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

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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