Title: Toward a Drugs and Crime Research Agenda for the 21st Century

Series: Special Report

Author: National Institute of Justice

Published: September 2003

Subject: Drugs and crime and drug policy

271 pages

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Toward a Drugs and Crime Research Agenda for the 21st Century



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



This and other publications and products of the U.S. Department of

Justice, Office of Justice Programs, National Institute of Justice can be

found on the World Wide Web at the following site:



Office of Justice Programs

National Institute of Justice

http://www.ojp.usdoj.gov/nij



--------------------------------



July 03



Toward a Drugs and Crime Research Agenda for the 21st Century



NCJ 194616



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Sarah V. Hart

Director



Findings and conclusions of the research reported here are those of the

authors and do not reflect 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.



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CONTENTS



Introduction



At the Intersection of Public Health and Criminal Justice Research on

Drugs and Crime



Research on Drugs-Crime Linkages: The Next Generation



The Drugs-Crime Wars: Past, Present, and Future Directions in Theory,

Policy, and Program Interventions



Appendix A: Summary of Proceedings



Appendix B: Forum Agenda



Appendix C: List of Participants



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INTRODUCTION



Henry H. Brownstein with Christine Crossland



For criminal justice practitioners who deal with drugs and crime day in

and day out, the reality of the drugs-crime nexus is indisputable. In a

manual designed to help police chiefs and sheriffs control drug abuse, the

International Association of Chiefs of Police (IACP) stated unequivocally

its belief in "a significant though complex" relationship between drug

abusers and criminal offenders. Change one group, IACP proposed, and

you change the other: "If there is a reduction in the number of people who

abuse drugs in your community, there will be a reduction in the

commission of certain types of crime in your community."[1]



When IACP released its manual more than a decade ago, researchers

already were confirming what practitioners believed and documenting the

relationship between drugs and crime.[2] Public policy and programs were

and continue to be developed on the basis of this knowledge.[3] But

although researchers and practitioners alike knew the relationship existed,

the nature of that relationship eluded them then and continues to elude

them today.[4] 



To shed light on the drugs-crime link requires research, and the first step is

to specify the research topics to be covered. Taking the lead, the National

Institute of Justice (NIJ) and the National Institute on Drug Abuse (NIDA)

brought together academics and other researchers and asked them to

answer three questions: What do we know about drugs and crime, what do

we not know, and, most important, what do we need to know? Both

agencies see this knowledge not as an end in itself but as a means to

accurately define the problem of drugs and crime and promote future

research. The agenda for research was developed under NIJ and NIDA

sponsorship at a forum held in Washington, D.C., in April 2001. The

findings of the Drugs and Crime Research Forum are presented here.



In Pursuit of the Drugs-Crime Link



If we are going to make progress toward solving the problem of drugs and

crime, we need to shed light on the nature of the drugs-crime link by

designing effective responses. Developing a research agenda on drugs and

crime means tackling the central issue of the drugs-crime link. Is the

link a matter of cause and effect or is it something far more complex?



There is no lack of theories. The direct cause model of the drugs-crime

relationship has attracted its share of supporters. It states simply that either

drug use leads to crime or crime leads to drug use. The simplicity is

appealing. Who would not find it tempting to believe that reducing drug

use can lower the crime rate? In fact, some policies and programs have

been developed on the basis of the direct cause model or the belief in a

significant relationship between drugs and crime. As IACP recognized, the

relationship is real enough. And NIJ's Arrestee Drug Abuse Monitoring

program has demonstrated year after year that among people apprehended

and charged with a crime, a large percentage uses drugs.[5]



However, as sociologist Erich Goode has cautioned, "Even the fact that

drugs and crime are frequently found together or correlated does not

demonstrate their causal connection."[6] The consensus among researchers

who study the issue confirms Goode's observation. The evidence for the

direct cause model is just not there.[7]



We seem more willing today to accept the complexity of the drugs-crime

relationship, more open to the notion that "[t]here is considerable

uncertainty . . . about the degree to which drug use causes crime or the

degree to which criminal involvement causes drug use."[8] In a recent

review of the literature, sociologists Helene Raskin White and Dennis M.

Gorman definitively dismissed the direct cause model. They concluded

instead that the drugs-crime link is best explained by the common cause

model, in which any association of drugs and crime has a cluster of

causes.[9]



Those who subscribe to the common cause model believe that to

adequately understand the relationship of drugs to crime requires attention

to many issues, social, cultural, chemical, and biological among them.

What the model means for policy and practice is that any response to drugs

and crime that works in one set of circumstances may not work in another.

For researchers, it means the research agenda is vast. Policy and practice

can be informed by what we know up to this point, but progress in

responding to the drugs-crime problem requires knowing more.



Building on the Past: The Drugs and Crime Research Forum



NIDA and the National Institute of Law Enforcement and Criminal

Justice, NIJ's predecessor organization, were asked by Congress in 1976 to

find out what was known about drugs and crime. The product of the

agencies' collaboration was Drugs and Crime: A Survey and Analysis of

the Literature. Though not strictly a research agenda, the survey was a first

step "to identify where the gaps in our knowledge lie and to direct research

to fill those gaps."[10] It was intended to "set the stage for more focused

future research."[11]



In 2000, NIJ's call for the development of a research agenda was another

step toward meeting that need. The authors of Drugs and Crime noted at

the time that "few if any [studies] directly address the drugs-crime nexus

issue."[12] This report on the development of the research agenda will

demonstrate that although much has been learned in the intervening years

about drugs, drug use, drug abuse, drug markets, and drug law

enforcement, much work is needed to shed light on the complexities of the

drugs-crime link.



Three papers were commissioned for the research forum. Each addressed

the questions of what we know, what we do not know, and what we need

to know about the drugs-crime link. Prepared by experts in epidemiology,

public policy, social work, and allied disciplines, the papers served as

the focal point and framework for discussions by forum participants. (The

forum summary, agenda, and a list of the participants are presented in

appendixes A, B, and C.) After the forum adjourned, NIDA created a

listserv for participants to continue to exchange their thoughts.



The discussions did not all fit the same mold. Roundtables were generated

from one-sentence statements by participants about drugs and crime.

What we do not know about the drugs-crime relationship was treated at

length. The many strands of thought, lines of discussion, and themes came

together when Forum participants addressed the final question: What

future research is most important, and what research is needed most

urgently? Mindful that the next generation of researchers will be tackling

the problem of drugs and crime, Forum participants recommended topics

for research by their graduate students.



Probing Drugs and Crime: Three Perspectives



"At the Intersection of Public Health and Criminal Justice Research on

Drugs and Crime" was commissioned by NIDA from James C. Anthony

with Valerie Forman. Anthony asked such questions as--



o Have we made effective and adequate use of recent developments in

science and technology to advance the study (and hence the understanding)

of the relationship between drugs and crime? Given the vast literature

generated during past decades on this subject, have we adequately,

appropriately, and effectively integrated research from both the public

safety and public health perspectives?



o Are the tensions between the two perspectives greater than our ability to

overcome them? Given what we know now and the current tension

between researchers in public safety and public health, how can we

conceptualize and organize our thinking and research to enhance our

knowledge and understanding of the relationship in the most productive

ways?



o What do we really know about the suspected causal connection between

drugs and crime? In looking at drugs and crime, what is the intersection at

which public health and public safety meet? How can we achieve the goals

of greater understanding and definitive evidence and greater mastery in

design and application in policy, programs, and techniques to prevent and

reduce harmful health and safety consequences of drug use?



o What do we need to do to integrate molecular biology, genetics, and

neuroscience into discussions of drugs and crime? What do we need to

do to place discussions of the drugs-crime nexus in the context of history?

How can we clarify the question of causal inference? How can we use the

notions of scale and rubrics to help understand the relationship between

drugs and crime? 



"Research on Drugs-Crime Linkages: The Next Generation" was

commissioned by NIJ from Robert MacCoun, Beau Kilmer, and Peter

Reuter. Among the questions asked by MacCoun and his colleagues

were--



o Are our conceptualizations of the relationship between drugs and crime

adequate to move forward in our understanding of that nexus? How must

we conceptualize the relationship to be able to address questions not only

of concomitance and statistical correlation, but also of social significance

and causality?



o To the extent that the drugs-crime relationship is causal, to what extent

do we understand the nature of the causal influences? How can we use

Paul Goldstein's tripartite taxonomy to build on work already done, and

how can we move beyond the taxonomy? How can we use notions such as

Bruce Johnson's conduct norm analysis or Alfred Blumstein's drugs-gun

diffusion hypothesis?[13]



o How does the considerable heterogeneity of users, substances,

locations, and situations as well as differences in market dynamics affect

what we need to have and to do to address the drugs-crime nexus? How do

we address the question of causal influences? How will research in the

coming decade deal with the heterogeneity of effects across users,

substances, cities, neighborhoods, and situations?



"The Drugs-Crime Wars: Past, Present, and Future Directions in Theory,

Policy, and Program Interventions" was commissioned by NIJ from Duane

C. McBride, Curtis J. VanderWaal, and Yvonne M. Terry-McElrath. In

this paper, McBride and his colleagues raised the following questions:



o In the past two or three decades, what progress has been made in our

knowledge and understanding of the relationship between drugs and

crime? Does knowledge of the statistical relationship help us understand

the nature of the relationship? What do we know about the nature of the

nexus and what do we need to do now to advance the state of our

knowledge? In the past century, how have we used that knowledge to

guide public policy? Could we do a better job of linking what we think and

what we know about drugs and crime to what we do to address individual

and social problems in the realms of public health and public safety? Do

we know enough about what has been tried (for example, programs and

program evaluations) to know what works?



o How is the idea of social capital important to our understanding of the

drugs-crime nexus? What is the significance of the dynamic tension

between drug policy as it shifts and the drugs-crime connection as policy

changes? What is the value of interventions and treatment when dealing

with drug-using offenders?



What Do We Need to Learn?



It will come as no surprise that the question of what we know about drugs

and crime was eclipsed by that of what we do not know and what we have

yet to learn. The papers and accompanying discussions yielded an

abundance of ideas on research topics for the coming decades. The major

themes included the following:



o Drug-related crime.



o Drug enforcement.



o Drug markets.



o Drug offenders.



o Drug policy.



o Treatment and intervention.



o Drug use and abuse.



o Ethnographic studies.



o Health sciences perspectives.



o Minority research.



o Research methods.



o Victimization studies.



Categorized more broadly, the topics proposed for research are the

drugs-crime nexus, the social contexts of drug use and crime, and refining

study methods and designs.



What Explains the Drugs-Crime Nexus?



We know that drugs and crime are related. We also know something about

the different ways they might be related, and perhaps something about the

ways they may be related in time and space. What we have yet to learn is

how they are related. In other words, we need to probe the underlying

dynamics of the relationship. We do not know, for example, why so many

people who commit crime also use drugs or why some people who use

drugs commit crime but others who use drugs do not commit crime.

Research in this broad area might take several directions.



Find new ways to conceptualize the drugs-crime nexus. Several years ago,

Goldstein proposed a tripartite framework as a way to disentangle the

relationship between drugs and crime, specifically violent crime. Violence

could be the direct outcome of ingesting drugs, the result of a user's

compulsion to obtain drugs or money for drugs, or a product of the

disorganization and violence inherent in the social systems in which drugs

are manufactured and exchanged.[14] Over the years, this framework has

been useful for studying drugs and violent crime but of limited value for

studying drugs and other types of crime. Beyond what has been learned

from this model, how can researchers conceptualize the way or ways drugs

and crime--not just violent crime--are related?



Combine research perspectives. Research on drug use illustrates how

different disciplines can combine forces. Social science research is

beginning to merge with biological research, particularly genetic research.

Questions include the following:



o How can the study of genes, the social environment, and behavior help

us better understand the link between drugs and crime?



o Are there physiological propensities for drug using? If so, what is the

impact of the user's environment?



o Are alcohol and marijuana complements of or substitutes for other

drugs?



o Do different drugs have different effects on groups of people who are

genetically different?



o How can we address the ethical concerns of such research?



Give more attention to minorities. A disproportionate number of the

people arrested, charged, and in custody for drug and other criminal

offending are from minority groups. The reason is unknown but needs to

be probed. What can we learn about the involvement of various ethnic

and racial groups in the drugs-crime link? What can we learn about gender

and the drugs-crime link? Some answers might be found in comparative,

multisite studies of drug use and drug markets in different ethnic

communities. What is the relationship of gender, age, race, and culture to

drug involvement and crime? What is the effect of disparity (in income,

for example), prejudice, and discrimination on the distribution of resources

used for treatment and prevention? How can we explain racial and ethnic

differences in drug use and involvement in crime? Do people view the

drugs-crime link differently because of their race, gender, or age?



From these general research areas on racial and ethnic diversity, it is

possible to derive many specific topics. What can we find out about the

relationship between drugs, crime, and the increase in the number of

women of color who are incarcerated? Have changes in the economy

affected the involvement of disadvantaged black and Hispanic/Latino

males in drugs and crime? If so, how? What is the impact of drug-related

incarceration on families and children or on prospects for education and

employment in minority communities?



What Do We Need to Know About the Social Context of Drugs and

Crime?



It is widely believed that drug use adversely affects users. But drug use and

crime are affected by and in turn affect forces operating in society at large.

Drug users interact with many people: sellers with buyers, buyers with

sellers, criminal offenders with their victims. There is a social context of

drug use.



Social patterns in the drug world. There have been many studies of drug

users and some studies of drug markets. But what do we need to learn

about the social relations and interactions of the people whose lives are

affected by drugs?



The commerce of drugs and crime: drug markets. Theories about and the

operations and institutional arrangements of drug markets are plentiful, but

not enough research has been done to test them. How stable are drug

markets, and how do they change over time? For example, has the

maturation of the crack cocaine market in some cities affected those cities'

crime rates? What is the connection between local market activity and

fluctuations in supply and demand at the national level? What influences

the relationship between sellers and buyers? How and why do new markets

emerge, and what impact do they have on existing markets? How are

prices set in local drug markets, and how are wages set?



Patterns of use and abuse. We know something about the demographics of

drug use, but what do we know about intergenerational patterns? How do

use patterns vary with social or biological differences? How do patterns of

alcohol use compare with patterns of use of other drugs? Can drug use

help explain juvenile involvement in crime or violence? Are patterns of

use of certain drugs, such as club drugs, designer drugs, or inhalants,

different from patterns of use of other drugs? What can we find out about

how and why people start or stop using drugs?



Criminal offending by drug users. There are some studies of drug

offenders, but how much do we know about how or why drug offenders

commit crime? Are some people genetically predisposed to drug use?

Is there a relationship between drug use and social status, and if so, how

might social status in turn be related to involvement in crime? Beyond

using illicit drugs, to what extent are drug users and sellers involved in

other crime? Can we realistically estimate how much other crime is

committed by drug offenders? What risk do these people pose to their own

health and safety? 



Victims of drug users and drug use. Drug users are in some ways their own

victims, but are there other victims? What do we know about other people

with whom drug users relate? How can we define for research and policy

purposes what we mean by "victims of drugs"? How do we define

victimization in this context? Are there indirect victims, such as families

and communities, as well as direct victims?



The public's response to drug use and drug-related crime. Society

considers drug-related crime and illicit drug use as affronts and responds

accordingly. Enforcement strategies are one example. To what extent are

the responses based on a real understanding of these problems? Are the

responses making a difference?



Enforcing drug laws. What is the effect of enforcement policies, programs,

and practices on drug use, drug dealing, and drug-related crime? What is

the relationship between street-level enforcement and street-level drug

market activity, particularly violent activity? What impact do drug

seizures, drug arrests, and asset forfeiture, among other interdictions, have

on drug and drug-related crime? What is the impact of public concern

about racial profiling and police corruption on the ability of law

enforcement to respond to drugs and crime?



Treating drug use and abuse. With so many different drugs and so many

different types of users, what can we say about the efficacy of drug

treatment in addressing drugs and crime? What is the nexus of drug

treatment and criminal justice? For example, what are the results of

treatment in correctional settings and what do evaluations reveal? Do

incentives or disincentives help drug users to succeed in treatment? How

do we define success? How important are aftercare programs and family

interventions? What is the best way to treat drug users who are dually

diagnosed (for example, those who are also mentally ill)? What are the

dropout rates for treatment, and what does it matter? What treatments 

work best with what types of drug use? How do we distinguish users

from abusers? What difference does that distinction make for treatment

planning?



Intervening to prevent drug use or crime. Although relatively little is

known about preventing drug use, the topic receives a great deal of 

attention. To what extent can media campaigns help prevent drug use? Is

the impact of prevention programs the same for all social categories of

users or irrespective of type of drug? How can we educate young people

about the impact that drugs can have on their lives? Should more attention

be paid to problem behavior, norm violations, and rule breaking than to

drug prevention?



Public policy. When we think about public policy on drugs, we typically

do not think about policy in general but rather about specific aspects, such

as interdiction, enforcement, treatment, and prevention. But can we step

back and think broadly and measure the impact of drug policy over the

past decade, or even the past century? Can we learn from policy

simulations that examine past and prospective views of drug use? Can we

learn from comparative studies of different countries? What is the impact

of different directions in drug policy? What policies have worked or not

worked with adult and juvenile drug offenders? Can research examine

drugs, crime, and public policy together? Can we find out from

policymakers and practitioners what decisions they need to make and

what questions they need to answer about drugs and crime? How can we

move drug policy analysis beyond econometrics (supply and demand, for

example) and begin to study drug use from the perspective of politics,

criminal justice, public health, and social work?



Methods of Studying Drugs and Crime



Research methods are dictated by the questions researchers ask. Some of

the questions already explored indicate that certain methodological

concerns might need to be addressed.



Attention to measurement and design. What are the best measures

currently available to study drug use and involvement in drug markets and

drug treatment? How can they be improved? How can we construct

integrated data collection measures? What is the best way to design

measures and procedures to evaluate drug control programs? What are the

best measures for assessing drug treatment outcomes? What is the role of

cost-benefit analysis in drug studies? What can we learn from longitudinal

studies about the long-term effects of drug use and abuse? How can we

introduce randomization to long-term studies of drug treatment? How can

statistical techniques developed by other sciences be adopted by the 

social sciences? How can we encourage multidisciplinary teams of

researchers to work together to study drugs and crime?



Ethnography. There is a long, distinguished tradition of ethnographic

research in the field of drug studies. Ethnographic studies, however, are

almost by definition limited to a single area or a small group of people.

What might we learn by secondary analyses of ethnographic studies?



What might we learn by replicating ethnographic studies in other

communities or among other groups of drug users? How useful might it be

to link ethnographic studies of community structure with studies of drug

users and dealers in their communities? What can we learn from studying

communities of sellers and users? Would it be useful to establish

prospective, qualitative field sites in various communities as a type of

surveillance system to monitor changing drugs and drug-use patterns?



Using available data and studies. How can we make better use of available

data to study drugs and crime? Are there obstacles to making better use of

available data to learn from them what we can? What can we learn from

meta-analyses of previously conducted research studies of drugs and

crime?



What Is In This Report?



Following this introduction are the three papers commissioned for the

forum and appendixes containing a summary of the forum proceedings, the

agenda, and a list of the names and organizational affiliations of the

participants.



Notes



1. International Association of Chiefs of Police, Reducing Crime by

Reducing Drug Abuse: A Manual for Police Chiefs and Sheriffs,

Gaithersburg, MD: International Association of Chiefs of Police,

1989:5.



2. See Tonry, M., and J.Q. Wilson, eds., Drugs and Crime, vol. 13 of

Crime and Justice: A Review of Research, Chicago: University of Chicago

Press, 1990; and R. Weisheit, ed., Drugs, Crime and the Criminal Justice

System, Cincinnati: Anderson Publishing, 1990.



3. See, for example, Forcier, M.W., "Substance Abuse, Crime and

Prison-Based Treatment," Sociological Practice Review 2 (1991):

123-131; Office of National Drug Control Policy, National

Drug Control Strategy--2000 Annual Report, Washington, DC: The White

House, 2000 (and earlier ONDCP annual reports); and Longshore, D., F.

Taxman, S. Turner, A. Harrell, T. Fain, and J. Byrne, "Operation Drug

TEST Evaluation," final report submitted to the National Institute of

Justice, U.S. Department of Justice, 2000 (grant 97-IJ-CX-0041).



4. Examples of studies that explored the nature of the drugs-crime

relationship in that period include Brownstein, H.H., and P.J. Goldstein,

"A Typology of Drug Related Homicides," in Weisheit, ed., Drugs, Crime

and the Criminal Justice System: 171-192; Chaiken, J.M., and M.R.

Chaiken, "Drugs and Predatory Crime," in Tonry and Wilson, eds.,

Drugs and Crime: 203-239; Fagan, J., "Intoxication and Aggression," in

Tonry and Wilson, eds., Drugs and Crime: 241-320; Goldstein, P.J., H.H.

Brownstein, P.J. Ryan, and P.A. Bellucci, "Crack and Homicide in New

York City, 1988: A Conceptually Based Event Analysis," Contemporary

Drug Problems 16 (1989): 651-687; and Johnson, B.D., T. Williams, K.A.

Dei, and H. Sanabria, "Drug Abuse in the Inner City: Impact on Hard-Drug

Users and the Community," in Tonry and Wilson, eds., Drugs and Crime:

9-67. 



5. Arrestee Drug Abuse Monitoring, 1999 Annual Report on Drug Use

Among Adult and Juvenile Arrestees, Washington, DC: U.S. Department

of Justice, National Institute of Justice, June 2000 (NCJ 181426).



6. Goode, E., Between Politics and Reason--The Drug Legalization

Debate, New York: St. Martin's Press, 1997: 119.



7. See, Brownstein, H.H., "What Does 'Drug-Related' Mean? Reflections

on the Problem of Objectification," The Criminologist 18 (1993): 1, 5-7;

Chaiken and Chaiken, "Drugs and Predatory Crime," in Tonry and Wilson,

eds., Drugs and Crime: 203-239; Fagan, J., "Intoxication and Aggression,"

in Tonry and Wilson, eds., Drugs and Crime: 241-320; Goode, E.,

Between Politics and Reason--The Drug Legalization Debate; White,

H.R., and D.M. Gorman, "Dynamics of the Drug-Crime Relationship," in

G. LaFree, ed., The Nature of Crime: Continuity and Change, vol. 1 of

Criminal Justice 2000, Washington, DC: U.S. Department of Justice,

National Institute of Justice, July 2000 (NCJ 182408); and Wilson, J.Q.,

"Drugs and Crime," in Tonry and Wilson, eds., Drugs and Crime: 521-

545.



8. Office of Justice Programs, Office of Justice Programs Fiscal Year 2000

Program Plan: Resources for the Field, Washington, DC: U.S. Department

of Justice, Office of Justice Programs, 2000: 23 (NCJ 182238).



9. White and Gorman, "Dynamics of the Drug-Crime Relationship," in G.

LaFree, ed., The Nature of Crime: Continuity and Change: 193. 



10. Gandossy, R.P., J.R. Williams, J. Cohen, and H.J. Harwood, Drugs

and Crime: A Survey and Analysis of the Literature, Washington, DC:

U.S. Department of Justice, National Institute of Justice, 1980: xi (NCJ

159074).



11. Ibid.: 122. The survey covered five "crucial areas": patterns of drug use

and criminal behavior; "life cycle" characteristics (age of onset of drug use

and crime, for example); "economic issues" (price and supply/demand, for

example); treatment; and methods (sampling, for example).



12. Ibid.: 122.



13. These works are discussed in this report.



14. Goldstein, P., "The Drugs/Violence Nexus: A Tripartite Conceptual

Framework," Journal of Drug Issues 15 (1985): 493-506.



--------------------------------



AT THE INTERSECTION OF PUBLIC HEALTH AND CRIMINAL

JUSTICE RESEARCH ON DRUGS AND CRIME



James C. Anthony with Valerie Forman



About the Authors



James C. Anthony, Ph.D., is a professor in the Department of Mental

Hygiene at Johns Hopkins University. Valerie Forman is a National

Institute of Mental Health predoctoral fellow with the Psychiatric

Epidemiology Training Program at Johns Hopkins University.



Introduction



This paper discusses intersections of public health research and criminal

justice research on the topic of drugs and crime. The drugs of interest

mainly are marijuana, heroin, and other internationally regulated

compounds of illegal origin, and such internationally regulated products of

legal origin as pharmaceutical cocaine hydrochloride, codeine, and

oxycodone, which also may be consumed on an extraordinary basis (i.e.,

outside the bounds of accepted medical practice). An important point of

departure for this paper is a widely held assumption about two goals of

research on this topic. The first goal is to achieve greater understanding

and develop a body of definitive evidence on drugs and crime. The second

goal is to achieve greater mastery of the design and application of policies,

programs, and techniques to improve public health and public safety by

preventing and reducing harmful consequences of drug use. 



The outline for this paper corresponds with assignments delegated at a

planning meeting held at the National Institute of Justice (NIJ) in January

2001. This introductory section provides some background notes on the

literature reviewed for the paper and describes an organizing conceptual

framework that can be used to assess gaps in the current evidence. The

next section identifies some tensions that merit discussion as we try to

forge a new research agenda on drugs and crime. We then address the

central question posed in our planning meeting for the drugs-crime

research forum: "What do we know about the drugs-crime

interrelationship?" We cannot provide a comprehensive answer to this

question in a relatively short paper, but we will offer a starting point for

discussion, focusing on suspected causal relationships between drugs and

crime. We also present a few concluding statements that were designed to

facilitate discussion at the forum on drugs-crime research held at NIJ in

April 2001.



A Burgeoning Literature on a Variety of Fronts



A scholar interested in the topic of drugs and crime has much to read.

Some of the classics of the field include Terry and Pellens's The Opium

Problem (1928); early papers on drug taking and sociopathy by Kolb and

Pescor, who were two of the early clinical leaders in research at the facility

that ultimately became the National Institute on Drug Abuse's (NIDA's)

Intramural Research Program and Addiction Research Center; and work

by Dunham and Lindesmith, whose surprisingly contemporary remarks

and observations started to systematize some of the field's research

questions on the social psychology of the drugs-crime relationship.

Many of the issues that confront the drugs-crime researcher today were

articulated by Terry and Pellens (1928), Kolb (1925), Pescor (1939),

Dunham (Faris and Dunham, 1939), Lindesmith (1938), and their

contemporaries in the first half of the 20th century.



These issues were re-articulated and a new set of themes was clarified in

subsequent research, such as The Road to H investigations led by Chein

(1964), the work of Preble and Casey as described in "Taking Care of

Business--The Heroin User's Life on the Street" (1969), Cohen's

Delinquent Boys (1955), and Robins' Deviant Children Grown Up (1966).

Two of the most important emerging themes from this research offer a

challenge to conventional thinking about the drugs-crime relationship:



o There is no single drugs-crime relationship. Rather, there are

drugs-crime relationships, most of which are complex rather than simple.



o There is no simple solution to the complex challenges faced when

drugs-crime relationships come into play.



By way of illustration, Brownstein and Goldstein offered and refined a

tripartite conceptualization of drugs-crime relationships, which serves as a

useful guide to some of the surrounding issues. Within this tripartite

framework, one set of criminal offenses is described as

psychopharmacologically induced (e.g., responses to intoxication states

after drug taking). A second set of offenses is described as

economic-compulsive in nature (e.g., instrumental income-producing

criminal acts as needed to stave off symptoms of withdrawal states that

appear once drug use has stopped). A third set of offenses is described as

"systemic" and might be understood best as a consequence of a drug user

entering or living within a social context in which extraordinary drug use

is just one of a set of often intercorrelated criminal behaviors. That is,

we do not need an appeal to drug intoxication, drug withdrawal states, or

drug-induced compulsive behavior to account for offenses observed in this

third category (Goldstein, 1985; Brownstein and Goldstein, 1990).



The tripartite framework clarifies three separate types of drugs-crime

relationships, none of which is simple. As for analysis of simple solutions

for these complex problems, a therapeutically oriented drug maintenance

program might reduce the economic-compulsive type of offending without

influencing the occurrence of crimes determined by poor judgment or

other manifestations of intoxication states. A successful supply-side drug

eradication program might reduce both pharmacological and

economic-compulsive types of offending, but not offending of the

systemic variety. Imprisonment of the drug user within a drug-free prison

environment might extinguish today's crimes but might not influence

tomorrow's offending when the prisoner is released back to the home

community. Even if the prisoner remains drug free during the immediate

postrelease period, the history of incarceration and a criminal record

might constrain job opportunities and economic success to the point of

inducing crimes that otherwise would not have been committed if the drug

user never had been incarcerated in the first place.



Illuminated in this manner, the facets of multiple drugs-crime relationships

become more clear; new opportunities for research open up. As these

opportunities have been recognized, there has been a tremendous growth

in scholarship and research activity on the topic of drugs and crime (see

exhibit 1).



Scholars may benefit from an assembled listing or bibliography of this

literature, now available in electronic form as a technical report from the

Electronic Collaboratory for Investigations about Drugs at Johns Hopkins

University (Forman, 2001). Readers interested in a recent comprehensive

review of these publications can turn to the Harrison and

Backenheimer-edited issue of Substance Use & Misuse on the drugs-crime

nexus in the United States, which was published by Stanley Einstein and

Marcel Decker, Inc., in 1998.



A Conceptual Framework for Drugs-Crime Research



Confronting the accumulated body of evidence and new literature, we have

attempted to sort each element of evidence in relation to a conceptual

framework originally devised for the field of psychiatric epidemiology and

epidemiological research in general (Anthony and Van Etten, 1998). This

conceptual framework is used as we train public health scientists for

advanced research on drug dependence and related conditions. The

framework may prove to be useful in the domain of criminal justice

research as well, perhaps with suitable amendments by interested teachers

and scholars.



The rubrics. Early in their public health research training, we ask our

predoctoral and postdoctoral fellows to master the epidemiology of drug

dependence. Here, drug dependence is defined as a syndrome or "running

together" of clinical features, and sometimes is called drug addiction,

especially when the focus is on such clinical features as obsession-like

cravings and compulsion-like repetitive behaviors in which drug

taking is central. The clinical features of the drug dependence syndrome

include pharmacological tolerance, characteristic withdrawal signs and

symptoms, almost obsessional thinking about drugs and drug-related

behavior, and other observable mental, behavioral, and social adaptational

manifestations of neuroadaptational processes that get started and progress

with repeated drug taking.



This epidemiology of drug dependence is a subject matter to be mastered

by the public health research fellows, just as they master the concepts,

principles, and techniques used as methodological tools in the public

health sciences. Mastery of this subject matter begins with study of the

just-mentioned clinical features, the history of diagnostic criteria or case

definitions used in public health research on drug dependence, and what

has been learned about its neuroadaptational and genetic substrates. In

the process, research fellows learn of patterned variation in drug

dependence syndromes, some of which can be understood in relation to the

pharmacology and pharmacokinetics of different drugs, such as cocaine

versus heroin or methamphetamine versus oxycodone. Research fellows

also learn about different measurement techniques used in laboratory,

clinical, and field studies of the drug dependence syndromes. For example,

under certain conditions, an appropriate dose of a narcotic antagonist can

be used as a bioassay to check for the presence of dependence on heroin or

other opioid drugs (e.g., via precipitated withdrawal). Nonetheless, in

general, the measurements of drug dependence rely heavily on self-report

information obtained under specially protected confidential circumstances.

To the extent that subjectively felt experiences such as "craving" and

obsessional thinking about drugs are central clinical features for drug

dependence, we cannot substitute human urine, saliva, or sweat samples

for self-reports (Anthony, Neumark, and Van Etten, 2000).



Once issues of definition and measurement have been mastered, research

fellows move on to what we call the "rubrics" of epidemiology--its main

subheadings and associated research questions. These main rubrics and

primary associated research questions are displayed in exhibit 2.



Successful research fellows learn these rubrics and use them to master not

only the state of currently available evidence on each form of the drug

dependence syndrome, but also the current gaps in evidence and the

research concepts and tools needed to fill the gaps in evidence.



The relationship of each rubric to an associated set of research concepts

and tools sometimes helps to clarify and differentiate the rubrics. Links

between each rubric and corresponding research concepts and tools are

presented in exhibit 3.



Quantity. Under the rubric of quantity, the main associated research

question is How many in the population are becoming affected, have

become affected, and are now affected?" In this context, "becoming

affected" can refer to becoming a drug user, developing drug dependence,

initiating criminal behavior, or some combination thereof (e.g., see

Gfroerer and Brodsky, 1992; Kosterman et al., 2000; Golub and Johnson,

2001a).



As reflected in the published scientific literature and technical reports

made available by NIJ, the Substance Abuse and Mental Health Services

Administration, and other Federal agencies, a substantial fraction of the

Nation's research expenditures on drugs and crime is directed toward the

"report card" function of public health and criminal justice research under

the rubric of quantity. A recent National Research Council report (Manski

et al., 2001) tallied more than 60 Federal agencies with data systems

designed to keep track of estimates on the number of drug users in

households, among school-attending youths, among arrestees, among

patients seen in emergency rooms, and in various other segments of

American life.



On the U.S. Department of Health and Human Services (HHS) side, we

have the National Household Survey on Drug Abuse (NHSDA) with

growing national probability samples of adolescents and adults (now with

a sample size of more than 70,000 subjects per year); the Monitoring the

Future (MTF) study, which started as a way to track drug use among

graduating high school seniors through a national probability sample each

year and now encompasses 8th and 10th graders; and a less intensive but

more massive Centers for Disease Control and Prevention (CDC)

surveillance of drug use and other health risk behaviors of teenagers in

school. On the U.S. Department of Justice side, we have other ambitious

survey operations, such as the Arrestee Drug Abuse Monitoring (ADAM)

program (formerly Drug Use Forecasting [DUF]), which monitors drug

taking among arrestees through both self-reports and bioassay techniques,

and the National Crime Victimization Survey.



Evaluated as part of the public health and criminal justice research

enterprise, these substantial efforts may be understood best as examples of

surveillance operations. The label "surveillance" does not trivialize the

important work of the professionals and scientists whose daily labors, year

in and year out, yield the hard-won surveillance data. In fact, many of our

country's surveillance operations in this domain of inquiry truly are gems

and tend to be regarded as the best of the best in the world. In some

respects, they are the envy of the world. Nonetheless, by definition,

surveillance activities are designed with timeliness and practicality in

mind, sometimes with deliberate decisions to sacrifice validity of

measurement in favor of enhanced survey response rates.



For example, NHSDA, MTF, and the CDC survey all use self-report

methods to measure drug-taking and crime-related behavior (e.g., weapon

carrying). The option of bioassays to confirm self-report data now is

regarded as impractical or too costly for surveys on a mass population

scale, and there has been concern expressed that bioassays might reduce

survey participation rates below acceptable values. NIDA is engaging in

survey research experimentation with bioassays to complement self-report

data to assess practical questions of this type. In the meantime, serious

concerns have been expressed about the capacities of these data systems to

provide evidence for policy evaluation (see, e.g., Manski et al., 2001).

Nevertheless, evaluated from the standpoint of original plans for the data,

these criticisms are somewhat impertinent as surveillance indicators. The

criticisms are asking the surveillance operations to do far more than they

originally were designed to offer.



The first rubric of epidemiology also encompasses studies of birth cohorts

that are intended to estimate risks of adversity, plot trajectories of

normative development, or quantify important population characteristics

such as rates of officially recognized offending. The concept of a cohort

study is familiar to criminal justice researchers and public health scientists

alike. Prominent examples in the criminal justice research arena include

Robins' classic nonconcurrent cohort study of children seen by child

guidance workers in the early 20th century (1966), and the work of Tracy,

Wolfgang, and Figlio entitled Delinquency Careers in Two Birth

Cohorts (1990).



The fact that the rubric of quantity is mentioned first does not mean that

research under this rubric is easy or a methodological snap. Not at all.

From the standpoint of data gathering, those of us who have recruited,

trained, and supervised teams of 60 or more field worker-interviewers and

quality control staff for data entry, documentation, and management can

appreciate the operational challenges in surveillance work. From a

statistical vantage point, the nature of the surveillance operations often

includes interdependent observations within samples (e.g., sampled

students within samples of schools; sampled household residents within

neighborhoods; multiple respondents within sampled households,

emergency rooms, or criminal justice facilities). These interdependencies

motivate solutions that call on the calculus (e.g., in Taylor series

linearization for variance estimation). In some estimation applications,

there is a need for Bayesian statistics not yet taught widely in graduate

research training programs.



As to the importance of these "counting" operations, we may turn to a

recent research contribution by Cohen, who incorporated values from

these surveillance operations in his attempt to estimate the monetary value

of rescuing a high-risk youth from a life of delinquency, crime, and other

socially maladaptive behavior (1998). To complete this work, Cohen had

to turn to an array of previous results from counting operations that

ranged from the National Institute of Mental Health Epidemiologic

Catchment Area surveys we conducted in Baltimore during the early 1980s

with colleagues at four other university-based sites to work that Blumstein

and his group completed to estimate basic parameters of criminal justice

research, e.g., an estimated 6 percent of all boys account for more than half

of all arrests (Blumstein et al., 1986). 



There can be little doubt that investigators in the drugs-crime arena should

be interested in Cohen's conclusions about varying programmatic

investments and the monetary returns from programs to intervene with

high-risk youths. Nevertheless, it is somewhat startling to know that

Cohen had to turn back to counting evidence gathered in the early 1980s

and before to produce estimates to be used for policy and programmatic

decisions almost two decades later. These quantitative estimates are not

Avogadro's number; rather, they are values expected to change over time,

if not from place to place. If we value probing quantitative criminological

research exemplified by Cohen's work, then we must ensure that the

drugs-crime research agenda includes periodic repetition of surveys to

yield the required estimates.



Studying the accumulated evidence on the drugs-crime relationship, we

have been able to sort much of it into the rubric of quantity. Quite clearly,

NIJ and NIDA now make a considerable investment in the basic counting

tasks required to estimate and quantify such parameters as how many

adult arrestees and juvenile offenders are taking drugs each year. Each

repetition of these surveillance operations provides evidence on variation

in the estimates from time to time and from place to place. The study of

this type of variation falls under the second rubric, which is called

location.



Location. Our second rubric is location, and the main associated research

question is "Where in the population are affected individuals more or less

likely to be found, with variation in occurrence and frequency

differentiated by characteristics of time, place, and person?" On occasion,

work under this rubric is guided by theory, but more often the research has

a more descriptive character.



James et al. (2002) provide an illustration of the nature of research and

evidence about location. The research team set out to plot geographic

variation in the occurrence of drug purchase opportunities experienced by

young adults in the United States. In this figure, a "drug purchase

opportunity," a special form of drug-related crime opportunity, is

measured by a survey response to a standardized assessment in interviews

conducted for NHSDA. As depicted in exhibit 4, and substantiated with a

univariate response regression model for description, there is variation in

the occurrence of these drug purchase opportunities across locational

regions of the country and for young men versus young women. In this

context, the statistical methods are not intended to probe the causes of the

observed variation from place to place, nor the observed male-female

differences. Rather, the methods are used simply to help quantify the

uncertainty in the survey-based estimates and substantiate the presence of

variation from place to place and the male-female differences (James et al.,

2002).



This illustration is useful because it reminds us that location refers not

only to geographic variation but also to variation in relation to

individual-level characteristics (e.g., sex, age, socioeconomic status,

ethnicity). For example, Fendrich et al. (1995) studied juvenile and older

murderers to understand varying degrees of drug involvement in murder.

Locational research also plots temporal changes, as illustrated in a recent

NIJ report on the possibility of new marijuana epidemics, to be described

below (Golub and Johnson, 2001b).



Estimates of the consistency of association between drug use and various

arrest and criminal behavior types also serve to illustrate analyses

focused on location within population experience: Crime was found to be

more common among drug users than among nondrug users. As Harrison

and Gfroerer (1992) make clear in their NHSDA analyses on this topic, the

research questions they were trying to answer concerned the number of

drug users, the number of individuals engaged in criminal behavior, and

the overlap in these numbers. With respect to location, their work clarified

the proportion of drug users who were engaged in criminal behavior and

the prevalence of criminal behavior in relation to drug use. As is true in

the work of James et al., these investigators did not draw on the apparatus

of causal inference, matching, or other scientific maneuvers to disentangle

whether the criminal behavior was a response to the drug use or vice versa.

Nonetheless, taking a step beyond studies of officially recognized crimes,

arrestees, and convicted criminals, Harrison and Gfroerer helped confirm

links between drugs and criminal behavior, but they did not seek to

produce definitive evidence about the causes of drug use or criminal

behavior.



Much of our current research enterprise at the interface of drugs and crime

has this type of descriptive character. Substantial HHS investments in the

MTF study and NHSDA already have been mentioned. On the NIJ side,

we call on ADAM to help clarify variation in the occurrence of drug use

among arrestees across multiple jurisdictions, not only in the United States

but also overseas. For the most part, we do not require these investments

to yield definitive evidence that might be central in causal inference.

Nonetheless, the evidence from these studies helps to describe the location

of drug taking, criminal behavior, and the intersections of these behaviors,

and sometimes to describe or predict the co-occurring and separate

patterns of drug use and criminal behavior.



Analyses conducted under this rubric without a special push toward causal

inference can be especially important in identifying hot spots within

geocoded areas as well as health disparities that might differentially fall on

one or another racial or ethnic minority group. Here, it is a predictive as

well as a descriptive purpose that can be achieved. However, when the

task is to predict and not to explain, there is no special calling for the

methods required for firm causal inferences, as depicted in exhibit 3.



Within the drugs-crime arena, there are many different examples of

surveillance operations under the rubric of location, such as we can see

in recent work by Golub and Johnson (2001b) in which they used

DUF/ADAM data as evidence to advance their claims about a new and

possibly expanding epidemic of marijuana use in the United States. True

to the descriptive character of locational research, Golub and Johnson

present evidence of the new and possibly expanding epidemic among

offenders in some areas (e.g., Atlanta) and evidence of no epidemic in

other areas (e.g., Miami), but they do not seek to explain why there should

be an epidemic in one place but not in another. Because these data are

from incarcerated individuals, an important set of complications arises in

their interpretation. One suspects that the observed time trends and

variation from place to place might reflect operations of local police

departments as much or more than it reflects any underlying change in the

dynamics of marijuana epidemiology.



This rubric of location also encompasses studies in which the investigators

may be striving toward causal explanation, but they fall short, often

demonstrated in a shift toward the language of "prediction" and away from

the language of "explanation." Two different hypothetical concluding

statements can illustrate this point. When the research team falls short of

its goal, the researchers may summarize their work by saying something

like "Based on this study's evidence, the level of drug use in early

adolescence predicted later delinquency and criminal behavior in the

young adult years." A different verb is selected for the alternative, stronger

form of concluding statement: "Based on this study's evidence, the levels

of delinquency and criminal behavior in the young adult years depend on

levels of drug use in early adolescence." 



As the focus shifts from description or prediction toward explanation and

causal inference, we move from the rubric of location to the third rubric of

causes. The shift in focus calls into play a new set of research concepts,

principles, and tools, as outlined in exhibit 3.



Many scholars will appreciate that a single study may contribute evidence

under several rubrics at once. For example, the periodic reports of

NHSDA, MTF, and ADAM routinely present evidence that falls under the

rubric of quantity as well as the rubric of location. Rarely, the authors of

these reports seek to make causal inferences from their surveillance data.



The yield of a study often is not clear at the outset or in the stages of study

planning, and the study orientation to theory is not always a discriminating

feature. Some theory-based studies have started as investigations of causes

but have ended up making contributions solely in the domains of

prediction and description. Other atheoretic studies end up making useful

contributions in our studies of cause. Consider the first conclusive study

on the topic of age-related risk of Down syndrome (DS) and associated

mental retardation, completed some 50 years ago. The investigators sought

to plot the risk of DS by the age of the mother at the time of delivery. An

exponential increase in risk after age 40 was clear in the first graphs. We

still do not know what causes the chromosomal trisomies that give rise to

DS, nor do we know why these trisomies and DS are more common when

older mothers give birth. But even in the absence of firm causal theory and

evidence, it has been possible to reduce the occurrence of DS in human

populations by encouraging mothers to bear their children before age 40.

Hence, a strictly descriptive study provoked an effective intervention to

reduce the occurrence of an important genetic condition.



It is regrettable that our studies of disparities affecting racially and

ethnically defined subgroups of the American population generally fall

under the rubric of location, as do our studies of the changing dynamics of

household and family composition in the United States. For example, we

now can say with some certainty that African-American males experience

rates of arrest, prosecution, and incarceration for drug possession offenses

that cannot be explained by their rates of drug taking, but we do not have

good evidence on the causes of this racial disparity. Initial inquiries

suggest differential law enforcement and judicial practices, which

sometimes encompass racial profiling, but rigorous scientific evidence

on these practices is scarce.



With respect to the dynamics of household and family composition, the

phenomena of youthful drug taking and related criminal offending have

links back to the families of origin, now often characterized by absence or

infrequent appearance of the father in many of our population groups.

This is not to say that female-headed households are homogeneous or

uniformly deleterious with respect to socially maladaptive behavior of

young people. It would be a mistake to presume that the traditional

mother-father household always and in all contexts is more protective than

a female-headed household with respect to the risk of youthful drug taking

or delinquent behavior (e.g., see Chilcoat, 1992). Mothers often mobilize

family resources or draw on assets that in some measure may help

compensate for absent fathers (e.g., by involving grandparents, neighbors,

church groups), as described by Kellam, Ensminger, and Turner (1977),

Pearson et al. (1990), and others.



A research agenda on race, ethnicity, and family or household composition

can be motivated by an awareness that the drugs-crime relationships will

depend to some extent on demographic trends. Against the backdrop of

demographic trends such as these, including an increased prominence of

Hispanic children and families in the United States, it will be important to

sustain the research agenda in the domain of locational variations of this

type. Important steps in this direction have been taken in the Federal

agencies responsible for surveillance of drug-related behaviors, including

increased attention to measurement of ethnic self-identification (e.g.,

with respect to Cuban origin, Puerto Rican origin, and other subgroups of

the Hispanic population; with respect to Chinese origin, Samoan origin,

and other subgroups within the Asian-Pacific Islander category). Similar

attention is required in criminal justice research such as ADAM and

I-ADAM (International ADAM) and in administrative statistics compiled

on operations of the criminal justice system in this country.



Whereas the human genome project is challenging conventional views

about "race" as a scientific concept, studies on self-identified

race-ethnicity will have a sustained importance in the NIJ-NIDA research

agenda on the topic of drugs and crime. 



This evaluation of importance can be grounded in an awareness of the

demographic trends described above, but it also draws on an appreciation

of what studies of self-identified race-ethnicity may teach us about the

influence of cultural contexts and socially learned behaviors with respect

to drug taking and criminal behavior. 



Finally, a note on ethnographic studies should be added here. In general,

the sample size and "sample space" characteristics of these studies do not

make ethnography an especially fertile discipline with respect to the first

rubric of quantity, except when the characteristic under study has

extremely limited dispersion. For anyone who looks to ethnographic

studies for quantitative values, there often are some unanswerable

questions about generalizability and precision of the study estimates. In

some respects, ethnography might be characterized as a search for the

boundaries of no variation in a socially shared human characteristic.



This is not to say that ethnography is barren when it comes to quantitative

data. To the contrary, the small scale of ethnographic research makes it

possible for ethnographers to shift directions more quickly than is possible

in ordinary surveillance operations. As a result, ethnographic field workers

helped in the early identification of crack cocaine, methamphetamine, and

oxycodone outbreaks--years before these outbreaks could be identified in

large-sample surveillance data.



Under the rubric of location, ethnographic field workers were among the

first to note inner-city adolescents whose drug taking started with

marijuana rather than with the more normative experiences with alcohol

and tobacco. They also were the first to characterize a growing use of

"blunts"--tobacco cigars hollowed out and filled with marijuana for a

combined tobacco-marijuana intoxication (Golub and Johnson, 1999). In a

recent round of observations, there is a suggestion that for some youths,

the typical "gateway" drugs have been skipped--an example of subgroup

variation in the more typical developmental sequences running through

alcohol, tobacco, and marijuana to drugs such as heroin, stimulants, and

hallucinogens. Large-sample epidemiological surveillance data now seem

to confirm the initial ethnographic observations on this topic (e.g., see

Golub and Johnson, 1999; Golub and Johnson, 2001a).



One of the reasons ethnographic research is important under the rubric of

location is that it can open our eyes to new conceptions of time, place, and

personal characteristics that impinge on the drugs-crime relationship.

These ethnographic studies are especially useful in descriptions of the

cultural context and socially learned behaviors described above. Their

evidence can add depth and insight to otherwise superficially understood

intersections of drug taking and criminal behavior.



Causes. The third rubric of epidemiology pertains to the study of causes

and draws on the research apparatus required for causal inference (exhibit

2). On occasion, this research apparatus can be quite simple in concept.

For example, a relatively small sample of monozygotic (MZ) twins

discordant for an important outcome is sufficient to provide definitive

evidence about environment with respect to the causes of that outcome.

These MZ twins are genetically matched: If they are discordant for

outcome, one may look for gene-environment interactions, but more often

one looks for differences in environmental conditions in utero (e.g.,

dichorionic versus monochorionic sacs), perinatally (e.g., insults at the

time of delivery), or in later development (e.g., head trauma for one twin

but not the other during infancy or childhood). The National Institutes of

Health (NIH) investment in recent twin research to estimate heritability of

different forms of drug use now generally is paying off in two ways:



o Each study is indicating at least some degree of heritability of drug

dependence, and sometimes heritability of drug use, especially legal drug

use (e.g., tobacco). 



o Each study is indicating ample room for gene-environment interaction

or for influence of environmental conditions and processes. 



These results from causal research help substantiate a case for a future

research agenda on the genetic sources of variation and on environmental

modulation of these genetic sources of variation.



Randomized trials with relatively simple structure also can be used to

probe causal hypotheses with definitive results. For example, these trials

may offer our best avenues toward definitive evidence on whether

cessation of illegal drug use is followed by reductions or elimination in

criminal behavior. An alternative is to nest the study of causes within a

more expanded agenda of systems research on drugs-crime relationships

(Manski et al., 2001). To the extent that systems research entails a finely

detailed specification of mechanisms that link events and processes within

a system, this type of research falls more clearly under the rubric of

mechanisms, as described below.



Outside of the simplicity of research on discordant MZ twins and

randomized controlled trials, a complex apparatus of study design and

statistical method is required to extract definitive evidence in research on

drugs-crime relationships. Given the importance of inferences about

causes in the drugs-crime relationship, it may be understandable that

graduate research training programs have become increasingly

methodological in their orientations.



It may be appropriate to discuss the potential contribution of ethnographic

research in relation to the causes of the drugs-crime relationship. To

date, most ethnographic research on drugs and crime has been descriptive

in character. It has provided leads for more probing causal investigations,

but it has not produced definitive evidence on the links between drugs and

crime. In this respect, ethnography's contribution may be most important

under the rubric of location. Before anyone could mobilize large-sample

surveillance operations to study the new drugs-crime phenomena

connected with crack cocaine (e.g., crack and prostitution), it was possible

for ethnographers to move in and make headway. To some extent,

ethnographers have been pioneers in research on methamphetamine and

club drugs such as MDMA (Ecstasy), and we can expect more of the same

in relation to our first new drugs-crime outbreaks of the 21st century,

which involve sustained release oxycodone.



An NIJ-NIDA investment in ethnographic research on drugs-crime

relationships of this type will continue to be important--if only to help us

begin to understand the unusually circumscribed geographic distributions

of methamphetamine and oxycodone use in the United States and the

patterns of criminal behavior associated with use of these drugs.

Ethnography can be used to produce a catalog of causal explanations for

methamphetamine's emergence as a threat to public health and public

safety in rural sectors of the American Midwest and for oxycodone's

emergence in small cities and towns of the Appalachian mountain range,

especially from West Virginia southward. It is not clear that ethnography

or any other scientific field will be capable of producing definitive

evidence about specific explanations in this catalog of causes.

Nonetheless, there is value and importance in the attempt to do so, and

ethnographers can bring rigor and scientific discipline to this process of

investigating these causes. The alternative seems to be to leave these

investigations to the field of journalism.



Mechanisms. Within epidemiology generally, mechanisms refer to

linkages of states and processes that lead toward expressions in clinical

features of health and illness or disease. As applied to the drugs-crime

relationship, one might ask about the mechanisms of linked states and

processes leading to or away from an association between illegal drug use

and criminal behavior.



For an illustration of these mechanisms, one may turn to the coercive

process and deviancy training models introduced in the work of Patterson

and Dishion. Their Oregon Boys study has provided longitudinal evidence

on what surely must be central linkages in the mechanisms underlying

drugs-crime relationships (e.g., see Patterson, Dishion, and Yoerger 2000).

For example, studying these school-based samples of boys through ages

17-18, and using standardized coding of a 30-minute free

discussion-interaction between best friends, they found substantial

over-time correlation of deviant friendship process (e.g., duration of

rule-breaking talk bouts as coded from videotape). Dishion also has

reported on a link from initial drug use to increased affiliation with deviant

peers and onward to initiation of criminal behavior that is more consistent

with the delinquency-to-drugs link that emerged in the longitudinal

research of Johnston and colleagues based on MTF analyses published

more than 20 years ago (Dishion et al., 1996; Johnston, O'Malley, and

Eveland, 1978), as well as on more recent studies (e.g., Elliott and

Huizinga, 1989).



The use of multiwave longitudinal study designs to probe into suspected

causal mechanisms is well known in both public health and criminal

justice research circles. The Alcohol, Drug Abuse, and Mental Health

Administration (the precursor to SAMHSA), and more recently NIH and

OJJDP have maintained support for a series of important longitudinal

studies over the years (e.g., see the work of Jessor and Jessor, Kellam and

Ensminger, Block and Block, McCord, Bachman, Kandel, Robins,

Elliott and Huizinga, Hawkins and Catalano, and many other studies of

this type, as listed in compendiums such as Verdonik and Sherrod, 1984).

Advantages of long-term investment in these longitudinal studies can be

seen in the research articles from many of the research projects with

multiwave assessments, for example, the Pittsburgh Youth Study (e.g.,

Loeber et al., 1998), the Denver Youth Study, and the Rochester Youth

Development Study (Loeber et al., 1999); and the research groups led by

the Brooks, Newcomb, and Bentler (e.g., see Brook et al., 1996, Brook et

al., 2000; Newcomb and Bentler, 1988; Newcomb 1992).



One of the questions in the design of an agenda for future research on

drugs and crime is how the evidence from large- and medium-sized

samples from longitudinal studies of this type might be linked with

evidence from the generally much smaller intensive studies of cases. Until

there is consensus about effective interventions to disrupt the drugs-crime

relationship, possibilities for a linkage exist through the concept of natural

history.



In the history of medicine and medical research, the first natural historians

of disease were clinicians and clinically oriented observers who made

careful observations at the bedside of patients, in the absence of effective

interventions. They watched, measured as best they could (e.g., body

temperature), and described change in relation to the passage of time from

the first recognition of clinical features. Within the realm of drugs and

crime research, ethnographers and social scientists generally have taken

over the responsibilities of careful clinical observers in relation to illegal

drug use and criminal behavior. During the last 50 years, thanks to the

work of Robins (1966), Winick (1962), Preble and Casey (1969), Agar

(1973), Waldorf (1998), Nurco (Nurco et al., 1975, 1996; Nurco, 1998),

and their successors, we have learned much about the natural history of

drug use, drug dependence, and associated criminal behavior through

ethnographic and social science research. 



The natural history of a disease proves to be an important element under

the rubric of mechanisms. In the past, a careful description of a disease's

natural history often has guided investigators toward underlying causal

mechanisms.



In the years before effective drug treatments, Winick and others drew

attention to the maturing out process for drug addicts, and there is a

parallel literature on maturing out with respect to criminal behavior in

general (Winick, 1963). The maturing out process continues to be an

important locus for new research on the drugs-crime relationship.



Other clues about causal mechanisms are being produced in observational

and longitudinal studies of individual cases or families characterized by

some feature of the drugs-crime relationship. For example, we have

Dunlap's intensive studies of families in which one of the members is a

crack cocaine dealer (Dunlap and Johnson, 1996; Dunlap, Johnson, and

Manwar, 1994); research such as Spunt's study of adolescent offenders

with a history of violent crime (Spunt et al., 1990), Longshore's linkage of

DUF and California Bureau of Criminal Statistics data (Longshore 2000),

and the earlier related studies started by Hser, Anglin, and McGlothlin

(1987); and investigations led by Inciardi, Johnson, and Goldstein or

members of their research groups (e.g., see Inciardi and Russe, 1977;

Inciardi 1990; Inciardi and Pottieger, 1998; Johnson, Dunlap, and Maher,

1998; Goldstein 1998; Spunt et al., 1990, 1994, 1995).



Several interesting elaborations of these intensive case studies have

developed in the realm of criminal justice research. For example, Logan

(2001) has added bioassays for metabolites of the neurotransmitter

serotonin as well as testosterone assays as part of his intensive followup

studies of crack users. This example serves to illustrate a potential

intersection of public health and criminal justice research that should be

explored in more depth as we work through a future agenda for research

on drugs and crime.



A conceptual shuttling back and forth between these intensive smaller

sample studies and the generally larger sample longitudinal studies would

seem to have advantages for investigators who work in one or another of

these arenas, and there are a few investigators who conduct both types of

studies (e.g., see Dishion and Loeber, 1985; Dishion, Patterson, and Reid,

1988; Dishion et al., 1996). This type of bridgework between the

microsocial and ethnographic research traditions and large-scale

longitudinal sample research deserves to be a deliberate focal point on the

future drugs-crime research agenda. This focal point is important because

the study of causal mechanisms and processes can draw attention to

potentially vulnerable links where new interventions might be directed.



In epidemiology generally, the focus of research on causal mechanisms is

shifting to genes and encoded gene products, as displayed in our most

recently emerging subspecialties of genetic epidemiology and molecular

epidemiology. To some extent, Elliott has a head start in a potential

cross-fertilization between criminal justice research, genetic epidemiology,

and molecular epidemiology. He already has introduced harvesting of

DNA samples in the context of his national longitudinal study (Elliott,

2001). Opportunities for case-control studies and other genetically

informative designs, including whole genome scans nested in a

case-cohort study design, will become possible as this research evolves.

Eventually, this type of work should lead us toward more definitive

evidence on causal mechanisms underlying the drugs-crime relationship,

including gene-environment interactions.



It is possible to make a forecast of likely integrations of genetic research,

cognitive sciences, and the more traditional disciplines of behavioral and

social sciences for a future agenda for NIJ and NIDA research on

drugs-crime relationships. For example, exhibits 5-7 represent an

elaboration of conceptual models our research group has developed as an

aid to our study of transitions from drug use to drug dependence. Exhibit 5

expresses a suspected causal influence of drug use on criminal behavior. It

also expresses a separate influence of drug dependence on criminal

behavior. These two specifications are consistent with the

Goldstein-Brownstein distinctions between drug-related crimes that

might arise from acute drug intoxication states versus crimes that are

rooted in the economic-compulsive behavior of an individual who suffers

withdrawal states as a result of sustained drug use and neuroadaptation.

There are many law-abiding drug dependent individuals who do not

commit crimes, even when they are suffering from withdrawal pains.

Hence, exhibit 5 includes a speculative causal pathway that runs directly

from withdrawal to the occurrence of criminal behavior, over and above

the separately specified role of the drug dependence syndrome for which

withdrawal serves as a manifest indicator.



We speculate that an individual's genome can contribute to the

drugs-crime relationship in different ways. Exhibit 5 concentrates on a

possibility that some genetic polymorphisms or mutations may be

intercorrelated manifestations of an underlying diathesis or vulnerability to

make the transition into drug dependence from a state of nondependent

drug taking, as reflected in pathway 1. It also specifies a possibility that a

specific polymorphism (or mutation) has an additional influence on this

transition, as reflected in pathway 2. As indicated by pathway 3, we may

hope for development of effective intervention techniques that can disrupt

what otherwise might be an expression of the diathesis. If effective, these

interventions will slow or disrupt the natural history of drug dependence at

a step in the process that links nondependent drug taking and the

subsequent transition into drug dependence. This effect of intervention, by

itself, may be sufficient to alter the drugs-crime relationships depicted to

the right of the exhibit.



The potential role of the cognitive sciences is expressed in the

intermediate pathways that link nondependent drug taking and drug

dependence to later criminal behavior. Here, aggression may be

conceptualized in a generic sense as rowdy misbehavior or social

maladaptation secondary to drug taking, which can occur with or without

criminal behavior. Executive dysfunction refers to impairments in the

cognitive processes that subserve human capacity to plan, direct, and

control one's future behavior within adaptational boundaries and may

encompass more generalized planning behavior (e.g., see Tolman,

Edleson, and Fendrich, 1996).



As depicted in exhibit 5, during states of acute drug intoxication, there

may be a release of aggressive behavior and a disruption of regulatory

executive functions. As levels of drug dependence increase, levels of

aggressive behavior can change in an upward or downward direction and

executive dysfunctions can occur. The complexity of interrelationships

between aggression and executive dysfunction is reflected in the reciprocal

causal paths between these two constructs. Increased executive

dysfunction translates as inept decisionmaking about aggression and the

subjective utility functions that govern decisions about whether to commit

a crime. As part of generally adaptive fight-flight responses and

modulation of monoamine neurotransmitter signaling pathways during

bouts of aggression, there can be a cascade of executive dysfunctions:

Mere rowdiness can be transformed into aggravated assault.



To be sure, exhibit 5 is only a model that represents little more than an

oversimplified representation of the complexities that link an individual's

genome with cognition and behavior. Models by definition are

oversimplified representations. It is fair to ask whether the model requires

additional specifications, such as the possibility that religious convictions

might tend to modulate the relationship between drug taking and

aggression or criminal behavior. In this oversimplification, exhibit 5 does

not convey all such possibilities. These possibilities for elaboration of the

longitudinal model should help the reader understand some of the

complexities faced in observational studies of causal mechanisms that

account for observed drugs-crime relationships.



Exhibit 6 presents even more simplification to sharpen focus on the

drugs-crime relationship specifically. The genetically based diathesis and

other covariates of exhibit 5 are set into the background (i.e., presumed to

exist but not explicitly depicted). In exhibit 6, we see a readily appreciated

reciprocity between the level of drug taking and the level of drug

dependence: (a) the more drug taking, the more we find increased drug

dependence levels, and (b) the more drug dependence, the more we find

increased levels of drug taking. We also see the level of criminal behavior

expressed as a function of levels of drug taking and drug dependence, as

shown in exhibit 5. An additional elaboration involves the longitudinality

of this model. We have levels of criminal behavior at one point in time

influencing levels of criminal behavior at future points in time, but in

exhibit 6, we do not specify a link from levels of criminal behavior to

subsequent drug taking or drug dependence levels. At least in theory, and

in some prior suggestive evidence, this omission represents a potentially

important misspecification of our model for the drugs-crime relationship

(e.g., see Johnson et al., 1995).



Exhibit 7 adds a level of complexity to the model depicted in exhibit 6 and

poses a substantive question for the agenda of action research: "How

might an intervention lead to change in this system of interrelationships?"

We introduce the possibility that social status (e.g., status in the

community, socioeconomic status, lawful income) depends on criminal

behavior and also on the level of drug dependence, and that criminal

behavior influences the subsequent level of drug dependence by its

intermediate influence on social status. The model depicted in this exhibit

also provides for a plausible link from the level of drug dependence to

subsequent criminal behavior. Namely, as drug dependence increases and

social status (e.g., lawful income) falls short, criminal behavior may

increase (as in the Goldstein-Brownstein tripartite model). In addition,

subsequent levels of drug dependence may be influenced by the changes in

social status, either upward or downward.



The model in exhibit 7 also introduces a conglomerate concept of

"assortative peering," expressing a well-known truism: "birds of a feather

flock together." The occurrence of drug taking is linked to later formation

of peer group relationships, as is the occurrence of criminal behavior. To

some extent, we can say that past drug use and past criminal behavior

influence current peer group affiliations, and to some extent, we can say

that past peer group affiliations influence future drug use and future

criminal behavior. These complexities are expressed by hypothesized

causal paths in exhibit 7.



Conceptual models of this type are incomplete representations of the

causal mechanisms that lie beneath observed drugs-crime relationships, yet

they are elaborations of the Goldstein-Brownstein tripartite model.

Nonetheless, most readers will agree that these representations are

oversimplified. If they have value, it is to highlight some future directions

for the joint NIJ-NIDA research agenda on drugs-crime relationships. 



We do not yet have a longitudinal research program to investigate the

relatively simple model of interrelationships between levels of drug use,

drug dependence, and criminal behavior as depicted in exhibit 6, let alone

the more complex model of exhibit 7, with its sociological construct of

social status and the social-psychological construct of affiliation with

behaviorally similar peers (assortative peering, homophily, etc.).

Fortunately, there already is a cadre of criminologists and drug researchers

who are trained in sociology and social psychology and can readily

incorporate the biomedical and clinical concepts of drug dependence into

their research plans, if supported to do so.



It will be more difficult to forge a research agenda that integrates the

genetics research and cognitive sciences constructs depicted in exhibit 5.

For the most part, genetics and cognitive sciences are unknown territories

for most NIJ and NIDA investigators who have made important

contributions in past research on the drugs-crime relationships. For most

drugs-crime researchers, it would not be difficult to integrate concepts and

measurements of aggressive behavior and the clinical syndrome of drug

dependence within their existing research plans. Far more difficulty will

be encountered during the process of integrating genetics and the

neuropsychological and neurophysiological measurements of the cognitive

sciences. 



We can learn a lot about the drugs-crime relationship simply by replicating

and refining important longitudinal research on drugs-crime relationships

that was initiated during the second half of the 20th century. Many of these

longitudinal studies have cohorts that still are intact, and followup studies

are now underway to learn more as these cohorts mature into adolescence

and make the transitions into young and middle adulthood. There are

mountains of data from 20th-century studies that have not yet been fully

exploited through careful analysis.



Nonetheless, as we look forward through the next decades of research, the

NIJ-NIDA agenda must go beyond what has developed as the best

20th-century research on the drugs-crime relationship. Ten decades from

now, if we are to leave the 21st century with an enhanced understanding of

the drugs-crime relationship and with a greater capacity for effective

action to improve public health and safety in this domain, we cannot

continue to work within the narrow paradigms and methodologies of the

traditional scientific disciplines mastered by drugs-crime investigators

of the 20th century. If we are successful, then in a few decades, the

biomedical, genetic, and cognitive science substrates of the drugs-crime

relationship will no longer be a matter of mere speculation, as depicted in

exhibits 5 and 7. There will be definitive evidence, solid understanding,

and effective action-plans based on what we learn from the pioneers who

move into that now-unexplored territory.



Prevention and control. The long-term value of research on causal

mechanisms depends on identifying potentially vulnerable linkages in the

sequence of states and processes that lead to illegal drug use and criminal

behavior. It may go without saying that increasingly definitive evidence

about causes and causal mechanisms will help us achieve our goals in the

domain of effective prevention and control. Nonetheless, a reminder may

be useful with respect to a dynamic interrelationship between etiological

studies (of causes) and the emergence of effective interventions. As

illustrated in the circumstance of DS and maternal age, with limited

evidence on the underlying causal mechanisms of DS, by manipulating

maternal age we have a very effective instrument to prevent and reduce the

risk of DS. As explained in our original paper on the rubrics of

epidemiology, many effective public health preventive interventions

emerged before firm knowledge about causes and causal mechanisms

became available (Anthony and Van Etten, 1998).



A related concept involves the use of randomized preventive trials to

provide increasingly definitive evidence about suspected causal

relationships. Some readers of this paper will know of work that Kellam

and our Johns Hopkins research team have completed, using randomized

field trials to probe the interrelationship between early aggressive and

rule-breaking behavior and later drug involvement among boys (e.g.,

Kellam and Anthony, 1998). In essence, we decided that more

observational research on the link from early aggression or deviance and

later drug use would be less important than an experimental test. Within

the framework of a randomized field trial, we tried to and succeeded

in reducing aggressive and deviant behavior of first-graders using an

experimental intervention assigned at random. For the boys assigned to

experimental intervention, we have found later reduced occurrence of drug

involvement, and we have replicated these results in a second cohort of

first graders (Kellam and Anthony, 1998). More replications along these

lines are needed before anyone can claim that early aggression or deviance

is a "cause" of later drug use, but this experimentation illustrates how

experimental research in the domain of prevention and control can yield

benefits in the form of improved evidence to test causal theories. This idea

is not new. Hawkins, Catalano, Offord, and others have noted it as well

(e.g., Hawkins, Von Cleve, and Catalano, 1991; Hawkins, Catalano, and

Miller, 1992; Jones and Offord, 1989). But it is an idea that often is

overlooked by investigators more interested in theory testing and who

orient themselves toward goal 1, described in this paper's first paragraph.

Under the fifth rubric, we try to orient the research to serve both goal 1

and goal 2.



Because elements of this rubric of prevention and control are being

covered in the companion papers that accompany this working manuscript,

I will close this section more quickly than might be customary. Before

doing so, I would like to mention the contributions of operations research

and systems research in this domain, which often have been neglected in

epidemiology. Over the years, the thoughtful and quantitatively sharp

work of Blumstein and colleagues has continued to inspire an important

line of research on prevention and control that is pertinent to the

drugs-crime relationship. Although I am not confident about all of the data

or assumptions of the underlying analysis approaches, I have been

especially impressed by the directions taken by Blumstein colleagues

Caulkins and Cohen in this regard.



For example, Cohen (1998) discusses potential synergy of programs and

distinguishes the aggregate benefits of programs designed to reduce

crime versus the sum of the benefits of individual programs. It is possible

that no single program would help city residents feel safe enough to derive

lifestyle-related expenditure benefits (e.g., walking a mile through a rough

neighborhood versus taking a taxicab because of concerns about safety).

Combinations of programs might do so. This distinction ties into the

concept of marginal costs versus average costs associated with drug-using

and delinquent youths or criminals, where the marginal costs exclude fear

of crime and private security expenditures because these costs are largely

unaffected by any one criminal's actions.



Caulkins and his colleagues developed a challenging line of systems

research that can ultimately yield new ideas and evidence about policy

instruments in relation to the drugs-crime relationship. The evolution of

this work toward selection of policies and programmatic instruments at

different stages of a drug-taking epidemic is especially important

(Caulkins, Crawford, and Reuter, 1993; Behrens et al., 1999). 



A Selective Overview of Tensions Faced in Research on Drugs and Crime



Numerous tensions are faced at the intersection of public health and

criminal justice research on the drugs-crime relationship. This section

identifies and describes a selection of these tensions, and in some

instances recommendations are offered for NIJ and NIDA action to help

resolve the tensions.



Tensions in Theoretical Perspectives, Concept, and Definition



Heterogeneity at the intersections of public health and criminal justice

research is not limited to differences of opinions and judgment about

empirical observations, the inferences we can draw from these

observations, and the uses to which we apply the observations (e.g., cost

analyses of alternative programs). There are some fundamental tensions

within and across theoretical perspectives and also approach.



The concept of scale. Ecologists work with a concept of scale that may

help us understand some of the tensions mentioned above and may serve

as an axis of orientation as we turn to future directions for research (e.g.,

see Brown, 1995; Wiens et al., 1986). As a concept, scale resonates with

what educational researchers and behavioral and social scientists often

have termed multilevel or hierarchical models, as in Ennett's and the

Duncans' research with young people nested within ecological niches of

higher order such as classrooms, schools, or families (e.g., see Ennett

et al., 1997; Duncan et al., 1997; Duncan, Duncan, and Hops, 1998) and

our own research group's nesting of individual drug users and collections

of drug users in their neighborhoods of residence (e.g., Bobashev and

Anthony, 1998; Petronis and Anthony, 2000). Parker and Toth (1990) also

have appealed to related macro versus micro concepts in their research on

alcohol and homicide, as have Patterson and colleagues in their research

on peer groups (Patterson, Dishion, and Yoerger, 2000). Bronfenbrenner's

ecological systems theory for human developmental research slices scale

into macro, meso, and micro divisions that many investigators have found

useful (Bronfenbrenner, 1979, 1986).



Although not with any direct reference to a formal ecological concept of

scale, we can see resonance of this concept in Markowitz and Grossman's

studies of taxes and regulations on alcohol and their hypothesized effects

on criminal behavior (Markowitz and Grossman, 2000), the research of

Caulkins and colleagues on national drug policy and programmatic

initiatives (e.g., Behrens et al., 2001), and Holder's research on preventive

interventions directed toward communities in the United States (Holder

1993, 2001; Holder et al., 1999, 2000). Scale is worked outward from the

individual organism in the direction of larger social groups, organizations,

and geopolitical units. In public health and criminal justice research, we

often refer to pre-established institutional or geopolitical boundaries

(schools, census tracts, nations) when we work at higher scale. In ecology,

mathematical models and methods such as advanced wavelet analysis are

used to allow the empirical data to inform scale--as in research on

landscape ecology (Anthony and Bradshaw, 2001).



Some tensions arise in research when investigators ignore scale in their

theoretical perspectives or empirical research reports. For example, most

of us work within a conceptual framework that leads us to comprehend

estimates of the drugs-crime relationship without reference to scale.

However, one should expect the drugs-crime relationship to be of one

order of magnitude when we are investigating individuals who all reside in

the same local area (e.g., as in much of the ethnographic research on the

drugs-crime nexus), a different order of magnitude when we work with

individuals and data from multiple neighborhoods, but with matching on

neighborhood in the analysis, and a different order of magnitude when our

data are from individuals across the Nation, with no analytical attention to

who lives near whom, except perhaps during the process of estimating

variances for confidence limits and standard errors (e.g., see Bobashev and

Anthony, 1998). 



Although not clearly within the scope of the original ecological concept of

scale, an investigator may work inward from the boundaries of the whole

organism toward subunits, ultimately leading to the signaling pathways

between neurons, messenger systems originating from genetic material,

and the simplest proteins and the encoding genes themselves. This

elaboration of the concept of scale creates yet another tension, in part

because the concepts of genetics and signaling pathways for

neurotransmission are more familiar in the public health research

community but are not yet in the mainstream of graduate or postdoctoral

research training in the criminal justice research community. To illustrate,

when I have talked with my criminal justice research colleagues about

Elliott's inclusion of DNA assays in the most recent waves of his National

Youth Survey, many of them have asked, "Why?" To be sure, some

skeptical behavioral genetics colleagues also have asked, "Why?" but this

is an instance in which the same verbal behavior has origins in

substantially different theoretical models. My point is that tension can

arise when concepts of scale are not made explicit.



Some of the work at the intersections of public health and criminal justice

research will be to make our concepts of scale explicit. In some respects,

this will be more readily accomplished as we work from the whole

organism outward, and the task may be more difficult as we try to integrate

molecular biology, genetics, and neuroscience into our discussions.

Nonetheless, this hard work will be essential as we make a 21st-century

science of drugs-crime relationships.



Orienting definitions and constructs. The literature also displays

considerable heterogeneity in orienting definitions and constructs. On the

public health side, there often has been an orientation toward drug use and

drug dependence or addiction as useful constructs in their own right. One

orientation often has been called the "medical model," but it amounts to

little more than an analysis of empirical syndromes (i.e., co-occurring

manifestations of the neuroadaptational processes that get started when

drug use begins, followed by a cascade of secondary and tertiary

adaptations, some of them occurring in the domain of social adaptational

roles and responsibilities). In a later section of this paper, I will return to

this syndrome concept. On the criminal justice side, drug use and the drug

problems associated with drug use often are treated as if they are not

interesting in their own right but are something akin to interchangeable

observable manifestations of something else that is more fundamental,

such as the "problem behavior syndrome" construct first elucidated by

Jessor and Jessor (1977) some 30 years ago. A more recent version of this

concept is a general deviance construct used by Scheier, Botvin, and others

in empirical studies (e.g., see Scheier and Botvin, 1996), and there also is a

recent respecification of the Jessor and Jessor model, with elaborations

that encompass the epidemiological concepts of risk factors and protective

factors (Jessor, 1998).



The literature also shows heterogeneity in the typologies of criminal

behavior or social maladaptation. Notions of childhood conduct disorder

followed by Antisocial Personality Disorder appear prominently in some

formulations, but are absent elsewhere (Loeber and Schmaling, 1985;

Stevens, Kaplan, and Bauer, 2001; Langbehn and Cadoret, 2001).



These definitions and constructs in our theoretical perspectives demand

work at the intersection of public health and criminal justice research. If

we cannot bridge these different approaches or marry them to produce

adaptive offspring, they will prove to be an unending source of unresolved

tension with implications for research progress. Unresolved tensions slow

down our progress in research that depends on a peer review process,

whether the peer review occurs at the stage of reviewing proposals or of

vetting journal articles.



At NIJ and NIDA, an important part of the research agenda can be a series

of meetings or technical workshops. The charge to workshop participants

is to bridge these orienting concepts and definitions across disciplines or

create an articulation between concepts that will accelerate research 

progress on drugs-crime relationships rather than slow it down.



Orienting conceptual frameworks and theories. The originating biomedical

branches of public health research sometimes take theory as a given or

work with theory in the background when there are emergent problems of

human suffering and disease to be solved. For example, the important

20th-century line of investigations required to identify lung cancer as an

adverse consequence of tobacco smoking was guided more by implicit 

concepts of carcinogenesis secondary to tobacco smoking. Strongly

articulated, explicit theories, if any, would have been mis-specified and

incomplete in that they could not possibly have incorporated the

postsmoking DNA adducts, protein adducts, and gene-encoded

metabolizing enzymes now prominent in the models of carcinogenesis. In

criminal justice research, true to its origins in the social and behavioral

sciences, the theoretical underpinnings are made more explicit (e.g., see

Thornberry, 1997; Kaplan, 1995). One might say that without explicit

theory, the research in this domain stands little chance in peer review, no

matter how important the empirical contribution.



This is another source of tension at the intersections of and sometimes

within the domains of public health and criminal justice research. In

Public Health Service study sections, I have seen study section members

be less than enthusiastic about proposed epidemiological research on drug

use and Antisocial Personality Disorder because the applicants had not

oriented themselves to the major theories of deviance well known in

criminal justice circles: "inadequate conceptual model" is the phrase that

comes to mind. I also have observed major differences of opinion about

scientific priority among experts in the criminal justice and social science

world, some of whom are comfortable with "psychologizing" constructs

within their theories (e.g., the self-derogation models developed by

Kaplan), and others who are more focused on constructs with a behavior

analytic origin (e.g., coercive process and deviancy training models

developed by Patterson, Dishion, and their research groups in Oregon).



Tension in relation to theoretical models has been readily apparent in this

NIJ-NIDA collaboration, which has offered a chance to step back and look

over a broad expanse of scientific progress in public health and criminal

justice research on the drugs-crime association. This broad perspective

creates germs of ideas that might be useful in a synthesis or integration of

various theoretical perspectives that range from the disciplines of

molecular or behavioral genetics to those of econometrics and the other

social sciences. However, there clearly is diversity and tension even within

fields as narrow as behavior genetics, where some work is oriented toward

developmental family processes (e.g., as advanced in the recent work of

Neiderhiser and colleagues), and other work is not (e.g., see Neiderhiser et

al., 1998, 1999; Neiderhiser, 2001; Brennan, Mednick, and Jacobsen,

1996; Tehrani et al., 1998; Kotler et al., 1999).



These tensions surface most clearly in debate and discussion of an

intersection of genetics research and studies of the drugs-crime

relationship. Many investigators from social science backgrounds are

hesitant to take part in discussions of genetics, gene expression, and

mechanisms of inheritance that might account for covariation of

drug-taking behavior and criminal offending. This hesitation can be traced

in part back to serious and important concerns about ethical issues,

eugenics, and the like. Some of the hesitation can be traced back to a gap

in graduate education: Graduates of social science training programs often

have not mastered the basics of human biology and genetics.



Looking from a different perspective, an observer can see other sources of

tension in relation to conceptual framework and theories. Graduates of

human biology and genetics programs often have not mastered the basics

of behavioral and social sciences research.



The intersection of the Human Genome Project, gene expression, and

proteomics with research on drugs-crime relationships merits close

attention at NIDA and NIJ. To some extent, this intersection can be

cultivated in a gradual process of shaping new investigators. NIDA's peer

review of its portfolio of research training programs and individual career

development awards can specify requirements for cross-discipline mastery.

On one side, new social science investigators can be required to master the

basics of human biology and genetics. On the other side, new human

biology and genetics investigators can be required to master the basics of

behavioral and social sciences.



NIDA already is sponsoring a series of training workshops for new

investigators to expose them to the different disciplines that now

contribute to its research mission. The initial workshops have focused on

epidemiology, pharmacology, and neuroscience and introduced

participants to those fields. Future workshops are planned, with a broad

agenda that cuts across the behavioral and social sciences, including

ethnography and behavior genetics, as well as domains of medical sciences

such as proteomics, drug development, and NIDA's clinical trials network.



Sustained investment in research education of these types will be needed at

NIJ and NIDA. Without attention to pharmacology, neuroscience, and

pharmacogenetics, it will be difficult for future investigators to develop a

fundamental understanding of the pharmacological and

economic-compulsive categories of offending in the Goldstein-Brownstein

tripartite conceptual framework. Without grounding in the social sciences,

it will be difficult for them to develop a fundamental understanding of the

systemic categories.



There now are investigators who can bridge the gaps that appear as

canyons between disciplines. Elliott's attempt to articulate his work with

the NIH human genetics initiative provides one example. In a primate lab

run by Steve Suomi at NIH, research on gene-environment interactions as

substrates of aggressive behavior, social maladaptation, and drug use

provides another example. This research is especially useful because the

environmental conditions experimentally manipulated in this lab have

conceptual linkages back to the deviancy training, inept parenting, and

parent-infant relationship models developed by Patterson, Dishion, Brook,

and others (Higley et al., 1996a, 1996b; Higley, Suomi, and Linnoila,

1996a, 1996b; Patterson, Dishion, and Yoerger, 2000; Dishion et al., 1996;

Brook et al., 1996; Brook, Tseng, and Cohen, 1996).



More examples of this type of bridgework are emerging from the work of

the research pioneers who try to keep pace with evolving contributions

from the NIH Human Genome Project. The NIJ-NIDA research agenda

can be enriched by a technical report series that brings examples of this

type to the community of investigators and research trainees.



Tension That Involves Approach or Methods



Review of the drugs-crime literature creates an opportunity for developing

new insights about the sometimes different approaches and methods that

have been developed in public health and criminal justice research work

groups. For example, ethnography with small groups has expanded to

almost large-sample ethnographic research that bears some resemblance to

large-sample survey research, but in many ways is different. To an

outsider, this expansion is a puzzle to be solved and has not yet been

grasped. In the public health research domain, the original role of an

ethnographer bore some resemblance to the role of the medical practitioner

as a student of the natural history of disease. The original natural history

studies were intensive case studies, with the doctor at the bedside of

individual sick patients making careful systematic observations about this

individual case and then that individual case, in the days when there might

have been symptom palliation (e.g., cold cloths for fever), but no effective

curative interventions to change the clinical course of disease. This has

some resonance with Agar's concepts of the ethnographer's attention to the

details of behavior and verbal expression and of writing the narrative and

taking down the stories of drug users in their own words (Agar, 1973). The

link from this role of the ethnographer to large-sample ethnography

remains unclear.



Measurement methods pioneered in behavioral sciences research and

introduced to studies of drug taking by Larson, Kaplan, and Schiffman

have started to surface in criminal justice research as well. Experience

Sampling Methods (ESM), originally developed to study the daily lives of

high school students, have now been introduced in research on drug use

(e.g., see Csikzentmihalyi and Larson, 1987, 1992). Their ESM procedure

requires study participants to wear an electronic pager device that beeps at

randomly scheduled intervals, signaling the participant to record some

predetermined aspects of his or her present feelings, activities, and/or

surrounding environmental conditions. Usually, dozens of self-reports are

collected over a week or more to capture as much of participants' daily

living as possible. One advantage of this method is the ability of the

researcher to examine drug use specific to each individual, given the

assessment of his or her baseline characteristics for comparison. An

additional benefit is the possibility of taking into account measured social

context of the behavior (e.g., see Farnworth, 2000). ESM also creates new

opportunities to investigate the determinants of drug-taking behavior that

might be unique to each individual and each situation (e.g., see Kaplan and

Lambert, 1995). 



These evolving ESM procedures require a number of conditions if

reliability and validity are to be enhanced. Kaplan and Lambert (1995)

identified the following prerequisites: having a favorable and trusting

relationship between study participants and researchers, ensuring complete

confidentiality of responses, meeting labor or equipment and programming

costs associated with beeping the participants several times per day, and

addressing difficulties faced when the participants are illiterate or

challenged by technology. 



Several recent studies of delinquent and antisocial behavior may help

clarify the utility of ESM procedures in research on the drugs-crime

relationship. For example, Farnworth (2000) studied a group of young

Australian offenders on probation and found that these respondents were

engaged in such productive activities as employment or education an

estimated 10 percent of the time. Compared with reference norms for

Australian adolescents, offenders spent 30 percent more time on passive

leisure activities. An estimated 42 percent of the time, offenders on

probation reported being bored, while 62 percent of the time they were

involved in unchallenging activities. The use of ESM to integrate studies

of drug-taking and criminal behaviors will provide new and important

evidence on relationships that generally have been studied via

retrospective reconstruction of behavior over long spans of developmental

time.



On another measurement front, there is a related tension that involves the

use of bioassay methods to study recent and past drug taking. Wish has

been a pioneer in the use of these methods for research on arrestees, and

recent studies by Harrison and Fendrich are extending this reach into

general household population samples of the type surveyed for the

National Household Survey on Drug Abuse (Wish, 1988; Yacoubian,

Wish, and Perez, 2001; Fendrich, 2001; Harrison, 2001). In future

research, one may anticipate these differences in approach to sustain a

tension until a general consensus has evolved.



With respect to approach in the domain of statistical methodology,

computational advances have contributed to an acceleration of innovation.

There is a resulting air of optimism for what might be accomplished, as in

the domains of longitudinal latent transition modeling, multilevel or nested

models, approaches to nonignorable missing data, and alternative methods

of research on directed acyclic pathways with mediation versus cyclical

pathways with reciprocities. At the same time, there is a tension because

these new statistical approaches have not become integrated in most

research training programs, and there remains certain skepticism about

heavily modeled data. 



Limitations on numeracy keep many of us from probing the assumptions

of complex models, whether these are models of behavior in individual

studies, econometric models, or operations and systems research models to

probe alternative program and policy decisions. Tension may be inevitable

in the face of such complexities.



Tension Involving Research Ethics



NIJ can play an important role in relation to investigations that probe

drugs-crime relationships. At present, a good part of the NIJ role has been

ceded to HHS and its new Office of Human Research Protections (OHRP).

True to its origins in NIH, OHRP is oriented toward the standards of

experimental medical intervention research (e.g., randomized trials to test

safety and efficacy of new drugs). OHRP specifications for informed

consent procedures and disclosure statements share this orientation.



Many behavioral and social sciences researchers have expressed concern

that the standards and specifications of experimental medical research

are not appropriate for studies of the drugs-crime relationship. For

example, in ethnographic and observational survey research, different

specifications for informed consent procedures and disclosure statements

are required. 



NIJ officials can initiate a useful dialogue with OHRP on this important

research topic. Perhaps more than any other government agency, NIJ can

help to stimulate a dialogue and negotiate a reorientation of current

practices in a manner that fosters new and creative research on the

drugs-crime relationship without a lapse in research ethics or slippage in

the protection of human subjects in this research.



Outside the Federal Government, researchers now face increasingly thorny

challenges in the protection of their research participants and the assurance

of confidentiality in relation to research data. For example, research that

includes assessments of tobacco smoking now requires special handling as

a result of legal action by the tobacco industry. These requirements

apparently extend to criminal justice research in which tobacco smoking is

approached as a self-reported indicator of deviance. The integration of

molecular biology and genetics into these research agendas, and even the

introduction of experience sampling methods or bioassays for drug testing,

raise new questions in the domain of research ethics, some of which have

been scrutinized in randomized experimental designs. These challenges

deserve the close attention of these research communities, with OHRP and

its NIJ counterpart in suitable roles.



Does Drug Use Cause Crime? A Focal Point



Each author of working papers for the drugs-crime research forum was

asked to identify a circumscribed set of research issues and probe what we

really know about them. Mindful of other sections to be written, we have

been able to organize these research issues in relation to a single focal

point, expressed in the question, "Does drug use cause crime?" One

advantage of this specific focal point is that it has a broad range and can

encompass many different strands of evidence developed in public health

and criminal justice research. Another advantage is that it is a crucial open

question for research on crime and drugs. As characterized by Harrison

and Backenheimer (1998), "Research has not been able to validate a causal

link between drug use and criminal behavior."



When confronted with an etiological research question such as "Does drug

use cause crime?," a public health scientist typically might turn to a

20th-century elaboration of the 19th century Henle-Koch postulates or

conditions for judging whether a specific disease might be caused by

specific bacteria. For a time, this 20th-century elaboration was known as

Hill's postulates (after Sir Austin Bradford Hill, a medical statistician)

and also as Evans's postulates (after A.S. Evans, an epidemiologist; Evans,

1976; Hill, 1965). Today, students of epidemiology learn them as criteria

for judging whether an association is causal or guidelines for evaluating

the evidence of a causal relationship, together with an analysis of the

relative strengths and weaknesses of evidence from randomized trials,

prospective and longitudinal studies, retrospective studies, and

case-control comparisons. Exhibit 8 presents these criteria and guidelines.



Before reviewing these criteria, four clarifications may be in order. First,

the criteria for evaluating causal significance of observed associations

represent standards of scientific evidence that are substantially different

from the standards used to judge causal evidence in civil and criminal

proceedings. For some segments of this paper's readership, the question,

"Does drug use cause crime?" may sound silly: "Of course drug use causes

crime. My grandmother could tell you that." (This was the type of reaction

TV/radio personality Rush Limbaugh gave to some of the early work that

Howard Chilcoat, Tom Dishion, and I published on the topic of whether

inner-city mothers and fathers might be able to help protect their children

against risk of early-onset drug use if they maintained levels of parental

vigilance generally associated with good parental supervision and

monitoring.)



Our response to these gentle readers is to beg forbearance. Of course, some

of what our grandparents learned to be true is not true, and the analysis of

responsibility for negligent or criminal acts in the individual case (as in a

court of law) necessarily has a different set of standards of evidence. For

example, evidence beyond a reasonable doubt is not the same as the

definitive evidence referenced in the first paragraph of this paper.



Our second clarification is that we acknowledge a possibility that

delinquent or criminal behavior might be a cause of drug use, the

chicken-egg problem referenced by Inciardi and advanced with evidence

by others. This possibility surfaces when one considers earlier sociological

models of deviance (e.g., Sutherland, Matza) or later sociopsychological

developmental models for youthful deviance, antisocial behavior, and

delinquency, such as the coercive interaction and deviancy training models

introduced by Patterson, Dishion, and colleagues; Coie and his colleagues

at Duke; and Kaplan at Texas A&M University (e.g., see Patterson, Reid,

and Dishion, 1992; Patterson, Dishion, and Yoerger, 2000; Dishion et al.,

1996; Coie and Lenox, 1994; Sandstrom and Coie, 1999; Bagwell et al.,

2000; Hubbard et al., 2001; Kaplan, 1995). For example, minor rule

violations in early childhood, well before the years of starting drug use,

might be followed by general peer rejection, differential association or

affiliation with other rejected and deviant peers, and subsequent

group-fostered delinquency and norm violations, including illegal drug

use. We note that this possibility, and the more advanced idea of

reciprocities between drug use and criminal behavior, do not necessarily

undermine inferences about drug use as a cause of crime. We face a

problem of slightly different conformation in our research on drug

dependence: The use of a drug is an absolutely necessary but not sufficient

condition for development of clinical syndromes of drug dependence, but

once the drug dependence process has started, the drug dependence takes

on a life of its own and becomes a determining influence for subsequent

drug use (i.e., drug use causes drug dependence, and then drug dependence

causes drug use).



Our third clarification is to ask first whether it is plausible that there is no

association between drug use and crime or criminal behavior or whether

there might be an inverse association (the more crime, the less drug use).

In our review of available evidence, we must acknowledge the possibility

that in some subsegments of human experience, there well may be a

negative association between drug use and criminal behavior (e.g., in the

highly disciplined and controlled environments of industrial espionage),

just as we must acknowledge the fact that some 90-year-olds have smoked

a pack or more of tobacco cigarettes virtually each day of adult life and

have not developed lung cancer. We also acknowledge the high probability

that in certain times and places or in certain subsegments of population

experience, there is no association between drug use and criminal behavior

(e.g., see Blum and Associates' studies of clinicians and professionals who

used LSD before it was regulated by the Food and Drug Administration;

Blum and Associates, 1964).



Notwithstanding these exceptional circumstances, there is a generally

consistent overall pattern of positive and sometimes quite strong

associations between illegal drug use and criminal behavior of other types.

These associations are observed not only in samples of offenders in the

criminal justice system (e.g., DUF and ADAM), but also in general

household population samples. This evidence has some vulnerability due

to constraints on methods (e.g., refusals by study participants to give

informed consent for participation), but recent consistent evidence from

general population surveys indicates that the observed association extends

beyond officially recognized crimes and does not suffer the transition bias

that is present in DUF, ADAM, and other criminal justice samples (e.g.,

perhaps the arrested or incarcerated offenders were caught because of

impairments from drug use, or the drug use of an offender is a

manifestation of a more general characteristic of carelessness that might

lead more readily to apprehension by the authorities).



Fourth, a "cloud of confusion" sometimes descends when people begin

talking about causes and causation. We will try to be clear. Although we

are asking whether drug use causes crime, we are not saying that there are

no other causes of crime. This issue sometimes is subject to

misinterpretation. For this reason, it might be more sensible to express the

question in a different way: "Under what conditions, if any, does criminal

behavior, as a response variable, depend in any substantive way on drug

use, such that we might be able to shape criminal behavior by shaping

drug use?" This question is not as pithy as, "Does drug use cause crime?"

but it might help us escape the cloud of confusion when we try to review

available evidence pertinent to this issue of causal inference.



Criterion/Guideline 1: Temporal Relationship



If illegal drug use is believed to be a cause of criminal behavior, then we

require evidence that illegal drug use has preceded the onset of that

criminal behavior. Judgments about this criterion or guideline can become

difficult when there are potential reciprocities. For example, when

sustained medicinal use of phenacetin and acetaminophen compounds

(e.g., Tylenol, Datril) was being investigated as a cause of interstitial

nephritis and end-stage renal disease (ESRD), one of the complications

was the possibility that the earliest clinical features of ESRD include

headaches. Of course, headaches can promote the sustained use of

pain-relieving medicines, including the acetaminophen compounds.



The drugs-crime relationship presents this type of temporal complexity, as

was seen in exhibits 6 and 7. Earlier aggression, conduct problems, and

criminal behavior may function as a direct cause of illegal drug use (e.g.,

see Kellam and Anthony, 1998), and possibly as an indirect cause (e.g., by

promoting affiliation with other delinquent and drug-using peers). Earlier

drug use also may function to promote later growth of conduct problems

or criminal behavior (e.g., see Johnson et al., 1995).



Criterion/Guideline 2: Biological or Other Theoretical Plausibility



Carrying books of matches is associated with the risk of developing lung

cancer, tends to precede rather than follow the onset of lung cancer, and

has at least a moderately strong association with lung cancer. However,

except with respect to the associated characteristic of tobacco smoking, we

have no biological or other theoretical plausibility to link carrying matches

per se with the etiology of lung cancer. Even if the matches-cancer

association were to withstand the challenges posed by the other criteria for

evaluating causal significance of an association, we would be inclined to

ask about the underlying theory and its plausibility and coherence in

relation to known relationships and facts.



The tripartite model for the drugs-crime nexus represents a substantiation

of plausible causal links from illegal drug use to criminal behavior. Other

related strands in the fabric of plausibility have been mentioned (e.g.,

differential crime opportunity, differential association).



The plausibility of a link between drug use and aggressive or violent

crimes rests to some extent on neuroscience theory and observed

clinico-pathological associations, as in contemporary thinking about

cocaine's influence on limbic-hypothalamic substrates of aggression

(Davis, 1996). In addition, there is a line of preclinical and clinical

laboratory experiments that has helped to solidify the plausibility of a

link from drug use to aggressive or violent behavior, and possibly to the

types of norm violations associated with nonviolent crime. The evidence

on links from the use of psychostimulant drugs (e.g., methamphetamine,

cocaine) and aggression is noteworthy in this respect. Administration of

cocaine to hamsters during adolescence increased the number of bites and

attacks indicative of a surge of offensive aggression (Harrison et al.,

2000). Moore and Thompson (1978), studying pigeons, found that high

doses of cocaine elicited aggressive behavior. In some species, increased

levels of aggression also have been observed with the administration of

amphetamine stimulant drug--not only when a large single dose (e.g.,

Melega et al., 1997), but also after sustained lower doses (Haber, Barchas,

and Barchas, 1981) are administered. These psychostimulants also may

increase the risk of self-directed aggression (e.g., see Peffer-Smith et. al.,

1983).



Experimental laboratory research with human subjects also has produced

supportive evidence along these lines, often with computerized

point-subtraction methods used to evoke aggression after the drug has

been administered and under control (no drug) conditions. For example,

Licata et al. (1993) administered a high dose, low dose, and no dose of

cocaine and found that subjects in the high-dose group expressed

significantly greater aggression than subjects in the control group; the

low-dose group did not differ from the control group.



Notwithstanding these strands of plausibility, there also is a considerable

amount of inconsistency in the observed data and some complexity in

relation to dose-response analyses. For example, Crowley et al. (1992)

found no increase in aggression when cocaine was administered in primate

lab research; Darmani and colleagues (1990) found increased aggression

among mice that were given relatively low doses of cocaine but not when

the mice were given higher doses of cocaine. Moro et al. (1997) found

reductions in the total number and length of aggressive activities in mice

after amphetamine administration. Cherek et al. (1989), studying humans,

examined the relationship between d-amphetamine on aggression using

point subtractions and found an increase in aggression among those

receiving 10 mg per 70 kg of body weight but a decrease in aggression

when 20 mg per 70 kg of body weight was administered.



Police experience on the street implicates dissociative drugs such as

phencyclidine (PCP) in relation to violent and aggressive behavior and

crime. We have been able to find some supportive experimental laboratory

evidence consistent with this streetwise experience (e.g., Burkhalter and

Balster, 1979; McCardle and Fishbein, 1989). Nevertheless, even with

PCP, there is a complex pattern of inconsistent evidence that does not

ring true with the experience on the street and common wisdom about

PCP. Tyler and Miczek (1982), Emley and Hutchinson (1983), and Miczek

and Haney (1994) reported no increase in aggressive behavior after

experimental administration of PCP and an erratic increase in aggression

only in a subgroup of animals receiving low doses. Hence, it may be

that PCP promotes aggression only in certain subgroups of the population

(e.g., see McCardle and Fishbein, 1989); and in some experiments,

animals receiving high doses of PCP were more likely to be victims of

aggression by nondrugged animals (e.g., see Russell, Greenberg, and

Segal, 1984; Tyler and Miczek, 1982).



In sum, there is some plausibility to the idea that drug use might promote

criminal behavior, with strands of plausibility coming from neuroscience

theory, the common wisdom and experience of criminal justice officials

and drug users, and laboratory experiments. The links between being a

drug user and becoming a crime victim represent an understudied

phenomenon, and the inconsistent patterns of laboratory evidence provoke

us to investigate the possibility that there might be substantial

heterogeneity within the population with respect to links from drug use to

aggressive behavior or to crime (e.g., see Parker and Rebhun, 1995).



History demonstrates one of the difficulties with this criterion for judging

causal significance of associations. Time and time again, new evidence

has contradicted what appeared to be a biologically plausible or

theoretically pleasing link between a suspected cause and a suspected

response. Today's biologically plausible or theory-driven causal inference

may be tomorrow's "old wives' tale." As is true for the other criteria and

guidelines, by itself this one counts for little.



Criterion/Guideline 3: Consistency of the Association



We already have clarified the possibility that no association or a negative

association might exist for certain subsegments of population experience.

For example, at some point, drug taking may incapacitate an individual

who otherwise would be involved in criminal behavior. Despite examples

of this type, and notwithstanding contrary evidence, the drugs-crime

research literature now includes a generally consistent replication of

positive associations between illegal drug use and criminal behavior (e.g.,

see Harrison and Backenheimer, 1998).



The body of laboratory experiments on drugs and aggressive or violent

behavior is not as consistent as one might expect. As described under

criterion/guideline 2, under some circumstances, laboratory experiments

have established a small set of drugs as causal agents in relation to

aggression and violence. However, for most drugs and many

circumstances, there are negative findings, and the evidence is not

consistent with causal links from drug taking to aggressive and violent

behavior.



Given the multiplicity of drugs, types of crimes, and varieties of social

contexts, it may be inevitable that the accumulated body of evidence on

the drugs-crime relationship appears inconsistent. Variation in the quality

of the research also has a bearing on consistencies or inconsistencies in the

evidence. As every first-year graduate student learns, research with

imprecise measurements will tend to yield evidence of no relationship

even when a relationship exists; research with measurements of limited

validity will tend to yield evidence of relationships where none exists.



Although not generally introduced as a feature of studying consistency of

relationships between causes and effects, a developmental perspective

may help to lead the reader to a greater appreciation of inconsistencies and

complexities faced in research on the drugs-crime relationship. That is, the

timing of the onset of the drug taking may condition the later expression of

criminal behavior and may lead to greater heterogeneity in the population

with respect to the drugs-crime relationship. For example, we have some

evidence on the possibility that earlier-onset drug use is associated with

later risk of developing drug problems (e.g., see Anthony and Petronis,

1995). We also have evidence that prompts us to conceptualize

earlier-onset drug use as a type of precocious adolescent development that

may disrupt normative developmental trajectories (e.g., see Newcomb,

1992; Dawes et al., 2000). There may be a tendency to interpret these

disruptions as sources of increased levels of later criminal behavior,

consistent with the idea that risk of drug problems are increased for

early-onset drug users; this has been the perspective our research group

has taken in its studies of this topic (e.g., Johnson et al., 1995; Anthony

and Petronis, 1995). Nonetheless, it is possible that precocious (i.e.,

early onset) drug taking is followed by disproportionately greater increases

in frequency of drug use and in risk of drug problems but that the

early-onset drug use dampens the level of criminal behavior that otherwise

might occur if the drug use had not started so early.



Our study of early-onset alcohol use and the later developmental trajectory

of conduct problems represents a case in point. In that study, cited above

under criterion/ guideline 1 (Johnson et al., 1995), we found that baseline

levels of conduct problems were greater for boys who had started drinking

alcohol before the adolescent years without parental permission and that

growth of conduct problems was greater for these early-onset alcohol

users--when compared with boys whose drinking did not start until later.

Similar relationships were observed for girls with early-onset alcohol

use--when compared with girls whose drinking did not start until later.

However, a discussion of this research with Blumstein has prompted us to

re-approach this problem with a different comparison in mind. Using

random effects regression, we are seeking to hold constant the baseline

level of conduct problems and study boys who have a high initial level of

conduct problems but who start drinking alcohol early on and compared

them with boys with an equally high initial level of conduct problems but

for whom alcohol consumption is delayed until adolescence. Approaching

the contrast in this manner, we may discover that early-onset drinking

dampens the growth trajectory for conduct problems; the steepest

trajectory for growth of conduct problems may be observed for boys with

high initial levels of conduct problems but without the impairments

associated with early drinking. The early drinking might lead to retardation

in the growth of conduct problems for boys who otherwise would escalate

to very high levels of conduct problems in adolescence.



This is a somewhat counterintuitive proposition, and it may run counter to

common wisdom and experience with respect to the effects of early-onset

drinking or drug use and the later lifecourse of young people. However,

our intuitions and common experience about these circumstances tend to

reflect a type of population-averaged summary of developmental

trajectories and generally do not encompass all varieties of human

experience. We mention this open research question as an example of the

complexities faced in developmental research on the drugs-crime

relationship and as a possible explanation for the inconsistencies observed

in drugs-crime research. The timing of the drug use may induce subgroup

variation in the drugs-crime relationship, which then is interpreted as

inconsistency in and a challenge to causal significance of the observed

associations.



Fortunately, complete consistency of evidence is not required. What is

required is a focused probing of the circumstances under which the

drugs-crime relationship is a causal relationship, with a deliberate effort to

ferret out situations in which there is no causal linkage between drug

use and criminal behavior. Deliberate scientific pursuit of these

circumstances and situations may require investigators to look overseas,

where use of such drugs as marijuana, cocaine, and heroin are not treated

as criminal behaviors. In social contexts of this type, by studying the

developmental trajectories of criminal behavior among young people with

and without early drug-taking experiences, we may be able to illuminate

some of the inconsistencies now observed in the drugs-crime evidence

available to us. For example, longitudinal studies of children growing up

in the Netherlands are underway. The recent effective decriminalization of

marijuana use in the Netherlands creates a social context for research on

this drug and later criminal behavior that merits attention on the NIJ-NIDA

research agenda. 



Criterion/Guideline 4: Alternative Explanations Ruled Out



This criterion or guideline represents the Achilles heel for much of the

prior research on the possible causal links between illegal drug use and

criminal behavior and represents a general difficulty for observational

research in general. Observing a possible causal relationship between

antecedent A and response B, the skeptical critic always can ask, "Isn't

there some unrecognized background factor C that can account for the A-B

relationship that you have observed in this study?" If so, "Isn't this a poorly

developed conceptual model?"



To some extent, these are a coward's questions about the drugs-crime

relationship in specific and about empirical research in general. Of course,

there might be some unrecognized background factor in empirical research

plans and in completed studies; if not the hand of the mischievous Norse

god Loki, then something else of a less celestial nature.



The challenge for the courageous skeptical critic is to assert a specific

background factor or set of background factors that might account for the

observed A-B relationship and that have not been considered explicitly or

taken into account in a study plan or description of completed work. For

example, observing the suspected causal association between tobacco

smoking and risk of lung cancer, the statistician Sir Ronald Fisher posed a

question of the following type: "Can't we explain the observed association

as a manifestation of an underlying predisposition or liability that

determines both the tobacco smoking and the lung cancer?"



In relation to the drugs-crime relationship, the most plausible background

factors seem to be of the variety named by Fisher, namely, unmeasured

predispositions; in this instance, the predispositions might involve who

abides by the conventional rules of society, who is willing to run afoul of

the law by taking a drug illegally, and who is willing to commit crimes

other than the crime of drug possession for personal use. To some extent,

these predispositions may be a manifestation of family heritage, a

manifestation of early experiential conditions and processes, or a synthesis

of both. Nevertheless, no matter what their origin, until these

predispositions are taken into account, they represent a plausible form of

alternative explanation whenever a drugs-crime relationship is found in

our empirical studies.



One line of response to this criticism has been to measure personality or

facets of temperament in observational studies and to re-estimate the

drugs-crime association with personality or temperament held constant

(e.g., via stratification or statistical adjustment in a regression model). But

this response always is subject to the criticism that the wrong facets of

personality or temperament were measured or that the measurement of

personality or temperament was not as good as it should have been.



It is in relation to this criterion that we now have new opportunities for

research at the intersection of public health and criminal justice research

on the drugs-crime relationship. Three important opportunities at this

intersection involve (1) genetics, twin, and family research; (2)

longitudinal studies with "subjects as their own controls" designs; and (3)

controlled experimental trials.



Future genetics, twin, and family studies can help to narrow the alternative

explanations in a useful manner. For example, in an earlier section we

described a design that exploits the genetic matching of monozygotic

twins to search for environmental conditions that contribute to the

occurrence of disease. Discordant MZ twin designs also can be used to

hold constant predispositions or liabilities linked to the individual genome

of the twins, while studying differences in the trajectory of criminal

behavior for the MZ twin whose illegal drug use starts first versus the MZ

twin whose illegal drug use starts later (or not at all).



Alternative twin and family research designs can be used to narrow other

explanations of the observed drugs-crime relationship (e.g., studies of

discordant siblings, studies based on the transmission disequilibrium test

when specific polymorphisms are under investigations). Cadoret and

colleagues have offered recent illustrations of the power of twin studies in

which some twins have been separated at birth, but these "natural

experiments" have become scarce in the United States and other parts of

the world where twins now generally are kept together in their new

adoptive families (e.g., see Cadoret et al., 1986, 1995; Cadoret, Leve, and

Devor, 1997). Tsuang et al. (2001) provide a recent useful overview of

pertinent findings from the Harvard Twin Study.



Longitudinal subjects-as-their-own-controls research designs also can help

rule out alternative explanations in the sense that each individual

participant is carrying forward a within-individual set of propensities to

become engaged in illegal drug use and other criminal offending. In these

longitudinal designs, in an otherwise law-abiding individual, if we were to

observe that criminal offending occurs only in the immediate aftermath of

a drug intoxication experience or only in the stages of withdrawal after

drug dependence, we would have additional evidence of a drugs-crime

association at the individual level. These longitudinal designs remain

vulnerable to a possible counterclaim that there is an underlying

predisposition that links earlier illegal drug use to later criminal offending

only during the context of drug intoxication or withdrawal states. That is,

the observed association between illegal drug intoxication or withdrawal

and the later criminal offending is a spurious artifact of uncontrolled

confounding: There is something else in the background, a third variable

that explains the observed sequence.



Medical and public health research is host to a variety of examples of this

type of spurious confounding. One of them involves the connection

between chickenpox and shingles. For most people, chickenpox occurs

early in life and shingles occurs late in life. There sometimes is an

exceptional case of shingles occurring with no prior history of chickenpox

in childhood, but these exceptional cases might be understood as instances

of "clinically inapparent" infections (i.e., with mild or minimal symptoms

in childhood, so mild as to pass without notice). A longitudinal research

design on this topic can lead to the impression that chickenpox causes

shingles, in the sense that shingles rarely or never occurs unless

chickenpox occurs first. This observed longitudinal link between

chickenpox and shingles satisfies the requirement described above:

Criminal behavior occurs only after a bout of illegal drug use. The fly in

the ointment in our chickenpox-shingles example is that we now know

that chickenpox does not cause shingles. Rather, it is an underlying virus

that causes both of these clinical phenomena. Exposure to the chickenpox

virus (herpes zoster) is the cause of chickenpox in childhood and is the

cause of shingles in later life when the virus emerges from an otherwise

dormant or latent state of no activity. The apparent linkage from earlier

chickenpox to later shingles is due to an underlying third variable, the

herpes zoster infection, which accounts for the appearance of both

outcomes.



The analogy to research on illegal drug use and later criminal offending

should be clear. Even when longitudinal research shows us examples of

participants who become engaged in criminal behavior only in the context

of drug intoxication or withdrawal states, we cannot be confident that

the illegal drug use is the cause of the associated criminal offending. Some

unknown underlying cause may be accounting for both outcomes.



The third approach, involving randomized trials, offers a way to bring

these unknown underlying variables into check. This approach already has

been described in relation to our research group's studies of an alternative

explanation for the drugs-crime relationship. Namely, we advanced the

hypothesis that a predisposing characteristic in the form of early

aggression or rule breaking is a potentially modifiable determinant of both

later illegal drug use and criminal behavior or other sorts. This hypothesis

does not reject the possibility that illegal drug use causes later criminal

behavior, but it introduces one alternative explanation for the observations

association between illegal drug use and criminal behavior (i.e., the earlier

aggression or tendency to break rules and social norms). As described

earlier, we sought to test this hypothesis by constructing an experimental

trial in which we disrupted the development of early aggression and rule

breaking (e.g., Kellam and Anthony, 1998). We used the power of

randomization to hold constant the profile of alternative explanations that

might account for later illegal drug use and criminal behavior. In a current

followup study of the youths who participating in this trial, we will be

testing whether the primary school intervention had a sustained impact on

illegal drug use and criminal behavior. If so, we might expect a weakened

association between illegal drug use and criminal behavior in the subgroup

of youths exposed to the active behavioral intervention arms of our study.



A related opportunity to test the drugs-crime relationship and to use

randomization to rule out alternative explanations involves controlled

trials of new therapeutic interventions directed toward illegal drug use and

drug dependence of adolescents. Observational studies now suggest

that entry into drug treatment reduces the rate of criminal offending, but

these studies leave open possibilities for alternative explanations (e.g.,

selection biases in the assignment of subjects to treatment, imbalances in

the other determinants of criminal offending). Randomization in the

setting of controlled trials of new therapeutic interventions creates an

opportunity to constrain these selection biases and bring into balance the

alternative sources of variation in criminal offending (e.g., see Manski et

al., 2001). 



By adding followup measurements of posttreatment criminal behavior to

current and newly emerging randomized controlled trials of therapeutic

interventions, NIJ and NIDA can help foster new evidence on the degree

to which illegal drug use is a cause of criminal offending. Alternative

explanations for the observed drugs-crime association and other

determinants of the offending behavior can either be brought into balance

by randomization or held constant as measured covariates in statistical

models of analysis. Some examples of past research along these lines are

described under criterion/guideline 7.



Criterion/Guideline 5: Dose-Response or Gradient Relationship



Absence of a dose-response or gradient relationship does not rule out

causal associations; there are good examples of threshold relationships

with no clear gradient. Nonetheless, there are examples in which the

probability or rate of criminal behavior is observed to be lower with lower

levels or frequencies of illegal drug use and is observed to be greater as

levels or frequencies increase.



In one recent and especially informative longitudinal cohort study, Brook

et al. (2001) studied the developmental trajectory of marijuana use from

childhood into adulthood and found that behavioral and attitudinal

indicators of unconventionality (e.g., attitudes tolerant of norm violations)

had a gradient relationship with later increases in marijuana involvement.

The research team also found that as levels of unconventionality increased,

so did marijuana involvement. These gradient relationships between

unconventionality and marijuana use help to substantiate a possible causal

link between earlier unconventionality and later developmental trajectories

of marijuana involvement. However, as in the circumstance of research on

the drugs-crime relationship, this research report leaves us with

unanswered questions of the following variety:



a. What about the predisposition that links unconventionality to the earliest

marijuana use? Where does the unconventionality come from, and is this

predisposition the same as the predisposition to smoke marijuana?



b. What about the reverse causal pathway and the possibility that

increasing marijuana use might promote later increases in

unconventionality?



c. As levels of marijuana use increase, are there later dose-response or

gradient-like increases in unconventionality?



In light of the population heterogeneity mentioned above, this

dose-response criterion might be especially troublesome in research on the

drugs-crime relationship. For example, consider the drug user whose

increasing bouts of intoxication yield less criminal behavior than

otherwise might occur and whose intoxication-associated carelessness

leads to apprehension and detoxification and outpatient treatment prior to

a bench appearance. The detoxification and treatment might be followed

by a return to the baseline level of criminal behavior (i.e., a higher level of

criminal behavior than was observed during the period of intoxication) and

an impression that treatment was ineffectual with respect to the frequency

of criminal behavior.



Criterion/Guideline 6: Strength of Association



Weak associations seem especially vulnerable to sources of spuriousness

and bias. One benchmark standard for strength is the association between

tobacco smoking and lung cancer: The risk of dying from lung cancer is

estimated to be 10 times or greater for persistent tobacco smokers than for

nonsmokers. Toward the other end of the spectrum of magnitude is a

widely appreciated but quite modest strength of association between being

male and illegal use of drugs: The risk of becoming an illegal drug user is

an estimated 1.5 to 3.0 times greater for an American male than for an

American female (Anthony and Helzer, 1995). Examining the range of

study estimates on the drugs-crime relationship, there are some studies

with extremely large relationships, but when a positive relationship is

observed, the strength of relationship tends to be quite modest. This

generally modest relationship may imply that alternative explanations

(e.g., predispositions) are sufficient to account for the observed

relationship.



Criterion/Guideline 7: Cessation Effects



Cessation effects already have been mentioned in the context of our

discussion of alternative explanations under criterion/ guideline 4. There

are many studies of co-occurring maturation processes that lead to fading

of both illegal drug use and other criminal behavior, especially since the

work of Winick. The observational studies of McGlothlin, Anglin, and

Hser in California and the work of Nurco, Lerner, and colleagues in

Baltimore also shed light on declines in criminal behavior during periods

of abstinence or reduced illegal drug use. The literature includes numerous

studies of what has happened to crime involvement after cessation of drug

use, based on observational studies.



As noted under criterion/guideline 4, some of the strongest evidence about

cessation effects can come from randomized experiments in which drug

treatment or other interventions are used to disrupt illegal drug use, with

subsequent evaluation of crime as an outcome of treatment. As noted

under criterion/guideline 6, for some segments of the drug-using

population, the cessation of drug use is followed by increases in frequency

of criminal behavior (i.e., once impairments associated with intoxication

are reduced).



Reprise: Does Drug Use Cause Crime? What Do We Not Know?



This review of a specific hypothesized causal relationship was intended to

highlight some of what we know about the drugs-crime relationship.

Its main purpose was to provoke discussion and help in a process of

identifying weaknesses and gaps in evidence that might be used to guide a

future research agenda. 



Evaluated in relation to these conventional criteria or guidelines for

judging the causal significance of observed associations, the reader

may have a better appreciation for the uncertainty conveyed in a recent

summary statement cited above: "Research has not been able to validate a

causal link between drug use and criminal behavior" (Harrison and

Backenheimer, 1998). The available evidence is ambiguous with respect to

temporal relationships. 



Instead, we offer a series of discussion points about what we might not yet

know.



Is the evidence on a temporal relationship compelling? Illegal drug use

precedes formal criminal behavior in some of these studies, but what about

the earlier antecedents of both drug use and crime in the form of rule

breaking, misbehavior, and minor norm violations? One can imagine a

co-occurrence process that begins with expression of irritable temperament

or aggression in the preschool years, followed by rule breaking or norm

violations in the primary school years, and then later co-occurrence of

illegal drug use and delinquent or criminal offending. Our own research

group and others have added some evidence on the possibility that drug

taking that starts by age 11 might promote growth trajectories for later

conduct problems among both boys and girls. The pattern of co-occurrence

of conduct problems and drug use is a centerpiece of Jessor's problem

behavior theory, and there is reason to look to experiments that will help

us differentiate these problem behaviors (e.g., differential response of

each form of problem behavior to different interventions, as suggested in

Dishion's early Adolescent Transitions experiment).



Plausibility? Our focus has been oriented toward the individual, but there

is a perspective on the drugs-crime relationship that is more ecological

or contextual in orientation. For example, a social environment

characterized by illegal drug use of individuals might give rise to norm

violations and criminal offending of other sorts, and not necessarily in the

form of offending by the drug users but rather in the form of offending

by others. The mugging of a heavily intoxicated drug user by a group of

nonusing passersby serves as one example of aggregate effects of illegal

drug use on crime that would not be apparent in individual-oriented

studies but would require multilevel studies of interrelationships between

individuals.



Consistency? What about the exceptions to a general pattern of

observations? It seems likely that the drugs-crime association varies from

time to time, place to place, and subgroup to subgroup. The study of

variation in these patterns of association will help to disclose the boundary

conditions and mechanisms that give rise to strong, weak, and possibly

inverse associations. Research across borders and in settings such as the

Amsterdam cannabis environment can help illuminate these boundary

conditions.



Alternative explanations? Several lines of research have been started on

the common causes for both illegal drug use and other criminal behavior,

some of them originating in family history studies and the clever adoption

paradigm adapted by Cadoret and his colleagues, some with a sharper

focus on mechanisms of inheritance (e.g., assays of genetic

polymorphisms), and some with a focus on personality and early social

environment.



It is not clear that studies to date have provided adequate control over

these sources of covariation. Nonetheless, the longitudinal study of

individuals over time has provided evidence from

subjects-as-their-own-controls designs, and the randomized trials of

interventions provide some evidence that, despite common causes, an

intervention directed toward illegal drug use can reduce frequency of

criminal behavior. Even if there are common causes (e.g., inherited traits),

for many observers, the longitudinal evidence coupled with experimental

evidence is sufficient to draw the inference that illegal drug use causes

criminal behavior. Reasonable people will disagree about this inference

from available observations, and the points of disagreement will lead us to

specific experiments or new studies to gather evidence that will be more

compelling.



Gradient? Is it possible that some of the inconsistency in observations

about the drugs-crime relationship can be traced to (a) selective attention

either to the lower end of drug involvement (e.g., among children,

adolescents, or high school seniors followed through the college years; see

Schulenberg et al., 1994) or to the higher end (e.g., among arrestees or

clients in drug treatment programs); (b) possible thresholds in the gradient

relationship, with between-sample heterogeneity with respect to the

effective threshold; or (c) an uncertain metric for assessing the type or

level of drug involvement? As described in the prior section entitled

"Criterion/guideline 2: Biological or other theoretical plausibility," we

have noted some inconsistent pharmacological effects across dosage levels

of the same drug and across different drugs. If we are to appropriately sort

the consistent and inconsistent findings of field studies on the drugs-crime

relationships, it may be necessary to reach for greater specificity with

respect to dosage levels or intensity of drug use and also with respect to

the pharmacological differences observed in laboratory experiments. It

no longer is enough to sort drugs into the non-scientific colloquial "soft"

and "hard" categories, nor to lump all "illegal drug use" as if there were no

heterogeneities of effect across the various forms of internationally

regulated drugs. The best field studies of the 21st century will abandon

these relatively crude classifications and will not carry forward an obsolete

tradition from the earlier ground-breaking days of drugs-crime research.



Strength of association? Due to uncertainties about reciprocal and dynamic

interrelationships between drugs and crime, it would be advantageous

to look closely at studies with fine-grained temporal analysis of the

drugs-crime relationship and to estimate strength of association

prospectively. This should be done in a manner that allows change in the

level of criminal behavior to be gauged in relation to change in the level of

drug use and vice versa, or with an expression of the relative risk of

criminal acts with and without antecedent illegal drug use. 



Cessation? Our recent National Research Council committee expressed

concern that selection effects, transition biases, or other artifacts might

lead to a spurious inference that criminal behavior declines or stops when

illicit drug use is ended, either with or without intervention. The evidence

on this criterion might require special scrutiny in light of concerns such as

these.



Conclusion



In the final section of this working paper, I would like to integrate the

organizing conceptual framework presented in the section on the rubrics

with the ecological concept of scale described previously. Here, there is an

adaptation of the formal ecological concept of scale that includes the

microcosm and an extension of the concept that reaches to the macrocosm

of the international regulatory environment. 



The integration of the five rubrics and the concept of scale is depicted in

exhibit 9. The result is a two-dimensional grid with the rubrics on one axis

and scale on the other axis and showing the conceptual domain where

research on drugs and research on criminal offending intersect. Each

rubric-scale intersection or subunit in the grid can be populated by past

and current examples of research on the drugs-crime relationship. In some

subunits, density of past and current research is quite high; work in these

domains may require strengthening, or perhaps these investigators should

be left alone to do their work. In other subunits, we have done little or no

past research activity; these subunits might warrant attention in a new

agenda for drugs-crime research.



Starting in the upper left-hand corner of this framework, we have the

intersection of quantity research with the microcosm represented by the

genes we inherit from our forebears. We may expect one day to have an

investigation that produces quantitative estimates of the frequency of

homozygotes and heterozygotes with respect to genes that are implicated

in the drugs-crime relationship, just as we now have these estimates for the

frequency of alleles mapped to apolipoprotein E4 and other genes or

polymorphisms implicated in the risk of developing Alzheimer's disease.



Working our way to the far upper right-hand corner, we stop at the level of

Nations. To the best of my knowledge, we have a limited set of

quantitative estimates for rates of drug-taking behaviors and criminal

justice statistics at the level of Nations; but definitive evidence on

variation across regions of the globe is lacking and represents a current gap

in knowledge. To some extent, this gap can be filled by cross-national

studies now underway, such as the World Health Organization's (WHO's)

recent World Mental Health 2000 research initiative being led by Ron

Kessler at Harvard and T. Bedirhan Ustun at WHO, with collaborators in

more than 20 countries around the globe (Kessler, 1999); the European

School Survey Project on Alcohol and Drugs (www.ipdt.pt/

investigacao/espad99/indice.htm); and cross-national studies supported by

NIDA in Latin America (e.g., Brook et al., 2001), including our own

PACARDO Project (Anthony, 2000).



In the middle range, between the microcosm of the gene and the

macrocosm of global regions, we have collections of estimates for various

social and geopolitical groups. In aggregate, these estimates can help us to

draw generalizations about the relative magnitude of problems associated

with drug taking of one sort or another (e.g., marijuana use versus cocaine

use) or with criminal behavior of one sort of another (e.g., aggravated

assault versus shoplifting or vandalism).



Even within the rubric of quantity, there are many gaps. For example, our

quantitative estimates often are based strictly on officially recognized

offending and do not encompass unrecognized offending. With respect to

drug taking, there is a plethora of evidence on the prevalence of drug use

and drug dependence but not much evidence on the incidence or risk of

becoming drug dependent. Here, also, we have big gaps in the evidence

that warrant some attention as we design an agenda for future research.



The intersections of the location, causes, and mechanisms rubrics with the

scale dimension brings us closer to evidence on variation from place to

place, time to time, or in relation to personal characteristics. A few

investigators have started to integrate genetic variation in their studies on

such topics as drugs and crime, and soon we may have more definitive

evidence on the relative frequency of different polymorphisms or

gene-encoded protein products for different subgroups of the population or

in different geopolitical zones. We can expect ecological analyses of the

between-subgroup and between-zone rates, with new evidence on location. 



Similarly, working outward from the simplest gene products to more

complex products of gene-environment interaction, the sex hormones

research of separate research groups led by Logan and by Angold,

Costello, and others should provide us with more evidence on rates of

antisocial behavior, drug use, and offending in relation to levels of

testosterone and other hormones before and after drug use (Logan, 2001;

Federman et al., 1997). The initial evidence is not expected to allow causal

inference, but the understanding of locational variation will allow us to

sharpen our causal theories and to integrate new biological perspectives on

the drugs-crime relationship.



In a middle position in this framework, somewhat overlapping the

different segments, the important line of research being conducted by

Higley, Suomi, and their colleagues in relation to gene-environment

interactions merits attention. This research, already mentioned in one of

the preceding sections, touches on aggressive behavior, social conditions

of child rearing, and drug use. Using a primate model, this research group

has been able to extend the line of research on infant-mother relations that

Harlow initiated. The group is engaged in experimental manipulation of

the early conditions of infant rearing, crossed with genetic predispositions

that in the wild have been found to be related to aggressive behavior and

excess mortality. The evidence from this research serves as an important

example of how the effects of an apparently noxious inherited

predisposition might be modulated by a change in child-rearing

environments. Does this animal model of gene-environment interaction

also hold for aggressive children, with later implications for their

drug-taking behavior? Questions such as this one merit discussion in

relation to the proposed drugs-crime research agenda, if only to choose not

to pursue these lines of research.



Turning to the last row of the framework, I offer some speculations about

gaps in research on prevention and control. At the level of scale that

reaches from microcosm to the whole organism, I see a gap in research on

underlying brain structures that subserve neuropsychological functioning

of clear importance in the choice behavior of drug users and offenders. To

the extent that drug users and offenders are making choices about various

elements in their behavioral repertoires, we may be able to understand

variations in response to prevention and control interventions as a function

of neuropsychological performance (e.g., with respect to direction, control,

and planning). Our comprehension of this variation can increase through a

program of research on fMRI brain imaging and neuropsychological

testing under experimentally controlled paradigms (e.g., aggression evoked

through computerized point subtraction or other procedures). In time, we

should be able to evaluate the degree to which response to these

interventions depends on brain structure and function as manifest in

neuropsychological tests as well as in response to genetic predispositions

of the type now being characterized in Suomi's primate laboratory and

elsewhere.



Working our way to the bottom right-hand side of this matrix, we find the

intersections with social groups and contexts of increasingly larger scale,

not only the peer group and family of origin or procreation, but also the

larger neighborhood, employment context, the community at large, and

across national boundaries. As we plot examples of intervention research

in this two-dimensional framework, it is easier to find examples of

individual investigations with narrow breadth of scale. For example, we

can find an intervention focused on the community but without elements

of intervention directed toward specific individuals in the community. We

can find many interventions directed toward individual arrestees but not

toward the social groups of which the arrestees are members.



One of the challenges for those who seek to shape the future research

agenda on drugs and crime will be to encourage broadband research that

cuts across multiple levels of scale. This is not to say that we should

eliminate narrow-band research because it often is necessary to solve a

research problem through focus, and focus is one of the defining

characteristics of narrow-band research. Nonetheless, as we look over

some of the more exciting research projects now underway, we can see

that the excitement is coming from the investigators' attempts to

encompass more than one level of scale. These attempts deserve

encouragement.



Before closing, we must turn to the empty spaces created in the circle but

not included as part of the two-dimensional grid. Within these spaces, we

have important drugs-crime research that does not fall neatly into the

two-dimensional conceptual framework. I am thinking of the recent

ethnographic studies of the gangs involved in drug sales (e.g., Levitt and

Venkatesh, 1998), and some of the other recent innovative qualitative

research on drug trafficking (e.g., Natarajan, Clarke, and Belanger, 1996;

Natarajan and Belanger, 1998), which shed new light on the structure and

organization of the criminal organizations that sustain drug supply and

influence drug-related criminal offending around the world. There also are

good recent examples of operations research focused on the organization

and administration of criminal justice agencies and the deployment of law

enforcement, prosecution, and judicial resources (e.g., see Maltz, 1996).

To the extent that these investigations guide us toward useful evidence

about prevention and control, and to the extent that they focus on

individuals or small groups of individuals (e.g., in a city or State), they

may be placed in the space on the left-hand side of the figure, between the

grid and the surrounding circle. To the extent that these control-oriented

investigations are directed to-ward international drug trafficking (e.g., see

Montagne, 1990), they may be placed in the space on the right-hand side

of the figure.



There are other research programs and initiatives that do not fall neatly

within the two-dimensional grid presented in exhibit 9. Methodological

research constitutes one set of examples (e.g., Wish et al., 2000; Harrison,

1997, 2001; Fendrich, 2001). Proposed new research on drug prices and a

consumer product index for illegal drugs represents another set (e.g., see

Manski et al., 2001).



As we move toward a new drugs-crime research agenda for NIJ and NIDA

at the intersection of public health and criminal justice studies, it is

important to remember the two major themes mentioned in the

introduction to this paper:



o There is no single drugs-crime relationship. Rather, there are

drugs-crime relationships, most of which are complex rather than simple.



o There is no simple solution to the complex challenges faced when

drugs-crime relationships come into play.



The two-dimensional grid encircled in exhibit 9 offers no simple solutions

to the complex challenges faced when drugs-crime relationships come into

play. That grid is only a tool that may help us identify important gaps in

the research evidence, gaps that must be filled as we work toward a more

complete understanding of the drugs-crime relationship and more effective

action plans that apply new understanding in the service of public health

and safety. In an important sense, the empty spaces encircling the

two-dimensional grid also can be useful tools as we try to identify and fill

the gaps in evidence. These empty spaces can serve to remind us that no

conceptual framework is all encompassing. We must "think outside the

box" in this regard. If we organize our scientific resources simply to

continue our current lines of research, we will not achieve lasting

reductions in illegal drug use and drug-related crimes, and we will never

lay claim to great victories in the service of public health and safety. 



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Author's Note



Valerie Forman coauthored the following sections: "Tension that involves

approach or methods" and "Criterion/guideline 2: Biological or other

theoretical plausibility." Correspondence concerning this paper should be

addressed to James. C. Anthony, Electronic Collaboratory for

Investigations About Drugs, JHU School of Hygiene and Public Health,

624 North Broadway, Room 893, Baltimore, MD 21205; e-mail

janthony@jhu.edu.



--------------------------------



RESEARCH ON DRUGS-CRIME LINKAGES: THE NEXT

GENERATION



Robert MacCoun, Beau Kilmer, and Peter Reuter



About the Authors



Robert MacCoun is with the Goldman School of Public Policy and

Jurisprudence and Social Policy Program at Boalt Hall School of Law,

University of California at Berkeley. Please email any comments to

maccoun@socrates.berkeley.edu. Beau Kilmer is with the Drug Policy

Research Center at RAND. Peter Reuter is with the School of Public

Affairs and Department of Criminology at the University of

Maryland.



Introduction



The association between drugs and crime in the public mind is so strong

that a recent psychology experiment showed the word "drug" tightly linked

to such words as "choke," "knife," "fight," and "wound" in participants'

associative memory networks (Bushman, 1996). Although it is routine in

academia to deride public ignorance of all things criminological, in this

case the public is hardly deluded. Consider the following facts:[1]



o Across 35 cities in 1998, between 40 and 80 percent of male arrestees in

the Arrestee Drug Abuse Monitoring (ADAM) Program tested positive for

at least one drug at arrest (Arrestee Drug Abuse Monitoring Program,

1999).



o Nearly one-quarter (22 percent) of Federal prison inmates and one-third

(33 percent) of State prison inmates--nearly 40 percent of State inmates

convicted of robbery, burglary, or motor vehicle theft--reported being

under the influence of drugs at the time of their offense (Bureau of Justice

Statistics, 1997a, 1997b).



o Among State and Federal prison inmates, 27 percent of those serving

sentences for robbery and 30-32 percent of those serving sentences for

burglary said they committed their offense to buy drugs (Bureau of Justice

Statistics, 1991a, 1991b).



o In the 70 percent of cases in which the victim formed an opinion, 31

percent believed the offender was under the influence of drugs or alcohol

(National Crime Victimization Survey, 2000).



o A recent estimate of the economic costs of drug abuse reported that 60

percent were associated with crime and criminal justice (Harwood,

Fountain, and Livermore, 1998). 



Considerable complexities and nuances underlie these associations.

Although many of these subtleties were anticipated by astute observers in

the 1970s (see Gandossy et al., 1980), the past decade has seen a solid

scholarly consensus form around the following principles (see Fagan,

1990; Parker and Auerhahn, 1998; White and Gorman, 2000):



1. Many different data sources establish a raw correlation between drug

use and other criminal offenses. But correlation does not equal

causation: In principle, drug use might cause (promote, encourage) crime;

criminality might cause (promote, encourage) drug use; and/or both might

be caused (promoted, encouraged) by some set of "third

variables"--environmental, situational, dispositional, and/or biological. In

fact, all three pathways have empirical support in at least some settings

and populations.



2. These causal influences are probabilistic, not deterministic. Most drug

users are not otherwise criminally active, and the vast majority of

drug-using incidents neither cause nor accompany other forms of

criminality. Nevertheless, drugs clearly play an important causal role in

violent and property crime.



3. These causal influences are contingent, not unconditional. There is little

evidence that drug use per se directly causes people to become aggressive

in some direct and unconditional manner or that criminality per se causes

someone to use drugs. The drugs-crime link varies across individuals, over

time within an individual's development, across situations, and possibly

over time periods (as a function of the dynamics of drug epidemics and,

possibly, drug control policies).



4. That drug use can causally influence criminality does not necessarily

implicate the psychopharmacological properties of the drug. Intoxication,

the need or desire to raise money to buy drugs, and the nature of illicit

markets are distinct mechanisms by which drugs can cause crime. Thus,

drug prohibition cannot be only a response to drug-related crime, but it

may also be a causal antecedent to some drug-related crime. 



5. Alcohol is a drug, and it stimulates or augments a great deal of criminal

behavior, almost certainly more than the street drugs combined. We expect

that understanding the considerable heterogeneity of effects across users,

substances, cities, neighborhoods, and situations--and the interactions

among these factors--will be the central focus of drugs-crime research

during the remainder of this decade. This paper reviews the existing

literature, focusing particular attention on Goldstein's (1985) taxonomy,

the temporal dynamics of drug markets, and the consequences of

prohibition. These highlight some of the questions that should drive this

research. 



Drugs-Crime Linkages: Expanding the Goldstein Taxonomy



Goldstein's Framework



Paul Goldstein's (1985) conceptual essay offered a tripartite classification

of drugs-violence connections:



o Psychopharmacological: Violence due to the direct acute effects of a

psychoactive drug on the user.



o Economic-compulsive: Violence committed instrumentally to generate

money to purchase expensive drugs.



o Systemic: Violence associated with the marketing of illicit drugs, such

as turf battles, contract disputes, and so on. 



Goldstein and his colleagues (Brownstein et al., 1992; Goldstein et al.,

1989; Goldstein, Brownstein, and Ryan, 1992) applied this scheme

empirically to homicides in New York State (1984) and New York City

(1988). They found that drugs and alcohol were important causes for a

large share of all homicides in both samples. For 1988, near the height of

the crack epidemic, they classified 53 percent of 414 homicides as drug or

alcohol related; there was also a substantial percentage whose

drug-relatedness could not be determined. Of those homicides that could

be determined to be drug or alcohol related, 14 percent were

psychopharmacological (68 percent alcohol, 16 percent crack), 4 percent

were economic-compulsive, and 74 percent were systemic (61 percent

crack, 27 percent powder cocaine). By contrast, in 1984, before the crack

surge, only 42 percent of homicides were drug or alcohol related; 59

percent of those were psychopharmacological (79 percent alcohol), 3

percent were economic-compulsive, and 21 percent were systemic.

The difference between the findings of the two years might reflect

differences in geography to some extent (New York State versus New

York City), but it also reminds us that these numbers are not eternal

verities; they result from complex and historically dependent market

dynamics. 



Subsequent Applications



The generalizability of Goldstein et al.'s (1989) original findings was

limited by their location (New York) and timing (the height of the crack

explosion; see U.S. Sentencing Commission, 1995, 106).[2] Many studies

have tried to determine whether crimes were drug related, but few have

assessed whether the offender's drug need, drug use, or role in the drug

market was directly responsible for the crime. Although most of the

studies that used this framework were conducted by Goldstein and his

colleagues in New York (Parker and Auerhahn, 1998), there are others

worthy of attention, especially given their unique approaches. General

findings include the following: 



1. Non-NDRI (National Development and Research Institutes, Inc.) studies

of New York City in the mid- to late 1980s found that crack sellers are

more violent than other drug sellers and that their violence is not confined

to the drug-selling context (U.S. Sentencing Commission, 1995, citing

Fagan and Chin, 1990).



2. Studies of juvenile delinquents in Miami in the mid- to late 1980s found

that they were much more likely to commit a drug-related

economic-compulsive crime than a psychopharmacological or systemic

crime (Inciardi, 1990).[3]



3. The per capita drug-related homicide rate remained fairly stable in

Chicago from 1973 to 1984 and fluctuated from 1985 to 1995 (data are

from the Chicago Homicide Dataset; Block, Block, and Illinois Criminal

Justice Information Authority, 1998). Despite the fluctuations, the 1995

homicide rate was strikingly similar to the 1985 rate for all drug-related

motives except for homicides that resulted from a drug transaction;

the latter increased tenfold from 1985 to 1995. 



4. Results from Lattimore et al.'s (1997) homicide study of eight cities,

which included surveys of local officials and ADAM/UCR (Uniform

Crime Reports) analyses for 1985-94, suggest that drugs other than

cocaine and crack were not associated with homicide trends "in any

discernible way." They also found that the drug market structure was

less associated with violence than was expected. The Lattimore et al. study

questioned the role of crack and systemic crime because the crack markets

were described as highly competitive in cities where the homicide rate was

declining, increasing, or remaining the same (1997, p. 89). It is not clear,

however, that the same conclusions could be drawn if disaggregated

homicide rates (by circumstance) were considered. (Additional discussion

and methodological descriptions of these studies are reported in appendix

A.)



Limitations of Existing Research on the Goldstein Framework



The Goldstein tripartite framework has been a boon to drug research

reviewers--it is invaluable as an organizing scheme--but still, we are struck

by the relative rarity of actual empirical applications. Existing applications

overrepresent New York, and they overrepresent the crack epidemic at its

height relative to earlier and later periods. In fairness, the taxonomy was

not proposed until 1985, but it could be applied retrospectively to earlier

homicide case files. In our view, such comparisons would be invaluable.

There has been little consistency in the methods used to implement the

scheme (e.g., Goldstein's trained coders versus Inciardi's survey approach).

Little has been learned from that methodological diversity because, to our

knowledge, no two methods have ever been applied to the same sample of

cases for comparative purposes. Indeed, if one imagines a

three-dimensional matrix of major cities by time periods by methods,

almost every cell is empty and there are almost no vectors with more than

one cell occupied. This spotty record makes it hard to identify either

temporal trends or the influence of local variations on drug popularity,

drug market structures, or policies and enforcement practices. Finally, the

scheme has been applied mostly to homicide and less often to other, more

prevalent violent crimes.[4] 



Parker and Auerhahn (1998) complain that Goldstein's categories are not

mutually exclusive. This critique presumes a classical set-theoretic

approach that, in our opinion, is neither feasible nor scientifically useful

for drugs-violence research. Mutually exclusive categories are not

necessary for scientific classification (Meehl, 1995), and they are usually

impossible to achieve using sparse and noisy archival data (Ragin, 2000).

But we agree with Parker and Auerhahn's (1998) contention that "the

Goldstein tripartite framework . . . is not treated as a set of testable

propositions but rather as a set of assumptions about the nature of drug-

and alcohol-related violence."



In our view, an understanding of the taxometric properties of drug-related

violence ought to emerge inductively from more fine-grained coding of the

underlying features of these events--whether various drugs were found as

evidence, the results of toxicology on the offender and the victim, various

features of witness reports, prior record information, and so on. Because

each property or attribute would be coded separately, there would be no

effort to force events into a single classification. Psychometric analysis

could be used to test the hypothesized latent structure.[5] Such analyses

pose enormous logistical difficulties, but the payoffs for advancing our

understanding of drug violence would surely justify the effort.



In the remainder of this section, we will examine other ways in which

Goldstein's taxonomic scheme might be expanded and refined.



Psychopharmacological Violence



The prevailing view about psychopharmacological (as opposed to

economic-compulsive or systemic) violence is that it is rare and

attributable mostly to alcohol rather than illicit drugs (Fagan, 1990; Parker

and Auerhahn, 1998; White and Gorman, 2000). According to Fagan

(1990, p. 243):



[I]ntoxication does not consistently lead to aggressive behavior . . . only

limited evidence that consumption of alcohol, cocaine, heroin, or other

substances is a direct, pharmacologically based cause of crime.



According to Parker and Auerhahn (1998, p. 306):



Our review of the literature finds a great deal of evidence that the social

environment is a much more powerful contributor to the outcome of

violent behavior than are pharmacological factors associated with any of

the substances reviewed here.[6]



The Goldstein et al. (1989) analysis provides some support for these

claims; only 14 percent of the drug-related homicides appeared to be

psychopharmacological, and these largely involved alcohol either alone or

in combination with other drugs. But one in seven is hardly a trivial

fraction, and those results reflect the peak of the crack market wars, when

systemic homicides were occurring in unprecedented numbers, inflating

the denominator. 



Moderators. Examining the literature cited in many recent review essays, it

is difficult to avoid the suspicion that some authors hold

neuropharmacological factors to a stricter standard of proof than the

sociological factors under study. If the psychopharmacological claim is

that marijuana, heroin, or cocaine ingestion directly promotes violent

behavior absent any situational provocation or stressors, then that

claim is probably false. But evidence for Drug x Situation and Drug x

Psychology interaction effects hardly exonerates drug use as a causal

factor. It may be that no drug is sufficient to produce aggression in

isolation from psychological and situational moderators. But it seems clear

that some drugs--certainly alcohol--can amplify the psychological and

situational facilitators of aggression. Relevant moderators (see Bushman,

1997; Fagan, 1990; Ito, Miller, and Pollock, 1996) include:



o Situational stressors and frustrators (see Ito, Miller, and Pollock, 1996).



o Expectancy effects: personal and cultural beliefs about the effect of the

drug on behavior, and local norms about tolerable versus unacceptable

conduct when under the influence (e.g., Critchlow, 1986; Stacy, Widaman,

and Marlatt, 1990).



o Disinhibition (e.g., Parker and Auerhahn, 1998; but see Fagan, 1990).



o Impaired cognitive functioning, including reduced executive functioning

(self-control and decisionmaking ability; Fishbein, 2000; Giancola, 2000),

reduced attention to situational cues (Steele and Josephs, 1990), and

reduced self-attention (Ito, Miller, and Pollock, 1996).



o Social threats to self-identity or self-esteem (Baumeister, Smart, and

Boden, 1996) that seem particularly relevant in "cultures of honor" (see

Anderson, 1994; Bourgois, 1996; Cohen et al., 1996).



Moreover, the absence of evidence does not equal evidence of absence; the

laboratory literature on drugs and aggression is simply too spotty at present

to permit any firm conclusions. Almost the entire experimental literature

on moderators of the drugs-aggression relationship has examined alcohol

rather than illicit drugs. 



Comorbidity: Drugs in association with mental illness or alcoholism. A

second potential class of moderators of the drugs-aggression link involve

comorbid conditions--substance abuse in tandem with schizophrenia or

other psychoses, personality disorders, or alcoholism. Numerous studies

have identified a high prevalence of illicit substance abuse among

individuals diagnosed with psychiatric disorders (e.g., Compton et al.,

2000; Kessler et al., 1996; Mueser et al., 2000).[7] The causal nexus of

these comorbid conditions is unclear. The MacArthur Violence Risk

Assessment Study (Steadman et al., 1998), a prospective followup study of

clients admitted to acute psychiatric inpatient facilities, found that

substance abuse increased the probability of violent behavior, but this was

true for both psychiatric patients and matched community controls.

Neither drug dependence nor psychiatric illness predicted subsequent

violent crime in a 6-year followup of released jail detainees (Teplin,

Abram, and McClelland, 1994). 



Drug Use and Victimization[8]



Increased victimization provides another mechanism by which drugs can

become linked with violence. Although this category can be subsumed

under Goldstein's psychopharmacological category, treating it as a fourth

category might have merit because the causal mechanisms differ and it has

been largely neglected by researchers. There are a number of reasons to

expect that drug users ought to be particularly vulnerable to criminal

victimization, especially when intoxicated. First, intoxicated people often

appear (and sometimes are) more vulnerable than other targets for such

offenses as robbery, rape, or hate crimes. Second, intoxicated people are

often obnoxious, annoying, and/or offensive in their appearance, conduct,

and speech. Third, intoxication makes people's conduct unpredictable and

ambiguous--intoxication impairs the perception of signals, but it also

impairs the transmission of clear signals to others. Finally, in an active

illicit drug market, drug sellers are sometimes both intoxicated and flush

with cash. 



Fagan (1990) notes that the vulnerability of drug users to victimization has

been long recognized. For example, Wolfgang (1958) studied 

"victim-precipitated homicides" by assessing the incidence of intoxication

among victims. And Fagan (1990) reviews evidence from animal studies

showing that "substances that induce changes in an opponent's behavior

might result in increased aggression by a drug-free attacker . . ." (p. 251). 



Although Goldstein (1985) acknowledged that the victimization of drug

users constituted a distinct drugs-violence linkage, he did not include it as

a separate category in his classification scheme. Since then, the

victimization of drug users has received little attention in the drugs and

crime literature. This is not surprising given how difficult it is to assess the

relationship. First, as Goldstein (1985) argues, it is difficult to obtain this

information because victims do not want to talk to the police while

intoxicated and often do not remember the details of the offense; thus, it

may go unreported. Second, the victimization surveys that ask about

substance use usually include it as a predictor but do not ask whether it

contributed to a specific event. Third, many of these surveys only ask

about (or report) general drug use, not about specific drugs or the

circumstances of their use. Finally, the label "victim" is often problematic

when the participants are codisputants; indeed, the "victim" may have

initiated the provocation. In our view, these concerns are valid, but they do

not undermine the importance of victimization as a research topic.



The ubiquity of alcohol has made it the subject of victimization work for

50 years, and there is general agreement about its role in victimizations,

especially sexual assaults. The research on drugs is not as robust, but there

are some important findings that should be addressed in future works on

drugs and crime. The following sections provide insight about this

relationship by examining existing victimization studies of the general

population, women, and hard drug users. 



The general population. The Nation's largest victimization survey, the

National Criminal Victimization Survey (NCVS), does not ask about

victim drug use, but it is used in conjunction with other data to provide

insight about drugs and crime. Using NCVS, Markowitz's (2000)

multivariate analysis of almost 450,000 observations found that marijuana

decriminalization (a proxy for lower marijuana prices) will result in a

higher incidence of robbery and assault while higher cocaine prices will

decrease these crimes.[9] Neither measure was significantly related to rape

or sexual assault. When victims' perceptions of offender drug and alcohol

use during assaults were used as the dependent variable, the significance

of marijuana decriminalization and cocaine prices was ambiguous

(significance depends on model specification). For perceived use during

robberies, neither was significant. Although Markowitz suggests the

perception variable is questionable because of underreporting, these

findings raise questions about the causal relationship and the role of drug

use by victims, especially marijuana.



Based on an instrument similar to NCVS, Fisher et al.'s (1998) survey of

3,472 randomly selected college students found that regularly taking

recreational drugs predicted an increased likelihood of a violent

victimization but not of a theft victimization. For the general population,

Cottler et al.'s (1992) survey of a probability sample of 2,663 household

residents found that those who had used cocaine or heroin more than

five times in their lives were more than three times as likely to have

experienced a physical attack than nonusers. Those who used marijuana

more than five times (no use of other drugs) and those who used pills or

hallucinogens more than five times were no more likely to have

experienced a physical attack than nonusers. This is one of the few studies

that presents its results by drug and raises questions about the situations in

which hard drug users put themselves.



Women. Much of the victimization research focuses on women because

many of the studies are about sexual assault. Fisher, Cullen, and Turner

(2000) randomly selected 4,446 college women to participate in their

National College Women Victimization Study. That study did not find that

marijuana use was a significant predictor of sexual victimization and

stalking.[10] These findings are consistent with Markowitz's claim that the

price of cocaine and marijuana are not significant predictors of sexual

victimization. Beyond using prices and self-reports, some researchers have

drug-tested rape victims to assess their drug use. Hindmarch and

Brinkmann (1999) found that 41 percent of the 1,033 participants tested

negative for alcohol and other drugs, 37 percent tested positive for alcohol,

19 percent tested positive for cannabinoids, and 0.6 percent tested positive

for flunitrazepam (Rohypnol); however, the lack of information about

participant characteristics and site locations would prevent researchers

from creating the necessary control groups. 



Drug users. Tardiff et al. (1994) found that 31 percent of one sample of

homicide victims tested positive for cocaine metabolites. This rate did

not vary for firearm deaths versus nonfirearm deaths. McElrath, Chitwood,

and Comerford (1997) surveyed 308 intravenous drug users who were

receiving methadone and/or inpatient drug treatment about their

victimization and drug use in the previous 6 months. Those reporting

heroin use were significantly less likely to be victims of violent and

property crimes. McElrath et al. argue that heroin users sometimes have

"running partners" who may also look out for each other, thus decreasing

victimization. Crack cocaine users were four times as likely to be victims

of property crime than nonusers, leading the authors to suggest, "it is

possible that the drug-seeking behavior associated with crack-cocaine

places users in contact with a larger pool of motivated offenders."



Drug-user-on-drug-user crime was also addressed in Inciardi's delinquency

study (1990). Respondents were asked about not only drug-related

offenses they committed but also drug-related victimizations; 4.6 percent

reported being victims of psychopharmacological-related crimes, 39.9

percent reported being victims of drug robberies, and 9.0 percent reported

being victims of systemic violence.



Although every youth in the survey used at least one drug daily, it is not

clear whether the victimizations occurred while the victim was under

the influence. 



Crime victim surveys and offender surveys require respondents to make

attributions about the causes of offenders' behavior. Such causal

attributions are susceptible to numerous well-documented biases (e.g.,

Nisbett and Ross, 1980), but to date there has been little methodological

work validating these survey responses.



Economic-Compulsive Violence



Arrested and incarcerated offenders report that they committed their

offenses to raise money to purchase drugs. Of course, this might be a

convenient rationalization or excuse for antisocial behavior. Should we

believe them?



At least for heroin addiction, the answer is probably yes. Studies of heroin

"careers" show that the frequency of criminal activity tends to covary with

periods of intense use (see Fagan, 1990, for review), and addicts

significantly reduce their criminal involvement during periods of

methadone maintenance (see review in Rettig and Yarmolinsky, 1995).

But in studies applying the Goldstein taxonomy (see above),

economic-compulsive criminality has been relatively rare. White and

Gorman (2000) argue, "[B]ecause there is more money in crack

distribution than in previous illegal drug markets, drug dealing may have

obviated the need to commit property crimes and income-generating

violent crimes" (p. 189). Indeed, in our survey of drug sellers in

Washington, D.C., in the late 1980s (Reuter, MacCoun, and Murphy,

1990), more than 40 percent reported keeping some drugs for their own

consumption--39 percent of crack sellers and 69 percent of heroin sellers.

However, the claim about the high returns for crack selling is probably no

longer correct. Bourgois (1996) reports that proceeds from crack sales by

experienced users who could not maintain legitimate jobs were less than

minimum wage.[11]



But the argument that drug selling has replaced other income-generating

crime might reflect limitations of recent work. First, as we have noted,

most studies applying the Goldstein framework were conducted at the

peak of the crack epidemic, when the sheer prevalence of street drug sales

was probably at an all-time high (see Saner, MacCoun, and Reuter, 1995).

Second, most studies have largely examined crimes with violent outcomes

rather than robberies or burglaries in which no homicide occurred. One

exception is the Caulkins et al. (1997) study, which attributed a substantial

fraction of robberies and burglaries to economic-compulsive crime, and a

sizeable fraction of those economic-compulsive crimes to cocaine. 



The ADAM Program provides some opportunities for studying these

issues (e.g., Arrestee Drug Abuse Monitoring Program, 1999). The

ADAM/DUF (Drug Use Forecasting) instrument was modified in 1995 to

include a question asking whether the arrestee needed drugs or alcohol at

the time of the offense.[12] Appendix B summarizes data for the period

1995 to 1999 for this survey item. As one would expect, these attributions

are more common for income-generating offenses (14 percent) than for

non-income-generating offenses (10 percent)--a reliable but quite modest

difference. 



Our understanding and interpretation of economic-compulsive crime ought

to evolve as the scientific understanding of drug dependence evolves.

Recent decades have seen great progress in the understanding of such

phenomena as tolerance, withdrawal, reinforcement, and drug craving (see

Science, 1997). Leshner (1997, pp. 45-46) notes that many assume the

following:



[T]he more dramatic the physical withdrawal symptoms, the more serious

or dangerous the drug must be. This thinking is outdated . . . many of the

most addicting and dangerous drugs do not produce severe physical

symptoms upon withdrawal. . . . What does matter tremendously is

whether or not a drug causes what we now know to be the essence of

addiction: compulsive drug seeking and use, even in the face of negative

health and social consequences.



There are also intriguing new findings from behavioral economics research

on the price elasticity of demand for cocaine and opiates--the percentage

decline in demand for a 1-percent increase in price. The conventional

wisdom is that addicts are relatively insensitive to price, at least in the

short run, because they are enslaved to their drug and must find ways to

obtain it to avoid withdrawal symptoms. If addicts were relatively

insensitive to price, one would expect price increases to produce increased

economic-compulsive crime. But recent studies (reviewed in Caulkins and

Reuter, 1996) suggest considerable price sensitivity, with elasticities for

cocaine ranging from -0.7 to -2.0. A possible explanation for the high

elasticity among heavy users is that they spend most of their earnings on

the drug and may respond to the increased difficulty of maintaining

desired consumption levels (i.e., avoiding withdrawal) by seeking

treatment.



Systemic Violence



The third of Goldstein's categories is systemic violence. This has been

narrowly interpreted as referring to struggles for competitive advantage.

We suggest here that drug markets generate violence in a variety of ways

and that market violence varies systematically over time and place. 



A brief history of the markets. There was an epidemic of initiation into

heroin use in the 1970s; after that, heroin initiation rates remained low

until the late 1990s. The number of heroin addicts (a function of the

number of initiates and the length of their addiction careers) remained

fairly stable at about 750,000 from 1981 to 1997.[13] During that period,

most heroin purchases were made by an aging cohort of experienced users. 



Powder cocaine and crack had a similar dynamic, only with different

parameters. Powder cocaine initiation rates were high from about 1975 to

1988; the number of dependent users has been quite stable since about

1988. The crack epidemic came later, from about 1982 to 1990 (depending

on the city; see Blumstein and Cork, 1996). Estimates of the number of

dependent users of either crack or powder cocaine range from 600,000 to

3,600,000 (see Rhodes et al., 2000).



Many retailers are now also frequent users (Arrestee Drug Abuse

Monitoring Program, 1999). Selling seems to be opportunistic for many

users; sudden access to an unusually large source of cash may lead a

regular buyer to become a seller for a day. Thus, at the low end of the

market, it may be difficult to distinguish systemic from

psychopharmacological violence.



Enforcement against these markets, as measured by years of jail time per

ton of drugs, probably declined through the early 1980s but then

intensified from 1985 onward. In 1990, the Colombian government

aggressively attacked the principal exporters of cocaine from Colombia.

There are a number of indications that this led to a temporary tightening of

the cocaine market; otherwise, prices have declined throughout the

period, while consumption has been declining modestly since 1988.



Conceptual issues. The markets for illegal drugs operate without the usual

protections against fraud and violence offered by the civil tort system. The

state, instead of attempting to facilitate transactions, aims to disrupt them.

Contracts cannot be enforced through written documents and the legal

system; agreements are made hurriedly, sometimes in ambiguous code,

and orally.[14] Territories cannot be allocated through bidding for

desirable locations because there is no enforceable ownership of property

for these purposes.



Yet the illegality itself is insufficient to generate high levels of violence in

the market. Prostitution, although frequently unsightly and sometimes a

nuisance, does not generate much by way of additional violence.

Bookmaking, notwithstanding the drama of the film "The Sting," was also

a generally peaceful affair; bookies were more likely to die in bed than on

the job. Even for some drugs, the markets generate little violence;

marijuana in general does not spark much injury as the result of

competitive or transactional disputes.[15]



Some drug markets, however, are clearly violent; many participants are at

risk of being killed or seriously wounded by others in the same business,

either as buyers or sellers, and there are unintended shootings of innocent

bystanders. The crack market is thought to be particularly prone to

market-related violence.



Why are these drug markets, particularly for crack, so violent? We suggest

that four factors contribute:



1. The youth of participants. Rates for violent crime peak early, at about

ages 18-22. The young are particularly likely to lack foresight and thus

engage in violence to settle disputes. The crack market was the first mass

drug market in which most of the sellers were young.



2. The value of the drugs themselves. The cocaine that fills a plastic 

sandwich bag is worth thousands of dollars. The return to sudden,

situational violence could be very high.



3. The intensity of law enforcement. Transactions are conducted under 

considerable uncertainty as a consequence of increased law enforcement.

Intensified enforcement increases the incentives for violence by raising

the adverse consequences of identifying someone as a potential informant.



4. The indirect consequence of drug use. Users are more violent and

aggressive, and this encourages dealers to prefer selling out of doors

or in highly protected settings. It also promotes unreliable behavior among

user/dealers and thus more retaliation by their suppliers.



It is probably the combination of these factors, rather than any one of

them, that accounts for the extraordinary violence associated with crack

markets in the late 1980s. That violence seems to have fallen substantially

in the late 1990s, perhaps reflecting the aging of participants in crack

markets (Golub and Johnson, 1997), although violence itself, as well as

enforcement, may also have selected out the most violent participants;

Taylor, Caulkins, and Reuter (2000) present a model in which violence

declines with more intense enforcement as a consequence of selective

incarceration. 



Competitive and internal violence. Attention has been given to violence

generated by competition between sellers. Less attention has been given to

violence within selling organizations, although the older literature on

organized crime and illegal markets reported a great deal on this (e.g.,

Block, 1980).



Criminal organizations are hindered internally by lack of access to the civil

courts. Employment contracts cannot be enforced except privately.

Managerial succession is complicated by the specificity of reputation

within the organization; a promising midlevel manager cannot readily

provide evidence of performance to another potential employer so higher

level managers get weaker market signals and may withhold deserved

promotions or merit increases. This gives incentives to lower level agents

to use violence for upward mobility.



Symmetrical with successional violence is disciplinary violence. Managers

have reason to fear subordinates who can provide evidence against them;

the longer lasting the relationship, the greater the potential for harm from

informing. Thus, managers may use violence as a tool to reduce risks of

informing. They have more incentive for doing so than do high-level

dealers in transactions with low-level dealers because the information

about these acts will spread more rapidly and extensively.[16] There are

numerous stories of this kind of violence in Colombian drug-dealing

organizations.



Thus, the violence in atomistic markets has different sources than that in

markets serviced by larger selling organizations. Which generates greater

violence from a given set of participants cannot be determined

theoretically, but some of the decline in market-related violence may

reflect changes in organizational structure.



Other market characteristics and violence. Exhibit 1 presents a simple

classification of markets according to whether buyers and sellers come

from the neighborhood or elsewhere. We believe that this taxonomy,

originally identified for purposes of analyzing vulnerability to enforcement

(Reuter and MacCoun, 1992), may also be useful in the study of violence.

Markets characterized by mostly resident dealers and customers are

labeled local markets. Export markets are ones in which residents of the

neighborhood sell drugs to nonresidents. Markets in which mostly

nonresident dealers sell to local residents are characterized here as import

markets. Finally, markets in which both sellers and customers are mostly

nonresidents are labeled here as public markets because they tend to occur

at such large public locations as parks, train or bus stations, or

schoolyards. 



Each class of market differs in the potential for violence. Local markets,

precisely because they involve buyers and sellers who know each other, do

not lend themselves to territorial competition. At the other extreme are

public markets, in which buyers and sellers cannot readily find each other

except at specific locations; the incentives for territoriality are

consequently greater.



Transactional violence may also vary in these dimensions. Local markets

discourage cheating of buyers as a consequence of the ongoing

connections between buyers and sellers; a local customer is more likely to

spread information effectively to other potential customers than one who

has little connection to other buyers. It is not clear whether much of the

transactional violence comes from buyers, as opposed to associates and

rival sellers.



If this is correct, then the maturation of cocaine and heroin markets will

tend to reduce market-related violence by reducing the size of all but local

markets. Moreover, as a result of the dissemination of beepers and cell

phones, an increasing share of cocaine transactions may be occurring in

locations (apartments, restaurants, offices) that are agreed on by the buyer

and seller for their mutual convenience. Johnson, Golub, and Dunlap

(2000, p. 191, table 6.1) report that in New York City in the 1990s, the

"seller style" included phone and delivery services as well as freelancers.

Poor and socially isolated cocaine users still frequently conduct

transactions in exposed locations, chosen precisely because they facilitate

the coming together of buyers and sellers. So probably do many heroin

addicts, given their generally impoverished state. The ability to choose

locations on the basis of specific situational need not only reduces

territorially motivated violence but also reduces the vulnerability of

buyers to robbery and other victimization because fewer of them need to

congregate at specific locations, which thus become less attractive to

predators.



The Temporal Dynamics of Drug Markets



In the past several years, numerous authors have examined the emergence

and decline of crack markets as a key factor in the steep rise in American

violence from 1985 to 1990, and the even steeper drop since 1993 (see

Blumstein and Wallman, 2000). In our view, the case for crack's role in the

crime rise is quite compelling; its role in the post-1993 decrease is more

subtle and by no means an open-and-shut case.



Many discussions of the crime drop fail to distinguish between a decline in

the crack market and a decline in the linkage between crack and crime--but

a decline in the crack-crime link is part of the crime drop outcome to be

explained. It is true that DUF (and now ADAM) data show declines

in positive cocaine tests among arrestees in many cities (e.g., Arrestee

Drug Abuse Monitoring Program, 1999). And the reduced violence

attributable to crack selling has made crack markets less visible. But

nationwide, hardcore cocaine use remained surprisingly stable during

the 1990s (Rhodes et al., 2000). Indeed, from 1990 to 1998, there were

rising cocaine mentions in emergency rooms (Substance Abuse and

Mental Health Services Administration, 2001) and rising cocaine seizures.

Nevertheless, recent multicity comparisons (Baumer et al., 1998;

Lattimore et al., 1997) indicate reliable positive correlations between

various indices of crack use and homicide and other offense rates.



Various experts have suggested that the changing dynamics of drug

markets may matter as much or more as any decline in total market activity

(e.g., Ousey and Lee, 2000). Below, we consider a few more complex

accounts of the link between crack market dynamics and violence.



NDRI'S conduct norm account. Johnson and his colleagues at NDRI

(Lipton and Johnson, 1998) have produced a valuable interdisciplinary,

multimethod program of research on street drug markets in New York,

spanning several decades. They recently offered an account of the decline

in drug-related violence based on the notion of "conduct norms" (Johnson,

Golub, and Dunlap, 2000), arguing that New York street drug markets

have passed through three phases. (They vacillate between "period" and

"cohort" versions of the story.) The "heroin injection era" peaked during

1960-73; the "cocaine/crack era" peaked during 1984-89; and the

"marijuana/blunts era" started around 1990. Associated with each era are

distinct birth cohorts with distinctive behavioral patterns. "HeroinGen"

drug users (born 1945-54) were active in drug sales and property crime,

but gun use was relatively rare. "CrackGen" drug users (born 1955-69)

frequently participated in robbery and used guns for protection and 

reputation. Finally, "BluntGen" drug users (born 1970-79) are less likely

than early cohorts to engage in violence. 



Drawing on their rich ethnographic database, Johnson and colleagues

(2000) argue that these behavior changes reflect two successive

transformations of conduct norms for appropriate behavior in the

drug-using community. For example, in CrackGen's "Subculture of

Assault," a shared norm counseled: "Be aggressive and threatening to

avoid robbery. . . . Carry weapons for protection. . . . Threaten or assault

those who attempt to sell crack in your territory. Maintain your reputation

as dangerous, tough, and 'crazy,' regardless of the physical harm inflicted

or suffered" (p. 181). But for the BluntGen, the norm states: "Don't use

crack. Crackheads are s---! . . . Addicts are the scum of the earth. Stay

safe, stay alive. Don't mix cocaine or heroin with my marijuana. Shun and

exclude heroin and crack users from peer groups" (p. 185).



This norm account is fascinating and quite plausible. From a policy

perspective, it would be tremendously useful to find a way to preserve and

promote the BluntGen's more pacifist stance (though not, of course, their

consumption of blunts). Still, the evidence is causally ambiguous. Are

these conduct norms actually causes of the decline in violence during the

1990s, are they descriptions of it, or are they consequences of it?



There is little doubt that conduct norms exist and are important in shaping

deviant behavior. Cialdini, Kallgren, and Reno (1991) make a useful

distinction between injunctive norms (what others think I should do) and

descriptive norms (what others are actually doing). There is ample

evidence that purely descriptive norms--changes in the local prevalence of

a behavior--can have a self-reinforcing action. But attitudes and norms

are shaped by behavior as well as shaping it; research on cognitive

dissonance theory and self-perception theory suggest that such

conformity-based behavioral changes will tend to produce corresponding

(but retrospective) changes in relevant attitudes (see Eagly and Chaiken,

1993). Controlled social psychology experiments show that norm diffusion

effects occur and that they can be strong, but these experiments also

show that apparent norm effects are sometimes spurious (e.g., Kerr et al.,

1987).



Clearly, research on drug-using norms cannot move to the

laboratory--although one can imagine informative scenario-based

experiments embedded in field interviews. But it would be enormously

useful to make additional use of the NDRI data (and related data sources,

such as the Office of National Drug Control Policy's Pulse Check),

linking the timing of the ethnographic material more precisely to

month-to-month quantitative archival data on drug selling (or its proxies)

and violent crimes. Furthermore, archives of ethnographic data collected in

different cities during the past decade might be reanalyzed to search for

cross-city norm differences that might correlate with cross-city differences

in violent crime. Ideally, one might develop methods for identifying

"leading indicators" of emerging trends in drug using, drug selling, and

drug-related violence.



Blumstein and Cork's drug-gun diffusion account. In a series of articles

(see Blumstein, 2000a; Blumstein and Cork, 1996; Cork, 1999), Alfred

Blumstein and his collaborator Daniel Cork hypothesize a causal chain

linking the late 1980s crack epidemic to rising violence nationwide.

According to Blumstein, the 1980s growth in illicit drug markets, together

with stringent enforcement crackdowns, led to the recruitment of juvenile

drug sellers. The intense market competition together with the recruitment

and rewarding of particularly aggressive youths created a need for sellers

(as well as nonseller youths in market neighborhoods) to be armed. This

increased demand fueled an expansion in the illicit gun market and a

diffusion of guns. The linkage between drug selling and gun possession is

well established (see Decker, Pennell, and Caldwell 1997; Sheley, 1994;

Tardiff et al., 1994).[17] Cork (1999) found support for the temporal

sequence of the Blumstein account using a sophisticated diffusion

modeling analysis of time-series data from multiple cities.



The Blumstein model is a compelling account of the rise of violent crime,

but more work is needed to establish its explanatory power as an account

of the subsequent decline in violence. The model is not inconsistent with

that decline--a decline in the crack market should have reduced the need to

be armed--but future research will have to assess whether declines in the

prevalence of drug selling (as opposed to changes in other features of the

markets) have produced reductions in the likelihood of gun possession and

gun violence. 



The maturation of addicts and of illicit drug markets. Because of reduced

initiation rates, it appears that the hardcore cocaine-using population

consists mostly of an aging cohort who started using in the late 1980s, in

much the same way that heroin addicts disproportionately belong to

cohorts who initiated use in the 1970s. If this is correct, drug-related

criminality should continue to decline, absent new waves of initiation, as

addicts "mature out" of violent crime or die from drug-related illnesses or

natural causes.



Many observers were struck by the violence of 1980s crack markets

relative to earlier heroin and marijuana markets. Many have speculated

that such markets "mature" over time as (a) dealer territories are firmly

established, (b) casual users drop out of the market, and (c) hardcore users

establish reliable dealer connections. All these factors suggest a shift from

open-air public markets toward more clandestine arrangements that seem

less prone to violence.[18] But at present, this is largely speculative; there

is anecdotal and ethnographic evidence for such changes but little

systematic longitudinal research that establishes a clear trajectory over

time.



The Consequences of Prohibition and Its Enforcement



Drug Involvement As Crime



The convention in articles on drugs-crime linkages is to state that for the

purposes of the essay, the fact that drug use (and sometimes drug selling)

per se is a crime is not relevant to the analysis. But the illicit status of

street drugs is vitally important to the analysis in several ways. First, drug

prohibition is arguably necessary for Goldstein's category of systemic

(market-related) violence (MacCoun and Reuter, 2001).[19] We simply do

not observe routine violence among alcohol or tobacco vendors. Second,

Goldstein's economic-compulsive violence, although not caused by

prohibition, is surely exacerbated by it because drug prohibition almost

certainly raises the price of heroin or cocaine far above what would be

their retail market prices (MacCoun and Reuter, 2001). Finally, there are

reasons to believe that the illicit status of drugs might have subtle

criminogenic effects through several different mechanisms, including

forbidden fruit effects, labeling or stigmatization effects, and "stigma

swamping."[20] Here we highlight two such mechanisms.



Incapacitation and replacement effects. Several authors (e.g., Blumstein,

2000b; Freeman, 1996; Kleiman, 1997) have suggested that the

incarceration of drug sellers is likely to produce a weaker incapacitation

effect than would occur for other offense categories, such as property and

sex offenses. Indeed, some have speculated that a replacement process

might even produce a net increase in the prevalence of drug selling. In a

highly competitive illicit market, the incarceration of a drug seller creates

lucrative drug-selling opportunities (customers and sales territory) for

others. According to Blumstein (2000b):



The pathological rapist's crimes almost certainly are not replaced on the

street, and so one can expect his full array of crimes to be 

incapacitated. . . . A burglar's crimes may be replaced if he is serving a

fence, who would recruit a replacement; alternatively, if he is simply

operating on his own, the crimes are not likely to be replaced. And the

participant in organized vice activity such as drug dealing would be likely

to have his transactions replaced by whatever organizational structure is

serving the market demand. That replacement could be achieved by some

combination of recruiting new sellers or by increasing the rate of activity

of sellers already active in the market.



Freeman (1996) offers a formal economic model that interprets this

replacement effect in terms of the elasticity of supply of dealers with

respect to drug market wages. The supply of dealers should reflect this

sensitivity to wages as well as changes in earnings opportunities in the licit

market (i.e., shift in the supply curve) and the demand for drugs (i.e., shifts

in the demand curve). 



At present, there is surprisingly little evidence either for or against the

replacement hypothesis. One indirect argument for its plausibility is that

the explosive growth in the incarceration of drug sellers during the past

decade was not accompanied by increases in street cocaine prices, as one

might expect if the supply of street dealers was tightening (Blumstein,

2000b; see also DiNardo, 1993). Indeed, street prices have dropped

substantially (Rhodes et al., 2000). Another indirect argument is the sheer

prevalence of drug market participation in some communities during the

late 1980s, when drug sellers were being incarcerated at record levels. For

example, Saner et al. (1995) estimated that in Washington, D.C., during

1985-91, nearly one-third of African-American male residents from the

1964-67 birth cohorts were charged with drug selling.



Statistical analyses of archival data might test the replacement hypothesis

by looking for evidence of increases in the initiation to drug selling as a

function of the arrest and incarceration of dealers. Ethnographic studies

might examine whether recruitment activities increase following police

crackdowns and whether existing street dealers increase their activity. But

isolating replacement effects will be tricky; note that general deterrence

and replacement effects, if they exist, will offset each other, which may

make it hard to find any effect of sanctions on subsequent dealing.



Can enforcement amplify violence? Several authors(Eck and McGuire,

2000; MacCoun and Reuter, 2001, chapter 6; Reuter, 1989; Riley, 1998)

have argued that under certain conditions, aggressive drug enforcement

might actually increase drug-related violence. Rasmussen, Benson, and

their associates have examined whether more intense drug enforcement

increases violent crime; much of this work is summarized in Rasmussen

and Benson (1994). The mechanisms involved are quite varied. For

example, enforcement might lead to more violence in competition. Benson

and colleagues (1992) found that the violent crime rate in a community

increased with more drug arrests in a neighboring community. This, they

argue, is a displacement effect; dealers move from the targeted community

to the neighboring one and struggle over the establishment of territories.

Another mechanism works through the limited capacity of the correctional

system; increased prison space for drug offenders reduces the penalties for

other crimes, including violent crimes, and thus induces higher

victimization. Benson and Rasmussen (1991) argue that, even assuming

that prison is effective only through incapacitation and not deterrence, the

observed rise in the resources devoted to drug enforcement in Florida in

the 1980s might have increased other crime by 10 percent. 



Supply reduction versus violence reduction. An important dialogue with

respect to drug users involves the prospects and tensions of integrating use

reduction strategies with harm reduction strategies (MacCoun, 1998;

MacCoun and Reuter, 2001). We see an analogous issue with respect to

the policing of drug markets (MacCoun and Reuter, 1994). Police tactics

designed to reduce the supply of drugs (and of drug suppliers) may or may

not be the most effective means of reducing the total social harm caused

by street drug selling. Some tactics might directly reduce drug-related

violence.



One example involves efforts to drive dealers indoors (see Kennedy's 1993

analysis of Tampa's QUAD program). Of course, crack houses are not

without their harms. In an ethnographic study of the crack market in

Detroit, Mieczkowski (1990, p. 90) concludes that "tavern-style crack

houses may encourage and make possible hypersexuality among

participants and thus increase the STD and HIV rates. The use of barter as

a supplement to a cash economy in the crack trade represents further

complications in creating social policies in reaction to this behavior." Still,

indoor markets are likely to be less violent. But the effects are multiple

and hard to balance. On one hand, indoor markets are less susceptible to

police surveillance or sting operations. On the other hand, driving dealers

indoors might increase users' search costs (Moore, 1990) and thus reduce

demand. Consumers in export markets would bear a disproportionate share

of these search costs because the locals often know the local dealers and

could easily locate them. This might lead to new local markets in the areas

from which the export consumers are coming and the associated

neighborhood violence that Benson et al. (1992) examined. Further

research on these issues is needed.



Heroin maintenance. If the drugs-crime link is mediated by the high price

and conditions of sale of a drug, and if a relatively small number of

frequent users are responsible for much of the crime, then perhaps

allowing access to that drug legally for those least able to quit might

reduce associated crime. There is increasing information and interest in

exploring just this possibility for heroin (see MacCoun and Reuter, 2001).



In January 1994, Swiss authorities opened a number of

government-administered heroin maintenance clinics.[21] Registered

addicts can inject heroin at a government clinic under the care of a nurse

up to three times a day, 7 days a week. Patients have to be over 18, have

injected heroin for 2 years, and have failed at least two treatment episodes.

By the end of the initial research trials of this program, more than 800

patients had received heroin on a regular basis without any leakage into the

illicit market. No overdoses were reported among participants while they

stayed in the program. A large majority of participants had maintained the

regime of daily attendance at the clinic; 69 percent were in treatment 18

months after admission. This was a high rate relative to those found in

methadone programs. About half of the "dropouts" switched to other forms

of treatment; some chose methadone and others chose abstinence-based

therapies. The crime rate among all patients dropped during the course of

treatment, use of nonprescribed heroin dipped sharply, and unemployment

fell from 44 to 20 percent.



Critics, such as an independent review panel of the World Health

Organization, reasonably asked whether the claimed success was a result

of the heroin or the many additional services provided to trial participants.

And the evaluation relied primarily on the patients' own reports, with few

objective measures. Nevertheless, despite the methodological weaknesses,

the results of the Swiss trials provide evidence of the feasibility and

potential effectiveness of this approach. In late 1997, the Swiss

government approved a large-scale expansion of the program. A similar

program is under development in the Netherlands and in Hamburg,

Germany. 



The proposal to study heroin maintenance on a trial basis in the United

States is politically controversial and would be logistically difficult.

Moreover, the normative and moral issues are clearly complex (MacCoun

and Reuter, 2001, chapter 15). But we should not reflexively dismiss,

without serious analysis, an intervention that could in theory (and with

some fragmentary evidence) help reduce the criminality of existing heroin

users and perhaps shrink the heroin street market, thereby creating new

barriers to heroin initiation. If nothing else, serious discussion of such a

program, and perhaps even formal modeling of alternative hypotheses

about its likely effects, might significantly advance our thinking about

drug market dynamics and the possibilities for effective intervention.



Summing Up: Directions for Future Research



Here we summarize our suggestions for profitable future research, in the

order in which we discussed them:



o Methodological attention to the measurement of Goldstein's taxonomy

of drugs-violence links and to the validation of self-reports of victim and

offender causal attributions for the role of drugs in criminal offenses.



o Greater attention to the role of drug use in criminal victimization.



o Retrospective historical analysis of long-term trends in drug use, drug

arrests, and drug-related crime, including recoding of ethnographic

databases, application of the Goldstein coding scheme to homicide case

files, age/period/cohort analyses, and econometric time-series analyses.



o Determination of the causal relationships underlying comorbid drug

abuse and mental illness conditions.



o Extension and replication of the rich experimental literature on

situational moderators of alcohol-related aggression, as applied to other

drugs.



o Econometric analysis of the effects of drug price changes on

drug-related criminality.



o Assessment of the effects of the availability of licit work and licit wage

levels on criminality.



o Additional multicity analyses (and cross-neighborhood analyses within

cities) with an emphasis on understanding heterogeneity in drugs-crime

relationships: Spatial analyses, analyses of variation in the demand for

different drugs, gang versus nongang involvement, ethnic and other

demographic groupings, indoor versus outdoor markets, import versus

export versus local versus public markets, etc.



o Estimation of incapacitation versus replacement effects resulting from

the incarceration of drug sellers.



o Simulation modeling and eventual pilot tests of the efficacy of heroin 

maintenance.



One other topic that was not even hinted at in our analysis and has been

almost totally neglected in the empirical research literature also should

receive attention: the likelihood of causal linkages between illicit drug use

and such white-collar crimes as corruption, fraud, and embezzlement.[22]



This is a long list of topics. That in itself is a reminder of how little has

been done to implement and build on Goldstein's insightful taxonomy.

Advances will require an acceptance of the fact that drugs may differ

widely in the extent and form of their criminogenic effects. That

substantially complicates an already difficult enterprise but is likely to be

the source of considerable policy insight.



Notes



1. Except where noted, these statistics were reported in Drug-Related

Crime (Office of National Drug Control Policy, 2000). 



2. In fact, Goldstein et al.'s (1989) findings might not fully represent New

York City since they did not look at the entire population or a random

sample of homicides. Rather, they chose one zone in each of four different

boroughs, with the goal of sampling precincts that represented a

cross-section of New York City.



3. These findings challenge the recent generalization by White and

Gorman (2000, p. 189) that "the economic motivation explanation has not

been supported among adolescents."



4. Our understanding is that the new NIBRS (National Incident-Based

Reporting System) database perpetuates this. Officers only have to

report the circumstances of the offense (which includes drug dealing) for

aggravated assaults/homicide (considered one category in the victim-level

file).



5. Approaches might include confirmatory factor analysis, cluster analysis,

Q-sort, or Ragin's (2000) fuzzy-set approach. We are less interested in

defending a particular method than in pointing out the surprising lack of

attention to these measurement and conceptualization issues in the field.



6. Fagan (1990, p. 255) and White and Gorman (2000, p. 185) argue that,

if anything, marijuana and opiates serve to suppress aggression. Actually,

Bushman's (1990) meta-analysis found more aggression among marijuana

smokers than placebo controls in laboratory experiments. But this effect is

partly due to the fact that the placebo controls showed significantly less

aggression than nondrug controls, indicating that participants also believed

marijuana would induce passivity. 



7. Note that other psychiatric disorders are less common among substance

abusers than substance abuse is among the mentally ill (Miller, 1993).



8. Beau Kilmer's work on this section was supported by NIDA grant

R01DA12724.



9. The assumption that decriminalization (as opposed to legalization) is an

indicator of lower price is questionable. In theory, it might increase

demand by reducing the nonmoney costs, which should increase price.

However, evaluations of decriminalization in 11 U.S. States, South

Australia, the Australian Capital Territory, and the Netherlands fail to

show any effects on demand (MacCoun and Reuter, 2001).



10. The authors report the statistically significant variables, not the entire

model. The entire model is listed in Fisher, Cullen, and Turner

(forthcoming) and includes a variable for "Frequency of smoking pot or

hashish." Because the significant predictors for stalking are the same in the

published and unpublished pieces, we assume the same model was used.

Because this is likely to be the model used to predict sexual victimization

in the published piece, we report that marijuana use does not predict

sexual victimization. 



11. Even if true, high returns from crack selling do not lessen the

criminogenic consequences of the market; the issue is what share of

revenues are generated by legitimate earnings or welfare and other transfer

payments received by buyers. 



12. The question yields four binary variables about whether the arrestee

was in need of drugs/alcohol (NEEDNO), alcohol (NEEDALC), cocaine

(NEEDCOCR), and marijuana (NEEDMAR) during the crime and one

text variable (NEEDOTHR) where the coder is asked to specify if the

arrestee mentioned another drug. Curiously, the 1995 (part 2) and 1999

ADAM codebooks do not report any binary variable for heroin--widely

believed to be the major source of economic-compulsive crime. Of the

44,000 ADAM arrestees in 1999, we estimate (using the open-ended field

responses) that about 1,100 reported they needed heroin, 1,800 needed

alcohol, 2,150 needed cocaine/crack, and 700 needed marijuana. Of those

reporting that they needed heroin, about 35 percent committed

income-generating crimes.



13. ONDCP reports, based on Rhodes et al. (1995, 2000), that the

prevalence of frequent use fell by one-third between 1988 and 1993 and

then returned to its 1988 level by 1998. It is difficult to identify supporting

evidence for such a dramatic fluctuation in the figures.



14. The bookmaking business has certainly generated written records; but

that is more central to the business itself, which involves the extension of

credit and usually numerous near-simultaneous transactions between any

one buyer and seller.



15. In the District of Columbia in the mid- to late 1990s, it was reported

that some street gangs were in violent disputes over the marijuana market

(Pierre, 1996; Lattimore et al., 1997).



16. Smith and Varese (2001) model the use of coercive violence in

markets for Mafia extortion; the model can be applied to

intraorganizational violence as well.



17. Decker, Pennell, and Caldwell (1997) did not find that drug users

(rather than sellers) were more likely to be carrying a gun than other

arrestees.



18. Alfred Blumstein appeared to endorse this account in his public

comments at the 2000 Annual Meeting of the American Society of

Criminology.



19. Necessary, but not sufficient; see Zimring and Hawkins, 1997; Ousey

and Lee, 2000.



20. The term "stigma swamping" was suggested to us by Jon Caulkins as

an apt label for a phenomenon about which many have speculated (e.g.,

Jacobsen and Hanneman, 1992; McGraw, 1985; Petersilia, 1990)--the

notion that the stigma associated with arrest and even incarceration is

reduced by the sheer prevalence of those sanctions. The term "stigma

swamping" is an informal control counterpart to Kleiman's (1993) formal

control version, "enforcement swamping."



21. The earlier British experience with prescription heroin is more

notorious but less informative; see MacCoun and Reuter, 2001, chapter 12.



22. We thank Terence Dunworth for making this observation.



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Appendix A. Other Applications of Goldstein's Framework



New York



Even excluding the works of Goldstein and his colleagues, much of the

work using the tripartite framework focuses on New York during the mid-

to late 1980s. The U.S. Sentencing Commission (1995) used Goldstein's

framework to compare the incidence of violence related to the use of

powder cocaine and crack. Using expert testimony and existing literature,

and largely focusing on the studies done in New York,[1] the Commission

concluded that crack was a greater source of systemic violence than

powder cocaine, that economic-compulsive violence was relatively rare

among cocaine users, and that "neither powder nor crack cocaine excite or

agitate users to commit criminal acts and that the stereotype of a 

drug-crazed addict committing heinous crimes is not true for either form

of cocaine" (p. x).



Miami



Inciardi's (1990) survey of 611 serious juvenile delinquents in Miami and

Dade County assessed offender self-reports of drug-related systemic,

economic-compulsive, and psychopharmacological crime. In the 12

months prior to the interviews, which occurred from 1985 to 1989, about 5

percent of the sample reported being a psychopharmacological victim, 59

percent reported having committed robberies ("the majority of which were

committed to purchase drugs," p. 100), and 8 percent reported being the

perpetrators of systemic crimes. Inciardi also administered a

supplementary crack survey to 254 of these delinquents from October

1986 to November 1987. This survey and other data analyses by Inciardi

led him to conclude that the Miami crack market was much less violent

and less (juvenile) gang-related than portrayed in the media and may be

"kindler and gentler" than other large cities. He also reported that the worst

years for murders in Miami were during its cocaine wars in the early

1980s. Inciardi found that "those more proximal of the crack distribution

market were more involved in violent crime" (p. 104). This study has at

least two advantages over Goldstein et al. (1989): Crimes other than

homicide were considered, and respondents were asked about drug-related

victimization. But the drug associated with these crimes was not listed as it

was in the Goldstein et al. study.



Chicago



One source that was developed to assess homicide fluctuations and

motivations is the Chicago Homicide Dataset (CHD). Detailed information

on every homicide in the records of the Chicago Police Department is

available for 1965-95 (Block, Block, and Illinois Criminal Justice

Information Authority, 1998). CHD does not include data on specific

drugs, but its motive classification fits nicely with the tripartite framework.

The four types of drug-related motives for homicide are selling or drug

business (this includes any homicides during or because of a

transaction);[2] an argument over possession, use, quality, or cost of

drugs; getting money for drugs or acquiring drugs for personal use; and

other drug involvement (e.g., baby dies of malnutrition because the parents

were high; offender was drug crazed).[3]



The per capita drug-related homicide rate remained fairly stable from 1973

to 1984 (around 0.4 homicides per 100,000 Cook County residents), with

"arguments" at a slightly higher rate from 1974 to 1977. Homicide rates

related to all of the motives fluctuated from 1984 to 1995, but it is

interesting that the aggregate rate for every motive except

"business/transaction" was virtually the same for 1984-85 and 1995 (still

close to 0.4). The advent of crack likely explains why homicide rates

related to all of the motives increased from 1985 to 1989, but it is of

special interest that the "business/transaction" motive skyrocketed during

those years. Clearly, more might be learned by examining the specific

drugs associated with "business/transaction" homicides in Chicago over

this time period. 



Eight-City Study



To learn why city homicide rates did not change uniformly in the early

1990s, Lattimore and colleagues (1997) comprehensively examined

homicide in eight cities for 1985-94: Atlanta, Detroit, Indianapolis, Miami,

New Orleans, Richmond, Tampa, and Washington, D.C. In addition to

comparing ADAM results with UCR data for these cities, Lattimore et al.

interviewed key policymakers, law enforcement and criminal justice

officials, and community leaders in the cities. These interviews revealed

that crack was most likely associated with community violence and

homicide, while the market violence associated with marijuana was a

growing concern in Washington, D.C., and Richmond.

Methamphetamines, LSD, PCP, and heroin were not associated with

homicide rates and were rarely mentioned by local authorities. It is

important to note that Lattimore et al. found that in many cases the 

perceptions about local drug trends differed substantially from drug trends

as measured by DUF/ADAM.



Lattimore and colleagues question the relationship between crack and

market violence because the crack markets were described as highly

competitive in cities in which the homicide rate was declining, increasing,

or remaining the same (1997, p. 89). But it is not clear that the same

conclusions could be drawn if disaggregated homicide rates (by

circumstance) were considered. The authors not only looked at how

competitive the market was, they also considered the stability of prices,

transactions, and participants. Their argument that links between drugs and

homicide "appear to fall mainly on the use side" (p. 92) relies on their

findings about participants: 



The general structure of participation in crack markets and the nature,

duration, and consequences of the "crack high" may account for the

relationship between the cocaine prevalence rates among arrestees and

homicide rates. Crack users reported the large number of "buys," extensive

networks of potential suppliers, and less reliance on a primary supplier,

suggesting that transactions were likely to occur in an opportunistic

manner. The high from crack lasts as little as 10 minutes; thus, when the

high wears off, the crack user may still be in the market and motivated to

buy more of the drug--and to commit a crime to obtain the money to do so.

(p. 141)



This is essentially an argument about economic-compulsive violence,

which other crack-specific studies have dismissed (see U.S. Sentencing

Commission, 1995). While this difference may be geographic (the other

studies were primarily done in New York City), it may also be the artifact

of a bivariate analysis of two datasets (UCR and ADAM) that did not

always cover the same populations. 



National Estimates



Others used nationwide data to learn more about the drugs-crime nexus.

Caulkins and colleagues (1997) used the tripartite framework to assess the

impact that mandatory minimum sentences have on cocaine consumption

and subsequent crime. Relying on estimates from Goldstein and his

colleagues (Goldstein, Brownstein, and Ryan, 1992; Spunt et al. 1990;

Spunt et al., 1995), the National Criminal Victimization Survey, inmate

surveys, and murder data for large urban counties, Caulkins et al.

determined the number of systemic, economic-compulsive, and

psychopharmacological crimes that were drug related. Their next step was

to determine how much of this crime was related to cocaine. Based on

information from Rhodes et al. (1995), the ADAM Program, the Office of

National Drug Control Policy (1995), and Goldstein (Goldstein et al., 

1989; Goldstein, Brownstein, and Ryan, 1992; Spunt et al. 1995), Caulkins

et al. (1997) suggest that cocaine accounts for about 75 percent of

drug-related economic-compulsive crime, 50 percent of illicit

psychopharmacological homicides, and 75 percent of systemic homicides. 



Notes 



1. New York: Chin and Fagan, 1992; Fagan and Chin, 1990; Goldstein et

al., 1989. Miami: Inciardi, 1990; Inciardi and Pottieger, 1991; Inciardi and

Pottieger, 1994. Los Angeles: Klein et al., 1991. Detroit: Mieczkowski,

1990.) The Commission also cited an unpublished DEA report and a

review article by Fagan (1990). The former found "that seven crack-related

homicides were 'multi-dimensional,' with systemic being one of the

dimensions," but it is not clear where these homicides occurred and what

the other dimensions were. 



2. The codebook reads: "Use code 1 when BUSINESS is the motive for

the incident (e.g., both victim and offender involved in dealing, victim

killed as a bystander of a drug business hit, victim killed because he

interfered with the business, victim killed during a drug transaction or

because of a drug transaction)."



3. Cases where there was no positive evidence or no information are not

included. Of the 23,817 homicides occurring between 1964 and 1995,

22,282 either had no information about drug motive or were not drug

related. Unfortunately, the non-drug-related homicides cannot be separated

from the no-information group.



--------------------------------



THE DRUGS-CRIME WARS: PAST, PRESENT, AND FUTURE

DIRECTIONS IN THEORY, POLICY, AND PROGRAM

INTERVENTIONS



Duane C. McBride, Curtis J. VanderWaal, and Yvonne M. Terry-McElrath



About the Authors



Duane C. McBride is a professor with and chair of the Department of

Behavioral Sciences and director of the Institute for Prevention of

Addictions at Andrews University; Curtis J. VanderWaal is a professor

with the Department of Social Work and associate director of the Institute

for the Prevention of Addictions at Andrews University; Yvonne M. 

Terry-McElrath is a research associate with the Institute for Social

Research at the University of Michigan.



Introduction



The relationship between drug use and criminal behavior has generated a

substantial body of literature in peer-reviewed journals, government

publications, and the public press. The very extent of such research--as

well as the breadth of policy positions based on or ignoring such

research--argues for the importance of a review that can summarize theory,

policy, and programmatic approaches to the issue. In this paper, we do not

attempt to provide a comprehensive review of the issues or literature.

Instead, we seek to provide a sufficient review of the most pertinent

knowledge about the drugs-crime relationship to stimulate further

discussion among researchers regarding the most important research

questions that still need attention. This discussion holds great promise for

the development of new approaches to the drugs-crime relationship.

As Brownstein has argued, "those who do the research are in the best

position to interpret their findings and offer advice based on their

conclusions" (1991, p. 132). This paper approaches the above task by

focusing on the following issues: (a) documenting the existence of the

drugs-crime relationship, (b) addressing the nature and complexity of that

relationship, (c) summarizing philosophical and theoretical contributions

that may best address the relationship, (d) reviewing both State- and 

Federal-level policy approaches to breaking the relationship, including

integrated program approaches, and (e) proposing key areas for future

research.



The Existence of the Drugs-Crime Relationship



The purpose of this section is to briefly discuss what is known about the

drugs-crime relationship. This discussion will focus on the historical

policy context; the empirical nature of the relationship overall; and

specific drugs, crimes, and populations.



Which Drugs and What Crime?



Before proceeding further, we wish to clarify what we mean by "drugs"

and provide a more complete picture of what is involved in "crime" related

to drug use. These clarifications are made in the hope that readers will

recognize that the crime aspect of the drugs-crime relationship is

multifaceted and that the current exclusion of alcohol from most

discussions of the drugs-crime relationship may be detrimental.



Substance Inclusion Decisions



The term "drugs" as used throughout this paper refers to currently illicit

substances in the United States based on Federal drug schedules. Alcohol,

prescription drugs, and other substances are excluded. Although it is

beyond the scope of the current project, it is important to at least mention

the alcohol-crime relationship. Greenfeld (1998) reminds us that an

estimated 36 percent of convicted offenders were drinking at the time they

committed their crimes and that a high correlation has been observed

between public order crimes and alcohol use. Alcohol is also strongly

related to violent crime (Coker et al., 2000; Dawkins, 1997; Ernst et al.,

1997; Parker and Auerhahn, 1998; Pihl and Peterson, 1995). Ironically,

this relationship often remains outside sentencing decisions and

monitoring procedures because alcohol is legal and therefore not subject to

the same arrest, seizure, and prosecution laws as are illicit drugs. Drug

treatment interventions, however, often include both alcohol and other

drugs. Comprehensive efforts to address crime and substance use should

include alcohol treatment in programmatic considerations.



The History of Drug Policy and the Definition of Crime



Crimes associated with drug use range from violent (such as murder and

aggravated assault) to acquisitive (burglary, forgery, fraud, and deception)

to specific drug-law violations. In addition, crimes such as bribery and

corruption are related to drug use as a result of drug policy prohibitions.

Traditionally, discussions of the drugs-crime relationship have focused

primarily on violent crime; however, it is important to recognize the

complexity of criminal acts associated with drug use. When considering

the drugs-crime relationship, this paper recommends that researchers and

policymakers include both violent and nonviolent crimes as well as drug

law violations and corruption associated with drug policy to grasp more

fully the resulting harms and societal costs (for example, see French and

Martin, 1996).



Efforts to address the drugs-crime relationship must incorporate a

realization of how the development of policy and law has contributed to

the relationship itself. Policy approaches to drug use in the United States

have historically ranged between legal markets in the 19th century to

decriminalization, harm reduction, medicalization, and strict prohibition

(as the dominant policy) in the 20th. Over time, policy has moved to

various points along this continuum, and it often resides at different points

at the same time in different locations and for different substances. Each

time policy shifts, the act of drug use takes on a slightly different character

in relation to crime. Thus, it is important to present a brief history of drug

policy in the United States, together with current possible positions in the

drug policy discussion, as each position has a unique implication for

fighting drug-related crime.



An understanding of American drug policy begins with three early

American cultural traditions that still strongly affect drug policy

discussions: (a) libertarianism, (b) the emergence of a relatively open legal 

market resulting from the libertarian perspective, and (c) Puritan

moralism. Libertarianism argues that government must have an extremely

compelling motive for interfering in the personal lives of citizens. Such

interference legitimately occurs only if a citizen's behavior is a significant,

actual risk to others (Mill, 1979). Consistent with this libertarian tradition,

early America had an open-market orientation that emphasized limited

government interference in the production and distribution of desired

goods and services.[1] Nineteenth-century national drug policy was

consistent with both libertarianism and the open market. While the Federal

Government regulated the importation of such drugs as opium and

cocaine, few regulations governed the distribution of these and other drugs

through what came to be called the patent medicine industry (Belenko,

2000; Inciardi, 2001; Musto, 1999). Patent medicines were extensively

advertised and, through them, the use of drugs such as opium and cocaine

became integrated into routine American cultural behavior patterns

(Musto, 1999).



Conflicting with both libertarianism and the market-driven approach is the

Puritan moralist perspective: Individual behaviors with the potential to

harm the community are seen as a community problem within the

legitimate purview of community action (Cherrington, 1920; Schmidt,

1995). Puritan and other religious and moral traditions present in

American history often viewed behavior such as substance use as

undermining the moral fabric of society, potentially causing the

withdrawal of God's blessing from America. The Puritan moralist

perspective dominated the early 1900s, an era of societal reform and

increasing prohibition (and thus increasing penalties for drug use). One of

the first successes of the social reform movement in the early 20th century

was the passage of the Pure Food and Drug Act of 1906, which required

the patent medicine industry to list product ingredients. The subsequent

passage of the Harrison Act of 1914 and the Marihuana Tax Act of 1937

made illegal the manufacture, sale, and possession of a variety of drugs,

including opiates and cocaine, as well as the nonmedical use of marijuana.

A strongly prohibitionist approach continued through the 1950s with the

Boggs Act of 1951 and the Narcotic Control Act of 1956, when mandatory

minimum sentences for Federal drug trafficking law violations were

strengthened and arrests without a warrant for drug charges were enabled.



The 1960s and 1970s represented a major cultural shift in the United

States. For a variety of reasons, American society experienced a "drug

revolution" during this era. There appeared to be an increase in the

proportion of individuals using drugs and in the variety of drugs used. The

evidence for this increase is seen in the number of drug-related arrests and

the increase in drug use in the general population (Musto, 1999). During

this era, drug policy initially shifted to a stronger treatment- and less

punishment-oriented stance. In 1966, the Narcotic Addict Rehabilitation

Act allowed the establishment of the civil commitment system instead of

prosecution for Federal offenders and encouraged State and local

governments to develop their own treatment programs. In 1970, the

Comprehensive Drug Abuse Prevention and Control Act consolidated and

replaced the patchwork of previous Federal drug laws. The Act created the

drug schedules in current use today and initiated the so-called "war on

drugs"; it also moved some possession or casual transfer offenses to

misdemeanors instead of felonies. This era may be considered a time when

drug use was primarily considered a medical/mental health problem to be

addressed by treatment, with lessened emphasis on criminal penalties for

possession and use.



With an apparent increase in drug use, as evidenced by an increase in drug

overdose cases and drug treatment admissions, a more prohibitionist

movement again swept the Nation. New York's Rockefeller Drug Laws

were passed in 1973, establishing mandatory prison sentences of up to 20

years for the sale of any amount of heroin or cocaine. The Anti-Drug

Abuse Acts of 1986 and 1988 continued to emphasize law enforcement

(although the 1988 Act gave more attention to treatment and prevention).

In yet another policy shift, treatment (including diversion into treatment

from the criminal justice system) and prevention received increasing

attention in the 1990s. Further, some States developed policies that

effectively decriminalized marijuana possession (removing jail/prison

penalties) and initiated policies, such as needle exchange programs, that

would reduce the dangers of injecting drugs.



Although scholars often focus on the relatively rapid development of

national drug policy, it is important to remember that many States passed

legislation prohibiting patent medicine and/or alcohol sales, as well as

marijuana use, a decade or more before similar legislation was passed by

Congress (Belenko, 2000). Because of how the United States is organized,

States often have or exercise considerable discretion regarding alcohol

and drug policies (Musto, 1999).



Essentially, the history of drug policy (and debates about where drug

policy should move in the future) can be broken down into five main

approaches: prohibition, risk reduction, medicalization,

legalization/regulation, and decriminalization (for an indepth discussion,

see McBride et al., 1999; see also Goode, 1997). Prohibition emphasizes

severe penalties for use, distribution, and production. Risk reduction uses a

public health approach to reduce the risks and harms associated with illicit

drug use and emphasizes education on risks, safer use practices,

prevention, and treatment. Medicalization calls for physician treatment of

drug addicts, viewing substance abuse primarily as a medical issue.

Legalization/regulation supports increased access to drugs through

governmental regulation of these substances, with possible distribution of

specific substances through governmentally controlled distribution

channels. Decriminalization calls for a complete end to the use of criminal

law to address individual drug use. This may imply a relatively open

market approach to drug availability and use, but that need not be the case.



Although there has been significant debate over which policy approach or

approaches might best address the drugs-crime cycle, more research is

needed that examines scientifically the effects of policy positions on both

drug use and crime. For the most part, current Federal drug law takes a

prohibitionist stance that includes a strong deterrence approach to reducing

the supply of drugs and high penalties for drug law violations. As a result,

a significant portion of the drugs-crime relationship is simply an artifact of

law and policy itself: "most directly, it is a crime to use, possess,

manufacture or distribute drugs classified as having the potential for

abuse" (Craddock, Collins, and Timrots, 1994).



The Statistical Relationship Between Drug Use and Criminal Behavior



The general conclusion of almost three decades of research on the

relationship between drug use and crime has been that there is a clearly

significant statistical relationship between the two phenomena (Austin and

Lettieri, 1976; Dorsey and Zawitz, 1999; Gandossy et al., 1980; McBride

and McCoy, 1993). Research indicates extensive drug use among arrested

populations, a high level of criminal behavior among drug users, and a

fairly high correlation between drug use and delinquency/crime in the

general population. Research also indicates significant differences in the

relationship based on drug type and type of crime. Importantly, all these

differences are further complicated by ethnic and gender issues.



The Drugs-Crime Relationship Within Various Population Groups



Drug use among arrested/incarcerated populations and crime among drug

users. From the early 1970s onward, biological and self-report data have

indicated a relatively high rate of drug use among arrested and incarcerated

populations (Arrestee Drug Abuse Monitoring Program, 2000; Austin and

Lettieri, 1976; Dorsey and Zawitz, 1999; Gandossy et al., 1980; McBride

and McCoy, 1993). In 1999, the Arrestee Drug Abuse Monitoring Program

(ADAM) collected data from more than 40,000 adults in more than 30

sites and more than 400 juveniles in 9 sites throughout the United States

(ADAM, 2000). In almost all cities where the ADAM project operates,

about two-thirds of both adult male and female felony arrestees had an

illegal drug in their bodies at the time of arrest (with higher rates among

females). Even among juveniles, the majority of arrestees were found to

have an illegal drug in their urine (with higher rates among males). The

data also suggest that, although current drug use rates among adult

arrestees are higher than those reported in the more isolated reports of the

1970s (Austin and Lettieri, 1976), these rates have remained steady for the

past 5 years (the same patterns are found among juvenile arrestees). An

argument can be made that with about two-thirds of arrestees already using

illegal drugs in the 72 hours prior to their arrest, there is not much room

for an increase.



A recent report from the Bureau of Justice Statistics (BJS) suggests that

drug use also is extensive among inmates in local jails (Wilson, 2000).

This document reports that the majority of inmates in State prisons and

local jails used drugs in the month prior to the offense that put them in

prison/jail. Interestingly, this same report also notes that about 10 percent

of jail inmates test positive for drugs while in jail.



The extent of crime among drug users also has been documented. From

the 1960s through the 1990s, surveys of drug-using populations both in

and out of treatment have consistently shown that the large majority of

users have extensive histories of criminal behavior and time served in

prison (Defleur, Ball, and Snarr, 1969; Inciardi, Horowitz, and Pottieger,

1993). This pattern applies to juveniles as well: Between 40 and 57

percent of adolescents treated for substance disorders also have committed

delinquent acts (Winters, 1998).



Drug use and crime levels among the general population. A tradition of

studies shows a correlation between drug use and delinquency in general

youth populations (Elliott and Huizinga, 1984; Elliott, Huizinga, and

Menard, 1989; Harrison and Gfroerer, 1992). Analysis from the National

Youth Survey has provided data often used to examine this relationship.

These data report a direct correlation between serious drug use and

delinquency (Johnson et al., 1991). Youths who used "hard" drugs (about

5 percent of the sample) accounted for 40 percent of all delinquencies and

60 percent of index crimes.



The Impact of Drug Type on the Drugs-Crime Relationship



The first National Institute on Drug Abuse (NIDA)-sponsored Crime and

Drugs Report (Austin and Lettieri, 1976) noted that a complex relationship

exists between type of drug use and type of crime. This relationship is

further complicated if multiple drug use exists. The 1999 ADAM report

shows that a fairly large proportion of arrestees tested positive for more

than one drug (up to 30 percent), and that reported criminal behavior

tended to include a wide variety of offenses. The ADAM data show that

while cocaine was the most likely drug found among adult arrestees in

large cities (and there is literature suggesting a significant relationship

between cocaine and violence), for many urban ADAM sites, violent

offenders were more likely to test positive for marijuana than cocaine. In

addition, property offenders were more likely to test positive for cocaine

than marijuana in most sites (ADAM, 2000).



The Impact of Crime Type on the Drugs-Crime Relationship



Drug law violations. A significant proportion of drug user arrests involve

violations of drug laws only. As noted previously, the United States

experienced wide drug policy shifts in the 20th century. Each shift has

uniquely affected crimes related to drug use and distribution. In a study of

611 juvenile cocaine users by Inciardi and colleagues in the early 1990s,

analyses showed that participants had committed more than 400,000

criminal acts in the 12 months prior to being interviewed. Of these, 60

percent were for drug law violations, mostly sales of small amounts

(Inciardi, Horowitz, and Pottieger, 1993). At the Federal level, a total of

581,000 drug arrests in 1980 nearly tripled to a record high of 1,584,000

in 1997. By 1997, 79 percent of drug arrests were for possession and 21

percent were for sales. Forty-four percent of drug arrests overall were for

marijuana offenses (Uniform Crime Reports, 1998). Drug defendants

comprised 42 percent of felony convictions (Bureau of Justice Statistics,

1999). A recent BJS Special Report (Wilson, 2000) also substantiates the

extensive percentage of drug-related crimes that result from violation of

drug laws, suggesting that about a quarter of jail inmates have a current

charge or conviction for drug law violations. Critics have argued that

since such arrests likely include many low-level users and dealers,

criminal justice processing and the stiff sentences that often are handed

down because of mandatory minimums may be inappropriate to the

offense level (McBride et al., 2001).



The violence connection. Changes in drug policy are usually driven by

concerns for public safety and the perception of a direct relationship

between drugs and violence (Brownstein, 1996, 2000). For example, the

drug policy reform movement of the early 1900s (changing from legal 

markets to strict prohibition) was accompanied by horror stories focused

on exaggerated claims of criminal behavior as a consequence of drug use.

In this literature, there was a particular emphasis on horrific violent crime

(including rape), with minority group members often portrayed as the drug

users engaged in the violent behavior. Musto (1999; see also Belenko,

2000; Hickman, 2000) documents the public concern of the time (perhaps

obsession) with Chinese opiate use, African-American cocaine use, and

the use of marijuana by Mexicans. The creation of the Narcotics Bureau

led to a type of media distribution industry focused on violence associated

with drug use, "documenting" the criminal consequences of such activity

(see Anslinger and Tompkins, 1953; Inciardi, 2001). Among the best

known of these efforts were the films "The Man with the Golden Arm"

(purporting to depict the effects of heroin use/ injection) and "Reefer

Madness" (showing the supposed behavioral consequences of marijuana

use). Although such media portrayals exaggerated the possible links

between drugs and crime, some research has connected drug use with

violence. Grogger and Willis (2000) conclude that without the

introduction of crack cocaine into urban America, 1991 crime rates would

have been about 10 percent lower. These researchers also examined the

impact of crack on specific types of violent crime and reported that the

biggest impact was on aggravated assault.



In 1985, Goldstein provided the perspective that has been most commonly

used to examine the relationship between drug use and violence.

Essentially, he argued for a tripartite scheme, where

"psychopharmacological violence" could result directly or indirectly from

the biochemical behavioral consequences of drug use;

"economic-compulsive violence" could relate to behavior/crimes engaged

in to obtain money for drugs; and "systemic violence" could emerge in the

context of drug distribution, control of markets, the process of obtaining

drugs, and/or the social ecology of drug distribution/use areas.[2] Some

researchers have concluded that there is minimal evidence regarding the

psychopharmacological impact of drugs on violence (Resignato, 2000);

however, Pihl and Peterson (1995) reviewed a wide range of studies on the

issue. They concluded that alcohol and drugs can be

psychopharmacologically related to violent acts through the release of

dopamine, which reduces inhibitory anxiety about the consequences of

aggressive behavior and increases the rewards associated with violence. In

addition, they argue that the psychopharmacological effects of drugs

interfere with the user's cognitive processing of the consequences of

potentially violent situations. It should be noted that these authors believe

that the evidence for psychopharmacological effects of alcohol use on

violence are much higher than for other drugs.



However, some indications point to the environment as being a more

powerful explanation of the drugs-violence relationship than the

psychopharmacological properties of drugs (Brownstein, 2000; Fishbein,

1998; Parker and Auerhahn, 1998). In terms of economic compulsive and

systemic violence, Collins (1990) as well as Fagan and Chin (1990) argue

that crack selling is the main contributor to the drugs-violence

relationship. Specifically, their research found that violence (mostly

robbery) emerged from the need to obtain money to purchase drugs

(predominately crack). Fagan and Chin suggest that the drugs-violence

relationship also emerges as a part of the subculture of violence.



In a 1994 study, Roth argued that drug users commit more property crime

than violent crime. A recent publication by De Li, Priu, and MacKenzie

(2000) examined the relationship between drug use and property and

violent crime in a population of probationers in Virginia. Results indicated

that drug use had a positive association with property crime, whereas drug

dealing had an association with both violent and property crime (though

the relationship was stronger for property crime). The analysis also

showed an interactive effect between drug use, drug dealing, and violent

and property crime. Among juveniles, Linnever and Shoemaker (1995)

found that arrests for both possession and selling of drugs were related to

the rate of property crime arrests. However, juvenile robbery arrest rates

were related to only drug sales arrests (not possession). A National

Institute of Justice (NIJ) Research in Brief supports this research, stating

"illegal drugs and violence are linked primarily through drug marketing"

(Roth, 1994, p. 1).



The Impact of Ethnicity and Gender



Much of the research that has been conducted on drugs and crime has not

had a sufficient focus on gender and ethnic variance. This limitation has

significant repercussions on applying findings to other population groups.

As Paniagua (1998) notes, the multicultural nature of current society must

incorporate a recognition of the complex nature of ethnicity and gender.

Specifically, individuals who share a similar ethnicity or gender will not

all be the same (i.e., recognition of language, acculturation, and

socioeconomic differences); however, it is important to recognize cultural

commonalities that may significantly affect both the extent and nature of

the drugs-crime relationship across individuals. Research that has focused

on ethnicity and gender indicates that these variables may significantly

affect various aspects of the drugs-crime relationship, including:



o Source of drugs and/or works (Taylor et al., 1994).



o Predictors of violence (Ellickson and McGuigan, 2000).



o Types of violence experienced and reactions to such violence

(Brownstein et al., 1994; Fine and Weis, 1998; Mazza and Dennerstein,

1996).



o Stress-coping factors (Vaccaro and Wills, 1998).



o Biological effects of drugs (Brady and Randall, 1999).



o Epidemiology of substance-use disorders (Brady and Randall, 1999).



o Psychiatric comorbidity (Brady and Randall, 1999).



o Social stigma issues (Brady and Randall, 1999).



o Medical consequences of drug use, including heredity issues and course

of illness (Brady and Randall, 1999).



o Assessment and treatment issues, including possible prevention settings

(Brady and Randall, 1999; Metsch et al., 1999; Paniagua, 1998).



o Differences in initiation of drug use (Doherty et al., 2000).



Summary: What We Know of the Past



The intended purpose of this section has been twofold. The first goal has

been to review the history of American drug policy (as well as possible

drug policy positions) within the framework of the relationship among

policy, drug use, and crime. The second purpose has been to summarize

the statistical documentation of the drugs-crime relationship. Hopefully,

this review has served to remind readers of the following issues:



1. American drug policy originated in the antithetical cultural traditions of

relatively open-market/libertarian values and Puritan moralist social

reform. These traditions still affect current debates about the drugs-crime

relationship, as well as the various policy positions between these two

endpoints on the policy continuum.



2. States have a history of experimenting with drug policies in advance of,

and sometimes in opposition to, Federal action on the same issues.



3. Public safety concerns have been the underlying rationale for the

development of drug policy at all levels of government.



4. Hyperbole, demagoguery, demonization, and perhaps even naivete have

historically characterized the drugs-crime debate (and may still). However,

there is a clear statistical relationship between drug use and crime. The

majority of drug users have extensive histories of involvement with crimes

and the criminal justice system; most arrestees are current drug users; and

there is a correlation between drug use and delinquency/crime in general

populations. A large proportion of this criminal activity is a result of drug

law violations.



5. Although there is some evidence that drug costs may be related to

property crimes and robberies, and that distribution and subcultural

elements surrounding drug use may be related to violence, there is debate

about the evidence for a strong and continuous connection between drug

use and violence. This relationship is also complicated by the type of drug

use, the category of crime, and ethnicity and gender.



The Nature and Complexity of the Drugs-Crime Relationship



As White and Gorman (2000) note, three main explanatory models exist

for grappling with the drugs-crime relationship:



o Drug use causes or leads to crime.



o Crime causes or leads to drug use.



o The relationship is purely coincidental or is based in a common

etiology.



Based on their evaluations of the research supporting and/or refuting each

of the three main models above, they conclude that "one single model

cannot account for the drug-crime relationship. Rather, the drug-using,

crime-committing population is heterogeneous, and there are multiple

paths that lead to drug use and crime" (White and Gorman, 2000, p. 151).

Ten years earlier, Collins (1990) also rejected simple explanatory models

for the complex relationship. The debates over both the direction of a

drugs-crime relationship as well as the etiological variables that may be

involved in the common occurrence of both drugs and crime have

significant implications for attempts to intervene in the drugs-crime cycle.



The Direction of the Relationship: Searching for a Cause



At the popular and sometimes at the governmental level, the drugs-crime

relationship is often clearly causal: Drug use causes crime. Models such

as Goldstein's tripartite scheme (1985) have been used to illustrate this

approach, specifying psychopharmacological, economic-compulsive, and

systemic causes of violence. As noted previously, arguments that focus on

the psychopharmacological properties of various drugs cite research that

indicates that stimulants may increase aggressiveness and paranoia and

that many drugs have a strong disinhibiting effect that could seriously

interfere with judgment (Pihl and Peterson, 1995). Economic arguments

posit that the cost of drugs, coupled with high unemployment among drug

users, results in the commission of property crimes to support drug use (16

percent of jail inmates committed their current offense to get money for

drugs; BJS, 1999). Those who argue for a systemic approach maintain that

drug use simply has a subcultural relationship with criminal behavior:

Because it is illegal, drug use involves the user in criminal subcultures that

often lead to future deviance (Fagan and Chin, 1990).



On the other hand, some researchers argue that a level of general

delinquency often precedes drug use (Elliott, Huizinga, and Menard,

1989). The subcultural explanation is used here as well: Involvement in

criminal activity and/or subcultures provides "the context, the reference

group, and the definitions of a situation that are conducive to subsequent

involvement with drugs" (White and Gorman, 2000, p. 174; see also

White, 1990). Individuals with deviant lifestyles and/or personalities may

also use substances for the purposes of self-medication (Khantzian, 1985;

White and Gorman, 2000) or to provide a "reason" for deviant acts

(Collins, 1993; White and Gorman, 2000). Although Apospori and

associates (1995) concluded that the relationship between early

delinquency and subsequent drug use was relatively weak, Bui, Ellickson,

and Bell (2000) found what they called a modest relationship between

delinquency in grade 10 and greater drug use in grade 12. Importantly,

they found no significant differences by ethnicity for this relationship.

Hser, Anglin, and Powers (1993) found that addicts who ceased narcotic

use were less likely to engage in criminal behavior over a 24-year

followup period.



Although there is some evidence of directionality in the drugs-crime

relationship, researchers who have attempted to address this issue

generally have concluded that the relationship is extremely complex and

defies attempts to sort out directionality. Work by Nurco and colleagues

on criminal careers initially found that increases in narcotic drug use were

often followed by increases in criminal activity; conversely, periods with

no drug use were associated with less criminal activity of all types (these

results applied for white, African-American and Hispanic narcotics

addicts; Nurco, Cisin, and Balter, 1981; Hanlon et al., 1990). However, in

a subsequent 1993 article, Nurco, Kinlock, and Balter found that narcotic

drug users had very early involvement in what these researchers call

"precocious criminal activity." This activity pattern occurred prior to

the onset of addiction, and therefore simply could not be attributed to

addiction itself. A recent article by Maxwell and Maxwell (2000) provides

another example of the confusing directionality, suggesting that drug use

has a very complex relationship with types of deviant behavior for women.

Their findings suggest that frequent use of crack, combined with early

onset of crack use, is related to prostitution. Drug selling, however, was

found to relate to decreased prostitution as it provided another opportunity

for income to purchase drugs. On a broader level, Curtis (1999) found that

drug use rates did not decrease in either the general or at-risk populations

during the 1990s; however, there was a widespread decrease in urban

crime during the same time period. He argues that market and cultural

forces were behind the observed changes in substance use patterns and

consequences: street drug dealers exerted higher control on both the drug

use of those who worked for them as well as the violence often associated

with street drug dealing.



A Common Origin



One of the traditions of research on the drugs-crime relationship has

emphasized that drug use and crime may not have a direct causal

relationship (White and Gorman, 2000), but may emerge in the same

contextual milieu and have the same antecedent variables such as poor

social support systems, difficulty in school, and membership in a deviant

peer group (Hamid, 1998; Inciardi, Horowitz, and Pottieger, 1993; Lurigio

and Swartz, 2000). These variables have been suggested to include such

issues as neighborhood context (McBride and McCoy, 1982), the

development of street identity for survival (Collison, 1996), social

isolation that prevents access to the social and economic systems of

society (Harrell and Peterson, 1992; Stephens, 1991), and lack of what is

now referred to as human and social capital (described later in this

chapter). Dembo and his colleagues have studied the drugs-crime

relationship among high-risk youths entering the juvenile justice system

throughout the last decade. In an important 1994 article, Dembo and

colleagues found that both delinquency and drug use emerge within the

context of family problems and peer deviant behavior. These researchers

found that for both males and females, as well as African-Americans and

whites, family alcohol and drug use, emotional problems, arrest history,

and peer deviant behavior were related to continuing drug use. Based on

these models, any simple attempt to only deter drug use through severe

punishment or treatment will not result in less crime or substance use, as

such approaches do not address the complex cause of both behaviors 

(Harrell and Peterson, 1992).



Summary



Research on understanding the nature of the drugs-crime relationship

illustrates that no simple causal model can explain the phenomena. 

Rather, the statistical relationship between the two activities may be a

result of their common etiological origin. As the purpose of this paper is to

present a background for discussion of possible research agendas to

expand and reform research on the drugs-crime relationship, it is 

important to ground such a systemwide effort in theoretical frameworks

that allow for the complex nature of the relationship. Such frameworks

can be then used to help shape possible future research.



Philosophical and Theoretical Contributions to Addressing the

Drugs-Crime Relationship



This section will provide a theoretical framework for reviewing current

programmatic approaches to breaking the drugs-crime cycle. The

theoretical approaches to be presented include both overarching behavioral

theories and philosophies specific to justice system programming.



Overarching Theoretical Approaches



While recognizing the existence of a wide range of theories on human

behavior, this paper uses ecosystems theory as an overall framework for

examining the drugs-crime relationship. Within this framework, the

concept of social capital has emerged recently as a promising approach to

breaking the drugs-crime cycle. Ecosystems theory. Human behavior,

including participation in drug use or criminal activities, takes place within

the broader social environment: circumstances, social norms, cultural

conditions, and interactions with others (Kirst-Ashman, 2000). Ecosystems

theory acts as an organizing framework (as opposed to a definitive theory

of behavior or development) that calls for an active awareness that the

interaction of biology; interpersonal relationships; culture; and legal,

economic, organizational, and political forces affects an individual's

behavior (Beckett and Johnson, 1995; Kirst-Ashman, 2000). It should be

noted that the relative influences of each force are likely to change

throughout the lifecourse of each person. Essentially, ecosystems theory

helps provide the perspective needed to understand the breadth of systems

(micro, mezzo, and macro) involved in any discussion of human behavior,

as well as specific theories that might be useful in addressing behavior.

The theory calls attention to inherent personal characteristics that affect

individual behavior, including competence, self-esteem, and self-direction

(Germain and Gitterman, 1995). 



Definitive theories of behavior that have been used to explain crime and

deviance have varied. Since the 1960s, the following theories have been

predominant: anomie, social disorganization, differential association,

social control, deterrence, labeling, and conflict (Liska, Krohn, and

Messner, 1989). Recently, however, attention has been directed to new

approaches with the hope that theoretical and research advances will better

support prevention and treatment: "integrated theory, general theory,

lifecourse transitions, and social capital appear to offer promise for the

future" (Bartollas, 2000, p. 564). We will focus specifically on social

capital since it is a relatively new theory with the potential to explain many

complex relationships.



Social capital. The social sciences have always had an interest in the

relationship among community organization, social interaction, and

individual behavior. Today, the concept of social capital increasingly is

used to understand the extent of community interaction and its effects.

Social capital was originally defined by Coleman (1988) as the quality and

depth of relationships between people in a family and community. Putnam

(1993) developed the concept to include "the networks, norms and trust

that facilitate coordination and cooperation for mutual benefit" (p. 2). The

World Bank Group (2002) modified the definition to include "the

institutions, relationships, and norms that shape the quality and quantity of

a society's interactions" (p. 1). Finally, Rose (2000) emphasized the utility

of social capital by defining it as "the stock of networks [relationships

between individuals] that are used to produce goods and services in

society" (p. 1422). Increasing evidence shows that social capital and the

social cohesion and normative environment enabling its development are

critical for community and individual quality of life. The productive utility

of informal face-to-face associations and formal organizational networks

has been noted, for example, in the areas of economic development

(World Bank Group, 2000), political participation (Putnam, 2000; Putnam

and Campbell, 2000), health promotion (Baum, 1997, 2000; Kawachi et

al., 1997; Kawachi, Kennedy, and Glass, 1999; Veenstra, 2000), and

general quality of life at the individual and community levels (Billings,

2000; Caspi et al., 1998; Lerner, 2000; Parcel and Menaghan, 1993;

Popay, 2000).



Recent studies based on social control and social bonding theories have

developed highly innovative solutions to crime prevention, linking the

levels of collective efficacy (Sampson and Raudenbush, 1999; Sampson,

Raudenbush, and Earls, 1997; Fagan, 1987), community cohesion and/or

integration (Hirschfield and Bowers, 1997; Jobes, 1999; Kawachi,

Kennedy, and Wilkinson, 1999; Kennedy et al., 1998; Lee, 2000; Mullen

and Donnermeyer, 1985; Walklate, 1998), local informal networks

(Bursik, 1999; Savelsberg, 1999), and youth family dynamics (Brannigan,

1997; Hagan, 1995, 1997; Macmillan, 1995; Sampson and Laub, 1990) to

crime rates in a given neighborhood.



Despite the extent of recent studies applying the concept of social capital,

very little research has been conducted to measure the relationship

between social capital and drug use. The only related (and very limited)

evidence points to the role of social capital in preventing youth behavior

problems (Parcel and Menaghan, 1993). Putnam (2000) found that this

was especially true for those at higher risk for parental abuse. As effective

intervention programs are developed, it is essential to differentiate

between the various forms of social capital (informal friendship and family

relationships versus formal institutional arrangements) and the quantity

versus quality of the social networks involved.



The concept of social capital can be applied to breaking the drugs-crime

relationship in several ways. First, high levels of social capital in

communities may play a role in preventing drug use and other deviant

behavior through the presence of stronger formal and informal social

bonds and networks. The presence of anti-drug-use norms within more

informal structures (such as family networks, communities of faith, and

neighborhoods) may contribute to lower drug use rates. Conversely, lower

levels of community social capital may be associated with greater access

to drugs and more lenient social norms and lowered social controls

regarding the use of drugs or association with drug users. Second, drug

users who have recently entered the criminal justice system may find that

the presence of high levels of social capital in a community result in a

stronger network of diversion options. This could be due, in part, to formal

and informal network interest in restorative justice (described later in this

chapter) versus punishment approaches to crime intervention. Third, once

a drug offender is incarcerated, high levels of social capital within the

offender's home community might better preserve networks of support for

reintegration upon the offender's release. Offenders might more easily

obtain jobs, receive support for continued sobriety, and receive

reinforcement for socially appropriate behaviors. Finally, communities

with high levels of social capital might have strong formal (vertical) social

networks in the form of coalitions or collaboratives working to reduce

substance use. Such agency connections may help focus the community on

policy development related to drug prevention and treatment systems in

homes, schools, and businesses. Such strong, integrated social networks

may offer a larger range of services and may develop more formal

horizontal relationships with other service providers, thereby improving

the coordinated delivery of services and care to those with drug or alcohol

problems. 



One example of the impact that social-capital-based concepts are currently

having on the drugs-crime relationship in the United States is the recent

establishment of the Office of Faith-Based and Community Initiatives in

the White House. This action has focused the Nation's attention on the role

of faith-based institutions in the provision of drug treatment, aftercare, and

other services. Such interventions may be particularly important in poor

and minority communities with large numbers of high-risk individuals,

where there are few (if any) traditional drug treatment programs. However,

these same communities are often served by churches and other

faith-based organizations that care deeply about the members of their

community and are well established in service provision. While concerns

about church-state separation, attempts at proselytization, and teachings of

bigotry and prejudice have prompted some to demand a clear ban on the

use of public funds to support faith-based institutions, others have begun

to carefully examine the potential of these organizations to improve the

lives of their clients. At present, there has not been sufficient research to

determine the effectiveness of treatment in faith-based settings.



Criminal Justice Philosophies



An examination of recent approaches to intervention in the drugs-crime

cycle requires a brief review of major criminal justice philosophies and

recent conceptual developments. Philosophies with the greatest promise

for success acknowledge the complex relationship between drugs and

crime. In addition, they attempt to incorporate factors that best support the

inherent personal characteristics that affect individual behavior and they

address the broader context of the social environment. These concepts

have significant implications for how programmatic interventions may

occur within the criminal justice system. Retributive justice. The

traditional criminal justice perspective of retributive justice generally sees

drug abuse as a willful choice made by an offender capable of choosing

between right and wrong and acting on that choice. The approach

emphasizes deterrence through strict penalties, including increasing

arrests, developing tougher sentencing laws, and building new prisons to

hold and punish offenders (McBride et al., 2001). Implementation of this

perspective does temporarily reduce the number of criminals on the streets

as well as interrupt an offender's drug use. However, drug-using offenders

do not appear to alter their behavior in the face of punishment alone

(Goldkamp, 1994). Thus, it is highly likely that offenders will recidivate,

and the cycle of drug use and crime will continue (Hora, Schma, and

Rosenthal, 1999).



Therapeutic jurisprudence and restorative justice. Therapeutic

jurisprudence has been defined as "the use of social science to study the

extent to which a legal rule or practice promotes the psychological and

physical well-being of the people it affects" (Slobogin, 1995, p. 196).

Within this framework, key players from the justice system (including

judges, prosecutors, and defense attorneys) move from adversarial roles to

problem solvers as part of a collaborative team while still performing their

traditional roles of guardians of community protection, administrators of

the law, and protectors of due process (Spangenberg and Beeman, 1998).

Therapeutic jurisprudence specifically addresses the needs and problems

of drug offenders from a medical, therapeutic perspective.



Drug addiction is viewed as a problem with deeply rooted biological,

psychological, and social influences, and substance abusers are seen as

having a condition that requires treatment. From this perspective, the

criminal justice system offers the best opportunity some offenders will

ever have to confront and overcome their drug use and its consequences.

Programmatic approaches that often employ therapeutic justice principles

include drug courts, restorative conferencing, cross-systems case

management, coerced and voluntary drug treatment programs, day

reporting centers, and intensive monitoring approaches. Each of these

approaches will be reviewed in greater detail later in this paper.



Within the past decade, a justice philosophy associated with the principles

underlying therapeutic jurisprudence has emerged: restorative justice.

Used primarily for nonviolent adult and juvenile offenders, the restorative

justice approach (also termed restorative conferencing) attempts to balance

the needs of victims, the community, and offenders. Unlike retributive

justice, which is concerned primarily with punishing the offender,

restorative justice seeks to repair the damage inflicted by the crime. This

approach makes the criminal process less formal by involving the victim

and community members in the planning and implementation of the

sentencing. Rather than asking what should be done to punish the

offender, restorative justice asks the following questions (Zehr, 1990):



o What is the nature of the harm resulting from the crime?



o What needs to be done to repair the harm?



o Who is responsible for the repair?



Restorative justice has been implemented in a number of programmatic

methods, including victim-offender mediation, community reparative

boards, family group conferencing, and circle sentencing (see Bazemore

and Umbreit, 2001). The shared features of these approaches include:



o Promoting citizen and community ownership of the criminal justice

system.



o Providing an opportunity for the victim and other community members

to confront the offender about his or her behavior.



o Providing opportunities for the offender to learn about the impact of the

crime and to take responsibility and be held accountable for the offense.



o Creating meaningful consequences developed by the victim, the

community, and sometimes by the offender and his or her support system.



Although concerns and implementation issues exist regarding restorative

justice (such as some resistance by the victims' rights movement, the need

for collaborative relations with the community at large, and potential

clashes with current sentencing and corrections law), the philosophical

approach shows promise as a future direction in addressing drugs and

crime (Smith, 2001).



Summary



Human behavior is an extremely complex phenomenon, and theories

imply that programs that acknowledge the multiple systems and factors

that affect behavior will have the greatest chance for realistically assisting

in behavior change--in this case, reducing both drug use and crime.

Although programmatic interventions focusing on punishment and

deterrence alone can temporarily reduce drug and crime rates, long-term

solutions seem to favor interventions based on principles similar to those

of therapeutic jurisprudence as well as restorative justice.



State- and Federal-Level Policy Approaches to Breaking the Drugs-Crime

Relationship



As noted previously, American drug policy is undergoing continual

modification. Thus, the observed relationship between crime levels

associated with drug use and drug policy is constantly changing. There are

currently a broad array of drug policy movements that may directly affect

the drugs-crime relationship. The most widespread and potentially

influential of these policy changes include marijuana medicalization

and/or decriminalization, lessening of the powder and crack cocaine

sentencing disparity, current activity surrounding club drugs, revisiting the

concept of mandatory minimum sentencing, treatment versus prison, and

model State drug laws. Each of these movements will be briefly described

below, with a focus on how the proposed policy changes may affect the

drugs-crime relationship.



Marijuana Medicalization



Movement toward the medicalization of marijuana has been ongoing since

the 1970s (see Belenko, 2000; Goode, 1997). The two actions that

preceded the movement were the National Commission on Marihuana and

Drug Abuse report in 1972 that called for reduced penalties for possession,

and the unpublished 1975 trial of United States v. Randal, which allowed

the use of a medical necessity defense for marijuana possession when a

glaucoma patient was arrested for growing his own plants (Belenko,

2000). By the end of 1982, 31 States and the District of Columbia had

enacted medical marijuana provisions (Markoff, 1997). However, in 1986,

the Food and Drug Administration approved the use of the brand-name

drug Marinol (dronabinol, delta-9-tetrahydrocannabinol, or THC) to

prevent the nausea and vomiting often occurring with cancer treatments

and to increase appetite in patients with AIDS. Many State medical

marijuana laws were allowed to expire or were repealed following

Marinol's approval (Dogwill, 1998).



Current efforts at marijuana medicalization began in the mid-1990s as a

result of media pressure and general dissatisfaction with Marinol and other

antiemetic drugs (Dogwill, 1998). As of the end of the 2000 legislative

year, 28 States had statutes providing for the medicinal use of marijuana

(Pacula et al., 2001). The type of laws enacted by States varies, and States

may have more than one law type. The list below shows the number of

States with currently operating laws and a brief description of the laws and

related protections (Pacula et al., 2001):



1. Therapeutic research programs (TRPs): 14 (only 6 of which are

currently operational). TRPs are administered by State health departments

or pharmacy boards and must be approved by the Food and Drug

Administration and adhere to specific Federal regulations. Protection is

provided only to approved and participating patients, physicians, and

pharmacies, and for specified ailments not responding to other available

treatments.



2. Physician prescription laws: 13. These laws are of three types: One

allows physicians to discuss the medical benefits of marijuana with

patients; the second allows physicians to prescribe marijuana for medical

purposes; and the third provides an affirmative defense for physician

discussion or prescription of marijuana. These laws protect physicians

only, not patients.



3. Medical necessity laws: 10. These actions provide a defense from

prosecution to patients and/or caregivers for possessing marijuana for

medical purposes if obtained via physician recommendation, certification,

or authorization.



4. Rescheduling laws: 3. These laws reschedule marijuana to categories

that recognize an acceptable use for marijuana and/or claim a lower

potential for abuse.



Of the four types of laws noted above, only TRPs are federally sanctioned.

Although the other three types of laws have been or are being challenged

in court, no firm ruling has been given that would clearly identify the final

outcome of medical marijuana initiatives. Although the outcome of the

medical marijuana debate is unknown, the policies in question have

several ramifications for the drugs-crime relationship (Pacula et al., 2001).

These include potential decreases in marijuana-related arrests due to a

supportable defense for medical use, significant changes in black-market

marijuana prices between States with varying medicalization policies,

changes in the ability or willingness to prosecute recreational marijuana

users, changes in possession penalties, and differences in use rates for both

adults and adolescents.



Marijuana Decriminalization



The decriminalization of marijuana possession in law or in enforcement

policy has been evolving for many years. In the early 1970s, the National

Commission on Marihuana and Drug Abuse called for the

decriminalization of simple marijuana possession. This would mean the

removal of all criminal penalties; possession would be neither a felony nor

a misdemeanor. In practice, the application of such a simple definition is

complex. Although 11 States indicate that they have decriminalized

marijuana, an examination of those statutes indicates that, operationally,

decriminalization means the removal of incarceration for first or second

marijuana possession offenses but may include fines and/or jail/prison

penalties for subsequent possession offenses. MacCoun and Reuter (1997)

have suggested that a better term might be depenalization. While the exact

definition of decriminalization is debated, complex, and inconsistently

applied, a review of State statutes shows significant variation regarding

possible penalties for simple marijuana possession ranging from no

monetary penalties and no incarceration to fines in the five figures and

multiple years in prison (ImpacTeen Illicit Drug Team, 2002). In addition,

anecdotal reports suggest that some local police departments simply do not

enforce existing marijuana possession laws. All of this suggests that States

(and communities) show significant variance in marijuana policy, and the

impact of this variance should be examined to determine the possible

ramifications for arrests, black-market prices, use rates, and associated

harms.



Lessening of the Powder and Crack Cocaine Sentencing Disparity



There has been considerable public and research focus on the current

sentencing differences between the possession or sale of powder versus

crack cocaine. Sentencing disparities emerged in the 1980s in the context

of large increases in crack cocaine use, together with the conclusion that

crack cocaine caused significantly more harm than powder cocaine to the

individual and the community through increased violence (McBride et al.,

2001). Congress eventually enacted legislation mandating 5-year prison

terms for the possession or sale of 5 grams of crack cocaine. This same

legislation mandated the same penalty (5 years) for the possession of 500

grams of powder cocaine (Sentencing Project, 1998). Thus, the Federal

Government defined the mandatory minimum sentencing disparity of

crack to powder cocaine at 100:1. The ramifications of this policy became

apparent fairly early in its application: There were significant increases in

the prison population, in the number of drug users in prison, and

specifically in the number of African-Americans in prison (Beck and

Mumola, 1999; Mumola, 1999). Currently, 86 percent of all Federal crack

cocaine defendants are African-American (Sentencing Project, 1998). In

1995, the U.S. Sentencing Commission recommended the elimination of

the sentencing disparity between crack and powder forms of cocaine,

arguing that the policy had not accomplished its goal of reducing crack use

but had resulted in significant unintended consequences. The

recommendation was not acted upon. In 1997, the same group

recommended moving to a 5:1 sentencing ratio, the Clinton administration

recommended a 10:1 ratio, and an additional bill was introduced in the

Senate specifying a 20:1 ratio. No action was ever taken, however, and the

initial sentencing disparity remains at the original Federal level of 100:1. It

is important to note that at the State level, sentencing disparity is not

universally mandated (but may be specified in State sentencing

guidelines). Some States, such as Michigan, have begun to modify the

disparity in their laws (Sentencing Project, 1998).



The Growing Club Drug Reaction



The general term "club drugs" refers to a "number of illicit drugs,

primarily synthetic, that are most commonly encountered at nightclubs and

'raves'" (Drug Enforcement Administration Intelligence Division, 2000, p.

1). Examples of club drugs include Ecstasy, Ketamine, Rohypnol, and

GHB (gamma-hydroxybutyrate). Both use rates and emergency department

mentions for these substances (especially Ecstasy) have recently increased.

Johnston, O'Malley, and Bachman (2001) report that use of Ecstasy in the

past 12 months among 12th graders increased from 6 percent in 1999 to 8

percent in 2000. According to the Drug Abuse Warning Network

(DAWN), there were only 25 emergency department mentions of Ecstasy

in 1994. In 1999, the number had risen to 2,850 (DAWN, 2000). Results

of these increases have been felt in both research and policy. Research

focus on the psychopharmacological effects of Ecstasy is growing (for

example, see Boot, McGregor, and Hall, 2000), as are attempts to provide

valid information about the effects and dangers of its use (Larkin, 2000).

At the Federal policy level, the Ecstasy Anti-Proliferation Act was enacted

in October 2000. The Act directs the U.S. Sentencing Commission to

increase penalties for Ecstasy trafficking as part of an increased deterrence

approach to use. State laws also are changing, with substantial numbers of

States moving to schedule Ecstasy and/or to increase penalties for sales

(ImpacTeen Illicit Drug Team, 2002).



Reconsidering Mandatory Minimum Sentencing



Mandatory minimum sentencing plays a significant role in the drugs-crime

relationship and has been a major component of the war on drugs. Initially,

it was thought that high mandatory penalties for drug law violations (such

as serving at least 85 percent of an assigned sentence) would have a

deterrent effect on drug use, related criminal behavior, and associated

costs (see McBride et al., 2001). However, the primary results of

mandatory minimum sentencing likely have been to increase dramatically

the number of drug-related arrests and the proportion of prisoners who are

drug users (Harlow, 1998; Mumola, 1999). Mandatory minimums for drug

charges may play a significant role in the shifting of power from judges to

prosecutors, prison overcrowding, and a breakdown in truth-in-sentencing

laws because of early release due to prison overcrowding. In reality, prison

overcrowding often makes mandatory minimum sentencing laws all but

impossible to enforce (see McBride et al., 2001).



Those who question the appropriateness of mandatory minimum sentences

have been supported by studies suggesting that this approach to addressing

the drugs-crime relationship is not effective and is more costly than

treatment (for example, see Caulkins et al., 1998). Significant activity at

the State and Federal level is focusing on mandatory minimum sentencing

revision. Along with seeking to reduce the crack/powder sentencing

discrepancy, the U.S. Sentencing Commission has been actively

supporting efforts to reevaluate mandatory minimum sentencing

(Sentencing Project, 1998). New York (the State that played a major role

in the introduction of mandatory minimum sentencing for drug offenders

via the Rockefeller Drug Laws) is seriously considering significant

modification of its policies. The proposed New York modifications focus

on an expansion of treatment services, a reduction in the range of

mandatory minimum sentences, and an expansion of judicial discretion

(Sengupta, 2001). If and when these changes take place (at the national

level and/or in specific States), it will be important to examine their

impact on the drugs-crime relationship. 



Treatment Versus Prison



Coerced treatment (also referred to as compulsory, mandated, or

involuntary treatment) is a heavily debated issue. Some oppose the

practice on philosophical or constitutional grounds, while many treatment

clinicians maintain that treatment can be successful only if a person is

truly motivated to change. Other researchers (Anglin and Maugh, 1992;

Salmon and Salmon, 1983) and policymakers have argued that few chronic

addicts will voluntarily agree to enter and remain in treatment without

external coercion. In a review of research examining the relationship

between various levels of legal pressure and treatment outcomes, Farabee,

Prendergast, and Anglin (1998) determined that findings generally

supported the use of coercive measures to increase the likelihood that an

offender will enter and remain in treatment. Specifically, they concluded

that compulsory substance abuse treatment is "an effective source of

treatment referral, as well as a means for enhancing retention and

compliance" (p. 7). Since researchers generally agree that length of time in

treatment is strongly related to treatment success, coercing offenders into

treatment and then applying graduated sanctions to motivate continued

participation is a potentially successful strategy. It can certainly be stated

that coerced treatment plays a major role in treatment referrals. Recent

studies indicate that the criminal justice system is responsible for 40 to 50

percent of community-based treatment program referrals (Farabee,

Prendergast, and Anglin, 1998). Rates of referral vary widely by substance,

with marijuana and methamphetamine referrals occurring significantly

more often than referrals for other substances (Drug Abuse Warning

Network, 2000).



However, Taxman (2000) argues that merely mandating an offender to

treatment does little to increase motivation or success. Simpson and

colleagues (Simpson et al., 1997; Simpson, Joe, and Brown, 1997) have

found that failure to address motivation and readiness for treatment

reduces treatment effectiveness. In addition, Farabee et al. (1999) maintain

that the application of mandated treatment varies widely, ranging from

simple referral to treatment to strict graduated sanctions with heavy

monitoring and clear penalties for failure. More research is needed to

determine which offender types may experience the greatest benefits of

coerced treatment, and with which levels of treatment structures and

settings (e.g. residential versus intensive outpatient with heavy

monitoring).



Reports on the promise of coerced treatment have prompted some State

legislatures to adopt various forms of corrections-initiated drug treatment

for nonviolent drug-using offenders. The following is a review of these

State initiatives, as well as a Federal measure under current consideration.



California. State voters recently passed the Substance Abuse and Crime

Prevention Act of 2000, which targets $128 million per year to help

counties develop the capacity to provide drug treatment, literacy training,

family counseling, and vocational training services for an expected 36,000

new treatment clients per year (San Francisco Examiner, 2000). 



Arizona. The Arizona Drug Medicalization, Prevention and Control Act of

1996 requires mandatory treatment and prohibits incarceration of first- and

second-time drug offenders. A 1998 Arizona Supreme Court report

concluded that the State saved $2.5 million in its first year by sending

users into treatment rather than prison (Arizona Supreme Court, 1999).

Although critics claim it is too early to argue for program effectiveness

due to selection bias and lack of long-term recidivism rates, the study

found that 77 percent of offenders tested drug free at the end of their

outpatient treatment programs. In addition, probationers who received

treatment were twice as likely to be employed (90 versus 41 percent), to

finish community service requirements (85 versus 40 percent), and to

complete probation successfully (85 versus 22 percent) when compared

with those who did not complete treatment.



New York. Governor Pataki recently unveiled a plan to reform the State's

Rockefeller Drug Laws by cutting minimum sentences from 15 to 8 1/3

years for some offenses, giving judges increased discretion in sentencing,

and giving prosecutors the power to divert repeat drug offenders into

18-month residential treatment programs in lieu of prison time (Gallagher,

2001). These plans resulted primarily from the recommendations of an

independent commission charged to study the impact of drug cases on

New York State courts. The principal recommendation of this commission

was to "launch a systematic, statewide approach to the delivery of 'coerced'

drug treatment to nonviolent addicts in every jurisdiction" (New York

State Commission on Drugs and the Courts, 2000, p. 7).



Massachusetts. The Department of Public Health's Bureau of Substance

Abuse Services recently reported that integrating such services across the

State resulted in significant improvements in a number of categories,

including reductions in crime involvement, psychological problems, and

use of health services, as well as improvements in employment levels and

abstinence rates (Massachusetts Department of Public Health, 2000).

Based in part on these successes, ballot initiative Proposition P was

introduced in the 2000 general election to divert drug forfeiture money

from police and district attorneys to treatment centers. The measure failed,

possibly due to claims that the initiative was a cover for efforts to

decriminalize dangerous drugs (Boston Globe, 2000).



National. The U.S. Senate is currently considering the recently introduced

Drug Abuse Education, Prevention, and Treatment Act of 2001 (S. 304,

2001). The measure would, among other things, authorize new funding

grants to States for the purpose of providing drug treatment services to

inmates and residential treatment facilities.



Model State Drug Laws In 1992, the President's Commission on Model

State Drug Laws was charged with the task of creating a compilation of

model State laws that would effectively address drug and alcohol use

(President's Commission on Model State Drug Laws, 1993). After a series

of public hearings, drug treatment program site visits, and meetings with

various individuals, agencies and groups, a total of 44 model laws and

policies were developed. In its report, the Commission noted that



[T]he legislative remedies offered within do not rely exclusively on

punishment and deterrence to "solve" drug problems. Instead, the goal of

this report is to establish a comprehensive continuum of responses and

services, encompassing prevention, education, detection, treatment,

rehabilitation, and law enforcement to allow individuals and communities

to fully address alcohol and other drug problems. Tough sanctions are used

to punish those individuals who refuse to abide by the law. More

importantly, the recommended sanctions are designed to be constructive,

attempting to leverage alcohol and other drug abusers into treatment,

rehabilitation, and ultimately, recovery. (pp. 1-2) 



The five main policy areas are as follows (see appendix A for a listing of

specific model laws and policies within these areas): economic remedies,

community mobilization, crimes code enforcement, treatment, and

drug-free families/schools/ workplaces (President's Commission on Model

State Drug Laws, 1993).



Following the compilation of the model laws and policies, The National

Alliance for Model State Drug Laws (Alliance) was organized as a

nonprofit group that would serve as an ongoing resource for States

considering implementation of legislation based on the model laws. The

Alliance has held several conferences across the United States to work

with elected and appointed officials, substance abuse professionals, and

other community leaders and members (National Alliance for Model State

Drug Laws, 2001). Several States have passed legislation using the model

laws as a framework for laws specifically tailored to their needs, including

Arizona, Arkansas, Georgia, Iowa, Kansas, Louisiana, Mississippi, New

Jersey, North Carolina, Pennsylvania, and Utah (National Alliance for

Model State Drug Laws, 2001). However, no known evaluations of the

impact of these laws currently exist. Additional efforts by the Alliance to

assist with drug policy revision include providing national and Federal

agencies with assistance on State and local laws and policies.



Summary



Trends in State- and Federal-level policies aimed at the drugs-crime

relationship can (and indeed do) move in different directions for different

substances. Although there has been considerable movement to modify

marijuana laws at the State level, no comparable action has been seen at

the Federal level. The movement toward reducing the sentencing disparity

between crack and powder cocaine (as well as reduce overall penalties) is

co-occurring with State and Federal trends to increase the scheduling and

penalties for club drugs such as Ecstasy. A further concern raised by this

section is that although research may indicate the legitimacy and wisdom

of revising current policy (such as moving to coerced treatment instead of

incarceration), there is often significant resistance to such actions based on

the fear of further escalations of the drugs-crime connection or negative

voter reaction. The nature of public policy is complex and reciprocal: The

public elects policymakers who support the majority view. This tends to

make legislators cautious about supporting changes in drug policy.

Therefore, the development of possible public policy that might contradict

traditional viewpoints can be highly problematic (Tonry, 1996). However,

the breadth and scope of potential legislative actions is impressive. With

an increasing number of States developing innovative laws based on

examples such as the Model State Drug Laws, there is need for researchers

to examine the possible effects of such policy changes.



This paper has reviewed a wide variety of data describing the drugs-crime

relationship and its complex nature, conceptual frameworks that may help

interpret the relationship, and the implications of policy for the

relationship. An important part of society's reaction to the relationship has

been to develop programs to intervene with or break the drugs-crime cycle.

Although such intervention attempts have occurred for more than a

century, they have become increasingly sophisticated as policy makers and

clinicians have come to further understand and apply research findings and

relevant conceptual models. The next section of this paper examines many

of the intervention programs that have been used and assesses key program

elements that have shown some success at intervening in the drugs-crime

relationship.



Integrated Programmatic Approaches to Breaking the Drugs-Crime Cycle



In developing programmatic interventions designed to break the

drugs-crime cycle among offenders, it is essential to ensure that neither

community safety nor offender accountability be compromised in any way,

particularly for violent and chronic offenders. However, as noted

previously, drug-related crimes exist along a continuum of severity

ranging from index crimes--such as murder and armed robbery--to more

minor offenses such as nonviolent drug possession. Interventions such as

drug treatment should be provided along a continuum as well.

Drug-involved offenders who commit serious crimes might receive drug

treatment services in a significantly restrictive prison-based therapeutic

community. Nonviolent drug-using offenders might receive sentencing and

ongoing supervision from a drug court and participate in minimally

restrictive victim-offender mediation, along with mandated attendance in

intensive outpatient drug treatment services.



Many jurisdictions struggle to integrate substance abuse treatment into

their criminal justice systems, which often view such efforts as adjunct

services rather than primary, integrated components. Taxman (2000) notes

six threats that impede the implementation of treatment services:



o Lack of clear crime control goals for treatment services.



o Lack of clear assessment and eligibility requirements.



o Insufficient treatment duration to effect behavioral change.



o Lack of supervision and sanctions/ rewards to reinforce treatment goals. 



o Lack of objective drug testing to monitor treatment progress.



o Insufficient case management services.



Many researchers and practitioners have argued that to address these

threats, a comprehensive and integrated approach should be used to

maximize treatment success and minimize future harm to the community

(Anglin and Hser, 1990; Inciardi et al., 1997; Taxman, 1998, Farabee et

al., 1999; Martin et al., 1999; Taxman, 1998). Taxman (2000) argues for a

systems approach in which "correctional and treatment agencies build a

delivery system that cuts across and integrates the systems, reduces

duplication in efforts to create and recreate processes for unique programs,

and emphasizes empirically driven programmatic components" (pp. 5-6). 

The following review will discuss interventions designed to break the

drugs-crime cycle among offenders using an integrated approach that can

be applied throughout the range of sentencing alternatives.[3] This

approach, which integrates restorative justice with an ecosystems

framework, includes the following components: immediate and

comprehensive assessment; judicial processing, including the use of drug

courts; supervision and monitoring, including graduated sanctions and 

cross-systems case management; cross-systems collaboration; the drug

treatment service continuum; and aftercare.



Comprehensive Assessment and Treatment Planning



Appropriate client selection, assessment, and placement have been

identified as critical components of the treatment continuum (Simpson and

Curry, 1997-98; Taxman, 1998; Farabee et al., 1999). Substance abuse

problems are usually enmeshed within a wide variety of other issues. Thus,

comprehensive assessment is necessary to successfully address alcohol and

other drug problems.



Assessment. Assessment usually occurs at the point of intake into the

criminal justice system (often at either centralized intake centers or police

stations). Intake recommendations can heavily affect judicial decisions; it

is imperative that intake personnel be thoroughly trained in the use of

comprehensive assessment tools. Such training should include

incorporation of culture and ethnicity issues in comprehensive evaluations,

as well as dealing with the complexities of clients with multiple diagnoses.

A poorly conducted assessment, using techniques and measurement

instruments that do not consider the offender's entire life situation in a

holistic manner, are destined to produce faulty and inadequate

recommendations and decisions. Careful assessment mechanisms not only

will help identify those services that are most needed by offenders, but

also will prevent system duplication leading to inefficient and poorly

coordinated service delivery. By properly assessing and coordinating

services at intake, the justice system can more effectively work towards

preventing increasing levels of future recidivism and drug use.



Offender evaluation generally occurs in two phases: initial screening,

followed by more comprehensive assessment. The primary purpose of

initial screening is to determine if the need for a more comprehensive

assessment exists. Thus, it is inappropriate to use screening instruments to

formulate a diagnosis or decide treatment needs. Screening instruments

also filter out individuals with medical, psychological, or legal problems

that need to be addressed prior to placement. Common screening

instruments include the CAGE Questionnaire, the Michigan Alcoholism

Screening Test, and the Offender Profile Index (for more detailed

descriptions of these tools, see Inciardi, 1994).



If the screening instrument indicates an alcohol or other drug problem, a

more comprehensive assessment is needed. At minimum, a comprehensive

assessment should include:



o An indepth examination of the severity and nature of the alcohol and

other drug abuse identified by the screening process.



o A more thorough assessment of additional problems flagged during

screening and further inquiry into problems that may not have been

identified up to that point.



o A strong effort to use multiple methods and sources.



Components of a comprehensive assessment instrument include:



o History and current patterns of alcohol and other drug use.



o Past and current involvement in the criminal justice system, including

any history of violent behavior and manifestations of antisocial personality

and psychopathology.



o Family and social support systems.



o Medical history and current health status, including HIV/AIDS

screening.



o Mental health history and current status, including screening for any

history of abuse, anxiety, or depression.



o Educational and vocational history and needs.



Two commonly used assessment instruments are the Addiction Severity

Index (ASI) and the Wisconsin Uniform Substance Abuse Screening

Battery (adapted from the well-known Minnesota Multiphasic Personality

Inventory). The Wisconsin instrument is composed of four separate

sub-instruments: the Alcohol Dependence Scale, the Offender Drug Use

History, the Client Management Classification interview, and the

Megargee Offender Typology. Important supplemental tests to these

comprehensive assessment instruments include the AIDS Initial

Assessment Jail/Prison Supplement and various biological tests to

determine recent drug or alcohol use, including urinalysis, breathalyzer

tests, blood tests, hair analysis, and sweat tests (for more detailed

descriptions of all of these tools, see Inciardi, 1994).



Comorbidity issues. Researchers report high rates of depression in street

drug-using populations (McBride et al., 2000). Additionally, a wide

variety of data suggest that there is a high rate of comorbidity among

incarcerated drug-using populations. Since the early 1970s, researchers

have called attention to the special needs of jail inmates with mental

illness (Gibbens, 1979; Gold, 1973; Verma, 1979). Although indepth

studies on the prevalence of mental illness in prisons are very limited,

researchers estimate that around 7 to 9 percent of jail inmates are mentally

ill (BJS, 1999, as cited in Lurigio and Swartz, 2000, p. 67). Rates of

mental illness among those who are alcohol or drug dependent are

believed to be much higher. Peters and colleagues (1992) found that, of

jail inmates who were receiving substance abuse treatment, more than half

self-reported a history of depression, 45 percent reported serious anxiety or 

 tension, and 19 percent had a history of suicidal thoughts. Among

juveniles, the Northwestern Juvenile Project has estimated that two-thirds

of juvenile detainees have one or more alcohol, drug, or mental disorders

(Teplin, 2001). Because depression is also a consistent predictor of

therapeutic noncompliance, it is important to make sure that an alcohol or

other drug-diagnosed arrestee is properly assessed and treated for

depression or other mental disorders (Markou, Kosten, and Koob, 1998).



The conditions and care received by the detained mentally ill have been

found to be grossly inadequate (Alemagno, 2001; Birmingham et al., 2000;

Lurigio and Lewis, 1987). Outcome studies suggest that to serve this

population better, the most effective approach includes adequately training

jail and prison personnel to meet emergency situations, perform basic

assessments, and make appropriate referrals to community-based mental

health services where safety concerns can be adequately monitored. Such

an approach would have the added benefit of also avoiding

community-based service duplication (Cox, Landsberg, and Paravati,

1989; Lurigio, 2000).



Treatment planning. The treatment plan should be based on the client's

needs, problems, strengths, and resources as identified in the assessment

process, and it should seek to use assessment information to match the

client with the best treatment modality and level of risk (Inciardi, 1994;

McLellan et al., 1997; see also Taxman, 2000). Although clients should

participate in the planning process to improve buy-in and treatment

compliance, they cannot dictate treatment goals. Treatment planning goals

and objectives should be specific, measurable, and attainable. They should

also be flexible enough to adapt to emerging client needs as they move

through the criminal justice and treatment systems. Goals must conform to

the limitations imposed by the court, parole or probation department, or

other criminal justice agency that has jurisdiction over the client. Good

treatment plans also are designed to address issues related to treatment

attrition, noncompliance, and inadequate progress (Inciardi, 1994).



At the conclusion of intake and assessment, intake officers generally have

the option of dismissing the case with no further action, placing the

offender in a diversion program, or referral to further justice system

processing.



Judicial Processing



If a decision is made to formally refer an offender to court for further

processing, judges will generally use the assessment and arrest report as

well as other facts to determine disposition and, if necessary, sentencing.

In most jurisdictions, factfinding and adjudication take place in 

conventional court systems. However, in an attempt to play a more active

role in breaking the linkage between substance use and crime, the judicial

system developed the drug court.



Specifically, a drug court takes responsibility for less serious drug-using

offenders, and often uses an intensive supervision and treatment program

based on graduated sanctions (described below). Drug courts are

partnerships between justice system personnel (prosecutors, defense

attorneys, and judges); treatment specialists; and other social service

personnel (National Association of Drug Court Professionals, 2000). Drug

courts allow judges to take a more active role than was provided by such

previous options as mandated lengthy sentences and to partner with

community resources and agencies. Judges draw on a variety of

professionals in assessing needs and recommending services. They are

then actively involved in the decisionmaking process regarding what

services are to be received. Judges also monitor compliance and apply

sanctions when a lack of compliance is evident. Some of the most unique

and essential principles of drug courts include immediate and upfront

intervention; coordinated, comprehensive supervision; access to a wide

variety of treatment services including long-term treatment and aftercare;

and graduated sanctions and incentive programs (Tauber, 1994; for more

indepth information on suggested organizational factors, see Berman and

Anderson, 1999; Cooper, 1997; McBride et al., 1999; National

Association of Drug Court Professionals, 2000; Peyton and Gossweiler,

2001).



Evaluations of drug courts have been mixed. Concern has been expressed

over evaluation research methodology, wide variations in populations

served, and lack of consistent standards for assessment and referral

(Inciardi, McBride, and Rivers, 1996; U.S. General Accounting Office,

1997). More recent reviews by Belenko (1998) and Covington (2001) have

concluded that drug courts have not been subjected to consistent or

methodologically strong evaluations that define terms clearly (from

program elements to definitions of success), examine the long-term impact

of drug courts using appropriate comparison groups, or identify what

program elements contribute to successful outcomes. Peyton and

Gossweiler (2001) suggest the need for more comprehensive policies and

protocols consistently applied in all drug courts. This would contribute

significantly to methodologically strong evaluations.



With the above concerns noted, evidence still points to a positive impact

for drug courts: high treatment retention, increased sobriety, and

reductions in recidivism have been noted in many drug court locations; in

addition, savings in jail costs can be substantial (Drug Strategies, 1997;

Cooper, 1997; Harrell, Cavanagh, and Roman, 2000). A recent evaluation

of a midwestern drug court by Spohn and colleagues (2001), which used a

comparison group design and controlled for a variety of social and

behavioral characteristics, concluded that drug court participants had

significantly lower rates of recidivism than those who received standard

court processing. To be successful, drug courts require a long-term

outlook, significant initial resource allocation, and available treatment

slots (Platt, 2001). Additional research is needed to address the significant

issues critics have raised regarding the scientific support for drug court 

enthusiasm.



Supervision and Monitoring



As stated in the introduction to this section, interventions for drug-using

offenders must ensure community safety as well as offender

accountability. Programmatic approaches designed to help accomplish

safety and accountability goals include supervision via a system of

graduated sanctions, use of drug monitoring and testing to substantiate

accountability, and system oversight and coordination through

cross-systems case management.



Graduated sanctions. Judicial processing within systems such as drug

courts often relies on graduated sanctions for supervision purposes. This

approach helps ensure offender rights and deters noncompliance.

Graduated sanctions are based on the theoretical foundation of procedural

justice, which posits that compliance is enhanced by procedures that are

perceived as fair (Taxman, Soule, and Gelb, 1999). Lack of compliance is

a significant problem across the justice system. Studies indicate that as

many as 61 percent of probationers fail to comply with release conditions

(Langan and Cunniff, 1992), and that 30 to 80 percent of new prison

intakes each year are probation and parole violators (Burke, 1997; Rhine,

1993). Some critics have expressed concerns that graduated sanctions are a

form of "net widening," in which probationers are given technical

violations for positive urinalysis tests. Such positive tests have become the

equivalent of crimes, although they are described by the drug treatment

system as relapses.



Taxman, Soule, and Gelb (1999) state that the efficacy of graduated

sanctions results from the use of structured, incremental responses to

noncompliant behavior and from an emphasis on swift response to

noncompliant acts through a series of specific sanctions that vary based on

such factors as the nature and number of violations. The concept of

graduated sanctions applies to the following:



o The type of initial treatment intervention (outpatient, residential, or

types of collaborative services).



o The service delivery sentencing context (from community diversion to

incarceration with coerced drug treatment in a State training school).



o Overall intervention/treatment program outcome goals.



o Progress within the program (McBride et al., 1999).



Taxman, Soule, and Gelb (1999) state that to be effective, graduated

sanctions must include three specific elements:



o Inform offenders about infractional behavior and the potential

consequences for such behavior.



o Ensure that all members of the graduated sanctions judicial team adhere

to the agreed-on sanctions model.



o Strive to uphold offender dignity.



Use of a behavioral contract informing the offender of the graduated

sanctions menu should be developed at intake or at the time of

court-ordered probation. Such a sanctions menu should reflect certainty,

consistency, parsimony, proportionality, and progressiveness (Taxman,

Soule, and Gelb, 1999), and it should provide for equivalent responses that

allow for tailoring sanctions to specific cases.



Research specifically evaluating graduated sanctions approaches is very

limited. However, the use of this approach is quite common within drug

courts. In addition, initial studies indicate that offenders in a pretrial

intervention program that used graduated sanctions had lower rearrest rates

for both short- and long-term (1-year) followup (Harrell, 1998). In

addition, the cost-benefits of graduated sanctions indicate promise

(Greenwood and Turner, 1993; Rivers and Trotti, 1995).



Drug monitoring and testing. In recent years, drug testing programs have

become increasingly widespread in criminal justice settings (Jacobs,

DuPont, and Gold, 2000). In 1998, 71 percent of jails reported having a

policy to test inmates for drug use; however, only 8 percent imposed

mandatory treatment in response to positive test results. Instead, the most

common responses to positive testing involved punitive sanctions ranging

from loss of privileges to adding time to the sentence (Wilson, 2000), a

practice that critics regard as net widening. Regular drug testing is often

part of an overall strategy in which both treatment and criminal justice

systems use graduated sanctions to monitor compliance. Advocates of

such strategies recommend that testing must be conducted frequently and

randomly. Researchers (Marlowe, 2001; Taxman, Soule, and Gelb, 1999)

have recommended several compliance-gaining strategies, including

clarification of negative and positive behaviors as well as swift, certain,

and progressive responses. It is important to use a team approach

in which treatment providers and criminal justice personnel share

information about progress or relapse issues. It is also important to ensure

that offenders are tested as long as they are under criminal justice system

supervision.



A wide variety of testing methods exists for illicit drugs, with variation in

reliability and validity among testing procedures. The most widely

practiced technique is urinalysis. Urinalysis offers a number of advantages

compared with other testing methods, including ease in obtaining a

sample, ability for sample retest, and low cost (Jacobs, DuPont, and Gold,

2000). However, subjects can easily tamper with samples, and testing only

reflects drug use within the last few days. The window of detection is also

small for blood sampling, although results are highly reliable. In contrast,

hair analysis allows for detection of long-term use (within the last 90

days), but provides unreliable data for studying variables other than simple

drug presence. The least invasive testing techniques include sweat patch,

saliva testing, and nail testing, but the wider utility of these approaches

remains to be studied. Although a combination of modalities is likely to

offer the most accurate results, privacy and feasibility issues usually

determine which methods are used in practice (Jacobs, DuPont, and Gold,

2000). Comprehensive outcome studies are needed to evaluate the linkages

between drug testing and expected (negative) consequences for positive

results.



Cross-systems case management, including TASC. Case management

provides one way for criminal justice systems to coordinate the

comprehensive needs of offenders. Case management has emerged as a

strategy to connect clients to needed resources throughout the service

continuum, at intake, during treatment, and after treatment. Case

management results in more rapid service access (Bokos et al., 1992),

higher levels of goal attainment (Godley et al., 1994; Rapp, 1997), longer

lengths of stay in treatment (Rapp et al., 1998), reductions in drug use

(Rapp, 1997), improved employment functioning (Siegal et al., 1996) and

improved connection to needed resources over time (Dennis, Karuntzos,

and Rachal, 1992; Godley et al., 1994; Schlenger, Kroutil, and Roland,

1992) when compared with standard treatment services. Research suggests

that case management may be effective as an adjunct to substance abuse

treatment for two reasons: Retention in treatment is generally associated

with better outcomes, and one of case management's primary goals is to

keep the client engaged in the treatment process (Kolden et al., 1997;

Siegal et al., 1995, 1996, 1997); and treatment is more likely to succeed

when a client's non-substance-abuse problems are also being addressed

(e.g. financial problems, family problems, etc.; see Siegal, 1998).



Case managers (CMs), who are often mental health or social workers,

support and reinforce treatment goals throughout the treatment continuum

by providing the following three functions: assessment (Babor et al.,

1991); treatment planning and goal setting, linking, monitoring and

advocating (Ballew and Mink, 1996), including navigating the

often-confusing social service system (Spear and Skala, 1995); and

assisting in offender reintegration with home or other placement, social

services, and the workforce. In addition, CMs may intervene in crisis

situations or assist offenders with relapse prevention strategies such as

developing non-drug-related leisure activities. Intensive case management

services are most critical during the vulnerable 2-month period following

discharge from primary treatment. They provide continuity of care while

simultaneously working to move the client toward independence.



Although a CM can help an offender navigate through the interconnected

array of treatment services, it is also clear that such services must be

provided in the context of the justice system. Drug courts, probation

offices, and other criminal justice system components must work with

CMs to coordinate an offender's movement through the justice system via

the use of graduated sanctions. The graduated sanctions process allows the

judge or probation officer to maintain an appropriate balance between

community protection and offender rehabilitation. However, judges

generally have neither the time nor the training to ensure that offenders

receive a continuum of services. According to a recent NIJ examination of

case management within the criminal justice system (Healey, 1999),

optimum case management models currently combine two broad

approaches: strengths-based case management--focusing on a client's

self-identified strengths and talents when developing a service plan, and

assuming a client's ability to use these strengths to move toward "socially

acceptable choices" (Clark, 1997; Enos and Southern, 1996; Rapp et al.,

1998; Siegal et al., 1997); and assertive case management-- requiring

active involvement of the CM in seeking out and delivering services to

clients as opposed to passive service provision (Healey, 1999; Inciardi,

McBride, and Rivers, 1996). Within the criminal justice setting, CMs

combine support and positive regard for a client's strengths with clear

disapproval of the behaviors that led the client to become involved with

the justice system.



Healey (1999) notes that criminal justice case management often involves

a conscious blurring of roles between CMs, mental health providers,

substance abuse counselors, domestic violence program counselors, and

other social service providers. Taxman and Sherman (1998) have

suggested that much of the role confusion can be reduced through a

systemic approach to case management, including agreed-on role

clarifications and resource allocation. Significant cross-training is often

necessary to allow such blurring to take place without confusion of

appropriate role responsibility or misunderstandings regarding

philosophical differences (Healey, 1999). 



Effective use of assessment data within a case management framework

requires a complex information system that can ensure the availability of

relevant information to those involved in service provision (Taxman and

Sherman, 1998). If services are to be integrated effectively, it is crucial

that intake, assessment, and progress information be shared and not be

needlessly duplicated. Such information can play a major role in increased

service delivery efficiency and improve the outcome of provided services

(for further discussion of this area, see Mahoney et al., 1998).



Perhaps the best example of a programmatic approach incorporating

cross-systems case management is TASC: Treatment Alternatives for Safe

Communities (also known as Treatment Alternatives to Street Crime, or

Treatment Accountability for Safer Communities). TASC is recognized as

an offender management model (Anglin, Longshore, and Turner, 1999)

that links criminal justice system legal sanctions with drug treatment

program therapeutic interventions (Sigmon et al., 1999; see also Inciardi

and McBride, 1991). The TASC approach consists of 4 distinct processes

and 10 critical elements (Bureau of Justice Assistance, 1995). The four

processes are:



o Identification of appropriate drug-involved offenders.



o Assessment of treatment needs.



o Referral to appropriate services and placement.



o Continuous case management at all points along the criminal justice

processing continuum (Anglin, Longshore, and Turner, 1999).



The 10 critical elements involve:



o Broad-based support within both the criminal justice and treatment

systems with formal communication systems.



o Independence as a unit with designated administrator.



o Appropriate staff training on TASC policies and procedures.



o An established data collection system.



o Explicit and agreed-on eligibility criteria.



o Documented assessment/referral screening procedures.



o Documented policies and procedures for drug testing.



o Offender monitoring procedures, including reporting procedures

(Bureau of Justice Assistance, 1995).



The usual position of a TASC program is that of a neutral party. Most

program sites do not provide treatment services of their own, nor are they

an official member of the criminal justice system. Thus, the programs can

be perceived as using nonbiased referral judgments and case management

decisions.



Evaluations of TASC programs have been mixed, based on whether the

evaluation is examining operational/procedural issues or outcome issues.

Operational/procedural evaluation results (see Anglin, Longshore, and

Turner, 1999) have been consistently positive, citing strong screening and

identification of drug-using offenders (Toborg et al., 1976); effective

linkages with the criminal justice system; increased ethnic diversity in

treatment; and increased treatment participation (Collins et al., 1982);

improvements in treatment retention (Hubbard et al., 1989; Inciardi and

McBride, 1991), and considerable cost-benefit ratios when compared with

any form of incarceration (System Sciences, 1979). Outcome evaluations

have been mixed. Studies focusing on recidivism generally show that

TASC clients either have higher recidivism rates or no significant

differences in recidivism compared with control groups (Anglin,

Longshore, and Turner, 1999; Owens et al., 1997). However, as TASC

uses higher monitoring levels, results on recidivism may simply indicate

"net widening"; those who are watched more are caught more. This may

indicate a possibility of higher public safety in TASC communities, rather

than program failure. Anglin, Longshore, and Turner's (1999) review of

five TASC programs chosen to reflect similar programmatic and

population characteristics (including adherence to the 10 critical elements)

indicated favorable outcomes for service delivery, drug-use days, drug

crimes, and sexual activity while high on drugs. However, these results

were either modest or were confined to high-risk offenders. Anglin,

Longshore, and Turner conclude that more problematic offenders may

receive the highest benefit from program participation. Covington (2001)

reminds program administrators and researchers that TASC programs have

generally not received consistent methodologically strong long-term

outcome evaluations. Future research should focus on these issues.



Cross-Systems Collaboration



By definition, the drugs-crime relationship crosses currently accepted

jurisdictional responsibilities and requires system partnerships. The

promising components described so far in this paper demand the

successful integration of a wide variety of services and jurisdictions,

including criminal justice, drug treatment, social services, and public

health. Effective use of immediate and comprehensive assessment, drug

courts, communication necessary for successful use of graduated

sanctions, cross-systems case management in the form of agencies such as

TASC, and post-criminal-justice transition services to reintegrate drug

users back into the community-- all of these approaches are based on an

integrated care system. Yet, as Sigmon et al. (1999) note, the adjudication

process is historically an adversarial system, and creating successful

partnerships that involve a variety of individual agencies is often 

difficult.

 

To build the infrastructure required to support cross-systems interactions,

collaborative efforts are becoming widespread. Eisenburg and Fabelo

(1996) argue that failure to develop an integrated infrastructure not only

negatively affects the outcomes of individual programs, but also hastens

treatment decay. Such infrastructures have a variety of names but one

essential goal: to have representatives from key agencies and services join

together to identify the problems their community is seeking to target,

develop effective goals and strategies to address those problems, and then

oversee the implementation of those goals and strategies (Sigmon et al.,

1999). The types of problems such collaborative efforts address should not

be narrowly construed. Sigmon and colleagues (1999) refer to adjudication

partnerships as an "umbrella concept under which many interagency

efforts can be classified" (p. 2).



While collaborative formation usually results from grassroots efforts of

local leaders (Sigmon et al., 1999), the recent emergence of State- and

county-level managed-care models often require provider subcontracts and

collaboration (McBride et al., 1999). Key agency members for

collaboratives addressing drugs and crime would include justice system

agencies (offices of the prosecution, the defense, and the court), as well as

other groups such as law enforcement, welfare, State and local corrections,

managed behavioral health care, community treatment, the health

department, and State and local managed-care initiatives (Mull, 1998;

Sigmon et al., 1999). Such a membership list would allow two essential

types of individuals: "1) those who understand and have an interest in the

broad and specific problems of community welfare, justice, alcohol and

other drug abuse, and health and social services, and 2) community leaders

who can ensure that productive change occurs" (McPhail and Wiest, 1995,

p. 28).



Although each collaborative will be uniquely tailored to the community it

serves, reviews of collaborative efforts have identified several critical

elements for success (Sigmon et al., 1999, pp. 2-4; see also Bureau of

Justice Assistance, 1995; McBride et al., 1999). These include leadership

designation, membership integration, goal setting, development of a team

approach, emphasis on a long-term view, research and evaluation, efforts

to develop broad-based community support, and sustainable funding (see

appendix B for a more thorough discussion of these elements).



Continuum of Drug Treatment Services



Many policymakers, particularly legislators, oppose funding for drug

treatment in correctional facilities, believing that the public wants

offenders punished rather than coddled (Lipton, 1998). However,

research involving numerous large-scale studies consistently demonstrates

that treatment has beneficial outcomes. These federally funded and

independently evaluated studies--including the Drug Abuse Treatment

Outcome Study (DATOS), the National Treatment Improvement

Evaluation Study (NTIES), the Treatment Outcome Prospective Study

(TOPS), and the Drug Abuse Reporting Program (DARP)--have all

confirmed drug abuse treatment efficacy through 1-year followup. These

findings remained valid when controlling for type of service received

(residential long-term, outpatient drug-free, or outpatient methadone

maintenance) as well as drug and client type (U.S. General Accounting

Office, 1998). However, the National Research Council (2001) has

questioned the strength of these studies' conclusions, arguing that because

the studies lacked randomized assignment, researchers "could not provide

rigorous evidence on the relative effectiveness or efficacy of particular

drug-by-treatment combinations, or estimate the absolute effect size,

cost-effectiveness, or benefit-cost ratio of treatment" (p. 230).



Cost savings for treatment relative to incarceration, interdiction, and health

care expenditures have been estimated by two recent studies. The first, the

California Drug and Alcohol Treatment Assessment (CALDATA),

examined the effectiveness, costs, and benefits of providing alcohol and

drug treatment in California (Gerstein et al., 1997). Economic savings to

the California taxpayer both during and after treatment were estimated to

be worth $10,000 per client, yielding a 1:7 cost- benefit ratio (the greatest

share of the benefits was found in crime reductions, with smaller savings

in health care and welfare costs). The study also reported a 68-percent

reduction in drug selling and a 60-percent reduction in arrests resulting

from drug treatment. In the second study, RAND researchers developed an

economic model to estimate the relative cost-effectiveness of four

cocaine-control programs: three "supply control" programs

(source-country control, interdiction, and domestic enforcement) and a

"demand control" program treating heavy users (Rydell and Everingham,

1994). Results indicated that for every dollar spent on drug treatment, $7

would have to be spent on incarceration and $25 on interdiction to achieve

the same degree of reduction in cocaine use (cost savings would vary

depending on factors such as treatment setting, length of time in treatment,

and degree of treatment structure). Further, they argued that even when

only looking at modest in-treatment effects (assuming 0-percent

post-treatment effectiveness through abstinence), cost savings for

treatment exceeded those that would be achieved through incarceration

and interdiction. This study was later updated to distinguish among a

variety of types of domestic enforcement and used a more optimistic

assumption concerning how responsive consumption is to

enforcement-induced price increases. Caulkins and his colleagues

(Caulkins et al., 1997) concluded that--



treatment is more cost-effective than either enforcement approach

[conventional or federal] at reducing both cocaine consumption and

cocaine spending. Treatment is solidly but not exceptionally more

cost-effective than the federal-level enforcement programs at reducing

consumption; it has a 1.6:1 edge over conventional enforcement and close

to a 3:1 advantage over mandatory minimums. (p. 51)



They also found treatment to be "enormously more cost-effective (on the

order of 70 times more cost-effective) at reducing spending on cocaine" (p.

51) than enforcement strategies that shrink consumption primarily by

driving up prices.



In a critique of the original 1994 RAND model, the Office of National

Drug Control Policy (ONDCP)-funded National Research Council

reviewers argued that RAND's conclusions were "based on problematic

estimates of treatment effectiveness drawn from uncontrolled

observational studies" (National Research Council, 2001, p. 225), and that

the assumptions and economic modeling procedures used by RAND

researchers were flawed in other ways and therefore not useful for

policymaking (Manski, Pepper, and Thomas, 1999). Caulkins, Chiesa, and

Everingham (2000) offered an extensive response to the latter set of

criticisms, showing that modifying the model to incorporate the reviewers'

suggested changes did not in fact materially alter the conclusions. As for

the concern that RAND's characterization of treatment was overly

optimistic, the evidence is ambiguous. Indeed, some have criticized their

model for being overly pessimistic (Caulkins, Chiesa, and Everingham,

2000). Clearly, future research in this area is needed to clarify and tighten

assumptions, improve methodologies, and incorporate more carefully

controlled data from drug treatment outcome studies (for more

comprehensive information on the economics of drug treatment services,

see Cartwright, 2001).



Inmate participation in treatment. Although billions of dollars are spent

each year to support drug abuse treatment, the large majority of offenders

do not receive drug treatment services of any kind. ONDCP spent

approximately 20 percent of its $18.4 billion budget on drug treatment in

fiscal year 2000 (ONDCP, 2000). More than half of such Federal funding

was allocated to support State block grants. In addition to these amounts,

State, county, and local governments (as well as private funding sources)

contributed significant funds to drug treatment efforts (U.S. General

Accounting Office, 1998). However, it is unclear what proportion of the

total available funds have been targeted toward treatment of drug-using

offenders. Regarding offender treatment services, 83 percent of State and

73 percent of Federal prisoners reported past drug use in 1997, with 57

percent of State and 45 percent of Federal prisoners reporting use in the

month prior to their offense (Mumola, 1999). However, reported

participation in drug treatment in Federal and State prisons is minimal in

most cases. The 1997 Survey of Inmates in State and Federal Correctional

Facilities (Mumola, 1999) reported decreases in the percentage of both

State and Federal inmates undergoing drug treatment. It is important to

note that these trends are difficult to interpret without knowing more about

the increases in actual drug treatment capacity within State and Federal

systems relative to inmate population increases.



Local jails have fared about the same as Federal and State facilities.

According to BJS's 1998 Annual Survey of Jails (Wilson, 2000), 66

percent of jail inmates were actively involved with drugs prior to their

current incarceration, and 74 percent reported past drug involvement.

Almost three-quarters of local jails (90 percent in larger jurisdictions) state

that they provide substance abuse treatment or programs for their inmates.

However, 64 percent of that total are self-help programs; only 12 percent

of jail jurisdictions (mostly large jurisdictions) provided detoxification,

counseling, and education in addition to self-help programs. There is a

substantial difference between what jails say they provide and what

inmates report. The percentage of inmates who actually reported that they

participated in substance abuse treatment or programs since their

admission to jail was estimated at 10 percent (19 percent for those who

had used drugs at the time of the offense). Despite these low rates of

participation in treatment, a broad range of studies continues to show that

drug treatment for offenders is effective.



Effectiveness of drug treatment for offenders. Drug treatment for offenders

is being taken seriously by even the strongest advocates of incarceration

for drug possession and use. Flooded court dockets, overcrowded prisons,

and high recidivism rates of drug-using offenders have convinced even

those most skeptical of treatment that it is impossible to incarcerate all the

illegal drug users in the Nation. Scientific research on the brain is offering

clues into the nature of drug dependence, leading most to agree with the

conclusions of NIDA: "Prolonged use of these drugs eventually changes

the brain in fundamental and long-lasting ways, explaining why people

cannot just quit on their own, why treatment is essential" (Leshner, 2001).

This view has also been adopted by ONDCP, which states that "chronic,

hardcore drug use is a disease, and anyone suffering from a disease needs

treatment" (ONDCP, 2001, p. 1). Recognizing both the public safety

benefits from breaking the cycle of drug use and crime as well as the

potential safety risks of allowing drug-addicted criminals on the

streets (Taxman, 2000), ONDCP's National Drug Control Strategy

advocates a two-pronged approach to the problem: punish criminals for

their behaviors while mandating sanctions-based drug treatment. However,

questions remain as to which treatment programs are effective, and for

which drug users. 



Three major cautions must be noted when reviewing the mostly

quasi-experimental drug treatment outcome studies. First, many studies

rely on client self-reports, which are least valid for higher penalty drugs,

recent use, and those involved with the criminal justice system (for further

limitations on the validity of self-report drug use, see Hser, 1997). A

second and related problem is selection bias. Both the selection of those

who elect to enter treatment (and are thus perhaps viewed as being more

motivated to remain in treatment) and program terminations may leave

only those participants who are most ready and capable of succeeding

when released into the community. Such "weeding out" of participants

who may be more likely to fail than succeed could lead researchers to

incorrectly conclude greater treatment effects than would be seen through

more careful attention to treatment design with randomized assignment to

treatment groups (U.S. General Accounting Office, 1998; Pelissier et al.,

2000). Third, making a generalization based on the issues just noted, a

recent National Research Council report (2001) notes that very few

randomized controlled research studies have been conducted on drug

treatment outcomes, thereby casting some doubt on the cause of some

outcomes.



Despite these challenges, however, some researchers are paying more

attention to improving the scientific rigor of these evaluations to achieve

the greatest accuracy possible. The National Research Council report

summarized five recent treatment evaluation studies that were, in the

committee's view, "the methodological state of the art in drug treatment

research" (2001, p. 227). The studies, none of which included drug-using

offenders, were noted for their random treatment assignment, treatment

fidelity, measurement reliability and validity, and continuous rather than

dichotomous outcome measurements. The committee also discussed in

some detail the ways in which drug treatment outcome studies could be

strengthened through improved methodological and statistical rigor. In a

separate review (in the same volume) of drug treatment in the criminal

justice system, Covington (2001) suggested guidelines for evaluating

criminal justice system-based drug treatment. These guidelines included

controlling for self-selection bias; controlling for stake in conformity such

as employment or marriage (i.e., if an individual is employed, he or she

has a greater incentive to adhere to treatment in order to not get fired; or, if

married, an individual may have a greater incentive to do well to prevent a

spouse from leaving); use of credible outcome measures; identifying

appropriate followup periods; linking retention to outcomes; and

identifying treatment components that promote recovery.



Treatment settings. Overall, the size and consistency of treatment effects

across many reasonably good studies tend to lend credibility to consistent

claims of treatment effectiveness. The following section reviews a sample

of recent outcome evaluations for offenders in a variety of treatment

settings, moving from more restrictive to less restrictive settings. Outcome

measures that are typically used to gauge drug treatment effectiveness in

such studies include reduced frequency or amount of drug used; relapse

time or length of abstinence period; crime, arrest, and conviction rates; and

maintenance of parole or probation status. 



Prison-based therapeutic communities. Therapeutic communities (TCs) are

generally intensive, long-term, self-help-based, highly structured

residential treatment programs for chronic, hardcore drug users. Although

still rooted in a self-help approach, prison-based TCs are more likely than

community-based TCs to have professionally trained staff, with inmates

being given a reasonable level of power and rewards without too much

program control (Wexler, 1995; see also ONDCP, 1996). Three TC

approaches will be reviewed below.



Wexler and colleagues have reported on the effectiveness of the Stay 'N

Out TC program used by the Department of Corrections in New York

State (Wexler, Falkin, and Lipton, 1990; Wexler et al., 1992). TC inmates

were compared with inmates assigned to milieu therapy, counseling, or a

no-treatment group (composed of those who volunteered for TC treatment

but were placed on a waiting list). Comparing male post-treatment arrest

rates, the groups receiving counseling and no treatment were equally likely

to be arrested (40 and 41 percent, respectively), while those receiving

milieu therapy had an arrest rate of 35 percent, and those receiving TC

group treatment had an arrest rate of 27 percent. One significant flaw in

this finding is the researchers' failure to account for other background

variables, causing some to question the strength of the treatment effect

(Pelissier et al., 2000). However, time-in-treatment effects were also noted

that showed a strong positive relationship between the number of months

in the TC program and the percentage of inmates who were successfully

discharged from parole. Specifically, the percentage of male TC inmates

who had successful parole discharges grew from 49 percent for those in

treatment for less than 3 months to 58 percent for those in treatment for 3

to 6 months. Positive rates further increased to 62 percent when inmates

participated in a TC from 6 to 9 months and to 77 percent for those in a

TC from 9 to 12 months. Those who eventually failed on parole were still

able to stay drug and crime free for significantly longer periods than the

comparison groups.



Field (1985, 1989) conducted two evaluations of the Cornerstone Program,

a TC for alcohol- and drug-dependent inmates in Oregon's correctional

system that also required at least 6 months of followup treatment in the

community. Participants had to be granted minimum security status by the

prison superintendent. Treatment clients had, on average, about 12 prior

arrests, 6 prior convictions, and 6 years of adult incarceration. In the first 

3-year followup study (1985), program graduates were found to have had a 

29-percent reincarceration rate compared with 74 percent for program

dropouts. Similarly, although 54 percent of program graduates were not

convicted of any crime (including minor offenses), only 25 percent of the

comparison group and 15 percent of program dropouts were not convicted

of a crime. Again, these findings should be viewed with some caution

given that participants who remained in treatment were acknowledged to

have been more highly motivated to succeed than program dropouts. It is

also impossible to separate out the effects of the 6 months of community

followup treatment (Pelissier et al., 2000). The second study (Field, 1989)

found that approximately 75 percent of program completers were not

reincarcerated, compared with 37 percent in the comparison group. In

contrast, only 15 percent of participants who dropped out of treatment

after less than 2 months in the program were not reincarcerated during the

3-year followup.



A major concern of this and similar studies is the high dropout rates from

voluntary drug treatment programs. For example, Field (1992) highlighted

that, of 220 volunteer inmates who had been admitted to Cornerstone over

a 2-year period, 65 withdrew after spending 1 to 2 days in the program,

58 withdrew after spending between 2 to 6 months in the program, 43

withdrew after spending at least 6 months in the program, and 43

graduated. Simpson and colleagues (1997) have estimated that, on

average, only 50 percent of all addicts who voluntarily enter treatment

actually complete the recommended treatment course. High dropout rates

tend to confuse conclusions about treatment outcomes because those who

remain in treatment could be arguably more motivated to remain drug and

crime free than those who drop out. As has been noted earlier, however,

offenders who are given graduated sanctions as a form of coerced

treatment generally stay in treatment longer, complete treatment programs,

and report less drug use while in treatment programs than

those in voluntary treatment (Simpson et al., 1997; Hubbard et al., 1989). 



The Key-Crest program is a corrections-based, three-stage treatment

model program that operates within Delaware's correctional system. The

first stage, the Key, is modeled on the Stay 'N Out program and includes a

12-month intensive residential TC that is based in the institution but

segregated from the rest of the inmates. The second stage, the Crest

Outreach Center, is a transitional TC in which inmates work during the

day and return to a community-based, more traditional TC environment

during their nonworking hours. In the third or aftercare stage, clients have

completed work release and are now on parole or other supervision.

Intervention at this stage usually involves group or individual counseling

as well as the opportunity to return to the work-release TC for booster

sessions. While earlier studies (Martin, Butzin, and Inciardi, 1995; Inciardi

et al., 1997) demonstrated short-term (1-year) benefits of this TC treatment

continuum, many of the positive improvements between the second and

third stage clients appeared to disappear in 3-year followup studies (Martin

et al., 1999). However, when less conservative analytical models were

applied (the new analysis examined Crest dropouts, Crest completers, and

Crest completers with aftercare), significant findings emerged. When

compared with the comparison group, Crest dropouts were more than three

times as likely to be drug free (as measured by initial self-reports and

subsequent urinalysis); Crest completers were more than five times as

likely to be drug free; and Crest completers with aftercare were seven

times more likely to be drug free. Rearrests on a new charge showed a

similar pattern, with Crest dropouts having the same rate of rearrests as the

comparison group. However, those who completed Crest did much better,

and those who completed Crest plus aftercare were the least likely to have

a new arrest. Specifically, less than one-third of clients with aftercare had a

new arrest, compared with more than two-thirds of the comparison group

(Martin et al., 1999).



Long-term residential treatment. Prison-based long-term residential

treatment is generally considered to last between 6 to 12 months.

Participants often live together in units separated from the regular inmate

population. These units are specifically designed to focus on drug

treatment. The degree of structure can vary, but generally a professional

drug treatment staff coordinates all programs and services. Compared with

TCs, prison-based residential treatment is generally more likely to include

professional therapeutic interventions using standard treatment

approaches. For example, the Bureau of Prisons includes programming on

criminal life- style confrontation, cognitive and interpersonal skill

building, and relapse prevention (Pelissier et al., 2000). Inmate-led

self-help approaches are not present in such facilities. The following

discussion will present an evaluation of long-term residential treatment, as

well as one specific evaluation project.



From 1990 to 1993, the National Institute on Drug Abuse funded the Drug

Abuse Treatment Outcome Study (DATOS), which included 96 programs

in 11 cities. Positive outcomes were reported in multiple treatment

modalities, including long-term residential treatment (Simpson et al.,

1997). DATOS found that individuals in long-term residential treatment

reduced weekly or more frequent use of cocaine from 66 percent in the

year prior to treatment to 22 percent in the year following treatment (see

exhibit 1). This same group reported a 26-percent drop (from 41 percent

down to 16 percent) in predatory illegal activity during that same time

period (Fletcher, Tims, and Brown, 1997). Similarly dramatic reductions

in self-reported cocaine use were also found for short-term residential

treatment.



Using one of the most methodologically rigorous research designs to date,

the Federal Bureau of Prisons (BOP) recently conducted a 3-year, 20-site

evaluation of its residential drug treatment programs (Pelissier et al.,

2000). During the three-phase Treating Inmates' Addiction to Drugs

(TRIAD) Drug Treatment Evaluation Project, more than 1,000 inmates

first voluntarily participated in a 9- or 12-month residential treatment

program. Treatment group results were compared with a true comparison

group as well as a control group, neither of whom received any drug

treatment services. A second phase required inmates to continue drug

abuse booster sessions (including relapse prevention and review of

treatment techniques) for 1 year following their return to the general

community. During the final phase, inmates were required to participate in

community transitional services in which they received individual, group,

and/or family counseling from community-based drug treatment providers.

Three-year followup findings indicated that men and women who were

motivated to change were more likely to enter and complete treatment.

Findings on both recidivism and post-treatment drug use were significant

for men but not for women.[4] Specifically, men who entered and

completed in-prison residential treatment were 16 percent less likely to

recidivate when compared with untreated inmates at 3-year postrelease

followup. In addition, participants who entered and completed treatment

were 15 percent less likely to use drugs than untreated inmates within 3

years after release. These findings are particularly significant because the

selection process actually attracted riskier offenders into the treatment

programs. In addition, this study carefully addressed the issue of selection

bias by comparing results using two different bias correction methods.



Day reporting centers. As noted previously, many offenders are serving

time because of nonviolent drug convictions. To deal with prison

overcrowding and the prohibitive costs associated with 

incarceration-based treatment programs, some correctional facilities have

developed day reporting centers (DRCs). DRCs are a form of intermediate

sanction in which offenders attend highly structured, nonresidential

programs where a variety of services and supervision are provided. First

introduced in the United States in 1986, DRCs can be operated by a wide

range of public, government, and private agencies, such as residential

community corrections centers, work release programs, jails, TASCs, and

treatment programs (Parent, 1990; McBride and VanderWaal, 1997).

Services such as drug treatment and education, GED courses, English as a

Second Language and life skills are often supervised by both corrections

and case management personnel. A DRC has three primary goals:

enhanced supervision and decreased liberty for offenders, treatment of

offender problems, and reduced crowding of incarceration facilities

(Parent, 1990). The concept has been adapted in a number of ways,

including:



o Providing enhanced treatment and supervision to probationers or

sentenced offenders not on probation.



o Monitoring inmates on early release from jail or prison.



o Monitoring arrested persons prior to trial.



o As a halfway-out step for inmates who have shown progress in

community-based corrections or work release centers. 



o As a halfway-in step for offenders who have violated their probation or

parole (Curtin, 1990, as cited in Diggs and Pieper, 1994).



These programs are probably most appropriate for nonviolent offenders

whose behaviors have not been improved through probation and/or who

need greater structure and treatment services than could be provided in a

less restrictive setting. While attending the center, participants are often

required to submit to random drug testing and participate in counseling,

education, and vocational placement assistance. Graduated sanctions are

applied when participants are found to have violated the terms of their

sentence.



Relatively few studies have been conducted to assess predictors of

program completion or termination in DRCs. Studies which have been

conducted are difficult to compare due to the wide variability of settings,

services, eligibility criteria, monitoring procedures, levels of supervision,

and termination policies (Diggs and Pieper, 1994). While some studies

have shown initial evidence of cost savings (Craddock, 2000) and lower

rearrest rates (Diggs and Pieper, 1994; McBride and VanderWaal, 1997),

evidence of program effectiveness was not as great in programs that lasted

12 months or longer[5] (Marciniak, 1999). Marciniak (2000) found high

rates of program termination for drug violations and rearrests. Several

authors (Blomberg and Lucken, 1994; Marciniak, 1999; Tonry, 1990,

1997) have also expressed concerns of "net widening" since many

offenders who would otherwise be sentenced to probation are placed in

DRCs where they are watched more closely and are therefore more likely

to be rearrested. Given the relatively recent emergence of this form of

intermediate sanctioning, future studies should focus on success indicators

such as program completion, drug use, rearrests, and cost-effectiveness,

particularly in longer term programs. Program success indicators should be

based on comparisons with offenders who would have been incarcerated

as opposed to those traditionally found in probation to avoid a

net-widening bias (Diggs and Pieper, 1994). 



Outpatient and intensive outpatient treatment. Taxman (1998) notes that

the location of drug treatment does not always relate to the intensity of

services provided to the client. Instead, the number of service hours is

often a better indicator. As such, community-based outpatient and

intensive outpatient treatment services are often used as a transition from

TCs and other more intensive corrections-based services. Such services are

particularly important to drug courts, who primarily use treatment

alternatives within the community. The setting is generally less important

than the quality and quantity of services provided to clients, although the

organization providing the services must be supportive of delivering

interventions to correctional populations (Pogrebin, 1978). The DATOS

study introduced in the previous section (regarding long-term residential

treatment) also included positive outcomes for outpatient drug-free

treatment: self-reported cocaine use dropped from 42 percent before

treatment to 18 percent at 1-year followup (see exhibit 1).



Treatment intervention approaches. The previous section reviewed

outcome studies on a variety of drug treatment settings, based on a range

of restrictiveness. Each of these settings often includes such intervention

approaches as life-skills training, group and individual counseling, relapse

prevention training, and educational and vocational skills training. In

addition, a variety of theoretical models influence the content and

approach to such interventions. It is beyond the scope of this paper to

review these approaches and theories. As mentioned earlier, however,

NIDA has conducted a number of large-scale research evaluations on a

variety of interventions (e.g. DARP, TOPS, DATOS), and readers are

referred to those studies to review intervention effectiveness. In addition,

NIDA is currently conducting controlled, multisite tests of emerging

science-based drug abuse treatments such as the use of

buprenorphine/naloxone treatments for detoxifying opiate-dependent

patients and incorporating motivational enhancement therapy into standard

treatments (Mathias, 2001). Motivational enhancements offer abstinent

clients a chance to win small prizes such as candy bars, Walkmans, or gift 

certificates to local restaurants by testing negative for various illicit drugs.

As the number of abstinent weeks increases, so do the number and value

of the incentives. It is anticipated that such evaluations will provide

preliminary evidence of effectiveness and efficacy so that knowledge

about treatment effectiveness can be improved.



Based on a comprehensive review of clinical and health services research

on drug abuse, ONDCP (1996) made the following recommendations

regarding critical elements for successful treatment in any setting (e.g.

prison based, residential, or outpatient):



o Complete and ongoing assessment of the client.



o A comprehensive range of services, including pharmacological

treatment (if necessary), counseling (either individual or group, in either

structured or unstructured settings), and HIV-risk reduction education.



o A continuum of treatment interventions.



o Case management and monitoring to engage clients in services of

appropriate intensity.



o Provision and integration of continuing social supports.



NIDA came to many similar conclusions in their research-based guide,

Principles of Drug Addiction Treatment (NIDA, 1999). This guide also

reviews scientifically based approaches to drug treatment and makes

recommendations. A full listing of the NIDA recommendations is found in

appendix C.



In addition to the recommendations and principles listed by ONDCP and

NIDA, it is important to recognize the importance of matching the

drug-using offender with the appropriate treatment. This simple concept is,

at times, especially difficult to employ in jurisdictions that may lack

adequate resources to provide a full continuum of services. Essentially,

treatment matching recognizes that no single treatment is universally

applicable. Levels of restriction and supervision, treatment modalities, and

psychopharmacological treatment options (such as methadone) must be

assessed on a case-by-case basis. The ramifications of this issue include

the need for training system personnel on treatment continuum issues,

realistic expectations by both treatment and criminal justice systems

regarding the potential impacts of available services, and the potential

need to educate the community on what can be expected from available

resources. 



Gender differences in treatment. Pelissier and her colleagues (2000)

completed a comprehensive review of literature on gender differences

among substance abusers (for supporting literature documentation of this

summary paragraph, see Pelissier et al., 2000). Although much of the

current increase in the number of incarcerated women is linked to

substance abuse (Kassebaum, 1999), few studies have examined gender

differences among substance-abusing inmates. Studies primarily on

nonoffending substance abusers show that women generally have different

social, psychological, and economic circumstances; different initiation and

drug use patterns; and different criminal histories than men. Most

discussions of treatment approaches for women include a strong focus on

ancillary services such as health care, child care, and female treatment

staff. Therapeutic recommendations include a focus on relationship issues,

support, skill building, and identification of strengths as opposed to the

confrontation strategies that are common for men (for a summary of

treatment effectiveness studies for men and women, see Landry, 1997).

Despite these differences, however, few treatment programs focus heavily

on women's issues, particularly in correctional facilities. Not surprisingly,

few studies have looked at outcomes of treatment programs designed

specifically for women (Landry, 1997), in part due to the relatively small

numbers of female drug treatment participants (Moras, 1998).



Aftercare



Aftercare (or continuing care) is defined as "a set of supportive and

therapeutic activities designed to prevent relapse and maintain behavioral

changes achieved in previous treatment stages" (Fortney et al., 1998, as

cited in Inciardi et al., 2001). The aftercare phase of the treatment

continuum is often neglected for drug-using offenders. As noted

previously, most drug-using offenders have high relapse rates and

therefore require extended periods of treatment exposure and ongoing

support to achieve and maintain sobriety. In addition, most treatment

graduates are ill equipped to integrate back into their old neighborhoods

(Berman and Anderson, 1999). For these reasons, providing aftercare as a

followup to more restrictive treatment may improve treatment

effectiveness. Cross-systems case management and collaboration are

critical at this phase in the treatment process to maintain an integrated

continuum of care for clients as they transition back into the community.



Martin et al. (1999) recommend that treatment interventions at this stage

include continued monitoring by previously involved treatment counselors

(such as TC counselors). Interventions at this stage could include regular

outpatient counseling, support groups such as Alcoholics Anonymous,

group therapy, and family therapy sessions. In addition, Tauber (1994)

calls for educational opportunities, job training and placement, and health

and housing assistance.



Several studies (Lash, 1998; McKay et al., 1998; Rychtarik et al., 1992)

with noncorrectional populations have suggested that improved treatment

outcomes can result from aftercare (most of these studies are correlational

in nature). In such settings, it is possible that selection bias is present,

since motivated clients may make better use of aftercare services (Inciardi

et al., 2001). However, recent studies with corrections-based treatment

followed by aftercare have also shown preliminary indications of success

(DeLeon et al., 2000; Wexler et al., 1999). Offenders in the

California-based Amity Right Turn Project received voluntary TC

treatment followed by community-based aftercare programming.

No-treatment control groups were compared with TC dropouts, TC

graduates, and aftercare completers after 12, 24, and 36 months. Although

recidivism rates increased for all groups as time increased, those who

completed both the treatment and aftercare phases had the lowest rearrest

rates. Inciardi and colleagues (2001; see also Martin et al., 1999)

conducted a similar aftercare study with Key-Crest participants. Voluntary

clients were randomly assigned and purposively sampled across four

groups: a no-treatment comparison group, treatment dropouts, treatment

graduates, and treatment graduates with aftercare. Researchers conducted

followup interviews at 18 and 42 months and collected information on

drug use (interview and urine screen) and rearrest rates (interview

compared with official prison records). Eighteen-month followups

indicated that treatment dropouts and graduates were twice as likely than

the comparison group to be drug free, and treatment graduates with

aftercare were three times more likely to be drug free. Preliminary data

from the 42-month followup were even more impressive. Although only

25 percent of the comparison group were arrest free, more than half of the

graduates with aftercare remained arrest free. Similarly, 25 percent of

comparison cases remained drug free, compared with 36 percent of the

treatment-with-aftercare group. Such studies could be further strengthened

with larger sample sizes, evaluating suitability of clients for treatment,

more careful control of self-selection bias, and careful analysis of other

intervening variables.



Summary



Current research suggests that successful programmatic efforts to

intervene in the drugs-crime relationship are based on a continuum of

integrated services stretching from assessment through aftercare. Although

research has evaluated the various components that might be most

beneficial for inclusion in a successfully integrated system, we know of no

studies that have attempted to measure the success or lack of impact of

such integrated approaches. 



Suggestions for Future Research



In any field of scientific inquiry, one of the easiest things to do is to call

for more research. Not surprisingly, that is exactly the most appropriate

thing to do with regard to the drugs-crime relationship. New conceptual

and mathematical models have emerged recently in the social sciences that

will allow a fresh perspective on many of the questions that have been

addressed in the past and provide a new baseline for the 21st century.

Human cultures change, some fairly rapidly, and even a brief review of the

past 25 years in the United States with regard to drugs and crime would

indicate that ours has changed dramatically. In the area of the drugs-crime

relationship, one illustration of this change is the apparent reduction in the

violence associated with cocaine/crack distribution. Such changes require

fresh examinations of previously collected data and more rigorous

evaluations of current programs and policies. Although there are certainly

many areas of potential further inquiry, the following areas are suggested:



Using Secondary Data Analyses to Provide a New Empirical Baseline for

Understanding the Drugs-Crime Relationship 



The Federal Government, other agencies, and universities have collected

enormous amounts of data that are directly relevant to many key

drugs-crime questions. These data include the National Household Survey

on Drug Abuse (NHSDA), the Monitoring the Future (MTF) study, the

Arrestee Drug Abuse Monitoring Program, and the Treatment Episode

Data Set (TEDS). These data could be used to provide a new baseline of

knowledge about certain statistical elements of the drugs-crime

relationship across the lifespan and in many different segments of the

population. In addition, these data could be used to demythologize many

policy and popular conclusions about the drugs-crime relationship. For

example, data from some of these systems call into question some beliefs

about the cocaine-violence connection as well as suggest that the criminal

justice system may primarily direct marijuana users to the treatment

system to the exclusion of other drug users.



Further Studying the Nature and Complexity of the Drugs-Crime

Relationship Using the Latest Interdisciplinary Conceptual and Analytical

Models



Many of the interventions that have been applied to breaking the

drugs-crime cycle have involved a fairly narrow focus on drug treatment

and have not sufficiently recognized the complex origins of both

behaviors. Further, there is increasing evidence of a need to include

multilevel variables in order to understand how crime and drugs are

connected. This was not possible previously due to the statistical precision

needed. In addition, the 2000 Census and geocoding provide an

opportunity to add another data dimension to drugs-crime analyses. For

example, if we could obtain parallel geocoding data for the ADAM

dataset, the number of questions that could be addressed about the

drugs-crime relationship would expand geometrically. We need to

integrate advances in analytical models with advances in neurobiology,

personality, family systems, and peer influence studies as well as include

broader contextual variables (including ecosystems theory, social capital,

economic opportunity, drug prices and market variables, drug laws/policy,

and geographical data).



Consider Using Computer Simulation Modeling to Examine Key Research

Questions



Some of the etiological ideas that researchers are examining may be

applicable to computer modeling in the future. For example, it might be

useful, in a simulated model, to manipulate reductions in supply, increases

in price, changes in policy (such as treatment on demand and/ or

marijuana decriminalization/medicalization) to examine how such issues

would affect drug use, crime, and their interrelationship. Although the data

entered in a simulation would be based on the types of research previously

noted, and the pitfalls and complexities of undertaking this approach have

not been thought out, it may be time for the drugs-crime field to begin

considering the use of computer simulation technology to address the

critical issues facing many communities.



Evaluating State Changes in Drug Policy to Examine Different Attempts

to Address the Drugs-Crime Relationship at a Macro But Yet Subnational

Level 



Throughout this document, it has been noted that while there has been

relatively little modification of drug law and policies at the national level,

there has been considerable legislative action in many States and

communities. Model State drug laws have been proposed. Many States are

moving towards allowing medical marijuana, and many States have

decriminalized marijuana possession (or at least removed incarceration

penalties for the first marijuana possession conviction). Other States are

changing club-drug laws to increase scheduling and penalties. In addition,

there are significant differences between States (and communities)

regarding treatment availability and budgets. For many years, there have

been calls for international research comparing the impact of different

national drug policies. However, given significant differences between

national cultures, these comparisons are difficult. Variance in State law

and policy provides a more readily available opportunity to examine

variance between entities (the 50 States) with differing laws and policies.

These changes suggest a number of possible research areas. For example,

comparing differences in marijuana use (or drug use in general),

perceptions of risk, and peer disapproval in States that have medical

marijuana and/or marijuana decriminalization with States with

high-deterrence prohibition policies could provide an excellent foundation

for evaluating changing drugs-crime policies. 



Evaluating Attempted Interventions in the Drugs-Crime Cycle for Net

Widening



As noted, the increasing availability of drug courts and other mandatory

treatment programs may encourage law enforcement to intervene earlier

and more formally in the lives of individual drug users. This change in

strategy and tactics could begin a formal criminal justice labeling process

that may exacerbate, rather than ameliorate, the relationship between drug

use and crime. It may also result in changing definitions of law violation

and increase the number of those arrested and incarcerated due to new

placement criteria and options. It is critical that we evaluate such changes

early so that lessons learned from them may be used strategically to change

later interventions.



Considering the Need to Establish Research Field Stations in High-Risk

Communities



One idea that has been discussed episodically in the drug field for the past

two decades involves the use of a research field station approach.

Although there have been some attempts to undertake such an endeavor,

these efforts generally have been limited in time and/or place. Existing

data (combined with geocoding) could be used to identify communities

with high rates of drug use and crime. Theoretically based multivariate

research projects could then be conducted in these targeted communities

from a qualitative, on-the-ground perspective. Such an approach might

permit researchers to understand some of the changes in violence

associated with crack distribution that seem to have occurred in recent

years.



Examining the Relationship Between Particular Enforcement Strategies

and Drug Markets

 

Recent modifications to the ADAM study (including asking subjects about

access to drugs and conditions that they perceive as affecting access)

provide the possibility of empirically modeling the effects of specific

enforcement strategies on specific drug markets (cocaine, crack, and

heroin) and drug prices. In particular, researchers may be able to evaluate a

particular enforcement strategy's impact on drug market location (moving

it indoors or to more urban settings), the number of dealers typically used,

the amount of time searching for drugs, or the price of that drug (from

STRIDE [System to Retrieve Information from Drug Evidence] or other

sources) and more. This could provide researchers with very important

information about how drug markets operate in local areas in response to

enforcement strategies.



Comprehensively Evaluating Current Programs Designed to Intervene in

the Drugs-Crime Cycle



Many programs exist that attempt to intervene in the drugs-crime cycle

from the juvenile to adult level. Although there have been significant

attempts to evaluate these programs, most of these efforts have been

descriptive or have used fairly simple analytical designs (often

quasi-experimental). What is needed are large-scale, carefully controlled

studies that focus on long-term program outcomes using multiple

indicators of success and that identify program elements related to

outcomes. These evaluations should focus on what the literature might call

best-case program models that generally involve comprehensive

assessment, needed service provision based on that assessment, case

management, graduated sanctions, and aftercare. Most outcome studies

examine such factors as rearrest rates or drug relapses. Additional

successful outcome measures might include such non-crime-related

outcomes as payment of child support, family formation and stability,

employment stability, and residential stability. In addition, it is important

to examine how these programs vary in their impact by gender, ethnicity,

and age as well as provision context (prison to community). Finally, it is

crucial to examine program costs relative to the cost of incarceration and

the cost of no intervention. Although specific recommendations for further

research were included at the end of each program intervention section in

this chapter, the following research questions are of high priority:



o Which drug testing methods offer the best combination of accuracy,

privacy, and feasibility? How does drug monitoring alone compare with

more comprehensive systems and treatment interventions in terms of

outcomes such as drug use and recidivism?



o What assessment protocols can most accurately be used to place

offenders in the safest, least restrictive, and most effective treatment

settings?



o What level and intensity of drug treatment services are most appropriate

for which offender types and settings?



o What forms and mixtures of the reviewed programmatic interventions

(e.g. graduated sanctions, supervision/ monitoring, various drug treatment 

services and settings, aftercare, etc.) predict program completion or

termination (or other specific outcomes) with which populations and under

which conditions?



Using Interdisciplinary Teams to Conduct Research on the Drugs-Crime

Relationship



A review of the literature shows that individuals from a variety of

disciplines have examined the drugs-crime relationship. Each discipline

has approached the relationship from its particular perspective, and each

discipline likely has an important and unique perspective on understanding

the relationship. Some of the critical reviews of conceptualization,

methodology, and conclusions in drugs-crime research are often based on

particular disciplinary perspectives. To broaden the perspectives of these

disciplines, the types of research issues/questions that have been proposed

require the efforts of an interdisciplinary team. If there is to be clear

definition, development, and operationalization of treatment program

elements, treatment providers must provide input. Researchers trained in

experimental or quasi-experimental design are crucial in developing and

carrying out the needed scientific designs. Social scientists (survey

researchers, geographers, and ethnographers) are needed if issues of

gender, ethnicity, and other sociocultural and spatial characteristics are to

be included in the design and data interpretation. Given today's strong

social concern relative to cost-benefit outcomes, it is crucial to include

economists on research teams. Drugs-crime research has clearly reached

the stage where interdisciplinary research teams are required. 



Establishing Interagency Cooperation in Funding Research



An examination of the various governmental reports and our conversations

with colleagues about this project suggest that many different agencies

focus on and issue reports about the drugs-crime relationship. It appears

that the authors of many of these reports are not aware of the excellent

research funded by other agencies. Given the limited resources in any

given funding agency and the different research traditions in various

agencies, integrated research will require significant interagency

cooperation. Such cooperation could make sufficient resources available to

address the types of complex research needed in drugs-crime analysis.



Notes



1. For economists, the term "open market" has a very precise meaning. In

this paper, however, we use the term in a general sense to indicate low

levels of government regulation.



2. The companion papers to this work discuss the psychopharmacological

and economic components of the drugs-crime relationship.



3. The focus will be primarily on adult intervention strategies since other

recent reports have completed a comprehensive literature review and

offered program guidelines focusing specifically on juveniles (McBride et

al., 1999).



4. Although Pelissier and her colleagues did not find a significant

treatment effect on postrelease drug use and crime for women, further

analyses indicated no significant differences between the coefficient for

men and women. This lack of significance for women is likely a reflection

of the smaller sample size for this population (Pelissier, 2001; personal

communication).



5. The issue of length of time in treatment as indicative of stronger gains

in treatment was raised previously in this paper. This issue is debated in

the field. Marciniak (1999) argues that longer may be better only up

through 9 to 12 months; treatment deterioration may then begin. Other

researchers argue that this outcome needs more study. 



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Authors' Note



The authors would like to thank Helo Oidjarv and Shannon Bond for both

their writing contributions and their assistance with literature review, and

Rachael Del Rio for her work in preparing the manuscript. In addition, the

authors would like to acknowledge the contributions of Frank Chaloupka,

Dick Clayton, Paul Goldstein, Jamie Chriqui, and Rosalie Pacula, who

reviewed various concepts presented in the paper. Finally, in addition to

the support provided by the National Institute of Justice, the authors would

like to acknowledge the ImpacTeen Project: a Policy Research Partnership

to Reduce Youth Substance Use supported by the Robert Wood Johnson

Foundation and administered by the University of Illinois at Chicago. The

views expressed are those of the authors and do not necessarily reflect the

views of the Robert Wood Johnson Foundation.



Correspondence concerning this paper should be addressed to Duane C.

McBride, Department of Behavioral Sciences, Nethery Hall 203, Andrews

University, Berrien Springs, MI 49104- 0030; e-mail

mcbride@andrews.edu.



Appendix A. Model State Drug Laws and Policies



The President's Commission on Model State Drug Laws' (1993) model

legislation specified five main policy areas. Following is a more complete

list of the laws and policies within each general policy area.



Economic Remedies



Forfeiture reform; money laundering; financial transaction reporting;

money transmitter licensing and regulation; ongoing criminal conduct.



Community Mobilization



Expedited eviction of drug traffickers; drug nuisance abatement; crimes

code provisions to protect tenants and neighbors; antidrug volunteer

protection; community mobilization funding; alcohol/other drug abuse

policy and planning coordination.



Crimes code enforcement



Prescription accountability; State chemical control; Uniform Controlled

Substances Act controlled substance analogs; continued access by law

enforcement to wire and electronic communications; wiretapping and

electronic surveillance control; driving while under the influence of

alcohol and other drugs.



Treatment



Addiction cost reduction; Medicaid addiction cost reduction; managed

care consumer protection; family preservation; early and periodic

screening; diagnosis and treatment services; health professionals training;

criminal justice treatment; caregiver's assistance.



Drug-free Families/Schools/Workplaces



For drug-free families, underage alcohol consumption reduction;

preventive counseling services for children of alcoholics and addicts;

sensible advertising and family education; tobacco vending machine

restriction; revocation of professional or business licenses for alcohol and

other drugs.



For drug-free schools, drug-free school zones; ban on tobacco use in

schools; intervention for students with substance abuse problems; State

safe schools; alcohol- and drug-free colleges and universities; truancy,

expulsion, and children out of school.



For drug-free workplaces, drug-free private-sector workplaces; drug-free

workplace workers' compensation premium reduction; employee

assistance programs and professionals; drug-free public work force;

drug-free workplace; employee addiction recovery.



Reference



President's Commission on Model State Drug Laws(1993), President's

Commission on Model State Drug Laws: Executive summary,

Washington, DC: President's Commission on Model State Drug Laws.



Appendix B. Critical Elements for Collaborative Success



As noted in the main body of this paper, reviews of collaborative efforts

have identified several critical elements for success.[1] These elements are

specified and discussed below.



Leadership



There is a need for one or more key agencies to start the collaborative

process, preferably bringing experienced leadership and/or supervision to

the table. This body must be willing to take the responsibility to identify

problems and help other members to envision solutions, maintain the

support and involvement of other members, and work toward helping

build an atmosphere of equality. Because in many communities the

relationship between the treatment and criminal justice systems is often

strained, there is a need to recognize differing primary responsibilities.

Within the context of the courts, the justice system has the primary role in

monitoring offenders along the graduated sanctions continuum; treatment

systems have the primary role in providing appropriate and effective

treatment services. Some evidence indicates that the optimum structure

might place in the position of managing partner a "neutral" group that does

not provide direct services (such as TASC) to ensure unbiased service

organization referrals, case management, and collaborative organization.

No matter who holds the leadership role, this individual/ agency/group

must seek consciously to actively involve all stakeholders from the

beginning of design and implementation of the proposed program(s) or

initiative(s).



Membership



As noted previously, membership should be broad based, representing key

agencies in the justice, law enforcement, and treatment systems, and a

broad range of other community agencies.



Goals



Collaboratives should design specific goals that are clear, useful in the

minds of participants, and achievable within specified timeframes,

including both short- and long- term goals, and with specified priorities.

Successful collaborative groups have reported the existence of a strategic

plan, including specific goals, an outline of programs related to achieving

those goals, evaluation methods, and regular public progress updates. A

description of goal and program review and change was related to

successful formation and structure.[2] Performance measures can be

especially useful for evaluation and thus the possibility of obtaining

continued funding.



Team Approach



Collaborative efforts should seek a team approach for both decision

planning and making. Leader agencies and/or organizations should seek to

maintain civility at meetings and encourage flexibility. Decisionmaking

should strive to use consensus-building methods. Efforts toward

developing a team approach can be assisted by making sure that each

collaborative member has a clearly defined role and responsibilities; this

can be aided by early cross-training for collaborative members in the

activities and responsibilities of the systems involved.



Long-Term View



Members should recognize the complexity of collaborative goals and

strategies, that neither substance abuse nor crime has a single solution.

Realistic timelines for all efforts should be set.



Research and Evaluation



Communities considering collaborative work should use available

information on best practices from the literature to guide collaborative and

program development. In addition, methods should be developed to

systematically collect objective data for monitoring and evaluating

collaborative projects.



Broad Support



The need to gain the support of the community at large is essential for

sustainability; active efforts to seek community input can gain support, and

regular communication about the goals and accomplishments of the

partnership can help maintain that support.



Funding



Long-term funding sources are crucial for the viability of any coalition.

External funding sources may assist in providing incentives for

development of successful partnerships[3] such as through block grants or

private foundations; in addition, communities may have the possibility of

pooling funds from various agencies. However, efforts should be made to

gain line-item legislative support for sustainability.



Notes



1. Sigmon, J., Nugent, M., Goerdt, J., and Wallace, S. (1999), Key

elements of successful adjudication partnerships (BJA Bulletin,

NCJ173949) pp. 2-4 [Online], available:

http://www.ncjrs.org/pdffiles1/bja/ 173949.pdf; see also McBride, D.C.,

VanderWaal, C.J., Terry, Y.M., and VanBuren, H. (1999), Breaking the

cycle of drug use among juvenile offenders: Final technical report (NCJ

179273) [Online], available: http://www.ojp.usdoj.gov/nij/drugdocs.htm.



2. Join Together (1999). Results of the fourth national survey on

community efforts to reduce substance abuse and gun violence [Online].

Available: www.jointogether.org/sa/files/pdf/survey98.pdf.



3. Kraft, M., and Dickinson, J. (1997). Partnerships for improved service

delivery: The Newark Target Cities Project. Health & Social Work, 22(2),

143-148.



Appendix C. Principles of Drug Addiction Treatment*



NIDA (1999) developed a list of scientifically based recommendations for

drug treatment applicable for use across the entire system of service

delivery. These principles are listed below:



1. No single treatment is appropriate for all individuals.



2. Treatment needs to be readily available.



3. Effective treatment attends to multiple needs of the individual, not just

his or her drug use.



4. An individual's treatment and services plan must be assessed continually

and modified as necessary to ensure that the plan meets the person's

changing needs.



5. Remaining in treatment for an adequate period of time is critical for

treatment effectiveness.



6. Counseling (individual and/or group) and other behavioral therapies are

critical components of effective treatment for addiction.



7. Medications are an important element of treatment for many patients,

especially when combined with counseling and other behavioral therapies.



8. Addicted or drug-abusing individuals with coexisting mental disorders

should have both disorders treated in an integrated way.



9. Medical detoxification is only the first stage of addiction treatment and

by itself does little to change long-term drug use.



10. Treatment does not need to be voluntary to be effective.



11. Possible drug use during treatment must be monitored continuously.



12. Treatment programs should provide assessment for HIV/AIDS,

Hepatitis B and C, tuberculosis, and other infectious diseases; and

counseling to help patients modify or change behaviors that place

themselves or others at risk of infection.



13. Recovery from drug addiction can be a long-term process and

frequently requires multiple episodes of treatment.



Reference



* National Institute on Drug Abuse (1999), Principles of drug addiction

treatment: A research-based guide (DHHS Publication No 00-4180), pp.

1-3 [Online], available: http://165.112.78.61/PODAT/PODATindex.html.



--------------------------------



APPENDIX A: SUMMARY OF PROCEEDINGS



Opening remarks were made by Sally T. Hillsman, deputy director of the

National Institute of Justice (NIJ), and by forum organizers Henry H.

Brownstein and Lynda Erinoff.[1] Dr. Brownstein is director of the Drugs

and Crime Research Division of NIJ. Dr. Erinoff is health science

administrator at the Epidemiology Research Branch of the National

Institute on Drug Abuse (NIDA). Roger Conner, director of Search for

Common Ground in America, served as facilitator of the forum

discussions.



Dr. Hillsman explained the origins of the collaboration between NIJ and

NIDA. In the Omnibus Crime Control Act, as amended in 1976, Congress

asked the two agencies to explore the relationship between drug abuse and

crime. That year NIJ and NIDA formed an interdisciplinary study team to

review state-of-the-art knowledge about drugs and crime and to

recommend a research agenda. NIJ published the agenda--essentially a

literature review--in 1980, and the resulting research significantly

advanced knowledge of the drugs-crime relationship. However, a great

deal remains to be done. Dr. Hillsman noted that in a 2001 report,[2] the

National Research Council (NRC) recommended that NIJ and NIDA

collaboratively undertake research to meet the challenge of informing

public policy in the area of drug use.



Dr. Hillsman noted the amount of research being done on drugs and crime

makes the field increasingly relevant to policy and practice. She reflected

that 25 years after the establishment of the initial NIJ and NIDA

collaboration, the two agencies are welcoming researchers to this forum

and are anticipating that the forum will stimulate another extraordinary era

of interest and productivity in the field. Although a great deal has been

learned about drugs, drug use, drug abuse, drug markets, and drug law

enforcement, the agencies and the scholarly community remain

ill-informed about the complexities and nuances of drugs-crime

interrelationships.



She emphasized the need for a focused research agenda in which

researchers target specific questions and the most effective methods.

Researchers who work for Federal agencies need to know how scarce

public funds will be spent to make the most significant contributions in

this area. All Federal, State, and local policymakers and practitioners need

to know which policies and programs will be effective in producing

healthier and safer communities. Dr. Hillsman pointed out that NIJ and

NIDA have played essential and complementary roles in creating a solid

scientific foundation for informed policies and practices, and that with the

help of forum participants, the two agencies will take up the challenge

posed by NRC. That challenge is clearly echoed by policymakers and

practitioners throughout the country, who are turning to the research

community to contribute sound and relevant knowledge to the Nation's

deliberations about drugs and crime.



Dr. Brownstein commented that the early and mid-1980s and through the

early 1990s had seen a great deal of interest in drugs and crime research.

Then, in the mid- and late 1990s, research seemed to have focused on

particular applied or practical areas. He suggested there is a need for more

theoretical research and assimilation of the knowledge accumulated during

the 20th century. He noted that the methods and technology to make this

possible are now available.



Dr. Erinoff noted that Dr. Brownstein designed the framework for the

forum and obtained the funding for it. He made certain that the public

health perspective was included and took a hard look at previous research,

including the tripartite model, which he and Dr. Paul Goldstein had

developed. Dr. Erinoff expressed hope that all forum participants would

emulate Dr. Brownstein in critically reviewing current research. She noted

that when NIDA staff had to choose someone to write the forum paper that

presented the public health perspective, they asked Dr. James Anthony to

do so and to look "outside the box." She appealed to the attendees to do

the same: to move outside their own frameworks.



"At the Intersection of Public Health and Criminal Justice Research on

Drugs and Crime"



James C. Anthony with Valerie Forman



The recent focus of Dr. Anthony's research has been on influences that

take a user from initial use of a drug toward drug dependence and on

factors that account for that transition. In discussing some of the directions

in which the field of drugs and crime research should be headed, he noted

possible genetic vulnerabilities to drug abuse, how those vulnerabilities

might influence drugs-crime relationships, and cognitive science

applications of current interest to NIDA.



Dr. Anthony noted his work in developing a conceptual framework for

identifying future research in this area. The framework consists of a matrix

that presents the rubrics, or the main questions asked, in epidemiology or

public health research: quantity, location, causes, mechanism, and

prevention and control. These rubrics are placed along the vertical axis of

the matrix. The five rubrics were discussed in relation to the ecological

concept of scale, which defines the level at which a subject is studied from

the microcosmic to the macrocosmic; that is, from genes at one end to

policies regulating nations or global relationships at the other. Scale is

placed across the horizontal axis. Each location on the matrix where

rubrics and scale intersect represents an area of past or current research.

Some units are filled, indicating past or current research; others are empty,

indicating that little research has been done. Evidence that crosses several

cells is termed broadband research; that is, research that cuts across

domains and levels of scale.



Discussion: Most Helpful Ideas 



Scale: A concept or a method? Dr. Anthony was asked to elaborate on the

concept of scale and how he interpreted it as applying to the biological

and social aspects of his work.



Dr. Anthony responded with an example from the field of ecology. For

ecologists, scale is the way one thinks about geocoding, in which trends

are followed in a census tract or a metropolitan area. Using a technique

called two-dimensional and three-dimensional wavelet analysis, the

ecologist allows the data to evoke the scale. When studying migratory

birds, for example, ecologists infer the scale from the migration pattern of

the birds. Ecologists tend to work upward and outward from the smaller

level or scale of the organism toward the larger level or scale of the forest

or the continent. In Dr. Anthony's own approach, he worked inward, in the

direction of methods microscopic in scale. This is in the spirit of the

ecological concept of scale, but is a twist on that concept, which has been

used in studies of delinquency in relation to such neighborhood

characteristics as social cohesion.



When asked whether scale should be viewed as a methodology, Dr.

Anthony responded that it should be viewed as a concept. Although scale

is not strictly methodological, it can guide researchers toward

methodologies. He applied it in the context of drugs and crime to provide

guidance on how NIDA and NIJ can work together to foster the next

generation of research.



NIJ, Dr. Anthony suggested, should not establish the kind of biobehavioral

laboratories required for research on the genetics of the relationships

between drug use and crime. Rather, it may be wiser to reinforce NIDA's

investment in those areas, with the two agencies coming to some

agreement. He recommended the same approach for directing, controlling,

and planning research on the pharmacological effects of drugs on

aggression and on the cognitive functions. Arrangements should be made

for research where substantial investment has already been made in

biobehavioral laboratory domains. With respect to national and global

policies, however, NIDA's research agenda has not been strong. NIJ can

fill this gap. NIDA has supported organizations and operations research on

drug dependence for correctional officers, police, and postrelease juvenile

justice programs. In this area, the agendas of the two agencies overlap, and

it is an area in which they both should be working.



Genetics of drug dependence. Dr. Anthony was asked how much progress

has been made in identifying genes or constellations of genes that might

predict dependence. He was also asked whether he thinks researchers will

discover an overall genetics of dependence, as opposed to highly specific

genetic links that predict dependence on particular drugs, each involving

different genes or sets of genes and their protein products.



Dr. Anthony responded that in the immediate future, genetic

polymorphisms[3] would be examine done at a time for effects on drug

dependence, but it will probably be 5 to 10 years before researchers

understand the covariation of specific polymorphisms in a way that will

allow them to measure shared diathesis[4] with respect to drug

dependence. He expects researchers to find that different genes regulate

responses to different drugs. He cited as an example the finding that genes

regulating the liver's metabolism of alcohol do not appear to have much of

an effect on cocaine metabolism.



One issue to be addressed in this context is whether polymorphisms sort

people into different latent classes of vulnerability rather than arraying

them on an underlying dimension of genetic vulnerability. Dr. Anthony

expressed hope that new interventions in areas like obesity, where the

array of known genes and polymorphismsis much broader than those for

drug dependence, will open up the possibility of studying

gene-environment interactions in a way that can guide NIDA's research

agenda on genetics and drug dependence.



A forum participant suggested that the distribution of drug use in society is

wide enough that genes could in fact play a major role in drug use.

However, looking at acquisitive crimes, violent crimes, and, in particular,

the intersection of drug use and crime and the types of people most likely

to be involved in both, we do not see those activities distributed

throughout society in a way that suggests such a role. It was further

suggested that NIDA should not place a lot of emphasis on genetic

research. Rather, social science research should be emphasized because

that is where researchers are more likely to find answers.



Costs versus benefits of genetic neuropharmacology research. The

intersection of the genetic neuropharmacology and social behavioral

components of drug use was seen as a key element of Dr. Anthony's paper.

A key issue is whether and how funding for this research can be improved.

Researchers who seek funding from NIJ or NIDA to conduct sophisticated

urine specimen tests, such as those using gas

chromatography/massspectroscopy (GC/MS), know the cost is about $56

per drug tested per GC/MS test. They also know the cost of genetic testing

is much higher, at about $500 per specimen. Given the huge price

differential, the cost-benefit balance becomes an important consideration,

making it difficult to decide whether to conduct a social science survey in

combination with biological data collection and genetic testing. Dr.

Anthony was asked to comment on the implications of these issues for

funding.



He responded by encouraging the participants to think about this problem

the way they would think about the evolution of computing speed and

costs. Researchers now are able to use multilevel models in their research

due to the always-increasing inexpensive computing speed available today.

Because change is occurring at a similar rate in assays for genes, advances

made by microarray technologists will cause the prices of these tests to

fall. The time this change will take is part of the reason Dr. Anthony

projected it will be 5 to10 years before researchers are able to understand

covariation between polymorphisms in the areas of drug dependence and

complex behavior such as criminal offending. Ten years might even be an

optimistic projection of the amount of time needed because, ultimately,

researchers want to identify the environments that modify the expression

of the genes. This calls for both observational studies and experiments. For

example, it took approximately 10 to 15 years between identification of

apolipoprotein-4 for Alzheimer's disease and recent work on interventions.



Types of crime to be addressed. One participant commented on Dr.

Anthony's statement that criminal behavior and drug use both affect a

person's social standing. The questioner inferred from Dr. Anthony's

statement that the effect is negative and suggested that there are probably

situations in which it is positive. Furthermore, an implicit assumption

made at the forum is that in discussions about the drugs-crime

relationship, researchers are dealing with one kind of crime. However, that

relationship (if there is one) may exist in a correlate sense, involving

economic crime, financial crime, cybercrime, and other types of crime.

The consequences of that relationship, which researchers in their current

analyses imply exists, cannot be proven. The question posed was whether

the forum was focusing on a particular type of crime, such as street crime.

If so, it should have been specified, because it would influence the kind of

research agenda that participants would want to shape.



Drs. Brownstein and Erinoff responded that, for the purposes of the forum,

they were not defining crime in any narrow sense. They wanted forum

participants to think more broadly and include the effects of alcohol in the

discussion. Forum participants were urged to keep in mind that the basis in

biological science for a relationship between alcohol and aggression is the

strongest for any drug.



Further comment by participants focused on the millions of episodes of

drug use that are not associated with crime. How, it was asked, could these

be reconciled with the framework suggested by Dr. Anthony? The

discussion also addressed whether drug-related violence is instrumental;

that is, whether it serves a purpose that promotes the perpetrator's interests.

Transcripts of interviews with drug sellers, which a participant had

reviewed before the forum began, contained descriptions of violent

activities that indicated the violence is instrumental. Most of the actions

described in these transcripts, which were not taken from a random sample

of drug dealers, did not appear to be the result of impaired functioning or

intoxication. Rather, they were quite deliberate, instrumental acts. One

participant noted that in discussing crime, the forum was addressing

property crime or violent crime and not including other acts that society

also defines as crime, such as the use of the drug.



Impact of IRBs on social science research. The impact of institutional

review boards (IRBs) on some lines of research recommended at the forum

were discussed in the context of potential to stifle social research,

especially research on juveniles. A participant suggested that researchers

would know less about drugs and crime than they do now if current

human-subject standards had been in effect in the past.



Understanding the roots of misbehavior. Dr. Anthony was asked about

integrating the micro and macro levels of research, specifically their

effects on funding, policies, and research on biological influences on drugs

and crime.



He responded by characterizing misbehavior as a phenomenon rooted in

the origins of the human species, family heritage, and social structure. The

more researchers understand about these factors, the more they can use

that understanding to shape policies and perhaps foster a more civilized

society.



Growth trajectories and the ecodevelopmental trajectory model. The

section of Dr. Anthony's paper that dealt with temporal relationships and

growth trajectories raised the question of the degree to which interventions

affect growth trajectories. Changes observed lately in drug markets, and in

the crack markets in particular, indicate a growth area only among senior

citizens. This growth trajectory, which begins at age 60, is not what would

normally be found. Another observed trajectory involves young men who

were well behaved between ages 18 and 25 who begin to misbehave when

they are between 30 and 40 years old. The questioner asked whether those

trajectories are outcomes produced by attempts to intervene and if so, what

this says about growth trajectories.



Dr. Anthony responded that the sense in which he discussed growth

trajectories was not related to the trends the questioner described. Rather,

it was in the context of the ecodevelopmental trajectory model.

Conceptually, this model cuts across the levels of scale. The characteristics

of an individual, over time and over development, are modulated by the

social characteristics of the peer group, the family, or society. Thus, there

is reciprocity over time between the predispositions of an individual and

the environment. An example is the growth of illegal income, or the

proportion of annual income earned through criminal behavior, by the

young men the questioner cited. One might ask, given one set of regulatory

conditions, what those growth trajectories would look like under another

set of regulatory conditions.



Dr. Anthony commented further that the paper presented by Dr. McBride

noted that State-by-State variations in drug regulations give researchers

opportunities for study. He had also discussed with Dr. MacCoun the

contrasts between growth trajectories for marijuana involvement by young

people in Amsterdam in contrast to young people in a comparable city in

the United States. The more ready availability of cannabis might have an

increased impact on the growth curve if the young people smoke more.

With respect to the cannabis itself, the trajectory might decline if the

young people segregate into heavier or lighter users, in contrast to young

people subject to the current regulatory scheme in the United States. These

developments would guide researchers toward some crossnational research

to look developmentally, over time, at the young people's dispositions.

Those dispositions might be to maintain a flat trajectory in drug use, to

shift from one drug to another, or to display a declining trajectory in drug

use.



Turning to the question of which intervention would make a difference,

Dr. Anthony commented that he had started off hoping to conduct policy

analyses in this area but had decided that the observational data were not

good enough for that kind of work. He questioned whether the time is right

for social experiments that would allow researchers to contrast one

regulatory condition with another. In addition, econometricians have

convinced him that there may be problems even with randomized

experiments, so researchers may not ever be able to collect definitive

evidence in this area. Whether a researcher's stumbling on something

might always be better than what can be designed in advance is a problem

of constructivism.



Discussion: Problematic Ideas



Mortality and morbidity due to drug-use-related injuries and diseases. A

question was raised about the usual focus of public health research on

interventions to reduce mortality and morbidity. Dr. Anthony's paper

focused on crime as an outcome, but other forms of mortality and

morbidity are also associated with the relationship between drugs and

crime. One is injury resulting from the violence inherent in the

drugs-crime nexus, and one can go beyond that to infectious diseases

associated with use of drugs. It is possible to view the correctional system,

where a great many drug users are incarcerated, as an opportune site for

public health interventions. About 15 to 35 percent of all infectious

disease cases, from HIV infection to tuberculosis, passed through a

correctional institution in the past year. Dr. Anthony was asked whether

these issues should be part of the public health focus on the drugs-crime

nexus.



He responded in the affirmative, stating that NIDA has an active research

portfolio in interventions in criminal justice environments and is likely to

increase its investments in that area. He suggested that this would be

another area in which NIJ and NIDA could coordinate.



Dr. Anthony commented on a point not included in his paper that relates to

the pharmacological model for the tripartite approach. He thought that in

the next 5 to 10 years researchers will see some interesting findings from

longitudinal studies of cocaine-exposed children. These studies will

demonstrate, he thinks, that it is not the children's drug use that leads to

their aggressive behavior, executive dysfunctions, or subsequent criminal

behavior. Rather, they will demonstrate that it is cocaine use by their

parents or the lifestyle associated with cocaine use by their parents. This

will be an interesting new line of research and a new way of thinking about

that part of the tripartite model.



Evidence linking drug use to aggression. Dr. Anthony was asked about the

nature of the experimental evidence linking the use of certain drugs to

aggression and whether that evidence is as strong as the evidence linking

aggression to alcohol use.



He responded that when studied under experimental paradigms, the use of

drugs like methamphetamine, cocaine, and the amphetamines results in

aggression under certain conditions. If one looks outside the laboratory

and examines comorbidities, one of the strongest co-occurrences is drug

dependence and alcohol dependence. Cocaine dependence can be treated,

for example, but if the subjects continue to drink heavily, they will still be

involved in alcohol-associated criminal behavior. This is a complex

problem in the societal environment, but that complexity should not blind

researchers to the clear experimental evidence linking certain drugs,

especially the psychostimulants and drugs like phencyclidine(PCP), to

aggression revealed in laboratory studies.



Among the complexities of this issue is that the drugs have different

effects at different doses. That is to be expected and does not contradict

the causal inference based on effects that might be observed at specific

doses. When violence is observed in people who are using PCP, it is

generally seen in those who have ingested very large doses. A similar

phenomenon is observed in methamphetamine users who have been on

runs that lasted a weekend or longer. The resulting paranoia,

suspiciousness, and other effects end in violence.



Dr. Anthony responded to a comment that violent drug users have

typically also used alcohol by citing instances in societies where alcohol is

not widely used and instances in which methamphetamine users who are

not drinkers are arrested for aggressive behavior. Although the

co-occurrence of methamphetamine and alcohol use is a palpable

association, there are exceptions.



Drug-related corruption. A comment was made about important topics that

appear to have been neglected in research conducted in the 1980s and

1990s. One such topic is drug-related corruption. It is a crime and it is

related to drugs, but researchers do not write much about it. Examples

cited included instances in which officials are involved in bribery, perjure

themselves, or otherwise break the law to obtain convictions.



Time-lagged effects and crime. A second neglected issue is time-lagged

effects. In applying the tripartite framework, researchers usually think in

terms of crimes that occur relatively soon after the drug activity. However,

people may also use drugs, become addicted, drop out of the labor market,

and end up homeless. They may stop using drugs, but 2 years later they are

picking pockets to buy food because they cannot find a job. It need not be

the case that economic-compulsive crime means only stealing to obtain

drugs within the next few minutes.



There also are children who suffer because of abuse or neglect at the hands

of addicted parents. Researchers should consider not only the "cocaine

babies" who were exposed in utero, but also children who were abused as

2-year-olds and commit crimes 20 years later. This issue has been

neglected because of the focus on the activities of users and sellers

proximate to the drug activity. Researchers should take a broader and more

holistic view of the types of crime they should be thinking about in

drug-related crime research. A suggestion was made to strike the word

crime, because the parent who is inattentive to a child, for example, may

not cross the line into criminality.



"Research on Drugs-Crime Linkages: The Next Generation"



Robert MacCoun, Beau Kilmer, and Peter Reuter



Dr. MacCoun acknowledged the importance of the need to define crime

more broadly and to include the study of corruption in future research. He

and his coauthors had focused on street crime and proposed some

consensus principles on causal directions that they thought would be

widely accepted in the drugs and crime research community. He also

acknowledged that the research reviewed represented enormous bodies of

work.



Discussion: Most Helpful Ideas



Victimization and the tripartite framework. Dr. MacCoun offered a

clarification of the victimization issue as it relates to the tripartite

framework. Victimization was initially included in the framework as a

subcategory within the category of psychopharmacology. But the concept

of victims is difficult to establish in the real world. In one study, for

example, participants in 40 percent of the violent events were classified as

codisputants. The researchers could not determine who was a victim and

who was a perpetrator.



The four-cell scheme for classifying drug markets. Reintroduction of the

four-cell design for describing drug markets was considered a strength of

the paper. In that design, markets are classified according to whether

buyers and sellers live in or outside the area where drugs are sold.

Although there has not been a great deal of research on the

operationalization of markets and the consequences of each type of

market, the approach was regarded as a useful policy paradigm. If

researchers can work with local law enforcement agencies to identify the

distribution of those types of markets and their locations, they will be one

step closer to helping the agencies implement policies appropriate for

the markets in particular communities.



Drug supply. Two comments were offered about drug supply. One

addressed outdoor versus indoor markets. The suggestion was that if

markets moved indoors, the ability of law enforcement agencies to drive

down the supply of drugs would increase because the agencies could use

such technologies as wiretaps. The other comment was that incapacitation

is largely a function of supply. That is, eliminating dealers may reduce

drug availability, although new dealers may take their place. The Federal

antidrug effort does not make a large dent in the supply. One operation

conducted in the 1980s that targeted a jungle laboratory seized several tons

of cocaine but had no impact on the cocaine supply because the dealers

had five or six other laboratories.



Clarifying legalization. Dr. MacCoun responded to a favorable comment

about his raising the issue of legalization by clarifying his use of the term.

It is very difficult, he said, to discuss alternatives to the current system

because the debate tends to focus on two models that are at polar

extremes: a free market in drugs and some version of prohibition. A range

of possibilities exists between these ends of the spectrum, and in

examining European models, researchers are looking at countries that have

legal prohibitions yet are signatories to international agreements on drugs.

The word legalization must be used cautiously because it implies

commercialization. The Swiss model, for example, is an incremental

model and is heavily regulated, thereby costly to apply.



Rather than studying the issue of drugs, crime, and their connections, more

time could be spent on the connections among drugs, crime, and policy

and the effect of their interaction. There are opportunities internationally to

examine innovations in policy, which by no means constitute legalization

in the sense of commercialization but are nevertheless more substantial

than the policy variations typically observed in the United States. If one

accepts the premise that drugs, crime, and policy all interact, researchers

could learn from instances in which policy varies. They could, for

example, conduct empirical data collection on experiments conducted in

other countries in an effort to understand drugs-crime-policy links.



Dr. MacCoun offered an example of an opportunity of this kind that has

not been addressed. In the1970s, Italy depenalized (that is, removed the

penalties for but did not legalize) personal possession of all drugs that are

prohibited in the United States. Italy maintained depenalization until 1990,

repenalized that year, then depenalized again in 1993. Researchers could

conduct archival research to examine the effects of these policy changes.



A participant offered two examples of other kinds of opportunities for

international research. One opportunity exists because of the externalities

of U.S. drug policy in relation to drug use by young people outside the

United States (in Latin America, for example). The United States has a

global impact, because of what it does domestically. This has been

neglected in research that focuses on the United States. The second

example is societies where the use of intoxicating substances is common

and the link to criminal behavior is absent. This presents another

opportunity for international research. Although policy variations are more

diverse outside the United States, other countries lack the data

infrastructure we have here, which complicates research efforts.



Researchers are on the brink of being able to capitalize on research on the

temporal sequencing of policy interventions. The analytic framework for

drug policy pits the various components of policy against each other in a

battle for resources. Conflicts about implementation can be found at the

Federal, State, and local levels. But researchers can develop first-order

models and simulations to anticipate epidemics and collateral problems

that may be associated with epidemics, prevent epidemics, address

epidemics early on in a cycle, and address them later on in a cycle.

This would allow consideration of more dynamic

policy/resource allocation.



Discussion: Problematic Ideas



Flawed methodology. A general question about methodology was

prompted by Dr. MacCoun's statement that the Swiss experiment is flawed

methodologically. Dr. McBride had made a similar point in his paper,

noting that research on interventions contains methodological problems,

but that the treatments work nevertheless. The question for Dr. MacCoun

was what policymakers should make of this discussion.



Dr. MacCoun addressed his skepticism about interventions, specifically

about the Swiss experiment with heroin maintenance. He noted that the

Swiss results were ambiguous because they lacked true random

assignment and because heroin maintenance was confounded with

provision of other forms of treatment. However, the Swiss experiments

demonstrate that heroin maintenance is logistically feasible and provide at

least tentative evidence for its benefits.



A forum participant asked whether the Swiss heroin maintenance

experiment serves as a lever forgetting addicts into treatment and, if so,

how the Swiss measure treatment outcomes. For example, is success

measured strictly in terms of abstinence, or is rehabilitation a positive

outcome? Dr. MacCoun responded that as a researcher he criticizes the

confounding of heroin maintenance with other interventions in the Swiss

study. However, on humanitarian grounds, he might celebrate that

weakness because it implies that the heroin maintenance program

encouraged Swiss addicts to seek other needed treatments.



Failed interventions. The results of a National Academy of Sciences

(NAS) study suggest that researchers have not done a good job

documenting which interventions work, but they can scientifically

document those that do not work. In the last quarter of the 20th century,

one of the most important interventions has been to lock up drug offenders

and "throw away the key." Research projects that use this kind of

intervention as a control almost always indicate better results for

treatment. Foreign interdiction is another failed intervention, as price and

purity data indicate. Data are also available on 25 other interventions that

do not prevent youths from starting drug use or other deviant behaviors. A

key element in a research agenda may be to develop a list of interventions

that are popular politically but do not work.



Successful interventions? At times in recent history, source-country

interdiction has been reported as effective. Examples are the Turkish

opium ban and the so-called French Connection. There have also been

spikes in prices to which the market adapted immediately. These

observations gave rise to the question of whether data indicate reductions

or increases in crime correlating with the price fluctuations.

Impulse-response analyses of these events, exemplified by an NAS review,

indicate that little is known about the suggested correlations.



Lack of direct measures of deterrence. Measurement of the effects of

deterrence on retail operations is also lacking. Researchers primarily use

price fluctuations as their core index, and that measure is weak. There is

no probabilistic sample and researchers rely on Drug Enforcement

Administration (DEA) data, which are designed for a different purpose.

This calls into question the usefulness of studying price fluctuations as

they relate to crime in drug markets.



Are drug epidemics cyclical? The dynamics of the drug scene and the

constantly changing nature of drug markets raise the fundamental question

of whether drug epidemics are cyclical. The time course over which

researchers have studied this phenomenon is 1.5 cycles, which is not long

enough to attempt a fit with any cyclical model. If drug epidemics are

cyclical, researchers should examine what has occurred before the next

cycle.



Event dynamics of the tripartite framework. The tripartite framework

could be applied to research on why a drug user becomes violent in one

circumstance but not in another and under what conditions violence does

or does not ensue during episodes of drug use. One study borrowed

methods from symbolic interactionism and game theory to examine drug

transactions. Researchers have tried to understand the sequence of

potential to motivation and motivation to action. In other words, they tried

to observe a cascading effect in which drugs may take the user from a

stable state to an aroused state and then to an aggressive state.



This particular study of drug transactions revealed that drugs have strong

psychoactive effects. The researchers examined the mediating mechanisms

through subjects' own narratives, in which they disclosed how they would

change their behavior in a confrontation. When they were under the

influence of drugs, they said, the stakes would rise: They would become

more boastful, their language would change, and they would misread

perceptions of danger or the cues from another person. This research

demonstrates that thinking about event dynamics as a framework in which

causal factors unfold over time is a promising method for examining this

issue.



Limitations of the tripartite framework. Researchers need to be aware of

problems in applying the tripartite framework as a measurement tool.

Although this framework is still important, it was designed to explain

connections between drugs and violent crime. In examining relationships

between drugs and nonviolent crime, we need to transcend the framework

and also use it to understand particular events. With respect to the latter,

multidimensional has been the most important category of analysis

because things rarely fit neatly into any of the others.



Researchers who apply the tripartite framework also need to go beyond

New York City to locations throughout the country to identify a reliable

source of data on the drugs-homicide link. The Arrestee Drug Abuse

Monitoring (ADAM) instrument contains a drug market section that

addresses the characteristics of markets over time, by location, and by

comparing indoor with outdoor. Another potential data source is a

NIDA-funded international study of the psychoactive and sociobehavioral

effects of marijuana use in Amsterdam, San Francisco, and Melbourne.



Decriminalization and the link between drug use and crime. What is the

link between drug use and nondrug crime? Because drug possession is

itself a crime, various types of decriminalization (which are not necessarily

the same as free access) will be needed to sever the link between drug use

and crime. This point is important from a research perspective because the

illegality of drugs is a constant in all research conducted in the United

States. Various models address the implications of illegality, such as

corruption and market-oriented violence. Opportunities for comparative

research should be sought in countries that have decriminalization

policies, countries where some drugs are part of the culture and used

freely, and in historical work on periods when drugs were legal in the

United States. Other research opportunities include the study of legal

drugs, such as alcohol, to see how society manages the effects of these

widely used substances.



Researchers' impact on State-level policies. Researchers' results can

influence policymakers and State budgets. Delaware, for example, actively

tried to introduce drug treatment into its prison system in the late1990s.

Delaware's attempts were closely associated with drug courts, which are

based on the premise that offenders who have extensive criminal histories

and signs of addiction will commit less crime if their addiction can be

halted. By making treatment part of corrections, the State has changed the

definition of crime.



An example of the way the definition of crime can change involves

urinalysis conducted among offenders on probation to test for drug use. A

positive test counts as a technical violation for which probationers may be

returned to jail. With the introduction of the therapeutic approach into

prisons, Delaware's Department of Corrections and judges have become

sensitive to the implications of positive urinalysis results. Although

classified as relapses, positive urinalysis results have become the

equivalent of crimes. In this way, research has affected policy as the

corrections system introduced treatment and changed the way crime is

defined.



Corruption in models of drug distribution. A comment was made about

corruption in connection with models of distribution. It is essential, in the

view of the participant who made the comment, that these models address

street-level ethnographic research that found some police on the street to

be involved in the drug trade to the extent of having a dramatic impact on

how the trade operates. Police corruption plays a dramatic role in the drug

trade on both the micro and systemic levels. One reason is that public

policy sometimes permits seized assets to devolve to police departments

on the basis of their own enforcement activities. A related issue is the way

in which police affect or do not affect particular drug markets depending

on how they choose to enforce the law.



Reports and Feedback From the Roundtable Discussions



Methods, Measurements, and Datasets



There is a need for integrated data collection and better measures.

Suggested areas for further research include identifying particular local

areas for saturation testing of multiple measurement methods and

determining how current measures overlap. In the National Household

Survey on Drug Abuse (NHSDA), data are gathered from the general

population, but other data collections, such as Monitoring the Future and

ADAM, are more narrowly targeted. We do not fully understand how the

methods used in these surveys overlap. The ADAM program has

attempted to include questions in the survey instrument that enable

analysts to link ADAM data to data in other surveys.



The validity of self-reports of both crime and drug measures is a

significant issue for research. Such issues as subjects' recall and

telescoping are addressed in parts of larger studies, but funding enables the

testing of the validity of self-reports in only a few studies. The wording of

questions, the order in which they are asked, and the effects of the

urinalysis itself (in the ADAM program) are possible areas of

investigation. Experiments involving random assignment of survey

questions offer an opportunity for study as does altering the sequence of

urinalysis and survey administration. Interviews with study subjects might

produce different results depending on whether the urine specimen is taken

before or after the interview.



How DEA data on such elements as price, purity, quality, and signature

information can be folded into programs like ADAM is a key issue.

Apparently signature analysis can be conducted as easily on urine

specimens as on actual samples of drugs. If so, it would enable additional

information to be integrated with the ADAM data.



Ethnicity and Race



Family and genetic issues as well as race and ethnicity are important for

future study. The Human Genome Project may provide data relevant to

studying drugs and crime. Researchers must do a better job of articulating

the importance of these factors. The public should not be led to believe,

for example, that there are single genes related to poverty or violence. The

need for more attention to diversity within and among ethnic and racial

groups was recognized as a priority. Acknowledging that caution must be

used in analyzing the concept of race in scientific research, participants

recommended the study of ethnic variation, learned behavior, and culture.

The addition of discussions of culture to the three forum papers was also

recommended.



We can expect diversity in drug use among different groups, such as

Hispanic Americans and blacks. An example of diversity within groups is

the drug use patterns of Mexican Americans in the Hispanic American

population. Diversity raises complex issues that involve conceptualization

in measuring environmental circumstances, conditions, and processes.

These issues affect research on ethnicity and on gene-environment

interactions. The research community must address the sensitivity of the

combination of the issues of genes and race, possibly through formation of

a NIDA-NIJ working group.



Several specific issues or phenomena involving ethnicity and drugs offer

opportunities for study. An example is the National Development and

Research Institutes study of the "blunt generation," which revealed that

black youths in New York City are shifting from crack to marijuana and

tobacco. This research can be used as a model to study whether the same

transition is occurring outside New York City.



Researchers should be mindful of the factor of religion because, like

ethnicity, it has different levels of importance for different ethnic groups

and a bearing on criminal behavior as well as drug use. Another area for

study is the differential effects of methamphetamine on different ethnic

communities. There are few examples in which blacks are represented

among either methamphetamine users or casualties of its use. However,

research has revealed users and casualties among members of other ethnic

groups, particularly Pacific Islanders.



Two research design issues were raised in the roundtable discussion. One

had to do with the false belief that there is variation by ethnic

group in the extent to which information from self-reports differs from

bioassay results. Recent research might be developing evidence that will

contradict some of these false beliefs. The other involved IRBs, protection

of human subjects, and the differences in the confidentiality certificates

issued by NIJ and the U.S. Department of Health and Human Services

(HHS). Discussions between NIJ and HHS about checks and balances in

the IRB processes would allow researchers to learn more about pressing

social problems that do not necessarily fit the HHS biomedical research

model.



Policy Issues



Researchers need to examine policies other than those specifically directed

at drugs, such as economic, social, and health policies. NIJ and NIDA

could consider commissioning a series of multidisciplinary review papers

that focus on the potential impact of policies on outcomes. The policy

community would be the target audience. Currently, no mechanisms are

available to examine policies at the Federal, State, and local levels. We

need a database that would enable researchers to examine variations in

policy among jurisdictions. Another important and related area for

research is the development of models that transcend econometric models

in examining the impacts of policies on outcomes. Researchers have not

developed models that examine the impact of public policies on behavioral

outcomes and the relationship between drugs and crime. Input from

practitioners about the impacts of policies on their constituents may

advance this line of investigation.



Drug Markets



How do researchers define and measure drug markets? Among the issues

considered in the roundtable discussion were the usefulness of such

measurements and the benefits to law enforcement agencies from this kind

of research. The discussion covered how researchers might measure the

harmful effects of drug markets and how to detect changes in those

harmful outcomes overtime. For example, how would researchers compare

the effects of crack markets that proliferated 10 years ago with the effects

of the blunt generation today? Nonharmful outcomes and the need to

examine how they change over time were also considered. Social control

mechanisms operating in markets, the question of whether market stability

is desirable, and health issues associated with market stability were also

suggested as topics for research.



Treatment in the Criminal Justice System



The treatment roundtable focused on two measurement issues and two

potential interventions. The first measurement issue was dropouts. When

drug users undergoing treatment drop out of the program, this affects any

evaluation under way because the numbers change. Other disciplines have

dealt with the problem by using econometric and other statistical

techniques. The participants thought some of these tools should be brought

into the drug treatment literature.



They also recommended comparing the effectiveness of different types of

treatments used in the criminal justice system, an undertaking for which

there is currently no common measure. The Addiction Severity Index

(ASI) was discussed, but using the ASI poses problems because of the

"past30-day" questions it includes. Opportunities provided by new

technologies for detecting drug use, such as hair testing and sweat patches,

were also considered.



Contingency management is an intervention examined in the Greenwood

study, which revealed that paying students to finish high school is

cost-effective. If this approach is applied to encourage treated prisoners to

receive more treatment or to refrain from using drugs once they leave

prison, it may offer opportunities for research.



The problem of treating drug-using offenders after release from prison is

another intervention issue that could benefit from research. In addition to

using contingency management, some States hire case managers to

encourage prisoners to continue receiving treatment. Texas, among other

States, makes such additional treatment a condition of parole. Research

indicates that contingency management has not worked well in the long

run because behavior starts reverting to baseline when rewards stop.



The impact of welfare restructuring on the drugs-violence nexus is also a

topic for future research. Some inmates were receiving Medicaid benefits,

which they were using to pay for drug treatment. Since they no longer

receive Medicaid, corrections-based treatment plays a larger role.

Outcomes other than refraining from drug use, such as payment of child

support, family formation, employment stability, and residential stability,

may also be useful as indicators that a former prisoner has addressed

problems associated with drug use.



In assessing the effectiveness of treatment programs, the fundamental

problem for researchers is obtaining the kind of post-treatment and

postrelease data they need. A study under way in Florida is examining this

issue in a nonprison treatment setting where researchers have access to

measures of criminality and other data. However, these measures may not

enable the researchers to effectively differentiate between the treatment

programs in which the subjects were enrolled, which include most

programs in Florida.



The reporter for the roundtable responded to a followup question about the

possibility of requiring treatment providers to track data. He noted that the

mandate for the Florida study came from the State legislature, which

requires evidence that money spent on treatment produces a result that is

more economically valuable to the State than the current expenditures.

However, treatment providers cannot respond very effectively to the

legislators' mandate because they do not have the resources to track all the

data.



The facilitator told forum participants to imagine a situation in which they

are approached by a philanthropist who claimed that he could raise large

sums of money if researchers could develop agreed-upon measures of

outcomes that were valuable and whose cost was lower than the cost of

producing the results. The participants were challenged to find out if they

could do so with the interventions they had tested.



In response to the challenge, one participant noted that in some studies of

the valuing of drug abuse treatment outcomes, people who are not drug

users are asked how much it is worth to them to live in a drug-free and

crime-free community. It is not possible to put a monetary value on such

issues. Other studies examine outcomes like abstinence or a range of

outcomes involving improvements in health, social functioning, and

criminal behavior. To provide guidance on improving drug abuse

treatment at the program level, NIDA has tried to shift the focus of the

research to what the program does, what is unique about it, how it is

organized and managed, and what is unique about the treatment delivery

system. Another responder stated that if the philanthropist could find a

way to support graduates from drug treatment programs who live either in

prison or in the community and are otherwise unemployable, guarantee

them jobs, and assure them of an income of about $20,000 per year, there

would be much better results than those that researchers are seeing now.



In a followup scenario, the philanthropist is prepared to supply the money

for whatever it takes to produce a graduate of a treatment program who

was formerly a drug user and in prison and to assure him or her an income

of $20,000 per year. The question for researchers is what is the value to

society of 50 of 100 people leaving prison, acquiring job skills, and

earning $20,000 per year 2 years after release? If researchers could specify

for the philanthropist the value to society, backing it up with a defensible

number, and tell him what it would cost to net 50 successes from the 100

released offenders, he would raise the money for those 50 people. He

would have to know and be able to tell his donors, however, the numerical

value of those 50 successes.



One participant who responded commented that for almost any

intervention, researchers could produce a calculation indicating that the

resultant number is better than doing nothing, although there probably is

no drug control intervention for whose effectiveness researchers could

provide definitive proof 20 years hence. This approach, however, is not a

constructive way to make practical managerial decisions and is not the

way that businesses, for example, think about such matters. Another

responder pointed out that a similar question is not asked about dialysis

treatment for end-stage renal disease or liver transplants for people with

cirrhosis, although they might persist in behaviors that promote their

diseases. Thus, researchers are imposing a standard on drug treatment that

they do not impose on other medical treatments.



"The Drugs-Crime Wars: Past, Present, and Future Directions in Theory,

Policy, and Program Interventions"



Duane C. McBride, Curtis J. VanderWaal, and Yvonne M. Terry-McElrath 



Current drug policies have not always been in effect and may not always

be in place, and some policy changes have been dramatic. Dr. McBride

discussed the historical context in which drugs-crime relationships should

be examined. In the 19th century, drug policies in the United States varied

enormously. Distribution was relatively open: Imports were regulated but

domestically there was some access and even commercialization. Drugs,

needles, and syringes were available through the Sears-Roebuck catalogue.

In reaction to this openness, many States began to heavily regulate drugs.

Officials from some States complained that other States openly sold drugs

that they themselves were trying to regulate. The labeling of drug content

was instituted and States made many changes in their laws and policies.



Discussion: What ideas from the paper are most helpful?



Cause and effect in the drugs-crime relationship. The section of the paper

dealing with the cause-effect relationship of drugs and crime suggested an

interesting line of inquiry. The forum discussions had looked primarily at

the relationship in terms of drug use preceding crime. From that

perspective, interventions were assessed on the basis of the effects they

might have on drug-related crime that immediately follows drug use.

There was no consideration of the early antecedents of drug use and

criminal behavior.



Study findings on the antecedents of drug use and criminal behavior

reviewed in Dr. McBride's paper, as well as research conducted by Dr.

Anthony on aggression in first-grade students, were cited as examples of

areas where further research is needed. Evaluation of classroom

interventions revealed that addressing conduct and aggression problems

reduced the risk of future drug use, which suggests that deviant behavior

may precede drug use.



History of drug policy. Participants identified the attention given to the

history of drug policy as a strength of Dr. McBride's paper. The conflict

between the puritan and libertarian traditions, which he cited, is played out

in current drug policy discussions.



Collaboration among agencies. As States develop comprehensive systems

to address drug problems in their criminal justice systems, collaboration

among agencies becomes more crucial to policy formulation. For example,

in the California Department of Corrections' treatment system, which

currently has 7,000 beds, the treatment providers and the corrections unit

that operates the system have been meeting regularly for years. Parole

officials began attending the meetings only in the past 6 months, however.

Parole is an essential policy element because the program includes an

aftercare component.



Using graduated rewards and clients' strengths in drug treatment.

Suggestions were made that graduated rewards, as well as the graduated

sanctions mentioned in the paper, should be studied for their use in drug

treatment programs. Further, more attention should be paid to the clients'

strengths in addition to their needs, problems, and resources. Dr. McBride

agreed that inclusion of a strengths-based case management system is

crucial to treatment.



Comorbidity issues. The comorbidity issues covered in Dr. McBride's

paper were considered relevant to the forum discussions of policy and of

treatment in the correctional system. As a result of high rates of

comorbidity and of deinstitutionalization in the mental health field, some

prisons are the major mental health service providers in large urban

counties. This situation influences the effectiveness of treatment in

correctional settings, and is a situation in which some medical care

providers feel more like law enforcement personnel.



Ballot initiatives and research. Ballot measures such as California's

Proposition 36 address drug policy, and are frequently supported by

advocacy organizations that are also interested in research. Social

scientists should try to gain currency with these organizations and open an

avenue through which the research community can examine these policy

experiments and their outcomes. Researchers previously have not made

strong connections to those who propose public policy reforms from the

perspective of the political right, and the same may now be true for the

political left.



Health versus criminal justice research funding. The Robert Wood

Johnson Foundation is funding a study of Proposition 36 that may become

a model for reporting that could affect public policy. The Robert Wood

Johnson Foundation focuses on health issues, and its sponsorship of this

project indicates that the criminal justice research community is

underfunded because a health funding organization is implementing

portions of the criminal justice research agenda.



Building collaborations between NIDA and NIJ to study drug enforcement

would be an important part of a future research agenda. Such collaboration

could address major policy issues, such as variations among States in the

intensity of drug enforcement and how strongly they enforce drug

prohibitions.



Researchers could also evaluate the effects of different kinds of

enforcement, but would need to identify appropriate outcome measures to

do so. State-level measures are being developed for NHSDA, but would be

inadequate for these purposes because they focus on the prevalence of

addiction. The ADAM sample frame is not suitable for this type of project,

which would address how enforcement affects drug use. The relationship

between drugs and crime, in and of itself, is not as useful as is research

that will inform drug policy. NIJ is primarily a policy research agency that

should be addressing such policy-driven issues as alternative enforcement

strategies.



Publishing policy research. Studies of Proposition 36, changes in the

Rockefeller drug laws, or the Swiss heroin experiment do not have perfect

control groups and random assignment of subjects because they examine

real-world situations. This may limit researchers' ability to publish in the

better journals. In addition to providing funding, NIJ and NIDA could

increase the demand for policy research by fostering publication outlets.



To obtain funding, grant applicants are required to address scientific

design issues. Poor designs submitted to the National Institutes of Health

(NIH) may not be acceptable to epidemiologists, but the New England

Journal of Medicine has published comparative studies of the impact of

handgun regulations on homicide and suicide rates in Vancouver and

Seattle. Dr. McBride cited these studies, which compared different

populations, as examples of flawed designs that would not have received

NIH funding but were nonetheless published in a quality journal.



Funding for secondary data analysis. Dr. McBride's paper was praised for

its list of suggestions for future research, particularly because of the

proposal that secondary data analysis could provide a new empirical

baseline for study of the drugs-crime relationship. Securing funding for the

analysis of NHS data, to assess the extent of drug use or the gateway

model has been difficult. The only sources of funding for analysis of

ADAM data have been small grants from NIJ or organizations like the

Robert Wood Johnson Foundation. Funding agencies spend large sums of

money supporting new data collection and relatively small amounts

supporting secondary analysis.



Discussion: Problematic Ideas



Policy implementation and evaluation. Without effective enforcement and

implementation, it does not matter which policies have been adopted. With

respect to tobacco, there was a great deal of policymaking at the State

level, but until there was enforcement, the policies did not make a

difference. Dr. McBride's paper suggests that policies directed at club

drugs (for example, changes in methamphetamine penalty structures) offer

important research opportunities. Researchers have an opportunity to

evaluate the effects of these laws and policies from both the criminal

justice and the public health perspective.



Dr. McBride noted in his paper that model laws developed by the National

Alliance for Model State Drug Laws have not been examined for their

effectiveness. This indicates a need for studies of implementation and

enforcement. One participant suggested that the forum should be open to

the possibility that not implementing current laws might be advantageous

in some situations.



References in the paper to the moral tensions surrounding drug policies

illustrate how values affect assessment of those policies. An example of

those tensions is the different standards of evidence used in assessing new

pharmaceutical products and in evaluating controversial new drug policies,

such as those based on relaxed enforcement. There is also a reciprocal

relationship between drug policy and drug use, because the public, to

whom laws and policies are directed, includes the voters who elect the

legislators who in turn make the policy. Policy research must take into

account that the consumers of policy, or the public, also influence policy.



Historical roots of current policies. In Dr. McBride's paper, the

juxtaposition of libertarianism on one side and puritan morality on the

other resulted in a lack of historical background needed for understanding

the current situation. Missing elements include the harm that drugs cause,

status battles among people who want their moral beliefs adopted as

official policy, and the agendas of interest groups.



In citing an example of the effects of interest-group issues, one participant 

suggested that if asset forfeiture laws changed so that seized assets were

spent on drug treatment rather than enforcement, the statistical portrait

of drug use might change. A better understanding of the historical roots of

current policies should be included in the research community's policy

research agenda. Also suggested for inclusion in Dr. McBride's paper were

more material about the racial dimensions of Prohibition, its 19th-century

roots, and its current manifestations; and a reference to Tonry's Sentencing

Matters in the paper's discussion of mandatory minimum sentencing.



Continuum-of-care treatment models. Studies of drug addiction as a

chronic disorder have implications for treatment models, such as

continuum-of-care programs. Current research has established the need for

continuum of care, and future research could systematically address the

elements of a continuum-of-care model rather than considering adaptation

of current models.



In order to provide good continuum of care, medical and social services

need to be linked. This would involve coordination among social service

agencies, public health agencies, and corrections or other criminal justice

agencies. Issues concerning the reintegration of treated drug users into the

community should also be addressed in future continuum-of-care research.



Computer simulations. Dr. McBride suggested that researchers start

thinking about computer simulations. A participant interpreted this to

mean creating broad models with many parameters, which would produce

many research questions that could be used to generate useful policy

analyses. The drugs-crime research field would benefit from a macro effort

in multiple places, with multiple perspectives, which would examine

policy concerns with research backing. Modeling would stimulate further

work in all areas of drugs-crime research.



A comprehensive surveillance system. In his paper, Dr. McBride did not

address the need for a comprehensive surveillance system that would

enable researchers to detect when peaks in drug-related violence begin.

Such a system would allow researchers to study the peaks as they form and

also understand why they form. A big peak of violence occurred in the

United States in the late1970s and early 1980s, and another occurred in the

late 1980s and early 1990s. Between those peaks was a valley, and a very

deep chasm began in the1990s.



Many explanations have been offered for the peaks, such as changes in

drug markets, incarceration rates, community policing, and enforcement of

quality-of-life offenses. Ethnographic field stations in high-risk

communities, enhanced data collection by police, and a study of medical

examiner data were proposed as research topics in this area. These

enhancements should be incorporated into a routine surveillance system

that would facilitate study of the next peak in violence. Such a system

would allow analysis of qualitative observations in conjunction with

overdose and arrest data.



Use of mild drugs is normative for adolescents. Developmental factors that

affect drug use and its relationship with crime had been alluded to in

previous forum discussions, but had not been a topic of discussion.

Developmental literature on use of mild drugs (alcohol and marijuana, for

example) indicates that this behavior is normative for adolescents. These

drug-using adolescents do not commit many crimes other than using the

illegal substance. If the drug use continues as they grow older and they

also move on to using harder substances, problems with other kinds of

crime are then observed.



The role of the family in shaping behavior. Another topic not adequately

addressed was the critical role of the family in shaping behavior. In

developmental psychology, interventions are family-based, rather than

broad-based population interventions. (An example of the latter is keeping

offenders in treatment.) The importance of interactive relationships within

the family was illustrated by research on children who have attention

deficit hyperactivity disorder (ADHD).When children with ADHD are

medicated, the behavior of the parents changes, even if that of the children

does not.



Changes in heritability. Quantitative-genetics research projects, such as

twin-sibling studies, have revealed that changes in heritability occur over

time and with respect to gender. Thus, if researchers identify a gene

associated with substance use, the association may not hold for all age

groups or populations. In addition, the concept of a single gene

determining complex behaviors like substance use is unsound.



Missing data estimation. Many researchers are working with techniques

for estimating missing data. These techniques may produce results more

representative of reality than those produced by other methods.

Biostatisticians use missing data techniques to model longitudinal data,

such as tracking youth drug use and transitions through different stages of

drug use. For example, researchers do not assume that dropping out of a

study is a random phenomenon. They try to account for it by modeling the

dropout process.



Many standard statistical methods are built on the assumption that missing

data are random, thus young people who drop out would be no different

from those who stay in the study. However, in studies of drug use,

dropouts often may be incarcerated, in low-income families, or moving.



What Do and Don't We Know About the Relationship Between Drugs and

Crime? Reaching for Consensus



The facilitator led a consensus-building exercise in which statements by

forum participants about the drugs-crime relationship were accepted,

amended, or rejected. Decisions were made according to an iterative

process; only ideas on which there was unanimous agreement were

approved. The statements concerned either what is known or what is not

known about the relationships between drugs and crime.



Consensus Statements on What We Know About Drugs-Crime

Relationships



The complexity of drugs-crime relationships is widely accepted and means

that the research tools we have been using to study that relationship cannot

get us very much further in the next decade. The complexity of the

drugs-crime relationship was accepted as fact. Forum participants arrived

at a consensus on the need for new tools, which would include both

paradigms and methods, if future research is to elucidate the relationship.

The belief that 10 more years of the same type of research currently being

conducted would not advance the understanding of the drugs-crime

relationship was disputed because some progress has been made.



We know that we need to know more about the effects of child abuse and

spousal abuse on drug use and drugs-crime interrelationships. The original

statement was amended to eliminate a clause on intergenerational effects

of abuse on crime and drug use because these effects have not been

sufficiently characterized.



We know that trends in drug use do not parallel rates of incarceration. The

number of people in the United States who are incarcerated has tripled

since 1983. There was no consensus on whether most of the increase was

due to enforcement of drug laws. The statement was amended to reflect the

consensus that we do not know whether the increases in incarceration have

resulted in decreases in drug use in particular or crime in general.



We know that drug use is neither a necessary nor a sufficient cause of

nondrug criminal behavior. The statement was accepted without

amendment.



We know that we need longitudinal data to sort out the relationships

between drugs and a host of other causal factors. The participants could

not arrive at a consensus on a statement that cause-and-effect questions

can be addressed only by using longitudinal data. It was modified to read

that longitudinal studies are important in making cause-and-effect

statements. This modification was not accepted, however, and consensus

was achieved only on the need for using longitudinal data to elucidate

relationships between drugs and many causal variables.



We know that illegal drug choices tend to vary with social position. This

proposition began as a statement that illegal drug preferences tend to vary

with social position. A participant objected, saying that what is available

in different markets may determine what options are available to be

preferred. The statement was accepted after "preferences" was changed to

"choices" and the meaning of the phrase "social position" was clarified.

Social position may be affected by, but is not synonymous with, either

social class or ethnicity.



We know that we urgently need local as well as national data (on drug use

patterns) to augment the utility of those data for practitioners. A

participant proposed that data on drug-use patterns must be local to be

useful because ethnographic and ADAM data show differences by site. For

example, methamphetamine use is not a problem in most U.S.

communities, but it is the major drug problem in Hawaii and southern

California. The audience for data may affect their usefulness; thus, for

example, national data may be useful to Federal policymakers.

Crossnational data may also be useful in addressing some issues.



Modifications of the consensus statement to the effect that drug-use data

need to be local to describe local markets, to be useful to practitioners

generally, or to be useful to local practitioners were all rejected. Local data

were deemed useful in detecting emerging trends in drug-use patterns. The

idea that trends in national data, such as the decline in drug use identified

by the Monitoring the Future Study during the 1980s, were not useful was

seen as implausible. The statement was amended to reflect a need to

augment national data with local data to maximize policy and practice

utility. The statement was amended as shown above and accepted by the

group.



We know that given arrest for a drug offense, an African-American is

more likely than a white American to be prosecuted; and given conviction,

an African-American is more likely to be incarcerated and for a longer

time than a white American. These official results do not accurately reflect

the racial differences in involvement with illicit drugs. There was general

agreement that this is known to the research community but not to society

generally. There is a need to disseminate the information among

policymakers and the forum publication will be a means for doing so.



We know that a person's drug taking makes him or her more likely to be

either a victim or perpetrator of a crime that otherwise would not be

committed. The statement was accepted without amendment.



We know that incarceration of drug sellers is in large measure offset

through replacement by other sellers. As originally proposed, the statement

read that incarceration of drug sellers leads to recruitment of replacements

for those sellers. There was no consensus on whether the replacement

phenomenon is known to occur or not. One suggestion was to modify the

statement to read that a consequence of incarceration of drug sellers is

recruitment of replacements. This statement was considered too weak

because there could be many consequences. Another proposal was to

modify the statement to read that the incarceration of drug sellers is in

large measure offset by the recruitment of additional sellers. The word

"recruitment," which implied that superior sellers were seeking

replacements, was eliminated in favor of "replacement," and the amended

statement was accepted.



We know that the interdiction efforts that have been conducted over the

past 20 years have not achieved their goal of substantially reducing

street-level access to drugs. As originally proposed, the statement read that

interdiction has had minimal effects on the availability of drugs at the

street level. Researchers do not have a sense of the flow of drugs from

source countries through transit and arrival zones to markets. Since there is

little empirical evidence of how much drug traffic is actually interdicted

and how interdiction has affected market availability, the statement was

amended as shown above and accepted.



Consensus Statements on What We Do Not Know About Drugs-Crime

Relationships



Long-term, intergenerational studies are needed to generate and test causal

hypotheses about drugs-crime relationships. A generation of grandparents

as well as parents has been heavily involved with illegal substances and

these people now have children or grandchildren. Thus, there are

intergenerational subjects who could be studied, but such studies would

not necessarily establish cause and effect. A suggestion was made that

intergenerational data are needed to evaluate cause-and-effect statements

and that they could be used to generate causal hypotheses. The proposed

statement was amended accordingly and moved to the do-not-know

category.



We do not know whether genes interact with the environment to make

people more or less prone to illegal drug use or addiction. In the proposed

statement, "We do not know how genes interact with the environment to

make people more or less prone to illegal drug use or addiction," use of the

word "how" implied that there is in fact a relationship between genes and

drug use. The statement was therefore amended and accepted as shown

above.



We do not know the extent to which the decline in rates of violence in the

1990s was related to changes in the crack cocaine market. In the proposed

statement, "We do not know the extent to which the decline in rates of

violence in the1990s was related to maturation of the crack cocaine

market," there was a risk of tautology in conveying the notion that a

market is mature if it is no longer violent. The statement, amended to

replace "maturation" with "changes," was accepted as quoted above.



We do not know about community involvement with and orientation

toward drugs, or how and why those change. "Community orientation"

means what the community thinks of the issue: For example, whether the

community cooperates with or opposes the police. The community is

divided into subgroups and subsystems that do not interact well. However,

New York City today enjoys a collective consensus reflecting dislike and

intolerance of heroin injection, crack sales, and crack use. This consensus

was absent a decade ago. Inner-city youths in particular routinely register

disgust at intravenous drug use and drug selling.



We do not know the effect of street enforcement on drug market violence.

The proposed statement, "We do not know whether some forms of street

enforcement actually increase drug market violence," was accepted as

amended to read as shown here. The phrase "some forms of" was removed.



We do not know how best to match treatment approaches to the individual

needs of offenders. As originally proposed, the statement read that

researchers do not know how to determine which type of drug treatment is

appropriate for which type of drug-abusing offenders. It implied that there

is always an appropriate treatment. The person who proposed the

statement responded that most studies do show a

length-of-time-in-treatment effect, regardless of type of treatment. Another

objection cited the many drug-dependent and alcohol-dependent persons

who mature out of their addiction without formal treatment: Researchers

do not know why this happens. Many people arrested as dealers falsely

claim that they are users and are offered treatment. In these cases there

clearly is no appropriate treatment. The statement was amended to propose

matches of treatment services or approaches to the individual patient and

was accepted.



In the aggregate, we do not know if increases in incarceration have

resulted in decreases in illegal drug use by the persons incarcerated. The

initial statement, "We do not know if increases in incarceration have

resulted in decreases in illegal drug use or crime," was considered too

broad. It appeared to mean that there is no class of persons researchers can

describe for whom incarceration results in a decrease in subsequent

criminal behavior or illegal drug use. Specific deterrent effects reported in

the literature would contradict such a statement. If the statement were

more specific, referring only to particular deterrence effects for drug use, it

could be true. The statement also appeared to be an assault on U.S. policy,

which is to "lock them up and throw away the key."



A proposed modification narrowed the statement to make it read that

researchers do not know if increases in incarceration have resulted in

decreases in illegal drug use by those incarcerated. It was intended to

include postrelease drug use by people incarcerated and then released

without treatment. There was general agreement that outcomes for

individual drug users cannot be predicted, but in the aggregate, postrelease

recidivism and relapse rates return drug use to roughly the levels it had

been before incarceration. The statement, as clarified and amended, was

accepted as reflecting the group's consensus.



We do not know enough about the co-occurrence of alcohol and other

drugs in the drugs-crime relationship. There is a great deal of statistical

evidence for this kind of co-occurrence, but a lack of understanding of its

effects on criminal behavior.



We do not have accurate price or sellers' income data for illegal drug sales.

The statement was accepted without amendment.



We do not know how the different policies implemented in various

jurisdictions have produced different outcomes. Policies vary nationally

and by State, and researchers need to know how those variations produce

different impacts. 



We do not know what etiologically differentiates drug-using offenders

from other offenders. The statement was accepted as representing the

group's consensus.



Statements For Which Consensus Was Not Achieved



A statement to the effect that enforcement alone will not reduce drug use

or related crime was rejected as uninteresting because few people claim

that only enforcement is effective and treatment does not matter. The

statement also failed to consider how much effort and resources would be

applied to the problem. Given enough resources, law enforcement agencies

could reduce drug-related crime.



The group rejected an assertion that crack sales/illegal transactions are

among the most common offenses in the United States, although the

assertion was supported by calculations indicating that they swamp other

kinds of felony offenses. A participant pointed out that each sale produces

at least one incident of drug use, so by definition there are at least as many

cases of crack use as there are of sales. Another participant cited research

in which crack metabolites were detected in ADAM samples. The data

show that roughly 90 percent of the cocaine-positive urine specimens were

positive for crack. If researchers could estimate the aggregate number of

crimes, especially felonies, then the crack sales would probably swamp

even thefts, and robberies would be negligible relative to the number of

crack sales. Marijuana sales would not swamp crack sales because many

crack users engage in 5 to 10 transactions each day. Other participants

disputed these contentions, citing work indicating that the entire universe

of cocaine-related transactions would not account for the supposed large

number of crimes.



Statements asserting that cause and effect can be determined only by using

longitudinal studies, that current beliefs about the effects of drug policies

are mainly expressions of ideological preferences rather than scientific

evidence, and that development of low-toxicity substitutes for marijuana

and alcohol are precluded by the Schedule I requirements in Federal law

were also stricken.



Discussion of Areas for Future Research 



Discussion: What Research in This Area Do You Think is Most

Important?



The following topics are areas of research that the forum participants

considered the most important objectives for future study.



Long-range cost-benefit analyses. Long-range cost-benefit analyses of

policies on drugs and crime are needed. Such work would address various

interventions, including those that have already been attempted (such as

incarceration). Inclusion of policy simulation studies was suggested

because they could be used to simultaneously produce cost-benefit

analyses as well as many other insights.



Secondary analyses of ethnographic data. Secondary analyses of

ethnographic databases from different cities should be conducted to

examine data collected during the peak years of the crack markets. These

studies should include comparisons among drug markets in different

neighborhoods or cities as well as prospective studies describing the

criminal justice and public health impacts of illicit drugs on selling and

using communities.



Effective, ineffective, and promising policies. Researchers should conduct

studies that document policies that work, that do not work, and that

show promise. Long-term incarceration was identified as the most

significant policy among those that researchers believe do not work.



A multicity, multimethod surveillance system. Prospective approaches that

combine ethnographic observations with arrest, drug pricing, and health

data could be employed by using field stations in high-risk communities.

An ongoing multicity, multimethod surveillance system should be set up.

It would focus on drugs and crime by using police data, medical examiner

data, and public health data (such as those documenting overdoses, deaths,

homicides, and HIV and other sexually transmitted diseases). A suggestion

that the crime data be limited to homicides (because the researcher can

identify the endings of cases) was rejected because researchers would want

to track changes in drug-use patterns in various places, including those

where few homicides occur.



Ethical implications of genetics research. The ethical implications of

policies based on genetics research in the areas of alcohol, drugs, and

crime should be investigated. Scientists have not been responsible about

addressing the ethical implications of their research; they should be

proactive about the issues raised by genetics research. An agenda or

process for bringing experts together to produce a consensus on ethical

issues was recommended.



An example of such proposed research is identifying links between genetic

susceptibility to drugs or alcohol abuse and various outcomes in the

criminal justice system. Researchers need to think in advance about what

the policy implications might be, and the ethical implications of those

developments should be discussed.



Drugs, mental illness, and crime. More work should be done on the

relationships among drugs, mental illness, and crime as well as the

appropriate interventions. Cognitive dysfunctions were also suggested for

study, making this a proposal to conduct research on mental illnesses,

cognitive dysfunctions, and drugs (in combination) and their relationships

with crime.



The structure of drug marketing in ethnic communities. Comparative

research on the structure of drug marketing and its implications indifferent

ethnic communities should be conducted at multiple sites. One of the

implications to be studied is the extent to which drug marketing results in

penetration of sales into the ethnic communities.



Operational research to improve treatment-outcome studies. Operational

research should be conducted to bring more rigor to therapeutic-justice,

treatment-outcome studies. Estimates indicate that up to half of hardcore

drug users are nominally in the criminal justice system, either as parolees,

as probationers, or in pretrial release status. This situation has significant

implications for national policy and budget. However, the relevant

research literature is inadequate because the programs vary significantly in

characteristics and eligibility requirements; many studies measured

recidivism rather than relapses, limiting their utility; and some studies are

based on nonrandomized comparison groups, which results in data

interpretation problems.



Randomized studies employing no-treatment arms are freighted with

ethical, legal, and analytic problems that must be addressed within the

context of the Code of Federal Regulations (CFR). Under CFR, with its

minimal risk requirement, it might not be practical or feasible to conduct

these experiments because international review boards (IRBs) will

interpret minimal risk stringently with respect to no treatment arms.

However, there may creative, equitable approaches to these kinds of

studies, such as conducting research in locations where scarcity of

treatment slots and randomization may provide a fair way to allocate

treatment. Random assignment to further treatment for previously

treated subjects was suggested as an ethical approach to controlled studies

of the effects of length of time in treatment.



Alcohol and marijuana: Complements or substitutes? Meta-analyses that

assess whether alcohol and marijuana are complements or substitutes

would be useful for modeling policy alternatives.



Drug "consumer price index." Methodological research on a so-called

consumer price index for illegal drugs was suggested as an important

research project. The proposed index would cover retail and wholesale

prices and would complement the DEA's System to Retrieve Information

from Drug Evidence (STRIDE) database. Reorganization of current data

collection or expansion of STRIDE through random drug purchases may

contribute to production of an index.



Survey policymakers. A survey of Federal, State, and local policymakers

to assess their research needs was proposed. The survey would focus on

questions that need to be answered in order to make better policy

decisions. The survey could also help build bridges between the policy and

research communities.



Relationships between distributors and consumers. Research on changes in

the relationships between drug distributors and consumers was proposed.

The attitudes and orientations of distributors would be investigated with an

emphasis on how distribution affects consumption.



Event dynamics in drug markets. The event dynamics in drug markets

should be studied with an emphasis on the role of peer groups and

associations. Peer associations may vary in different ethnic communities

and thus affect drug-selling behaviors. The influence of ethnic

communities mayor may not affect sales in those communities and could

be instrumental for marketing in other communities or cities.



The market research could focus on analyzing when drugs cause

delinquents to engage in crime, rather than analyzing the actual buying and

selling events. This approach would emphasize the drugs-crime

relationship rather than the buyer-seller relationship. Drug-selling peer

groups observed at different times have been observed first encouraging,

then subsequently discouraging their members' violent activities. This

indicates that peer relationships affect the types and frequency of crime.



Extending the focus of the proposed research beyond cocaine to, for

example, the marijuana market, was suggested. Marijuana use has been an

epidemic for 30 years in the United States but little is known about how it

is sold.



Effects of felony disenfranchisement on minority communities. The

political and social ramifications of felony disenfranchisement laws, which

are driven by large numbers of drug-related felony convictions, should be

examined for their effects on minority communities.



Effects of genes and the environment on drugs-crime relationships. Studies

of interactions between drug-using and -selling environments and the

psychopharmacological and genetic aspects of drug use should be placed

on the research agenda. As genetics research becomes more important in

the drugs-crime field, researchers may start touting"drug genes" without

conducting research on how people with different susceptibilities function

indifferent environments.



Drugs have certain physiological effects and there probably are certain

genetic proclivities affecting susceptibility to those effects. However, the

consequences of those proclivities differ according to interactions with the

environments in which the drugs are used. The effects on crime and other

behaviors may vary indifferent communities and subcultures within the

larger society. There may be stigmatization and other consequences that

result from interactions between people's genetic makeup and the

environments in which they live, but people with similar drug genes may

respond differently in different environments.



Not all drug users need treatment. Allocation of limited resources should

be based on research that examines which drug users truly need treatment

rather than those whose behavior should be addressed through law

enforcement. Researchers should study methods to identify users who

require treatment as a way to avoid the negative social consequences of

drug use.



Drug hackers. Researchers need to investigate a growing group of

sophisticated drug users and the more specialized substances available for

their consumption. The cocaine problem may diminish substantially as

more pharmacologically savvy drug users become more numerous.

Amphetamine and barbiturate use has become commonplace; researchers

may have to consult pharmaceutical manufacturers and experts in

pharmacology to address this phenomenon.



A large segment of mainstream America is involved in using illicit drugs

in new ways. Researchers need to change their paradigm of who drug users

are and how they behave. A participant volunteered the term "drug

hackers" to describe new, pharmacologically savvy drug users. They are

similar to computer hackers in that they use drugs in unintended ways,

combining many different substances to mix effects.



Polypharmacy. Research on polypharmacy, with emphasis on the

interactions of licit and illicit drugs, should be included in the research

agenda. Studies of interactions between illicit drugs and alcohol are

particularly important.



The dark side of drug enforcement. Research should be conducted on the

negative aspects of drug enforcement. This includes studies of the flow of

asset forfeiture funds across enforcement agencies and the degree to which

that flow affects enforcement policies.



Enforcement-induced demand shifts. Researchers should examine the shift

in demand from one drug to another as law enforcement focuses on

particular drugs, and the degree to which that shift is helpful or

detrimental. In other words, they should examine whether demand is

shifting to drugs that are less or more serious in their marketing or crime

potential.



Consequences other than crime. The research community should study

consequences of drug use other than crime, such as mental health effects.

The health effects of cocaine and methamphetamine have already been

examined.



Early deviant behavior and drug use. Researchers need to study how parent

monitoring, family cohesion, and family structure affect early deviant

behavior and how that might in turn affect affiliation with drug-using

peers and drug use. Examination of the onset of criminal behavior

following the onset of drug use in monozygotictwins[5] would illuminate

the links between drug use and crime. If there is a causal relationship,

researchers should see crime starting earlier in the twin who starts drug use

earlier.



Middle-class addicts. The criminal activities of middle-class addicts, and

the social and legal consequences of those activities, should be

studied and compared to the criminal activities of low-income addicts.

This research would elucidate and deracialize the issues related to the

consequences of drug use and crime. The differences between

middle-income and low-income addicts in use-to-addiction levels and

crime-commitment levels (for both undetected and detected crime) are not

known.



Ethical issues and genetics research. In the forum on genetics research,

participants expressed apprehension about ethical issues raised by genetics

research and the need for further study of those issues. Stigmatization and

labeling of drug users are major concerns. However, the ability to give

patients a small dose of a prescription drug, measure a protein encoded by

a gene whose expression is a secondary response to the drug, and use that

measurement to predict whether the individual is likely to become

dependent on the drug, would aid a physician working in a therapeutic

context. Researchers should not oppose taking advantage of these kinds of

benefits of the Human Genome Project. Ethical considerations are an

important part of good research and should not be considered an

impediment, but they also should not be the only consideration.



Effect of economic development on the drugs-crime nexus. A study of the

effect of changes in the economy on drug use, drug trafficking, and the

drugs-crime nexus would be useful. An example is the economic boom of

the 1990s as an explanation for the decline of crime and violence during

that period.



The developmental role of the family in shaping behavior. There is a need

for more research with a developmental focus that assesses the influence

of family life on drug use and the drugs-crime relationship. One approach

to understanding the role of the family in shaping behavior involves

genetic influences on parenting. Some genetically influenced

characteristics of children, such as their temperament, affect how their

parents treat them. Thus, examination of genetic influences and family life

are critical because these interactions are frequently dyadic.



Continuum-of-care treatment models. Treatment researchers think that the

length of time drug users remain in treatment is the best predictor of

treatment success as defined by recidivism or drug use. Many people drop

out of treatment at some point in the process. Researchers should measure

the impacts of continuum-of-care models on treatment effectiveness.



Racially disproportionate impacts of drug policies. The participants

discussed whether the research community should address variations in the

effects of drug policies on different racial and ethnic groups in American

society. The incarceration rate is racially disproportionate, but whether the

process leading to that impact involved race-influenced decisionmaking

remains controversial and difficult to investigate. Race is often a covariate

in analyses of ADAM data but it is not a powerful covariate in explaining

dependent variables. Like gender, it frequently washes out when

multiple-level controls are used. 



Comparisons of data from incarceration or other criminal justice processes

with drug-use data reveal gross racial disproportionality. However, it is by

involvement in marketing, rather than in drug use, that people become

involved with the criminal justice system. Research that includes controls

for participation in drug-market activity would be useful in identifying the

size of the disparity in racial impact, where it occurs, and what factors

contribute to it. Income level, for example, is a strong covariate with race,

and the way offenders are treated in the criminal justice system varies by

income level. Researchers must separate a variety of race correlates from

race itself as factors in racial discrimination in order to determine how

much racial disparity is not due to racism and how much is a residual that

is directly attributable to racism.



There are also difficulties in classifying people by race. For some research

questions, what may be more important is how people are viewed by the

police. For example, is their skin color dark enough to be viewed as black,

regardless of how they self-identify culturally.



Underreporting by racial and ethnic groups. The disproportionate

underreporting of drug use by members of some ethnic groups and how

this affects research findings are important topics for future research.



Treatments whose effects differ by race or sex. Researchers need to know

more about how the effect of treatment differs by race. They do not know

if there are specific ways to administer treatments that are more effective

depending on race or gender. Recent Federal Bureau of Prisons studies

indicate that treatments that are effective for men are not working for

women.



Intergenerational discontinuities in drug taking. Research on

intergenerational discontinuities in drug-taking would be useful and would

relate to such issues as the blunt generation phenomenon. Researchers are

observing similarities in the degree to which new generations buck trends

or defy expectations.



Discussion: What Research in This Area Is Urgently Needed?



Forum participants were asked to describe areas of research that they think

are most urgently in need of study.



Ethical issues in drugs and crime research. Theoretical studies of ethical

issues are needed to address the impact of IRBs on drugs-crime research.

Researchers must do some rigorous thinking about sound ethical models

rather than slavishly borrowing from the clinical trial model used in

medical research. That clinical model emphasizes autonomy and informed

consent in ways that may not be realistic in drugs-crime research. The

research community could convene a consensus-seeking meeting of social

and medical scientists to discuss how existing IRB criteria should be

modified for social science research.



More empirical research is needed to supplement the work of professional

ethicists, whose background in philosophy may not reflect the values of

ordinary people, including drug users, and the way in which the latter

regard the ethical and moral implications of research conducted with or for

them. Survey research could be conducted with the subjects and

beneficiaries of drugs-crime research to increase researchers'

understanding of the ethical perspectives of various stakeholders.



Social scientists should be included on Federal panels that produce

regulations governing research. Although these panels consist of

physicians and laboratory researchers, the regulations they formulate are

applied inappropriately to social science.



New statistical methodologies. Advances in statistical methodology should

be used more widely in drugs-crime research. They could be applied to

such issues as whether researchers should conceptualize behavior

problems as latent dimensions. This would involve arraying people along a

continuum of problem behavior or as manifestations of different classes,

such as drug users who do or do not commit violent or property crimes.

The statistical tools needed to clarify uses of dimensions, classes,

categories, and continua are evolving rapidly, and are interrelated with the

missing data issue and selection bias problems. Approaches used by

quantitative sociologists and psychologists are already becoming

mainstream biostatistical methods.



Scientific justification for mandatory minimumsentences. Research on 

scientific justification for mandatory minimum sentences was suggested,

with particular emphasis on studying different mandatory minimums by

type of substance. Mandatory minimums have a direct bearing on the

racial disproportionality of drug policy impacts. There is an urgent need

for research on the marginal cost-effectiveness of mandatory minimums

and whether there are sociological justifications for them. This research

would involve factors such as the way markets are structured.



Discussion: What Research in This Area Would Be Recommended to the

Best and Brightest Graduate Students?



Participants were asked to think about areas of research that would offer

direction to researchers just starting their careers.



Interventions for high-risk youths. Almost no research has been conducted

on interventions for high-risk youths who have been arrested. Most

treatment outcome studies focus on adult offenders who are already deeply

involved in drugs and crime. A large body of evidence assembled over the

past 20 years indicates a progression in drug use among arrested youths. At

age 12, only a few arrestees test drug-positive. At a slightly older age, drug

tests might detect marijuana, and cocaine or heroin often are detected in

older youths. Thus, there is a need for research on interventions for

younger arrestees during their initial contacts with the criminal justice

system. Developmental psychology literature on antisocial behavior,

although not specific to drug use, maybe a source of information about

prevention strategies for intervention with early starters.



Linking policy interests with established disciplines. The difficulty in

recruiting graduate students who are interested in policy research maybe

ameliorated by linking policy interests to the traditional concerns of

existing academic disciplines, such as economics, psychology, and

sociology. For example, research that affects policy might involve the

study of labor markets and address such topics as the relationship between

licit and illicit wages.



Policies that affect youth behavior. Students could study policies that

affect young people's behavior, including their involvement in the

macro-educational job market and labor opportunities available to them.

One area of research to pursue is the possibility that economically, the job

market may be better in the illegal than in the legal domain. Students could

study policies ranging from economics to education as well as

drug-education prevention. Various aspects of the research could be

assigned to members of interdisciplinary teams.



Interdisciplinary or comparative research. Graduate study is typically

individualistic, which is not consistent with the way research is conducted

after graduation. Students should seek interdisciplinary work or the

opportunity for comparative studies and not be overly concerned about the

topic. They could work on these projects and still establish expertise in a

specialized field by publishing some lead author or sole author articles in

the journals of a particular discipline.



The criminal addict paradigm. Empirical studies of nonuse crimes

committed by drug users would followup on research that suggests the

major crime committed by addicts is selling drugs. Researchers found that

people who did not have a criminal history before becoming addicted did

not adopt criminal behaviors other than drug selling after becoming

addicted. The proposed studies may reveal that the amount of crime

committed by drug addicts, other than drug use and drug selling, is

dramatically lower than conventional wisdom would indicate.

Hypothetically, the results would fit a bell curve, with a few people at one

end who commit many crimes, a few at the other end who commit a small

number, and most subjects in the middle only selling drugs. Researchers

need to define this paradigm because of its policy implications.



The role of cognitive dysfunctions in drugs-crime relationships. The

effects of cognitive dysfunctions (whether they precede or are induced by

drug use) on drug users' decisions related to crime and their responses to

interventions could be studied. Responses to interventions such as

incarceration or treatment, for example, may be a function of cognitive

deficits that either precede or follow drug use.



Rational choice models of drug use. Students should consult economists

and others who study consumer choice behavior for assistance in

developing research that examines drug use as a choice among various

behaviors. Studies could address the degree to which a young person's

decision to use, or not use, drugs is based on benefits to be obtained

immediately or in the future.



Analyze ADAM data. In the new ADAM survey, large amounts of data

have been collected on drug treatment and crime; this information also is

connected to census tract information. This valuable data collection

presents an opportunity for students to conduct data analysis without

collecting data.



Secondary data analysis. The best use of graduate students' time might be

secondary data analysis using ethnographic or quantitative data. With

mentoring and analytical experience, students could become accustomed

to working with data and could gain experience with data collection after

graduation.



The effects of moderating factors on accepted theories. When theories

become established or findings are mixed, students should focus on the

moderating effects or interaction effects. They should study conditions

under which theories offer better or worse explanations for research

findings. Moderating factors may cause existing theories to work in some

settings but not in others.



Theory integration within or across disciplinary boundaries. Students

should consider integrating theories within or across disciplinary

boundaries by examining how their own theories fit with those of other

drugs-crime researchers or theories formulated in other disciplines.



Methodological integration in drugs-crime research. Methodological

integration, which employs techniques from other disciplines such as

epidemiology or geographical information systems, may be useful in

drugs-crime research.



Family and social networks in minority neighborhoods. The research

community needs new models of what constitutes a healthy family.

Development of such models could focus on family and social network

protective factors for reducing crime and drug use in high-risk

neighborhoods. For example, 35 percent of black households are headed

by women, but the prevalence of lifetime drug use is lower among black

Americans than among white Americans. The models and methods

researchers use to study family structure are not useful for explaining drug

use and crime in black or Hispanic-American communities.



Club drugs and crime. Almost everything researchers know about drugs

and crime is based on past epidemics of cocaine, heroin, and marijuana

use. Little is known about the relationship of club drug use to other kinds

of drug use and crime. This potential epidemic involves mainly white,

educated, 18- to 25-year-old users.



Club drugs and the Internet. People normally start using drugs in the

context of their peer group. The Internet may influence use of club drugs.



Inhalants. Inhalants/huffing is another category of drug use that should be

studied by young researchers.



Marijuana markets. Research on marijuana markets was suggested as a

separate research topic.



Policy implications of research findings. Having investigators discuss the

policy implications of their findings and addressing the implications of

scaling up successful interventions were suggested as research topics.



History of drug policy. Study of the history of drug use and its relationship

to crime was suggested as a way to provide perspective on the origins of

current drug policies and acceptance of the fact that policies can change

over time.



Comparative international research. Graduate students should develop

fluency in one or more foreign languages, quantitative and methodological

skills, and expertise in comparative research in order to conduct

dissertation research in a foreign country. Examination of entire drug

enforcement regimes will require comparative international research and

developing the capacity to conduct this kind of research will be

advantageous.



Comparative research across drug types. Comparative research across drug

types was encouraged. Focusing on the nexus of drugs, crime, and

violence, the work would examine which aspects of drugs and their

markets give rise to different levels of pharmacological and market-related

crime. The ethnographic literature will be important in this kind of

research.



Onset, popularity, and termination of markets for illicit drugs. Students

could study various criminal career paradigms and use them to analyze the

creation, duration, and termination of drug markets. This would include a

study of the prevalence of drugs that suddenly appear on the market and

would produce a history of a particular drug market. It would also extend

the study to a number of markets to determine the factors that contribute to

onset, popularity, and termination of markets for new illicit drugs.



The noncriminal drug user. A suggestion was made that students conduct

research on noncriminal drug users.



Interdisciplinary work involving genetics. Interdisciplinary research

encompassing fields such as genetics was suggested. The methods of other

disciplines could be applied in novel ways in the drugs-crime field.



The effects of interdiction programs. Exhaustive analysis of interdiction

programs and their effects may result in savings on interdiction

expenditures.



Extradisciplinary knowledge. Graduate students should acquire some

knowledge outside their discipline in fields such as pharmacology.



Prostitution and drugs. The study of prostitution as a criminal activity

related to drugs was suggested as a research topic.



Future trends. Students should look beyond the issues that researchers

have been studying for the past 20 years and try to assess future trends in

the drugs-crime nexus.



The flexibility and mobility of drug markets. A study of drug markets

could focus on their flexibility and mobility.



High-functioning drug users. Studies of drug users who live routine lives

and are not involved in crimes other than taking illicit drugs would be an

interesting research topic.



Models and simulations. Researchers should have graduate students create

models and conduct simulations of the effects of alternative drug policies

on crime. The work would be methodologically challenging because

students would have to understand statistics, econometrics, and simulation

software and conduct a literature review for each base estimate to

determine whether it is high or low.



Closing remarks



Dr. Brownstein commented on the need to involve more researchers who

are members of minority groups in future discussions of drugs-crime

interrelationships. Practitioners and policymakers also could be more

involved in the process; the forum would be the first of many discussions

about these issues.



Dr. Erinoff thanked Roger Conner for acting as forum facilitator and

reminded participants that they may submit additional comments on drugs

and crime through an e-mail listserv. She and Dr. Brownstein will

moderate the submissions.



Bennett Fletcher, research psychologist at NIDA, reminded the group that

drugs and crime research has been important to NIDA since the agency's

founding in 1974. He encouraged broadening the agency's criminal justice

initiative and vigorous followup of the forum.



Dr. Hillsman was pleased that the relationship between NIJ and NIDA had

been strengthened. She thanked the facilitator, organizers, authors, and

participants for their efforts and then adjourned the meeting.



Notes



1. The summary was prepared by CSR, Inc.



2. Manski, F., John V. Pepper, and Carol V. Petrie, Informing America's

Policy on Illegal Drugs: What We Don't Know Keeps Hurting Us,

Washington, DC: National Academy Press, 2001.



3. Genetic polymorphisms are differences in DNA sequences among

individuals, groups, or populations. Genes for blue or brown eyes are an

example.



4. Diathesis is a condition of the body that makes tissues react in certain

ways to certain external stimuli and thus makes them more than usually

susceptible to other conditions.



5. Identical twins.



--------------------------------



APPENDIX B: FORUM AGENDA



Thursday, April 19, 2001



8:30-9:00 a.m.--Registration and Coffee Service



9:00-9:30 a.m.--Opening Remarks



o Sally T. Hillsman, Deputy Director, National Institute of Justice



o Henry H. Brownstein, Director, Drugs and Crime Research Division,

National Institute of Justice



o Lynda Erinoff, Health Scientist Administrator, Epidemiology Research

Branch, Division of Epidemiology, Services and Prevention Research,

National Institute on Drug Abuse



9:30-9:45 a.m.--Facilitator Comments



o Roger Conner, Director, Search for Common Ground in America



9:45-10:00 a.m.--Group Exercise



10:00-11:00 a.m.--At the Intersection of Public Health and Criminal

Justice Research on Drugs and Crime



o James C. Anthony with Valerie Forman



10:00-10:15 a.m.--Presentation



10:15-11:00 a.m.--Discussion



11:00-11:15 a.m.--Break



11:15-12:15 p.m.--Research on Drugs-Crime Linkages: The Next

Generation



o Robert MacCoun, Beau Kilmer, and Peter Reuter



11:15-11:30 a.m.--Presentation



11:30 a.m.-12:15 p.m.--Discussion



12:15-12:30 p.m.--Discussion and Planning



o Topics for lunch: "One-sentence statements"



12:30-1:30 p.m.--Working Lunch--Roundtable Discussions



1. Topic 1



2. Topic 2



3. Topic 3



4. Topic 4



1:30-1:45 p.m.--Break



1:45-1:55 p.m.--Remarks



o Richard A. Millstein, Acting Director, Division of Epidemiology,

Services and Prevention Research, National Institute on Drug Abuse



1:55-2:15 p.m.--Reports and Feedback From the Roundtable Discussions



2:15-3:15 p.m.--The Drugs-Crime Wars: Past, Present, and Future

Directions in Theory, Policy, and Program Interventions



o Duane C. McBride, Curtis J. VanderWaal, and Yvonne M.

Terry-McElrath



2:15-2:30 p.m.--Presentation



2:30-3:15 p.m.--Discussion



3:15-3:30 p.m.--Break



3:30-5:00 p.m.--Discussion



o What don't we know about the relationships between drugs and crime?

Reaching for consensus



Friday, April 20, 2001



8:30-9:00 a.m.--Registration and Coffee Service



9:00-10:30 a.m.--Discussion



o What research in this area do you think is most important?



o What research in this area do you think is urgently needed?



10:30-10:45 a.m.--Break



10:45-11:45 a.m.--Discussion



o What research in this area would you recommend to the best and

brightest graduate students?



11:45 a.m.-12:00 noon--Closing Remarks



--------------------------------



APPENDIX C: LIST OF PARTICIPANTS



James C. Anthony

Department of Mental Hygiene

School of Public Health

Johns Hopkins University



Alfred Blumstein

The Heinz School of Public Policy

Carnegie Mellon University



Henry H. Brownstein, Director

Drugs and Crime Research Division

National Institute of Justice



Jonathan Caulkins

RAND



Jamie F. Chriqui, Technical Vice President

Center for Alcohol and Drug Policy

The MayaTech Corporation



Roger Conner, Director

Search for Common Ground in America



Christine R. Crossland, Program and Policy Analyst

Drugs and Crime Research Division

National Institute of Justice



Richard Curtis

Department of Anthropology

John Jay College of Criminal Justice



Karen Cyrus, Program Assistant

National Institute of Justice



Kelly Damphousse

Department of Sociology

University of Oklahoma



Ross Deck, Deputy Director

Office of Programs, Budget, Research, and Evaluation

Office of National Drug Control Policy



Terence Dunworth

Abt Associates Inc.



Robert B. Eiss, Director

Office of Programs, Budget, Research, and Evaluation

Office of National Drug Control Policy



Lynda Erinoff, Health Scientist Administrator

Epidemiology Research Branch

Division of Epidemiology, Services and Prevention Research

National Institute on Drug Abuse



Jeffrey Fagan

Columbia Law School



Nora Fitzgerald, Social Science Analyst

National Institute of Justice



Jerry Flanzer, Acting Chief

Services Research Branch

Division of Epidemiology, Services and Prevention Research

National Institute on Drug Abuse



Bennett Fletcher, Research Psychologist

Analytic Staff

Office of the Director

Division of Epidemiology, Services and Prevention Research

National Institute on Drug Abuse



Patrick Gartin, Chief

Statistical Services Division

Drug Enforcement Administration



Sidra Gifford, Statistician

Bureau of Justice Statistics



Paul J. Goldstein

Great Cities Institute & School of Public Health

University of Illinois at Chicago



Lana D. Harrison

Center for Drug and Alcohol Studies

University of Delaware



Sally T. Hillsman, Deputy Director

National Institute of Justice



Dana Hunt

Abt Associates Inc.



Bruce Johnson

National Development and Research Institutes, Inc.



Coryl Jones, Research Psychologist

Epidemiology Research Branch

Division of Epidemiology, Services and Prevention Research

National Institute on Drug Abuse



Beau Kilmer

Drug Policy Research Center

RAND



Richard Lempert, Professor

University of Michigan Law School



Natalie Lu, Drug Testing Technology Specialist

National Institute of Justice



Robert MacCoun

Goldman School of Public Policy & Boalt Hall School of Law

University of California, Berkeley



Susan E. Martin

Prevention Research Branch

National Institute on Alcohol Abuse and Alcoholism



Harry Matz, Senior Trial Attorney

Narcotic and Dangerous Drug Section

Criminal Division

U.S. Department of Justice



Duane C. McBride, Director

Institute for Prevention of Addictions

Andrews University



Tom Mieczkowski

Department of Criminology

University of South Florida



Arnold Mills, Public Health Advisor

Epidemiology Research Branch

Division of Epidemiology, Services and Prevention Research

National Institute on Drug Abuse



Richard A. Millstein, Acting Director

Division of Epidemiology, Services and Prevention Research

National Institute on Drug Abuse



Janae M. Neiderhiser

Center for Family Research

George Washington University



Diana Noone, Social Science Analyst

Drugs and Crime Research Division

National Institute of Justice



John P. O'Connell

Office of the Budget

Statistical Analysis Center

State of Delaware



Robert Nash Parker

Robert Presley Center

University of California, Riverside



Michael Prendergast

Drug Abuse Research Center

UCLA Integrated Substance Abuse Programs



David Pyle

Drugs and Alcohol Research Unit

Home Office

London, England



Beth A. Reboussin

Department of Public Health Sciences

Wake Forest University School of Medicine



Peter H. Reuter

School of Public Affairs and Department of Criminology

University of Maryland, College Park



K. Jack Riley, Director

Criminal Justice Program

RAND



Frank R. Shults, Senior Advisor

Office of the Deputy Attorney General

U.S. Department of Justice



Karen P. Tandy, Associate Deputy Attorney General

Office of the Deputy Attorney General

U.S. Department of Justice



Patrick H. Tarr, Senior Policy Advisor

Office of Policy Development

U.S. Department of Justice



Bruce Taylor, Senior Social Science Analyst

National Institute of Justice



Yvonne M. Terry-McElrath

Institute for Social Research

University of Michigan



Yonette Thomas, Health Scientist Administrator

Epidemiology Research Branch

Division of Epidemiology, Services and Prevention Research

National Institute on Drug Abuse



Curtis J. VanderWaal, Associate Professor of Social Work

Andrews University



William Vega

Robert Wood Johnson Medical School

University of Medicine and Dentistry of New Jersey-University Behavioral

HealthCare



Helene Raskin White

Center of Alcohol Studies

Rutgers University



Eric Wish, Director

Center for Substance Abuse Research



--------------------------------



About the National Institute of Justice



NIJ is the research, development, and evaluation agency of the U.S.

Department of Justice. The Institute provides objective, independent,

evidence-based knowledge and tools to enhance the administration of

justice and public safety. NIJ's principal authorities are derived from the

Omnibus Crime Control and Safe Streets Act of 1968, as amended (see 42

U.S.C. sections 3721-3723).



The NIJ Director is appointed by the President and confirmed by the

Senate. The Director establishes the Institute's objectives, guided by the

priorities of the Office of Justice Programs, the U.S. Department of

Justice, and the needs of the field. The Institute actively solicits the views

of criminal justice and other professionals and researchers to inform its

search for the knowledge and tools to guide policy and practice.



Strategic Goals



NIJ has seven strategic goals grouped into three categories: 



Creating relevant knowledge and tools



1. Partner with State and local practitioners and policymakers to identify

social science research and technology needs. 



2. Create scientific, relevant, and reliable knowledge--with a particular

emphasis on terrorism, violent crime, drugs and crime, cost-effectiveness,

and community-based efforts--to enhance the administration of justice and

public safety. 



3. Develop affordable and effective tools and technologies to enhance the

administration of justice and public safety. 



Dissemination



4. Disseminate relevant knowledge and information to practitioners and

policymakers in an understandable, timely, and concise manner. 



5. Act as an honest broker to identify the information, tools, and

technologies that respond to the needs of stakeholders. 



Agency management



6. Practice fairness and openness in the research and development process.



7. Ensure professionalism, excellence, accountability, cost-effectiveness,

and integrity in the management and conduct of NIJ activities and

programs. 



Program Areas



In addressing these strategic challenges, the Institute is involved in the

following program areas: crime control and prevention, including policing;

drugs and crime; justice systems and offender behavior, including

corrections; violence and victimization; communications and information

technologies; critical incident response; investigative and forensic

sciences, including DNA; less-than-lethal technologies; officer protection;

education and training technologies; testing and standards; technology

assistance to law enforcement and corrections agencies; field testing of

promising programs; and international crime control. 



In addition to sponsoring research and development and technology

assistance, NIJ evaluates programs, policies, and technologies. NIJ

communicates its research and evaluation findings through

conferences and print and electronic media.



To find out more about the National Institute of Justice, please contact:



National Criminal Justice Reference Service

P.O. Box 6000

Rockville, MD 20849-6000

800-851-3420

e-mail: askncjrs@ncjrs.org



--------------------------------



NCJ 194616