The disadvantage to using nurses, especially in uniforms, is that some comparability problems will emerge with other countries. That disadvantage, however, is offset by the need to collect valid local data. XI. Data Analytic Results The initial I-ADAM study in Chile took place January 22-28, 1999, in three detention centers in the capital city of Santiago: the First Police Station of Santiago (First of Santiago), the Fifth Police Station of Conchal, and Lo Espejo. Uniformed nurses employed by the Ministry of Health conducted the interviews. Every eligible male arrestee, regardless of the offense with which he was charged, was interviewed. Interview hours were from 8 a.m. to 10 p.m. Interviews were conducted within 6 hours of the arrestees' arrival at the detention center and lasted an average of 10 minutes. The interview process went smoothly; the police took no action that could have influenced the number of respondents or the quality of the data collected. Sample Characteristics Interviews were conducted with 134 adult males in three locations. The largest number (n = 99) of respondents interviewed were brought to the First of Santiago detention center. When asked, 92 (68.7 percent) of 134 respondents provided urine samples. Two samples were too small to be analyzed, however, so only 90 samples were tested. The age range of the study respondents was from 12 to older than 45; the average age was 29. Comparisons of the detention centers show that 12- to 19-year-olds made up more than 23 percent of the sample in Conchal, but 30- to 44-year-olds made up more than 71 percent of those interviewed at Lo Espejo and about 50 percent of those interviewed at First of Santiago. As seen in exhibit 3, most arrestees interviewed (50.8 percent) were single. Most interviewees (61.3 percent) had a full- or part-time job. Only 1.5 percent of arrestees reported having no formal education; 48.1 percent had attended high school. Although none of the respondents at either First of Santiago or Lo Espejo reported receiving assistance from government programs, 6.3 percent of those interviewed at the Conchal detention center were on public assistance. Exhibit 3 shows that the largest group of respondents were arrested for drug or alcohol offenses in Conchal and Lo Espejo. In First of Santiago, the largest group of respondents were arrested for illegal street vending. Urine Test Results Exhibit 4 shows the test results from the urine samples taken from interviewees. Approximately 48 percent of the respondents tested positive for at least one illicit drug (excluding alcohol), and 12.2 percent tested positive for two or more illicit drugs (9 of the 11 multiple drug users tested positive for cocaine and marijuana). The highest drug prevalence rate was for marijuana, followed by cocaine, alcohol, benzodiazepines, and amphetamines. No prevalence was detected for the six other drugs tested (barbiturates, propoxyphene, methaqualone, PCP, opiates, and methadone). Respondents' Self-Reported Drug Use Exhibit 5 shows respondents' self-reported drug use during the 3 months before the I-ADAM interview. Forty-one percent reported having used an illegal drug other than alcohol; 66.4 percent reported having consumed alcohol. Rates of use of illegal drugs ranged from 32.8 percent for marijuana to 0.7 percent for inhalants. No interviewees reported having used amphetamines or methamphetamines in the previous 3 months, although one interviewee tested positive for amphetamines (see exhibit 4). Exhibit 6 shows information gathered about arrestees who used all drugs, including coca paste, powder cocaine, or cocaine in any other form. Information gathered includes marital status, age, education levels, rates of treatment, and rates of multidrug use. Cocaine users also reported significant levels of use of marijuana, amphetamines, and tranquilizers. This was the case even though no interviewees reported having used amphetamines in the previous 3 months (see exhibit 5). Exhibit 7 shows the reported mean age of first use of certain drugs, ranging from age 15 for inhalants to age 24 for coca paste. XII. Policy Implications and Applications of Data The initial I-ADAM pilot data for Chile show a high level of drug and alcohol use (60 percent of participants tested positive for drugs and/or alcohol) among arrestees in the three Santiago sites. The data may overstate the level of drug use among all arrestees, however, given that two of the three pilot sites (Conchal and Lo Espejo) were chosen in part because of the high levels of drug- related activity in those areas and that, in those two areas in particular, a majority of those interviewed had been arrested for drug-related offenses (see exhibit 3). As the number of interview sites increases and as the I-ADAM project moves into metropolitan areas outside Santiago, the interview samples will become more representative of the arrestee population as a whole, and comparisons of arrestee drug use among metropolitan areas can be made. One unique factor of Chile's I-ADAM program is the use of uniformed nurses from the Ministry of Health to interview the arrestees. The rationale behind this has been to gain the confidence of the arrestees and to encourage participation in the project. Nonetheless, urine testing of arrestees found that, as in other countries, a higher proportion of arrestees tested positive for drugs (47.8 percent) than admitted to drug use within the previous 3 months (41.9 percent). This indicates that some portion of arrestees will not be forthcoming about current drug use, even if there is no incentive for them to conceal their drug use. The involvement of the Ministry of Health in the I-ADAM program at a basic level may have another benefit, however, in fostering closer cooperation between the Ministry of Health and other I-ADAM stakeholders (the Carabineros, CONACE, and the Ministry of Justice) in the development of drug policy in general. In particular, this may lead to greater cooperation among the stakeholders in making drug treatment and drug education programs offered by the Ministry of Health available to arrestees and to the prison population. Notes 1. The current Constitution of Chile was approved by a plebiscite on September 11, 1980, and became effective March 11, 1981. The Constitution was again approved and amended by referendum on July 30, 1989, and amended in 1993. (Constitution of the Republic of Chile, Santiago: Government Junta, 1980, retrieved October 24, 2000, from the World Wide Web: http://www.richmond.edu/~jpjones/confinder/ Chile.htm; Central Intelligence Agency, The World Factbook--Chile, Washington, DC: Central Intelligence Agency, 2000, retrieved August 15, 2001, from the World Wide Web: http://www.odci.gov/cia/publications/ factbook/geos/ci.html; Hudson, Rex A., Chile--A Country Study, Washington, DC: Library of Congress, Federal Research Division, 1994, retrieved October 24, 2000, from the World Wide Web: http://lcweb2.loc.gov/frd/cs/cltoc.html.) 2. Hudson, Chile--A Country Study (see note 1). 3. United Nations Development Programme, Human Development Report 2001, New York, Oxford University Press, 2001, retrieved August 30, 2001, from the World Wide Web: http://www.undp.org/hdr2001.pdf. 4. Instituto Nacional de Estadsticas, Compendio Estadstico 2000, Santiago: Instituto Nacional de Estadsticas, Departamento de Servicios al Usuario y Difusin, 2000, retrieved August 15, 2001, from the World Wide Web: http://www.ine.cl/chileci/compen/compind.htm. 5. U.S. Census Bureau, Statistical Abstract of the United States 2000: The National Data Book, Washington, DC: U.S. Department of Commerce, Economics and Statistics Administration, U.S. Census Bureau, 2000, retrieved August 30, 2001, from the World Wide Web: http://www.census.gov/prod/www/statistical-abstract-us.html. 6. Hudson, Chile--A Country Study (see note 1). 7. Ibid. 8. Ibid. 9. Bureau of Democracy, Human Rights, and Labor, Human Rights Report, U.S. Department of State--Chile Country Report on Human Rights Practices for 1997, Washington, DC: U.S. Department of State, 1998, retrieved August 15, 2001, from the World Wide Web: http://www.state.gov/www/global/human_rights/1997_hrp_report/ chile.html. 10. Hudson, Chile--A Country Study (see note 1). 11. Ibid. 12. Bureau for International Narcotics and Law Enforcement Affairs, International Narcotics Control Strategy Report, 2000--South America, Washington, DC: U.S. Department of State, 2001, retrieved August 30, 2001, from the World Wide Web: http://www.state.gov/g/inl/rls/ nrcpt/2000/index.cfm?docid=883. 13. Ibid. 14. Bureau for International Narcotics and Law Enforcement Affairs, International Narcotics Control Strategy Report, 1998--South America, Washington, DC: U.S. Department of State, 1999, retrieved August 30, 2001, from the World Wide Web: http://www.state.gov/www/global/narcotics_law/1998_narc_report/samer9 8_part2.html. 15. Ibid. 16. Ibid. 17. Ibid; Hudson, Chile--A Country Study (see note 1). 18. Bureau for International Narcotics and Law Enforcement Affairs, International Narcotics Control Strategy Report, 2000--South America (see note 12). 19. The Drug Abuse Warning Network (DAWN) is a large-scale, ongoing drug abuse data collection system sponsored by the Substance Abuse and Mental Health Services Administration of the U.S. Department of Health and Human Services. DAWN's major objectives are to identify substances associated with drug-related episodes and deaths reported by emergency departments and medical examiners, monitor trends in drug use consequences, detect abuse of new drugs, and assess health hazards associated with drug use. DAWN abstracts data from records of drug-related visits to emergency departments of acute care hospitals in the United States and drug-related deaths reported by 145 medical examiner jurisdictions in 43 metropolitan areas. Since 1988, DAWN emergency department data have been collected from a representative sample of 685 hospitals, including 21 oversampled metropolitan areas. DAWN medical examiner data are not nationally representative. 20. The Drug Use Forecasting (DUF) program was the predecessor to the ADAM program. Starting in eight U.S. cities in 1987, DUF was the first program to examine the prevalence of drug use among arrestees using a combination of interviews and drug testing of a sample of arrestees. For a history of DUF, see Reardon, Judy A., Drug Use Forecasting Program: Measuring Drug Use in a Hidden Population, Washington, DC: U.S. Department of Justice, Office of Justice Programs, National Institute of Justice, 1993, NCJ 144784. ------------------------------ England and Wales Trevor Bennett Trevor Bennett is the director of the New England and Wales Arrestee Drug Abuse Monitoring (NEW-ADAM) Program. He is a university lecturer at the Institute of Criminology, University of Cambridge, and a fellow of Wolfson College, Cambridge. He has served as acting director and deputy director of the Institute of Criminology. I. Overview of Demographic Profile of Nation The United Kingdom is a union of four countries: England, Wales, Scotland, and Northern Ireland. The New England and Wales Arrestee Drug Abuse Monitoring (NEW-ADAM) Program operates, as the name suggests, in England and Wales. Scotland is operating its own pilot program, and Northern Ireland has not yet begun to implement a program. NEW-ADAM is a national program that interviews arrestees and tests them for drugs. Surveys are conducted in 16 locations in 13 of the 43 police force areas in England and Wales. Fifteen of the 16 locations are in England; 1 is in Wales. In one force area, the Metropolitan Police District in London, four sites were selected. The survey sites are evenly spread geographically and cover a range of metropolitan and large urban areas as well as some smaller and rural districts. The United Kingdom is a parliamentary democracy. The Parliament in London has full responsibility for England and Wales and partial responsibility for Scotland and Northern Ireland, which are developing their own national assemblies or parliaments as part of the national devolution of power. Local governments, which are accountable to the central government, decide how counties and cities are administered. England and Wales have a combined population of approximately 51 million (see exhibit 1), of which nearly 25 million are men and slightly more than 26 million are women. About 25 percent of the population is younger than age 20. Ninety-four percent of the population is white. The major nonwhite ethnic groups are black (1.7 percent), Indian (1.6 percent), Pakistani and Bangladeshi (1.2 percent), and Chinese and other (1.2 percent). Exhibit 2 shows crime trends over the past decade using data from the British Crime Survey (BCS), a national household survey of self-reported crime victimization, and officially recorded crimes submitted by the police to the Home Office. The BCS is based on a nationally representative sample of the population aged 16 years and older (19,411 persons in 2000) and ascertains the number of personal and household victimizations. Police-recorded crimes include only those offenses reported to and recorded by the police. The two data sources show similar movements in crime rates during the past 10 years. Crime increased during the first half of the 1990s, peaking in 1992 for police-recorded crime and 1995 for BCS-reported crime victimization, then declining. Although the BCS covers