Title: I-ADAM in Eight Countries: Approaches and Challenges
Series: Research Report
Author: Bruce Taylor (ed.)
Published: National Institute of Justice, May 2002
Subject: More issues in criminal justice: criminal justice system
170 pages
417,066 bytes

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U.S. Department of Justice
Office of Justice Programs
National Institute of Justice

I-ADAM in Eight Countries

Approaches and Challenges

RESEARCH REPORT

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

U.S. Department of Justice
Office of Justice Programs
810 Seventh Street N.W.
Washington, DC 20531

John Ashcroft
Attorney General

Deborah J. Daniels
Assistant Attorney General

Sarah V. Hart
Director, National Institute of Justice

Office of Justice Programs
World Wide Web Site
http://www.ojp.usdoj.gov

National Institute of Justice
World Wide Web Site
http://www.ojp.usdoj.gov/nij

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

I-ADAM in Eight Countries

Approaches and Challenges

Editor
Bruce Taylor

Contributing Authors 
Vicknasingam Balasingam, Trevor Bennett, Henry H. Brownstein, Luis
Caris, Willemijn Garnier, Doug Johnson, Peter Klerks, D. Locke,
Antoinette Louw, Toni Makkai, Neil McKeganey, Visweswaran
Navaratnam, Hilal Hj. Othman, Charles Parry, Janine Plaisier, Andreas
Plddemann, Bruce Taylor, Elna van Niekerk, and Gina Weir-Smith

May 2002
NCJ 189768

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

National Institute of Justice

Sarah V. Hart
Director

Points of view or opinions stated in this document are those of the authors
and do not represent the official position or policies of the U.S.
Department of Justice.

The National Institute of Justice is a component of the Office of Justice
Programs, which also includes the Bureau of Justice Assistance, the
Bureau of Justice Statistics, the Office of Juvenile Justice and Delinquency
Prevention, and the Office for Victims of Crime.

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

Foreword

James O. Finckenauer

James O. Finckenauer is director of the International Center of the
National Institute of Justice. He is on leave from the Rutgers University
School of Criminal Justice, where he is a professor of criminal justice.

The International Arrestee Drug Abuse Monitoring (I-ADAM) program
began just over 2 years ago. I-ADAM in Eight Countries: Approaches and
Challenges is the first look at the general results of this international
experiment. The compendium provides an update--a kind of status report--
on the state of I-ADAM's implementation. 

It also provides an opportunity to address the broader subject of
international comparative research. Research purporting to examine crime
and justice issues across national boundaries, while occasionally lauded,
has been relatively rare. This rarity is attributable in part to the great
difficulties faced by any would-be comparativists; some of these
difficulties are of sufficient gravity to call into question the very worth of
any such undertakings.

Skeptical questions often raised about comparative research include: What
is its value? What are its contributions to our body of knowledge about
crime and criminals? What are its pitfalls? And perhaps most important,
are those pitfalls so potentially damaging to research credibility as to
render any findings and conclusions from international comparative
studies meaningless? Although this initial and modest effort by the I-
ADAM program can serve as a useful case example, it will obviously not
definitively answer the criticisms and questions. It will, however, permit
us to begin to address a number of issues subsumed within some of the
questions.

Before turning to cross-national research in general and the I-ADAM
studies in particular, let us first consider the issue of the overall worth of
any research information that is "comparative." Findings and results of
research can be grouped into three types of information: descriptive,
comparative, and explanatory. Although any research results must begin
with descriptive information, mere descriptions, by themselves, tell us
very little. For example, let us say we find that 30 percent of arrested drug
users recidivate. What are we to make of this isolated piece of
information? Is that figure high, low, or average? Is it increasing or
decreasing? Without some basis for comparison, we do not know. Thus,
we see the need for comparative information--literally, an answer to the
question, "Compared with what?" Before/after studies, multisite studies,
and experimental/control studies, for instance, all introduce a comparative
frame of reference. Of the three information types, explanatory
information is of the highest order in facilitating understanding. But to
obtain explanatory information, one must have rigorous research designs
that enable testing causal assumptions so as to actually explain the
phenomenon in question. Such designs are quite expensive and difficult to
maintain in criminological studies.

As the above discussion implies, comparative research can occur in many
forms. Only one of these--albeit the one most thought of as "comparative
research"--involves cross-national work. Cross-national comparative
studies introduce cultural and national diversity into the research design.
They enable us to address questions about the universality of crime and
criminal behavior, the criminal justice system response, the offender and
community reactions to that system response, and the universality of the
interactions among these factors. With respect to drug abuse, the focus of
the research reported here, we can ask about differences across countries in
drugs, drug use markets and prices, or the age and gender of users. We can
further ask about differences in the relationship between drug use and
criminal offending, the type of crimes committed, and, again, offender age
and gender. As the introduction to this compendium points out, comparing
the prevalence of drug use among arrestees in different countries is
valuable to help identify invariant factors that predict drug use across
countries and general patterns of human behavior that are not culturally
specific.

I-ADAM has considerable potential for creating a research-based policy
platform. The value in having answers to questions such as those just
mentioned lies in finding cross-national differences that lend themselves to
policy interventions. For example, if specific criminal justice responses or
prevention strategies are shown to be effective in particular instances, they
can be replicated and tested in other jurisdictions, which is one of the
motives behind the I-ADAM initiative.

Pitfalls of Comparative Research

Some words about a few of the pitfalls in cross-national work, alluded to
earlier, are in order. A major barrier to be overcome is that of language.
Except where research sites share a common language, translation is
necessary. Written instruments require not only translation from the
original into the second language, but also translation back to the original
to verify accuracy. Despite the utmost efforts of the researchers,
differences in meaning often creep in that can change the results. Because
roughly half of the countries in the I-ADAM project are English speaking,
this was not a problem. Nevertheless, it was an issue for the sites in Chile,
Malaysia, and the Netherlands. For example, the Chilean report indicates
that the interview schedule was translated into Spanish and then given
"minor edits and adaptation to the Chilean idiom." It is this kind of
adaptation that can introduce imprecision and differences in responses.
Language will become an even greater problem if and when countries such
as Russia and Ukraine are added as sites, as planned.

Cultural differences in research traditions and methods also have to be
reconciled in cross-national studies. The scientific method does not govern
everywhere. Sampling can mean different things in different countries.
The same is true of access to data, protection of human subjects, and
policies with respect to publication of research findings. The Chile report
is again a case in point. Referring to the questionnaire, the report says "it
was deemed necessary to add as well as remove a few questions on the
basis of cultural applicability." Similarly, Australia's report indicates that
"changes were made to the instrument based on feedback from local sites,
interviewers, and interviewees"--in part because "terminology did not
translate." Introducing differences also introduces variability that can
threaten validity.

Comparative research is also made difficult by the variation in data
reliability and validity across countries. Crimes and criminal justice
practices (such as arrests, prosecutions, and convictions) are defined and
recorded differently. These difficulties both challenge and discourage
researchers and lead to skepticism with respect to the credibility of
cross-national research.

These potential problems confronted the I-ADAM project and required the
existence, at the outset, of a very compelling argument and rationale for
the program, which is stated quite succinctly in the Introduction and
Overview chapter. Drug use and the crimes attendant to drug use are
global problems. They infect both developed and developing countries.
Drugs devastate individual abusers and their families. Drug money feeds
transnational organized crime, corrupts governments, and finances civil
wars and terrorism. To develop effective policies for confronting these
problems, we obviously need to know and learn as much as possible about
them. Unfortunately, for many of the reasons outlined earlier, existing
drug research makes cross-country comparison difficult or impossible. In
many cases, no research existed. The report from Malaysia indicates, for
example, that there had never been a study conducted in that country to
determine the level of drug and alcohol use among the arrestee population.
It was hoped that the ADAM method and protocols could help fill the gaps
and overcome incomparability.

Method and Protocols

I-ADAM has systematically attempted to deal with the host of potential
problems that are common to comparative research and to ensure
uniformity in its approach. The research in the eight countries has
proceeded in a parallel way to avoid any history effects. As with the
original ADAM, I-ADAM employs two data collection methods:
individual interviews and urinalyses. One of the first issues for
comparability is the uniformity of the sampling procedure for choosing
those subjects from whom to collect data. In accordance with ADAM
practice, arrestee participation must be voluntary. Adult male and female
arrestees (individuals booked and processed by the police) who are
detained long enough to be interviewed, but less than 48 hours, make up
the pool from which the sample of volunteers is to be drawn. Sites use
probability sampling methods, or if the population is small enough, they
interview the entire universe. Alternatively, some sites use convenient
sampling methods to reduce the cost of data collection.

A second comparability issue is the need for uniformity with respect to the
interviewers and the interview environment. The ADAM protocol
stipulates that interviewers should not be law enforcement personnel to
avoid any coercion or biasing of responses. All interviewers are carefully
trained in the administration of the interview schedule. The interviews
themselves are conducted in private or semiprivate settings to encourage
confidentiality.

A major issue for uniformity is the interview schedule itself. Dropping and
adding questions obviously works against uniformity. The effect of
changes is not itself uniform, however. Because all questions in the
schedule are not created equal, as long as "core" questions are retained and
changes are on the margins, a condition of relative uniformity can be
maintained. One effect of alterations in questions is to limit the
comparative analyses to just those items that appear in the same manner in
all forms.

With respect to urinalysis, many comparability problems are avoided.
Assuming the sample has been properly chosen, there is less room for
human variation and error in collecting and analyzing urine samples than
in conducting the interviews. Five common drugs are tested for all I-
ADAM sites: marijuana, cocaine, opiates, amphetamines, and
benzodiazepines. Drug testing is a highly reliable method of ascertaining
whether a subject has recently used drugs and what drug (or drugs) has
been used.

With this background, but also with the reminder that I-ADAM is both
limited and in its early stages, we can make some observations about the
experiences to date. These observations are, of necessity, impressionistic
and suggestive.

Assessment and Observations

The I-ADAM effort described in these pages represents a rare and, in some
senses, unique research effort. Because it was adapted from the ADAM
foundation, it starts with a tried-and-true methodology. It is also relatively
narrowly focused and well defined, thus reducing the risk of
incomparability. Unlike other comparative research projects, no
considerable time needed to be spent in designing the research (e.g.,
formulating research questions, sample designs, or data collection and
analysis strategies). With the research design already in place, individual
country projects could begin as soon as such practical issues as funding
and political support were addressed.

The first observation deals with the samples in the different countries.
These samples, including those in the U.S., tend to be regarded and even
treated as nation specific, when this is clearly not the case. As is pointed
out in the U.S. chapter, within-country variability makes any assumptions
about population homogeneity untenable. It is generally accepted that due
to the variability among and between the 35 sites in the United States,
results cannot be generalized to any larger population. This is even a
greater problem when results are compared across international borders.
Thus, any results will need to be specific and treated with caution.

Considering the sample limitations and variations in the interview
schedule, the report from the Netherlands takes what is perhaps the most
appropriate perspective on the comparability of data collection at this
stage. The Dutch say that "comparisons with I-ADAM data from other
countries should perhaps be restricted to hypothesis-forming impressions
and should not be used to form conclusions about the drug situation in the
Netherlands." This is wise advice. The value of using these reports to
develop testable hypotheses and glean other heuristic effects should not be
dismissed or downplayed.

There are numerous possibilities to be explored here. For example, South
African data show that nearly 80 percent of the offenders arrested for
housebreaking tested positively for drugs. Furthermore, the number of
housebreakers in South African sites using cocaine was four times that of
those committing other crimes. In Australia, the strongest correlation with
respect to drug use and offending was between property offenses and
opiate use. Scotland found relatively high levels of opiate use among the
arrestees tested but much more so among females than males. The U.K.
found that many of the measures of drug use correlate strongly with many
of the measures of crime. What might be made of all these findings? What
are the general patterns of relations between drug use and offending? What
is the particular connection here between drugs and housebreaking, and
opiates and property offending? Why the gender distinction in Scotland?
What are the differences in these respects across countries? These and
other questions are stimulated by the current research.

This compendium illustrates that a reasonable beginning has been made.
There are problems and there are corrections to be made. Nevertheless, the
potential value is clear. The report from England/Wales sums up rather
nicely the ultimate value of I-ADAM. Pointing out that these data add to
our fundamental knowledge about drug abuse and crime and the way they
are linked, the report says, "The data generated by the I-ADAM
partnership can be used to compare international trends in drug misuse.
The program allows for monitoring changes in drug misuse across
countries and over time. This evidence can then be used to inform national
and international drug policies."

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

Table of Contents

Foreword
James O. Finckenauer, National Institute of Justice, Washington, DC,
USA

Executive Summary

Introduction and Overview
Bruce Taylor, National Institute of Justice, Washington, DC, USA

Australia
Toni Makkai, Australian Institute of Criminology, Canberra, Australia
Doug Johnson, Australian Institute of Criminology, Canberra, Australia

Chile
Luis Caris, Chief, Alcohol, Tobacco, and Drug Unit, Ministry of Health,
Santiago, Chile
Bruce Taylor, National Institute of Justice, Washington, DC, USA

England and Wales
Trevor Bennett, Institute of Criminology, University of Cambridge,
Cambridge, England

Malaysia
Visweswaran Navaratnam, National Centre for Drug Abuse Research,
Universiti Sains Malaysia
Vicknasingam Balasingam, National Centre for Drug Abuse Research,
Universiti Sains Malaysia
Hilal Hj. Othman, National Centre for Drug Abuse Research, Universiti
Sains Malaysia

The Netherlands
Peter Klerks, Dutch Police Academy
Janine Plaisier, WODC, Ministry of Justice, The Hague, the Netherlands 
Willemijn Garnier, Ministry of Justice, The Hague, the Netherlands

Scotland
Neil McKeganey, University of Glasgow Centre for Drug Misuse
Research, Glasgow, Scotland
Clare Connelly, University of Glasgow School of Law, Glasgow, Scotland
John Norrie, University of Glasgow Robinson Centre for Biostatistics,
Glasgow, Scotland
Janusz Knepil, Department of Biochemistry, Gartnavel General Hospital,
Glasgow, Scotland

South Africa
Elna van Niekerk, CSIR, Division of Roads and Transport Technology,
Pretoria, South Africa
Charles Parry, Medical Research Council, Cape Town, South Africa
Andreas Plddemann, Medical Research Council, Cape Town, South
Africa
Antoinette Louw, Institute for Security Studies, Pretoria, South Africa
Gina Weir-Smith, Human Sciences Research Council, Pretoria, South
Africa 
D. Locke, Crime Information Analysis Centre, Pretoria, South Africa

United States
Bruce Taylor, National Institute of Justice, Washington, DC, USA

Concluding Thoughts
Henry H. Brownstein, National Institute of Justice, Washington, DC, USA

Appendix A: Model I-ADAM Survey Instrument

Appendix B: Demographic, Economic, and Drug Information by Country

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

Executive Summary

This publication is primarily a progress report on the implementation of
the International Arrestee Drug Abuse Monitoring (I-ADAM) program in
eight countries and on the challenges they faced. Those countries are
Australia, Chile, England, Malaysia, Netherlands, Scotland, South Africa,
and the United States. Although some research findings are presented, the
principal purpose of this report is to describe the experiences of the
countries as they engaged in the process of launching I-ADAM.

Providing the first review of the early stages and status of I-ADAM in
participating nations, this volume attempts to identify common problems
in developing an I-ADAM site and approaches to surmounting
implementation barriers. As noted toward the end of the Introduction and
Overview chapter, the sequence of subtopics in each of the eight country
chapters is the same, ranging from general information to such issues as
obtaining funding, creating a survey instrument, developing research
methods, and training.

This report documents that, overall, reasonable progress has been made in
implementing the I-ADAM experiment. Problems remain; some
adjustments are needed. I-ADAM's impressive potential, however, is
undiminished.

International ADAM Program in Brief

I-ADAM is an outgrowth and extension of the Arrestee Drug Abuse
Monitoring (ADAM) program, developed and operated by the National
Institute of Justice, U.S. Department of Justice. Its origin dating back to
the mid-1980s, ADAM tracks trends in the prevalence and types of
hardcore drug use--such as cocaine, heroin, marijuana, and
methamphetamine--among booked arrestees in 35 sites across the United
States. Obtained through a standardized methodology and protocol
governing arrestee interviews and urine specimen testing, ADAM provides
a series of localized assessments about the U.S. drug abuse problem in the
arrestee population that are a central component in studying links between
drug use and crime and other social problems.

Aspects of ADAM can be customized to address specific needs at the
community level. Thus, data collected through ADAM can also provide a
fundamental research and evaluation tool that local analysts, policymakers,
and practitioners can use to target drug-related issues of particular interest
to the locality, such as evaluations of drug treatment and pretrial diversion
programs.

In 1998, the ADAM concept began expanding internationally as the I-
ADAM program, envisioned as a research partnership among criminal
justice organizations worldwide. Like its namesake, I-ADAM serves the
twin functions of research and policy guidance. The program's major goal
is to develop a standardized international drug surveillance system--
similar survey instruments, sampling, training, and other protocols--that
facilitates cross-country comparisons of the prevalence of drug use among
arrestees and permits an assessment of the consequences of drug abuse
within and across national boundaries.

To the extent that its data identify similar drug problems across national
borders, I-ADAM can promote a standard basis for nations to coordinate
drug control policies and resources and to improve multilateral
cooperation. I-ADAM identification of a growing substance abuse
problem in a country's arrestee population can help forecast a potential hot
spot for international drug trafficking.

Researchers may also use I-ADAM data in some cases to develop such
estimates as the following: the relationship between drugs and crime,
sources of illegal income for arrestees, drug dependency, use of substance
abuse treatment, drug market dynamics, and certain public health-related
consequences of drug abuse. I-ADAM can address topics of local interest
(e.g., domestic violence) and international concern (e.g., drug prices).

Comparing Drug Use Across Countries

I-ADAM is a network of researchers from various nations working
together to address problems in each of their countries that are unique in
some ways yet common in others. One of the themes that emerges from I-
ADAM data is that drugs are a global issue. All eight countries have
problems. Marijuana in one form or another is the drug that is most
commonly used by arrestees throughout the world. In Australia, 50 to 66
percent of all arrestees tested positive for cannabis. In Chile, 30 percent of
arrestees tested positive. In South Africa, 36 to 44 percent tested positive. 

But some drug problems are unique to particular countries. In South
Africa, for example, 19 to 25 percent of arrestees tested positive for
mandrax, a blend of methaqualone and antihistamine that is rarely, if ever,
found being used by arrestees in other nations. 

The most serious problem in each country differs: England and Thailand
report that opiates are the main problem. Scotland has a serious problem
with injection drugs. 

In addition to the similarities and differences in drug use among nations,
the nations also report similarities and differences in terms of the problems
they have in implementing I-ADAM. For example, in all countries people
commit crimes and are arrested and booked daily, night and day. Yet in all
countries, it is not possible to conduct interviews 24 hours every day. 

The researchers report that in those nations where I-ADAM programs have
been implemented or planned, policymakers and practitioners in criminal
justice and public health generally express high levels of interest in the
program. At the same time, most are experiencing problems identifying
and securing adequate funding to support an ongoing program. All must
deal with collecting data in a hectic environment, and all must work with
local law enforcement and correctional officials to ensure that the program
operates in a way that benefits the community without disrupting the
ongoing operation of the local jail. 

Ultimately, I-ADAM is a fragile multinational network of people who
share a common interest in the problems of drugs and are trying to work
together to do something about it.

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

Introduction and Overview

Bruce Taylor, National Institute of Justice

Nations are increasingly recognizing a shared interest in better
understanding the causes of crime and drug problems. The problem of
drug use and related crime is a global phenomenon. No longer can the
drug/crime problem be thought of in isolation or strictly in national terms.
The drug trade affects most nations of the world, and the problems that
arise because of drugs can be quite severe. In both developing and
industrialized countries, problems related to drug abuse include crime,
sexually transmitted diseases, accidents, deaths, poverty, unemployment,
and decreased productivity. Illicit drugs can be devastating not only at the
individual level; they can also corrupt governments and undermine
international relations. Despite the growing nature and globalization of the
drug problem, the quality and extent of research on this subject has not
kept pace. Most drug abuse research to date has been done independently
by dozens of countries using different research methods. Unfortunately,
the results have not been comparable across countries.

In response to this dearth of international comparative drug research, the
National Institute of Justice (NIJ) launched the International Arrestee Drug
Abuse Monitoring (I-ADAM) program in 1998, with the first annual I-
ADAM conference in Miami. I-ADAM was designed to provide an
international research platform to study the relationship between drugs and
crime and other social problems. By attempting to identify invariant
factors that predict drug use across countries, I-ADAM has the potential to
broaden the research community's understanding of the nature of the drug
epidemic. More important, I-ADAM is designed to provide a data-driven
framework for informing and coordinating global drug control policy.
Many recommendations that are made regarding global drug control
policy are made without the benefit of empirical research. A fundamental
element in designing and planning effective drug control strategies is the
presence of extensive and reliable data, which are not available in many
countries around the world. I-ADAM is being designed to meet the needs
of policymakers by providing a base from which data-driven policy
recommendations can be generated. I-ADAM data should make it easier
for drug control policies to be coordinated across nations, and improved
coordination of drug-control policies could improve the international
community's ability to combat the pernicious effects of the global drug
trade.

One of the most significant barriers to drug policy research has been
funding. Most countries do not have the resources to collect data that are
representative of their entire population. However, I-ADAM is an
established monitoring system for focusing on the areas of a nation with
the worst drug problems (the largest cities), and where people using the
most drugs (arrestees) can be found. Also, I-ADAM can provide
prevalence estimates for low-base-rate drugs not typically used in the
general population (e.g., heroin and cocaine). Finally, the drug use patterns
of arrestees are often a good indication of future problems. For example,
the U.S. program documented high prevalence rates for cocaine long
before the epidemic was detected by drug treatment centers.

Historical Background

In 1987, NIJ created the Drug Use Forecasting (DUF) program to serve as
one of the U.S. Government's primary sources of information on drug use
among arrestees in cities. DUF became one of the primary research tools
on drug use, crime, and related social indicators. In 1997, the DUF
program was redesigned and renamed ADAM (Arrestee Drug Abuse
Monitoring) to reflect the geographic expansion and increased
methodological rigor of the program and its development as both a
research and policy platform and a system for locally initiated research on
topics identified by sites. At its core, however, the ADAM program
preserves DUF's simple concept: interviewing and drug testing arrestees.
A component of the new ADAM program was the development of an
international drug surveillance system among arrestees. The international
element to NIJ's work is relatively new; in the past, NIJ has worked mostly
with U.S. Federal, State, and local officials. In 1997, the NIJ International
Center was launched as the central organizing body of NIJ's international
efforts. Its mission is to stimulate, facilitate, evaluate, and disseminate
national and international criminal justice research and information.

With the transition from DUF to ADAM, the development of the I-ADAM
program became an important goal. Prior to the formal launching of the I-
ADAM program, two countries--Chile and England--started collecting
ADAM-like data in 1996. 

In April 1998 in Miami, I-ADAM held its first annual conference for
representatives from eight nations (Australia, Chile, England, the
Netherlands, Panama, Scotland, South Africa, and Uruguay), two
international organizations (The Organization of American States and the
United Nations International Drug Control Programme), experts in the
field of drug surveillance systems, NIJ staff, and other U.S. Federal
representatives (the Drug Enforcement Administration and the National
Institute on Alcohol Abuse and Alcoholism).

In July 1998, officials from England's Home Office announced the second
phase of development for the New England/Wales ADAM program
(named NEW-ADAM), which added several new sites and began a
time-series design in revisited sites. The second wave of NEW-ADAM
data collection began in August 1998; two locations were surveyed in that
year (South Norwood in London and Copy Lane in Liverpool). 

With the exception of England (1996) and Australia (March 1998), most
countries represented at the first I-ADAM meeting in Miami did not have
funding for I-ADAM work. In August 1998, Chile and Scotland secured
funds for I-ADAM data collection, and in November 1998, South Africa
secured funds for I-ADAM work.

Also during 1998, NIJ began conducting field assessments (in Scotland
and England in September 1998, Australia in October 1998, Chile in
December 1998, and South Africa in January 1999) and training for
interviewer staff (in Australia in January 1999 and Chile in January 1999).
In the fall of 1998, the infrastructure for I-ADAM started to take shape,
with the development of the core survey and an I-ADAM training
program.

At the beginning of 1999, Chile and Australia started data collection; I-
ADAM held its second strategic planning meeting in April in Chicago. In
addition to those who attended the first meeting, representatives from
Malaysia and Taiwan were present at this meeting. In April 1999, NIJ
released Comparing Drug Use Rates of Detained Arrestees in the United
States and England,[1] which represented the first comparative analysis of
arrestee drug use rates across two countries and the first publication of the
I-ADAM Program.

In mid-1999, three more sites started collecting data (the Netherlands,
Scotland, and South Africa), and another country (Spain) contacted NIJ
and expressed interest in I-ADAM. NIJ visited Madrid in October 1999
and participated in the Seminarios Internacionales Complutenses. NIJ also
participated in an international meeting held by the World Health
Organization in Vancouver, Canada, in December 1999 to generate
interest in I-ADAM.

In November 1999, NIJ met with other Federal agencies involved in drug
policy work, research, treatment, and law enforcement. The dual purposes
of the meeting were to inform interested parties about the status, goals and
objectives, costs, and future rollout plans for I-ADAM and to start a
dialogue among potential Federal or international funding partners and
NIJ. One important issue discussed at the meeting was the wisdom of
expanding I-ADAM from the eight self-funded countries currently
involved to a second generation of I-ADAM sites. At the end of the
meeting, a number of representatives expressed interest in I-ADAM on
behalf of their organizations and their desire to collaborate with NIJ on
developing a program.

In December 1999, the Medical Research Council of South Africa released
its first I-ADAM report containing data from three metropolitan sites, and
in 2000, a number of countries began publishing the results of their I-
ADAM work. Australia released two I-ADAM publications in January and
two more in March. Additional publications were released by the Medical
Research Council of South Africa in May. Scotland released its first
publication in June, and England released its second program publication
in July.

Early in 2000, a number of innovative developments occurred in I-ADAM.
In February 2000, the first international comparison study of two drug
testing kits was completed. This study demonstrated the similarity in
results between different drug testing kits; the fact that England is using a
different urinalysis kit than the United States does not appear to affect
results. In March, data collection for the first-ever national probability
sample of arrestees started in South Africa, and the program's first Asian
country (Malaysia) began collecting I-ADAM pilot data in May. In early
to mid-2000, a number of important I-ADAM-related meetings were held.
First, an I-ADAM section was added to the U.S. ADAM annual meeting,
and the third annual I-ADAM conference was held in September in
Washington, D.C. The third conference was the largest I-ADAM meeting
to date (double the size of the second conference); its more than 50
attendees included 15 representatives from 11 countries (Australia, Chile,
England, Malaysia, Russia, Scotland, South Africa, Taiwan, Thailand,
Ukraine, and the United States), more than a dozen officials from other
U.S. Federal agencies, and researchers and policymakers from a variety of
other organizations.

The year 2000 also contained some setbacks. In June, the Netherlands I-
ADAM group stopped collecting I-ADAM data.

Early 2001 involved a fair amount of I-ADAM activity. In Australia, three
reports were released, and additional funding was approved.[1] In
announcing funding of $1.8 million to continue the Australian I-ADAM
program, known as DUMA, for a further 2 years, the Honorable Chris
Ellison, Minister for Justice and Customs, said: "DUMA testing for the
first time provides the criminal justice system with quality data on the
drugs-crime link and demonstrates the Government's commitment to
evidence-based policy making."

In England, a summary report on the NEW-ADAM program covering July
1999 and April 2000 data collection was issued.[2] The Honorable Bob
Ainsworth, Home Office Minister responsible for coordinating the Drugs
Strategy, welcomed the publication of the study by saying: "The NEW-
ADAM research reveals that the first point in the criminal justice system is
picking up a group of particularly prolific drug using offenders. In 1999-
2000, this group represented 15 percent of arrestees. Our target is to
reduce the size of this group by one quarter in 2005 and by a half in 2008."
The summary report presents results of drug use and offending among
adult arrestees in eight locations in England and Wales. It sets baselines
for the "Communities" component of the national antidrug strategy.

In South Africa, the I-ADAM group published a report on the third phase
of data collection for their Three Metros Study, and held a workshop to
discuss ADAM findings and implications for policy.[3] A panel of South
African experts from justice, corrections, drug research, social services
department, offender rehabilitation and police was invited to the workshop
to give their views on the drug-crime situation and what was learned from
the data. 

In the United States, the first release of data collected under the new
ADAM sampling scheme and revised survey instrument was made
publically available, and ADAM published the "Methodology Guide" and
"Data Analytic Guide" by posting the reports on the ADAM Web site.
Also, a number of international participants attended the 2001 ADAM
Annual Conference held in Miami in June 2001. 

Data collection has also proceeded as scheduled in the other I-ADAM
participating countries. In 2001, a few other countries (Barbados, Nigeria,
and Venezuela) expressed interest in joining the I-ADAM effort.
Representatives from Thailand who attended the third I-ADAM annual
meeting began preparations to collect I-ADAM data in late 2001 in Chiang
Mai city. The three studies are:

1. Makkai, T., and K. McGregor, "Drug Use Monitoring in Australia
(DUMA): Annual Report for 2000," Research and Public Policy Series,
No. 37, Canberra: Australian Institute of Criminology, 2001; Johnson, D.
"Age of Illicit Drug Initiation," Trends and Issues in Crime and Criminal
Justice, No. 201, Canberra: Australian Institute of Criminology, 2001;
Makkai, T., "Drug Use Amongst Police Detainees: Some Comparative
Data Testing," Trends and Issues in Crime and Criminal Justice, No. 191,
Canberra: Australian Institute of Criminology, 2001. 

2. Bennett, T., K. Holloway, and T. Williams, "Drug Use and Offending:
Summary Results From the First Year of the NEW-ADAM Research
Programme." Home Office Research, Development and Statistics
Directorate Research Findings 148. London: Home Office, 2001.

3. Parry, C., A. Louw, and A. Plddemann, "Drugs and Crime in South
Africa: The MRC/ISS 3 Metros Arrestee Study (Phase 3)." Research Brief.
Pretoria: Medical Research Council and Institute for Security Studies.

Description of Program

The I-ADAM Program is an international partnership of
government-sponsored research organizations. All participating
countries/jurisdictions are being operated through local/national funds.
Countries participate in I-ADAM to stay current on the latest scientific
methods of arrestee drug surveillance survey work, take part in
comparative data analytic projects on cross-national differences in drug
use, and receive technical assistance on the basic operation of a data
collection system.

I-ADAM's development is important because the existing drug
surveillance systems around the globe, in many cases, are not compatible.
Therefore, post-hoc comparisons across countries with independently
designed systems are very difficult. The existing general population
household surveys found in some countries use very different measures of
drug use and were not designed for multinational comparisons. From its
inception, I-ADAM has been designed to be a standardized international
surveillance system (with similar instruments, sampling, training, and
other protocols).

I-ADAM serves two functions: research and policy guidance. Research
might show, for example, that certain market conditions must exist for
particular drug epidemics to thrive. The findings could then be used by
countries that are not experiencing the epidemic to plan prevention efforts.
It is hoped that, in the future, I-ADAM can help form a standard basis for
nations to coordinate drug control policies. A growing substance abuse
problem in a country's arrestee population can help forecast a potential hot
spot for international drug trafficking. Through development of
addendums, I-ADAM can be used to help estimate the characteristics of
drug markets around the world; such data should prove useful for
coordinating international drug control efforts.

I-ADAM is a standardized international drug surveillance system that for
the first time provides researchers with a platform to compare the
prevalence of drug use among arrestees in different nations and allow
them to assess the consequences of drug abuse within and across national
boundaries. I-ADAM has three main components: voluntary, anonymous,
and confidential interviewing; similar data collection methods; and
standardized measures.

Voluntary, anonymous, and confidential interviewing

At I-ADAM data collection sites, trained interviewers (who are not in law
enforcement) conduct individual interviews with detained arrestees and
collect voluntary and anonymous urine specimens from interviewees.
Every I-ADAM site provides a private or semiprivate interview
environment that is conducive to open, valid, and reliable responses by
participants.

Similar data collection methods

Each I-ADAM site uses similar eligibility criteria for selecting study
participants. Site staff collect data from male and female booked/processed
arrestees detained long enough to be interviewed (but less than 48 hours).
Study participants are generally interviewed before they have seen a
magistrate or judge, but they have access to legal counsel if they wish to
ask about the voluntary nature of the study.

Data collection from juvenile males and females is optional. Each I-
ADAM site attempts to obtain a sample size large enough to provide a
reasonable level of statistical precision where all the main age and gender
groups are represented in sufficient numbers. Typically, the site schedules
about 2 to 3 weeks of quarterly interviewing at the jail/lockup. Most I-
ADAM sites collect data from 150 adult male and 75 adult female
arrestees each quarter to reach a total of 900 arrestees annually. I-ADAM
sites aim to use a definable study/catchment area and to understand the
representativeness of their data. Ultimately, probability-based sampling
methods will be adopted at each I-ADAM site. At I-ADAM sites in
England and Scotland, the entire universe of eligible arrestees is
interviewed at selected study sites during a selected time period. When the
universe of cases is interviewed, the problem of complicated sampling
schemes is avoided, but the cost of data collection increases dramatically.
The sites that have adopted population-based data collection schemes have
used this method because of the small number of arrests made in their
jurisdictions. By interviewing all of the eligible cases, these sites are able
to maximize the number of interviews that can be conducted in the
shortest period of time, thereby reducing the burden of data collection to a
few weeks per quarter.

Standardized measures

In collaboration with NIJ, international sites determine the type and
number of drugs in the drug test panel. Currently, at least five common
drugs (marijuana, cocaine, heroin/opiates, amphetamines, and
benzodiazepines) are being tested by all the I-ADAM sites. Also, NIJ has
developed a core I-ADAM survey instrument in consultation with the
other I-ADAM sites, and the agreed-on core survey is being implemented
by all the active sites. The development of a revised core I-ADAM survey,
which might include such new topical areas as drug dependency, criminal
history, and drug markets, is under consideration. At a later point,
common addendum surveys will be developed for special topical areas
(e.g., domestic violence).

Organization of This Compendium

The chapters in this report provide a review of the developmental stages of
I-ADAM in participating countries, barriers to development, national
stakeholders involved in the development of I-ADAM, research methods
used in I-ADAM, and analytic results (if data are available). This report
does not involve direct statistical testing of differences across countries;
instead, it is intended to be descriptive. The report attempts to identify
common problems across countries in developing an I-ADAM site and
approaches to resolving those problems. Each country provides a summary
of its I-ADAM results and likely policy implications or applications of its
data. Also, site description tables covering sociodemographic
characteristics, economic information, and drug use data are included in
the appendix for each I-ADAM country.

All country chapters follow the same basic outline. The first three sections
of each chapter provide some broad information about the participating
countries. Here, the attempt was made to provide some context for I-
ADAM work in terms of the general sociodemographic conditions present
in each country, the basic operation of the criminal justice system within
which I-ADAM needs to fit, and the status of drug control policy. Section
I covers national census information on each country. A basic
demographic profile is provided, including statistics on population size;
geographic size; ethnic, gender, and age distribution; unemployment,
poverty, and literacy rates; income; gross national product; percent living
in urban conditions; birth rate; life expectancy; population growth;
mortality rates; and gender composition. Section II provides a description
of the country's criminal justice system, the arrest process, and the
detention system. Prior research with DUF (and now ADAM) has shown
that the study of arrestees is important because they typically represent the
hardcore population of drug users and are the group consuming the
majority of illicit drugs.

Section III examines the general policies in place to deal with drugs in
each participating country. A fair amount of variability exists within I-
ADAM on the issue of drug control policy. For example, the Netherlands
has a policy of harm reduction, or a medical model. Therefore,
consumption of certain small amounts of drugs is tolerated by law
enforcement in the Netherlands. Malaysia, however, has a strict
zero-tolerance policy for drugs, and the death penalty exists for certain
drug offenses. The overview of a country's drug control policy helps to
explain the drug use of its population.

Section IV covers the developmental history of I-ADAM in each country.
For most participating countries, this history is fairly recent--beginning
around 1998--and the programs have developed quite rapidly. Section V
examines the goals and objectives of I-ADAM. It is important to
understand the local/national focus of I-ADAM and that, without the
achievement of local goals, little room for international work exists. Most
participating countries have not formally stated their goals and objectives,
but the authors identify at least some of the broad aims of the program.
Section VI documents the difficult work of getting an I-ADAM site
operational and is meant to help interested countries start a program.
Issues reviewed in this section include:

 o Obtaining funding.

 o Deciding to conduct in-house research or to contract it out.

 o Negotiating access to the lockup facilities where arrestees are held.

 o Learning about the catchment area for the project and how arrestees are
processed therein.

 o Handling urine specimens.

 o Creating a survey instrument that is culturally applicable for the local
arrestee population.

 o Designing a survey that conforms to I-ADAM core standards but retains
its utility for local purposes.

Section VII reviews the numerous barriers that exist to conducting this
type of work, such as obtaining adequate funding and obtaining a large
enough sample to allow sufficient statistical precision. Given the
importance of securing political support for I-ADAM to sustain the
program, section VIII discusses the national stakeholders involved.
Section IX reviews the site-specific research methods used in the program.
This section pays special attention to detailing the sampling scheme and
related data collection protocols. Section X reviews training issues. NIJ
has developed a training curriculum and related materials and made it
available to all participating I-ADAM jurisdictions. NIJ and its contractors
have also visited each of the countries to assist and/or participate in the
development of local training programs. This section identifies difficulties
that have been encountered in training I-ADAM interviewers and areas
that need to be focused on in the future. The final sections review the main
data analytic results of I-ADAM in each country (Malaysia did not have
findings at the time this compendium was written), the policy implications
of I-ADAM, and various examples of I-ADAM data applications.

Note

1. Taylor, B., and T. Bennett, Comparing Drug Use Rates of Detained
Arrestees in the United States and England, Washington, DC: U.S.
Department of Justice, National Institute of Justice, 1999, NCJ 175052.

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

Australia

Toni Makkai
Doug Johnson

Toni Makkai is director of research at the Australian Institute of
Criminology and program director of the Drug Use Monitoring in
Australia (DUMA) project. She has held university teaching and research
appointments in England and Australia. Doug Johnson is currently a
project officer with the Commonwealth Attorney General. Prior to this, he
was a member of the DUMA project team at the Australian Institute of
Criminology.

DUMA is funded under a 3-year grant from the Commonwealth's National
Illicit Drug Strategy. The data used here were collected for the Australian
Institute of Criminology's Drug Use Monitoring in Australia project by the
National Drug Research Institute at the Curtin University of Technology,
Hauritz & Associates Pty Ltd, and Forsythe Consultants Pty Ltd, with the
assistance of the Queensland, New South Wales, and Western Australian
Police Services. Neither the collectors nor the police services bear any
responsibility for the analyses or interpretations presented here.

The opinions expressed here are those of the authors and do not
necessarily reflect those of the Australian Institute of Criminology.

I. Overview of Demographic Profile of Nation

Australia has one of the most stable and conservative democracies in the
world. The official Head of State, the Queen of England, and the
Westminster style of government are evidence of its British heritage.
Parliament consists of two chambers, the House of Representatives and the
Senate. Voting is along party lines, and the party that captures a majority
of seats in the House of Representatives--or that can assemble a coalition
with a majority of seats--is given the opportunity to form a government.
The majority party's leader becomes the Prime Minister. The Australian
political system is a federal system in which the States have significant
power relative to the Commonwealth Government. The country comprises
six States and two Territories. Each State has its own Parliament and
Premier, and each guards its sovereignty jealously. The Territories also
have their own Parliaments and Chief Ministers, but they have less
sovereignty over their own internal affairs.

Australia is at once one of the world's most sparsely populated countries
and one of its most urbanized. A population of 19.1 million, 1/14th that of
the United States, occupies a landmass of 7,692,030 square kilometers,
nearly the size of the United States. At the same time, 80 percent of
Australia's population is clustered in a few large coastal cities at the edge
of an otherwise virtually uninhabited continent. Characteristics of the
population, including population growth, life expectancy, birth and death
rates, and literacy (see exhibit 1) are in keeping with those of other
industrialized, Western countries.[1] Australia's population enjoys a high
standard of living, as shown in exhibit 2.

Besides its geographic distribution, the other distinguishing feature of
Australia's population is the role that immigration has played in its growth.
Although Australian-born individuals contributed two-thirds of the
increase in population between 1901 and 1998, by June 1999, 24 percent
of the population was born overseas. Moreover, although the population is
still heavily Anglo-Celtic in background, the sources of immigration have
diversified since World War II.

Drug and Crime Statistics

The primary sources of drug statistics in Australia are the National Drug
Strategy Household Survey on Drug Use, school-based surveys, and the
annual Illicit Drug Reporting System (IDRS), which includes surveys of
injecting drug users (IDUs). The household and school surveys are random
samples conducted every 2-3 years and are based on self-report data.[2]
The most recent surveys show upward trends in the use of illicit drugs. As
shown in the drug arrest statistics (see exhibit 3), cannabis remains the
most popular illicit drug, followed by heroin and amphetamines. IDRS is
conducted annually; IDU surveys are convenience samples that use
self-report data. The IDU surveys show that heroin and amphetamines are
the most popular illicit drugs among IDUs.

The Australian Bureau of Criminal Intelligence collects annual data on
drug-related issues (exhibit 3), price, and purity. The average drug purity
in 1998-99 was 65 percent for heroin, 51 percent for cocaine, and 17
percent for methamphetamines.[3] Prices vary across jurisdictions. In
January-March 1999, the price of a cap (0.1-0.3 g) of heroin was estimated
to range from $A25 in parts of New South Wales to $A100[4] in the
Northern Territory.

The last national crime victimization survey was undertaken in 1998. Data
from this collection found that the prevalence rate for all offenses against
households was 9.0 percent and for all offenses against persons was 4.8
percent. The most common crime was breaking and entering, with a
prevalence rate of 7.6 percent. The survey found that those who were
assaulted during a 12-month period were more likely to be repeat victims
than were victims of other crimes. Forty-six percent of assault victims had
experienced two or more assaults during the previous 12 months.

Since 1993, national crime statistics have been collected on seven major
crimes recorded by police in Australia: homicide, assault, sexual assault,
robbery, unlawful entry with intent, motor vehicle theft, and other theft.
The most common crime recorded by police is "other theft," which
includes pickpocketing, bag snatching, and stock stealing. This category
accounts for slightly less than half of the total recorded crimes. The rates
of assaults increased from 1993 to 2000. The rates of property offenses
and robberies also increased from 1993 to 1998, decreased in 1999, and
appear to have increased again in 2000. In 1999, 342 murders were
recorded, which represented a rate of 18 per 1 million population; murders
decreased by 12 percent in 2000 to 302.[5]

II. Description of Criminal Justice System, Arrest Process, and Detention
System

Australia's federal system of government has implications for its criminal
justice system. The States and Territories administer criminal justice, but
"the components and processes of criminal justice are essentially the same
across Australia."[6] Australia is served by eight police forces: one in each
State and the Northern Territory, and the Australian Federal Police, which
also polices the Australian Capital Territory. The Drug Use Monitoring in
Australia (DUMA) project operates in three States: Queensland, Western
Australia, and New South Wales.

Exhibit 4 illustrates the usual arrest process for offenders. Once an offense
comes to the attention of the police, the officer can decide whether to
investigate further. If the officer proceeds with the investigation, three
options are open: The suspect can be issued a "notice to attend" or its
equivalent, given a summons, or arrested. A notice to attend is usually
given for relatively minor offenses. A summons is given for civil offenses
such as traffic incidents or tax matters. In both these instances, the
offender is usually not brought to the police station. If the matter is more
serious, the officer can either arrest the suspect immediately and bring him
or her to the police station or ask the suspect to accompany him or her to
the station for further investigation. Once at the police station, the
arresting officer can decide to continue with a formal charging process or
release the suspect from custody. If the suspect is charged, the seriousness
of the charge will determine whether the suspect is to be held in custody
for a magistrate's hearing. If the charge is not serious, the suspect is
released on bail following completion of formal charges. In the
magistrate's court, the suspect can either be given bail and released or
refused bail and remanded into custody.

DUMA staff cannot interview a detainee until the arrest process is
complete. In some sites, if the offender is refused bail, he or she is then
transferred to corrective services. DUMA personnel must interview the
detainee before the transfer. Some sites also have a maximum detention
time. In New South Wales, the police can detain a suspect for up to 4
hours for investigative purposes (an application can be made for another 8
hours). After that time, the suspect must be charged or released. DUMA
staff must gain access to the detainee before this deadline. There is a last
window of opportunity to interview those people charged and then
remanded into custody by the court; if remand is within 48 hours after
arrest, then data collection can proceed.

Australia has State and Federal courts. Seventy-nine percent of court
hearings in 1996-97 were for criminal matters, which State and Territory
magistrates' courts usually handle. These courts have no jury and normally
cannot impose a sentence longer than 2 years. Most defendants in the
magistrates' courts are found guilty; the majority of defendants are male.
The district or higher court hears more serious criminal matters.

Defendants who cannot afford their own solicitors can apply for legal
assistance, but they have no constitutional right to representation. On
conviction, the courts can impose a range of measures, including a fine,
suspended sentence, community-based supervision order, home detention,
periodic detention, and incarceration. In 1997-98, 74,810 persons were
sentenced in Australia. Of these, 25 percent were placed in a community
corrections program, 25 percent were given a prison sentence, and 2
percent were given periodic detention.[7] The rate of imprisonment in
Australia of persons older than age 16 has increased significantly in the
past two decades, rising 52 percent from 91.6 per 100,000 population in
1983 to 139.2 per 100,000 population in 1998.

III. Status of National Drug Policy

The drug of choice in Australian society is alcohol, and, although the
country's temperance movement was active in the late 19th and early 20th
centuries, alcohol was never prohibited.[8] Before Federation in 1901,
opium and cocaine were legal and as widely available as alcohol and
tobacco. At the turn of the 20th century, considerable concern grew about
the use of opium, particularly by ethnic Chinese. A combination of factors
caused the States to introduce legislation to ban opium use. During the
early 1900s, laws were passed to ban over-the-counter medications,
including heroin. Those drugs no longer could be sold without a doctor's
prescription. A policy of drug maintenance under the control of general
practitioners continued until the early 1950s. Concurrently, an
international outcry about high levels of legal heroin use led to a Federal
ban on the importation of heroin, and Australian States banned the
manufacture of heroin within their jurisdictions.

By the early 1980s, the first cases of AIDS were diagnosed, civil liberties
were increasingly being eroded, the profits from organized crime were
growing exponentially, and public officials were being corrupted by large
sums of money from the drug trade. In 1983, the Federal Government
introduced a national harm minimization strategy that was most clearly
defined in the 1993-97 National Drug Strategic Plan:

Harm minimization is an approach that aims to reduce the adverse health,
social, and economic consequences of alcohol and other drugs by
minimizing or limiting the harms and hazards of drug use for both the
community and the individual without necessarily eliminating use.[9]

Successive governments have continued to endorse this policy, but at first,
law enforcement was not supportive. By the 1990s, law enforcement
agencies were committed to harm minimization, at least at the policy level.
Throughout the 1990s, a range of drug and crime indicators suggested that
illicit drug use and related criminal activity were increasing. The Federal
Government responded in 1996 with the launch of the National Illicit Drug
Strategy (NIDS), which allocated more money to both supply and demand
reduction strategies.

IV. Background History to DUMA

Throughout the 1990s in Australia, deaths due to opioid overdose
increased at an alarming rate; illicit drugs, particularly heroin, were widely
available; and open drug markets started to appear in some cities. Crime,
particularly property crime, was increasing. In 1997, the Federal
Government reinvigorated its commitment to a national drug policy by
allocating more money for law enforcement, treatment, and education.
Given the severity of the problem and the link between illicit drugs and
crime, the Australian Institute of Criminology (AIC) successfully applied
for funds to conduct the Drug Use Monitoring in Australia (DUMA) pilot
project. The project began collecting data in January 1999 and continued
under current funding arrangements until December 2001.

V. Goals and Objectives of DUMA

As a pilot study, DUMA's primary purpose is to apply the U.S. Arrestee
Drug Abuse Monitoring (ADAM) methodology and questionnaire to
Australia; its secondary purpose is to begin collecting credible data on
drugs and crime. The project specifically aims to determine whether the
ADAM methodology can provide the following:

 o Reliable drug prevalence data on detainees.

 o Aggregated data to local and national law enforcement and treatment
agencies for monitoring, evaluation, and assessment purposes.

 o Timely and high-quality data to inform policy on drugs and crime.[10]

VI. Getting Started

A. Obtaining Funding

NIDS provided new funds for drug policy, half of which was directed
toward supply interdiction efforts. AIC obtained $1.6 million in funding
for DUMA over 3 years from NIDS's supply-side funds, which represents
0.76 percent of the total money allocated to supply-side intervention
strategies.

B. Contracting for Data Collection

AIC does not collect DUMA data itself. Instead, a partnership with local
police and local universities or research companies operates at each site.
Memorandums of understanding govern the working relationship between
AIC and the data collectors. Each site has its own advisory or steering
committee that deals with local strategic issues. Participating State police
services are well represented on the local committees.

C. Facility Access

Facility access must be obtained at two levels. At the higher level, the
State police commissioner in the relevant jurisdiction must give
permission for access. At the second level, local watchhouse personnel
must cooperate with the data collection team. Interviews take place at each
site usually over a 3-week period every 3 months. Fieldwork began in
January 1999 at the Queensland (Southport watchhouse) and Western
Australia (East Perth lockup) sites and in the third quarter of 1999 at the
two New South Wales sites in Sydney (Bankstown and Parramatta).
Exhibit 5 shows the periods when fieldwork was undertaken. Start dates at
each site varied according to local conditions, but they were generally
within a few weeks of each other. The collection of data at the two New
South Wales sites--one after the other rather than at the same time--
complicated matters.

Only adult males were interviewed in the first quarter of 1999 in the
Queensland and Western Australia sites. Collection was expanded to
include adult females in Queensland in the second quarter of 1999 and in
Western Australia in the third quarter of 1999. In New South Wales, adult
males, adult females, and juveniles were interviewed from the start. The
legal definition of an adult is age 17 in Queensland and age 18 in Western
Australia and New South Wales.

DUMA interviewers cannot be law enforcement officers or court
personnel. Given Australia's size, interviewers must be recruited locally.
Thirty-one interviewers were used across all sites in 1999. The average
age of interviewers was 33. Twenty of the 31 interviewers were female,
and 23 were Australian born. Interviewers were often postgraduate
students enrolled in psychology, drug research, or criminal justice
programs. All interviewers were required to undergo training before each
data collection. As part of the training, they engaged in role playing and
discussed their error reports from the previous collection.

After police processing, DUMA interviewers approached detainees and
asked them to participate in a confidential and voluntary research project.
Detainees were shown a statement describing the study; interviewers read
the statement to those with reading difficulties. Interviewers pointed out
that the detainees did not have to take part in the interview if they did not
want to, they did not have to answer any questions that they did not want
to, and they could stop the interview and leave at any time. Detainees were
then asked whether they agreed to take part in the study.

In 1999, seven people started the interview and chose not to complete it.
Detainees could also choose to complete the interview but not provide a
urine specimen. Three hundred and fifty detainees (25 percent) who
completed interviews in 1999 chose not to provide urine specimens;
another 66 (5 percent) tried to produce a specimen but could not. At some
sites, detainees were offered food or coffee or tea to thank them for taking
part.

D. Knowing the Catchment Area

Although the sites are referred to by the name of the area where the site is
located, the catchment area may not necessarily reflect the city boundaries.
A number of differences were observed among the four sites. The size of
the population in the catchment areas varies greatly (see exhibit 6). This
reflects the nature of each site. The East Perth site is a large, old facility
designed to take detainees from a large portion of the city. Many police
stations in the city have the capacity to handle only a few detainees; the
East Perth facility accommodates detainees who are to be held overnight if
a local police station is not open 24 hours a day or does not have a holding
cell available. Sydney has no large central facility for detainees. Local
police stations handle their own detainees and take them from other parts
of the city only in emergencies. It is rare for detainees to be held for longer
than 4 hours in these facilities; if they are to be held overnight, they are
transferred to Corrective Services. The Southport watchhouse caters to the
entire southeastern region of Queensland. It is a modern facility with the
capacity to hold detainees overnight and serves the local magistrate's
court.

Police districts do not always overlap with census districts, so it is difficult
to determine the precise characteristics of the catchment areas using
census data. Postal codes and local census districts were used to match the
police districts as closely as possible. Exhibit 6 provides basic census data
on each catchment area. East Perth, Bankstown, and Parramatta differ little
in terms of the mean age of the population, the percentage of males, and
the percentage of Australian-born people. The catchment population in
Southport has a slightly smaller proportion of people with jobs, and both
Bankstown and Southport have a higher percentage of people who left
school at age 14 or younger. The percentage who have never married
ranges from 28 to 32 at all sites.

E. Drug Testing Issues

All drug testing for the DUMA project was conducted at Pacific
Laboratory Medical Services, Northern Sydney Area Health Service, in
Sydney. The laboratory is accredited to the Australian Standards AS3408-
1995, and it consistently seeks to improve the sensitivity of its tests. In
2000, the EMIT[TM] (enzyme multiplied immunoassay testing) assay for
methadone and amphetamines will be changed to CEDIA[R]. CEDIA
shows fewer false positives due to proprietary medications, and its reagent
is more sensitive to MDMA (Ecstasy or XTC) and methylamphetamine.

Urine is routinely tested for six classes of drugs: cannabis, opiates,
methadone, cocaine, amphetamines, and benzodiazepines. A test is
deemed positive when the drug or its metabolites are detected at the cutoff
levels prescribed in Australian Standard AS3408-1995.[11] Confirmatory
tests are undertaken when a sample tests positive for opiates,
amphetamines, or benzodiazepines.

F. Instrument Issues

Cultural applicability

DUMA has attempted to keep the core questionnaire as close as possible
to the U.S. ADAM questionnaire. Throughout 1999, however, changes
were made to the instrument based on feedback from local sites,
interviewers, and interviewees. In some cases, terminology did not
translate or distinctions (i.e., summary/indictable) were not appropriate for
some sites. As a result of interviewer complaints about the length of the
drug grid, it was broken down into separate grids. In addition, interviewers
reported that they were skeptical about detainees' responses to questions
related to money earned from illegal activities. As a result, these questions
have been moved toward the end of the questionnaire in the hope that
initial doubts about the confidentiality of the process will recede as rapport
develops between the interviewer and the interviewee.

Standardization versus local utility

Each site has local concerns, and the pressure to include other questions is
always present. The means of overcoming this pressure is to encourage
sites to develop local addenda that can be used in their jurisdictions to
answer specific policy questions.

VII. Barriers to Developing DUMA

Although AIC secured money for the DUMA pilot project, ongoing
funding is by no means certain. The five potential barriers to the long-term
development of DUMA are--

 o Securing ongoing funding and cultivating greater support at the policy
level.

 o Further promoting cooperation and dedication of resources by police at
the local site. 

 o Maintaining a well-trained interview team when the work is
intermittent.

 o Recognizing and solving ethical problems when dealing with a
vulnerable population.

 o Addressing legal issues in which neither the interviewer nor the detainee
has protections such as those provided by the statutory and regulatory
confidentiality requirements stipulated under U.S. legislation.[12]

VIII. National Stakeholders Involved in the Development of DUMA

DUMA is a partnership among AIC, local police, and researchers. Exhibit
7 indicates the general arrangements by which the DUMA project is
overseen. The project has been funded by NIDS to run pilot sites in three
jurisdictions (Queensland, Western Australia, and New South Wales) over
3 years. It is affiliated with the International Arrestee Drug Abuse
Monitoring (I-ADAM) program and has a scientific advisory committee
with whom AIC consults concerning technical and methodological issues.

Each site has a local steering or advisory committee that supports local
data collectors, monitors the local progress of the study, suggests ways of
improving the project, and ensures that information is disseminated to
relevant local agencies. The committees are made up of a cross-section of
people that includes representatives from local law enforcement and
researchers.

IX. Research Methods

No attempt was made to sample within the available pool of detainees.
The selected sites were regarded as having a high volume of detainees
relative to other possible sites. Even these sites, however, processed
considerably fewer detainees than comparable U.S. sites. Maintaining
24-hour coverage would not have significantly increased the number of
detainees interviewed and would have been prohibitively expensive.
Interviewers entered the sites when the number of detainees was expected
to be highest.

The major eligibility criterion was that the detainee had not been held in
custody for more than 48 hours. Approximately 10 percent of detainees
were deemed ineligible by local police, usually due to an assessment that
there was a risk to the interviewer. Thus, the sample was not a random
sample of all detainees brought to the police station or of all persons
detained by the local police. 

In all three jurisdictions--Queensland, Western Australia, and New South
Wales--police are increasingly using notices to attend court or the
equivalent that are issued on the spot rather than bringing people to the
police station for questioning. Normally, these notices are for minor
offenses when the person has no prior criminal record. DUMA has no
access to these people.

Because the study is anonymous, interview subjects cannot be tracked
across interview periods. Given that a substantial number of detainees
self-reported that they had been arrested in the previous 12 months, it is
likely that some detainees appeared in more than one quarter of interviews.
Strictly speaking, the sample is one of detentions rather than detainees.

X. Training Issues

AIC has developed a training protocol manual for each site based on the
U.S. National Institute of Justice protocols for the ADAM program and
adapted to local conditions. Sites are required to train staff before each
data collection. In addition, AIC produces a report for each site that details
question-by-question errors by the interviewers to assist in the training
process.

XI. National Data Analytic Results

The data represent four quarters of interviews for the Queensland and
Western Australian sites and two quarters for the two New South Wales
sites.[13] As a result, the total sample size for 1999 was much smaller for
the New South Wales sites than for the other two sites (see exhibit 8). In
2000, each site was monitored every quarter. Because fewer women than
men are detained by the police, the sample size for women was
considerably smaller, which should be borne in mind when examining the
data for females.

In 1999, the program interviewed 1,402 detainees, 1,366 of whom were
defined as adults in their relevant jurisdiction. Urine specimens were
collected from 978 adult and juvenile detainees. Both the interview and
the provision of a urine specimen were voluntary; detainees could choose
to complete the interview and not provide a specimen. Approximately 70
percent of both men and women who agreed to an interview also provided
a urine sample. Only data from adults are presented in this section.

Across all four sites, detainees of both sexes were usually younger than
age 30. The largest concentration by age tended to be in the 21- to
25-year-old group, as shown in exhibit 9.

Detainees were asked if they had been arrested (excluding their current
arrest) and if they had spent time in prison in the previous 12 months.
These data are presented in exhibit 10. The pattern is similar across the
four sites: approximately half of detainees reported at least one prior arrest
in the previous 12 months, and more than 15 percent had spent time in
prison during the previous 12 months. Parramatta had a slightly higher rate
of prior imprisonment for males than the other sites, and it had the highest
percentage of detainees self-reporting a prior arrest in the previous 12
months. These data indicate that many detainees are cycling through the
system and that interventions are needed to break this cycle.

During the DUMA pilot project, all detainees were interviewed regardless
of the charge. Exhibit 11 shows what was determined to be the most
serious charge at arrest for the detainees interviewed. The most serious
charge was not always obvious from the charge sheet; interviewers
recorded up to three charges. Information from all three charges was
considered when determining the most serious charge: Violent offenses
were assigned the most serious charge, followed by property, then drug,
then traffic (including drunk driving) offenses. All remaining offenses
were classified in the "other" category.

The charge profiles varied among the sites. Southport had the lowest
percentage of adult male detainees charged with a violent offense and the
highest proportion charged for traffic offenses (many for drunk driving).
Almost half of the adult male detainees in Parramatta were charged with
property offenses, as were approximately three-quarters of adult female
detainees. Drug arrests across the four sites varied for adult males from 7
percent in Parramatta to 15 percent in Bankstown. East Perth had the
highest percentage of "other" charges, many for outstanding warrants.

Exhibit 12 shows the percentage of detainees who tested positive for drugs
by gender and site. Drug use among detainees was common among the
sites; approximately three-quarters of adult male detainees across all sites
tested positive for any drug. There were, however, significant variations
among the sites for individual drugs. A higher percentage of both male and
female detainees tested positive for cannabis in Southport and East Perth
than in the two Sydney sites. By contrast, a much higher percentage of
detainees in the two Sydney sites tested positive for opiates; the rates for
adult males in Sydney were almost double those in East Perth and triple
those in Southport. Virtually no detainees tested positive for cocaine,
except in Bankstown, where 12 percent of adult females tested positive for
the drug. Only 4 percent of adult males tested positive for amphetamines
in Bankstown, compared with between 12 and 14 percent in the other three
sites. Multiple drug use is common. It was highest overall among arrestees
in Bankstown and Parramatta--the two sites with the highest rates of opiate
use--although the single group with the highest prevalence rate was female
arrestees in East Perth, 47 percent of whom used more than one drug.

Exhibit 13 shows that, consistently across all sites, adult male detainees
tested positive for a range of drugs regardless of the charge for which they
were detained. Males detained for minor offenses up to the most serious
violent offenses tested positive for cannabis, opiates, and amphetamines.
The positive test rates for cannabis were higher than for other drugs, in
part because the test could detect cannabis use for up to 30 days, whereas
it could detect use of opiates and amphetamines only within the previous 2
to 4 days.

Opiates were detected in similar and significant proportions across all
offense categories in all sites except Southport. In Southport, 32 percent of
property offenders tested positive for opiates, but among those charged
with other offenses, relatively few (less than 12 percent) tested positive for
opiates. In the other three sites, a significant percentage of detainees
charged with a range of offenses tested positive for opiates; 23 percent of
violent offenders in East Perth, 46 percent of those charged with "other"
offenses in Bankstown, and 46 percent of those charged with traffic
offenses in Parramatta. The strongest correlation in all sites was found
between property crimes and the use of opiates. It was particularly strong
in Bankstown, where 78 percent of property offenders tested positive for
opiates.

As with opiate use, amphetamine use occurred across all offense
categories. This applied less to the Sydney sites, which had a relatively
small pool of detainees who tested positive for amphet-amines. The
correlation between violent offending and amphetamine use was nowhere
near as strong as that found between opiates and property offending. In
Bankstown, none of the violent offenders tested positive for
amphetamines, but the sample size was small (15 offenders charged with a
violent crime). At the other three sites, from 11 to 15 percent of those
charged with violent offenses tested positive for amphetamines.

XII. Policy Implications and Applications of Data

A key goal of policing is to reduce crime. Given that certain criminal
activities are closely associated with illicit drug use, monitoring the use of
drugs by detainees is of key importance to law enforcement. DUMA
provides for the first time a reasonable and independent indicator of
drug-related crime in specific areas in Australia.

Australian law enforcement has not had a systematic monitoring system to
track drug use among people who come into contact with criminal justice
agencies. Much of the discussion on the links between drugs and crime has
been based on anecdotal evidence or localized studies. More rigorous
national collections are required for evidence-based policymaking.
DUMA's goal is to overcome a significant limitation in Australia's
national surveillance of illicit drug use by undertaking ongoing monitoring
of detainees' involvement in drugs and crime.

Law enforcement concerns itself with both the demand for and the supply
of illicit drugs. To enact successful policies to intervene in illicit drug
markets, long-term monitoring of these markets is required. As with all
commercial markets for major products, local markets are inextricably tied
to global markets; one cannot be understood without the other. To
understand supply, one must understand where, how, and when demand
occurs and changes.

The purpose of DUMA is to improve understanding of the supply and
demand for illicit drugs among detainees at the local level while providing
comparable data across sites to facilitate the aggregation of national data.
DUMA represents a research platform in the criminal justice system that
can enable monitoring of supply and demand for illicit drugs at the local,
national, and international levels.

DUMA data are now being used in three ways. First, local watchhouse
personnel use the data to ensure a high standard of care for detainees.
Appreciation of the types and amounts of drugs used by those coming into
the watchhouse helps watchhouse staff better prepare for any medical
situations they might face. Second, strategic law enforcement analysts at
the State and local levels use the data to improve their understanding of
drug consumption patterns and related criminal activities. Finally, local
health agencies use the data to plan new drug treatment options.

Notes

1. Australia's literacy rate compares favorably with those of the United
States and the United Kingdom. According to the International Adult
Literacy Survey, 17 percent of Australian adults ages 16-65 are at the
lowest level of literacy, compared with 23 percent in the United Kingdom
and 24 percent in the United States. In contrast, 17 percent of Australian
adults ages 16-65 are at the highest level of literacy, compared with 19
percent in both the United Kingdom and the United States. Organisation
for Economic Cooperation and Development, Education at a Glance 2000,
Paris: Organisation for Economic Cooperation and Development, 2000:
table A2.3a.

2. Makkai, Toni, Linking Drugs and Criminal Activity: Developing an
Integrated Monitoring System, Trends and Issues in Crime and Criminal
Justice Series No. 109, Canberra: Australian Institute of Criminology,
1999.

3. Purity levels are calculated only on those seizures that have been
analyzed at a forensic laboratory. See Australian Bureau of Criminal
Intelligence, Australian Illicit Drug Report 1998-99, Canberra: Australian
Bureau of Criminal Intelligence, 2000: tables 11.11, 11.13, and 11.14.

4. Ibid., tables 11.11, 11.13, and 11.19.

5. Australian Bureau of Statistics, National Crime Statistics/Recorded
Crime, Australia, 1993-2000, Canberra: Australian Bureau of Statistics,
1994-2001, ABS 4510.0. 

6. Wimshurst, Kerry, and Arch Harrison, "The Australian Criminal Justice
System: Issues and Prospects," in Crime and the Criminal Justice System
in Australia: 2000 and Beyond, ed. Duncan Chappell and Paul Wilson,
Sydney: Butterworths, 2000.

7. For more detailed information, see Makkai, Toni, "Crime in Australia,"
in Sociology of Australian Society, ed. Jake Najman and John Western,
Melbourne: Macmillan Publishers, 2000.

8. Makkai, Toni, "Harm Reduction in Australia: Politics, Policy, and
Public Opinion," in Harm Reduction: National and International
Perspectives, ed. James A. Inciardi and Lana D. Harrison, Thousand Oaks,
California: Sage Publications, 2000: 171-192.

9. Ministerial Council on Drug Strategy, National Drug Strategic Plan
1993-1997, Canberra: Australian Government Printing Service, 1993: 4.

10. A more detailed outline of DUMA is provided in Makkai, Toni, Drug
Use Monitoring in Australia (DUMA): A Brief Description, Research and
Public Policy Series No. 21, Canberra: Australian Institute of
Criminology, 1999.

11. More detailed information on urinalysis testing is provided in
Australian Institute of Criminology, DUMA: Drug Detection Testing,
Research in Public Policy Series No. 25, Canberra: Australian Institute of
Criminology, 2000.

12. 42 U.S. Code 3789g and 28 Code of Federal Regulations Part 22.

13. This section of the chapter draws from data presented in Australian
Institute of Criminology, DUMA: 1999 Annual Report, Research in Public
Policy Series No. 26, Canberra: Australian Institute of Criminology, 2000.

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

Chile

Luis Caris 
Bruce Taylor

Luis Caris is a psychiatrist and professor at the School of Public Health,
University of Chile, where he directs the drug prevention program. He also
is chief of the Alcohol, Tobacco, and Drug Unit, Ministry of Health; a
short-term consultant to the Pan American Health Organization; and a
consultant to the Organization of American States-CICAD. Bruce Taylor
is the deputy director of the Arrestee Drug Abuse Monitoring (ADAM)
Program at the National Institute of Justice (NIJ). 

I. Overview of Demographic Profile of Nation

Chile is a long, thin country in the extreme southwest of South America.
Its closest neighbors are Argentina to the east and Bolivia and Peru to the
north. Chile is more than 2,650 miles long but only about 300 miles wide
at its widest point. Chile is as geographically isolated as it is diverse. To
the south, it reaches into the Antarctic zone; to the west, the Pacific Ocean;
to the north, the Atacama Desert; and to the east, the Andes.

Chile exhibits many of the traits that characterize Latin American
countries. Its colonization by Spain began in the 16th century. The culture
that evolved was largely Spanish; the influence of the aborigines is
negligible. The country has a relatively homogenous, primarily mestizo
population with a strong cultural unity (see exhibit 1 for demographic
information). Chile has no sizable minority groups. During its history, a
small elite has controlled most of the land, wealth, and political life. Chile
did not depend as heavily on agriculture and mining as other Latin
American countries; it also developed a manufacturing economy. Chile is
one of the more urbanized Latin American countries, with a substantial
middle class. More than 85 percent of the total population is urban; the
metropolitan area of Santiago, the capital, has a population of more than 5
million.

The Republic of Chile was established in 1821. It is divided politically
into 13 regions (Regions I-XII and the Santiago Municipal Region), 51
provinces, and 300 municipalities. Chile has a long history of
representative democratic government and political freedom, with only a
few short-lived exceptions. From September 1973 to March 1990, a
military junta headed by General Augusto Pinochet Ugarte presided over
the longest period of authoritarian rule in the country's history. Chile is
governed in accordance with the Constitution of 1980,[1] approved by a
plebiscite called by General Pinochet to change the Constitution of 1925.
The 1980 Constitution places state administration in the hands of the
President, who appoints the state ministers. The regions are headed by an
intendente (intendant), provinces are headed by a gobernador (governor),
and municipalities are headed by an alcalde (mayor). In towns with fewer
than 10,000 inhabitants, the mayor is appointed by the municipal council;
in towns and cities with more than 10,000 inhabitants, the mayor is
appointed by the President of the Republic.[2]

Chile is one of Latin America's most economically developed countries,
with a diversified free- market economy characterized by a high level of
foreign trade (see exhibit 2). According to the human development index,
Chile leads all Latin American countries in terms of development and is
categorized as having high development in a world context, ranking 38th
overall.[3]

Although Chile's crime rates in the early 1990s remained far below those
of the United States, the notion that common crime was rare in Chile until
the 1970s and 1980s is a myth. Chile's rural areas were plagued with
outlaw gangs in the early 19th century. Attempting to analyze the crime
situation under the military regime in the 1970s and 1980s is confusing
because the government and media tended to lump ordinary criminal
behavior together with dissident violence. Figures on crime and criminals
released by the Instituto Nacional de Estad'sticas (National Statistics
Institute--INE) are not enlightening as to the true prevalence of crime in
the country. Neither juvenile nor adult crime rates are broken down by
gender, and no statistics are provided on prison populations. Few, if any,
published sources provide general crime statistics, with the main exception
of figures for arrests, which are readily available in INE's Compendio
Estadstico.[4] Chile's reported crime rate of about 1,300 crimes per
100,000 people is low compared with the reported U.S. rate of about 4,615
crimes per 100,000 people.[5]

Chile long remained relatively unaffected by either drug trafficking or
extensive drug abuse. Small increases in both occurred during the late
1960s and early 1970s, reflecting an international trend.[6] By the early
1970s, Chile had become an important regional center for cocaine
processing. Drug trafficking has been growing in Chile since the early
1980s, not only because of its geographic configuration and location
bordering on the world s two leading producers of coca--Peru and Bolivia-
-but also because of its economic stability. With its open-market economy
and bank secrecy laws, Chile is an attractive haven for money laundering.
By 1992, Chile's most serious drug-related problem involved illicit drug
transit along the northern corridor to Africa. In early 1993, a new
cocaine/cocaine paste drug route reportedly came from Bolivia through the
Azapa Valley.

After 1989, drug-related crime increased dramatically, particularly in the
north of the country. In 1990, the police estimated that 20 percent of
Africa's population aged 15 to 34 were habitual drug users. Of 385
homicides (0.3 per 10,000) in Chile during 1990, nearly 77 (20 percent)
were classified as drug related.

II. Description of the Criminal Justice System, Arrest Process, and
Detention System

Criminal Code

The Criminal Code of Chile, first drafted in 1870 after two unsuccessful
attempts, was promulgated in 1874 and modified in 1928 and again in
1930. Its models were the criminal codes of Austria, Belgium, France, and
Spain. The death penalty, abolished in 1930, was reinstated for certain
crimes in 1937 and abolished again in 2001. 

The Criminal Code is divided into general and special sections. The
general section enumerates general principles of criminal law relating to
jurisdiction, the concept of crime, attempted crime, second-party
participation in the commission of crime, habitual criminals, penalties, and
circumstances that exclude or extinguish criminal responsibility. The
special section defines specific offenses and their appropriate penalties.
The courts are charged with ensuring that the penalty is appropriate not
only to the crime but also to the criminal's culpability.[7]

Classification of Crimes

Crimes are divided into three basic categories: crmenes (serious crimes),
delitos (minor crimes), and faltas (misdemeanors). A crime is defined as a
voluntary act or omission for which the law imposes punishment. Criminal
responsibility is specifically excluded in cases in which the defendant is
insane or younger than 10. Minors 10 to 16 years old are not held
criminally responsible unless it can be proven that they acted with full
understanding of their acts. Criminal responsibility is also excluded for
violent acts committed in the defense of one's own person, property, or
rights; those of one's spouse; or those of a third party. Other excluded
violent acts are those committed--

 o Accidentally in the exercise of a legal act.

 o In the exercise of public duty.

 o Under duress or fear.

 o Resulting in the killing or wounding of the accomplice of an adulterous
spouse.

Criminal responsibility is also excluded for crimes of omission owing to a
legal or irresistible cause. Suicide and attempted suicide are specifically
decriminalized.[8]

Arrest Procedure

The Chilean Constitution states that no one may be arrested or detained
unless on the order of a public official empowered by law. The police may
detain someone caught in the act of committing a crime or based on
suspicion. On detention, an arrestee must be brought before a competent
judge within 24 hours. The Constitution allows civilian and military courts
to order detention for up to 5 days without arraignment and to extend the
detention of suspected terrorists for up to 10 days. The law affords
detainees 30 minutes of immediate and subsequent daily access to a
lawyer and to a doctor to verify their physical condition. The law does not
permit a judge to deny such access. The Constitution allows judges to set
bail.[9] Trial by jury is not provided for, and heavy reliance is placed on
police evidence in criminal cases. 

The Courts

The founders of Chile drew from the example of the United States in
designing the institutions of government, and from Roman law and
Spanish and French traditions, particularly the Napoleonic Code, in
designing the judicial system. The 1925 Constitution introduced reforms
aimed at depoliticizing and improving the judicial system by guaranteeing
judicial independence. The organization and jurisdiction of Chile's courts
were established in the Organic Code of the Tribunals (Law 7,241),
adopted in 1943. This law has been modified on several occasions, mostly
recently by Organic Constitutional Law 18,969 of March 10, 1990, and
Law 19,124 of February 2, 1992. Chile's ordinary courts consist of
juzgados de letras (local courts), major claims courts, the cortes de
apelacin (appellate courts), and the Supreme Court. There is also a series
of special courts, such as the juvenile courts, labor courts, and military
courts in peacetime. The local courts consist of one or more tribunals
specifically assigned to each of the country's communes, Chile's smallest
administrative units. In larger jurisdictions, the local courts may specialize
in criminal or civil cases, as defined by law. Chile's 16 appellate courts
each has jurisdiction over 1 or more provinces.[10]

The Penal System

Chile's penal system has been standardized since 1930, coming under the
jurisdiction of the Minister of Justice. The system emphasizes
rehabilitation of the offender. The degree of confinement is reduced
progressively throughout the prisoner's sentence and ends, subject to good
behavior, in conditional release for periods up to 50 percent of the total
sentence. Chile has approximately 140 penal institutions with a total
capacity of approximately 15,000 inmates; in 1990, however, the
estimated number of prisoners was larger than 25,000. During the third
quarter of 1990, for example, Santiago's San Bernardo Prison, designed to
hold 800 prisoners, housed 3,300 inmates.[11]

III. Status of National Drug Policy

In 1999, a comprehensive revision of Chile's 1995 counternarcotics law
was undertaken and proposed strengthening changes were drafted. The
changes focus on authorizing flexibility in sentencing (currently, the
minimum sentence is 5 years regardless of severity of the offense),
combating money laundering through mandatory reporting of transactions
and creation of a financial intelligence unit, and harmonizing the drug
code with Chile's ongoing legal reform.[12]

The Chilean Government's coordinating body for drug policy and demand
reduction activities is the Consejo Nacional para el Control de
Estupefacientes (National Drug Control Council--CONACE). CONACE's
2001 annual budget of approximately $15.2 million represents a real
increase of more than 30 percent from its 2000 budget. Of CONACE's
2001 budget, $8.2 million is earmarked for demand reduction programs--
$3.1 million for community-based prevention programs, $2.6 million for
prevention targeted at schools, and $2.5 million for drug treatment.
Resources to be channeled to school- and community-based programs will
double under the 2002 budget.[13]

In a major drug policy initiative in 1998, CONACE decentralized its
national project bank for drug prevention, education, and rehabilitation. As
a result of the decentralization, regional councils and local municipalities
gained more input in projects that account for approximately 90 percent of
the national project bank's funds. Individual projects also can be proposed
and implemented by nongovernmental organizations, local governments,
universities, and other institutions.[14]

Chile is not considered a center of production of illegal drugs. Partly
because of its geographic isolation, it has until recently avoided many of
the problems created by illegal narcotics in other South American
countries.[15] As a consequence of the expansion of drug trafficking and
narcotics abuse during the late 1960s and early 1970s, Chile's first
antinarcotics law had been passed by 1973. Later, the Government formed
a special narcotics unit and began a highly effective crackdown, bringing
the narcotics problem under control within a year. Government antidrug
forces also pioneered a youth education program against narcotics. The
dismantling of a large drug-trafficking and money-laundering ring in May
1998 demonstrates the Government's continued efforts to counter drug
smuggling and related criminal activity.[16]

Chile is a party to the 1988 United Nations Drug Convention. Government
and private organizations support drug-abuse prevention and rehabilitation
programs. Chile continues to play a leading role in the Organization of
American States' Comisin Interamericana para el Control del Abuso de
Drogas (Inter-American Drug Abuse Control Commission--CICAD),
including its efforts to create a multilateral evaluation mechanism to
combat illegal drug trafficking and abuse. Chile worked closely with
CICAD in the area of money laundering in 1998 and sponsored public-
and private-sector seminars on the topic.[17] Chile has joined the Grupo
de Accin Financiera de Sudamrica Contra el Lavado de Activos (South
American Financial Action Task Force on Money Laundering--
GAFISUD), created in December 2000. In addition, in August 2000, the
U.S. and Chile signed an umbrella agreement to share information,
strategies, and resources to continue joint efforts against narcotics.[18]

Chile has several ongoing data collection systems that help inform drug
policy. I--ADAM will serve as another indicator of drug use in Chile.
Currently, the Chilean Government conducts a door-to-door household
drug survey of a representative sample of the population every 2 years, a
school-based drug survey, a study of emergency rooms similar to the Drug
Abuse Warning Network program in the United States,[19] and various
treatment facility surveys.

IV. Background History of the I-ADAM Program in Chile

In 1994, the Ministry of Health set up an alcohol and drug
surveillance/monitoring system aimed at assessing alcohol and drug abuse
in Chile. Monitoring was conducted in several cities and data were
gathered on drug type, drug and alcohol abuse, and health outcomes.
Public school students and people entering hospital emergency rooms, jail
detention centers, and treatment centers answered self-administered
questionnaires about the health risks associated with alcohol and/or drug
use, protective behaviors, prevention, and consumption. Data were
analyzed to assess the magnitude of alcohol and drug abuse, and an early
warning system against the use of alcohol and/or drugs was set up. As
previously mentioned above, the Government conducts a door-to-door
drug survey of a representative sample of the population every 2 years.
Although research has been done in Chile on the relationship between
health and drugs/alcohol, the relationship between drugs and crime has yet
to be explored. In 1998, Chile implemented an I-ADAM project to explore
this relationship and to serve as an indicator of drug use in the country. 

As a precursor to its participation in the I-ADAM project, Chilean health
authorities conducted a 10-day study of drug abuse among detained
arrestees in March 1997. Five hundred forty-nine arrestees (499 men and
50 women) from six police stations in the Santiago municipal region
participated in the research. The police stations were located in Santiago
city, Renca, Nuoa, Pealoln, San Miguel, and Conchal. Chilean police
bring all persons arrested for nontraffic offenses to the police stations for
booking. During this 10-day period, researchers attempted to interview all
arrestees: 75 percent of the arrestees approached by the research staff
agreed to take part in the study, and 75 percent of those who participated
agreed to provide a urine specimen. Because of budget restrictions, urine
testing was done only for cocaine and marijuana. The study instrument
and a report of this study are available only in Spanish.

V. Goals and Objectives of I-ADAM in Chile

The primary aim of I-ADAM in Chile is to generate drug abuse
surveillance/monitoring data. Program objectives include the following:

 o Testing the applicability of the I-ADAM research methodology.

 o Assessing the applicability of the I-ADAM instrument.

 o Describing the types and forms of drug use in detention centers.

 o Generating information concerning the magnitude of substance abuse in
the arrestee population.

VI. Getting Started

A. Obtaining Funding

The Ministerio de Salud (Ministry of Health) funds and operates the I-
ADAM program in Chile. The Ministry of Health has five divisions, one
of which is the Divisin de Salud de las Personas (Division of the People's
Health). This division has three components: the Departamento de
Programas de Las Personas (People's Health Program), Departamento de
Epidemiologa (Department of Epidemiology), and Departamento
Odontolgico (Department of Odontology). I-ADAM in Chile is operated
as a research program of the People's Health Program; its name is
Vigilencia Epidemiologica Drogas en Chile (Drug Epidemiological
Surveillance in Chile).

Because Chile's I-ADAM program is administered by employees of the
Ministry of Health, nearly all the costs associated with this research are
absorbed as part of employees' salaries. The only extra costs incurred by
the I-ADAM program are for the laboratory costs of urine testing and
overtime pay for the field site director and the team of interviewers to
conduct the research interviews. I-ADAM management aimed for two data
collection points per year at each site. Funds were allocated for one data
collection point in 1998 and for two data collection points in 1999. Efforts
are under way to seek funding from the Ministries of Health and Justice
and from foreign and multinational agencies and foundations operating in
Chile.

B. Contracting for Data Collection

As indicated above, this project was conducted in house by staff of the
Ministry of Health. Hiring a contractor to conduct this work was
considered cost prohibitive.

C. Facility Access

Access to the lockup facilities was secured through a partnership between
the Ministry of Health and the Carabineros (the national uniformed
police). The mayors (commanders) of the comisaras (police stations) gave
research staff written permission to conduct the study and gain access to
the jails. Because police were not accustomed to having research
conducted in their jails, they were briefed in detail about the scope of the
project.

D. Knowing the Catchment Area

The 1999 I-ADAM study was conducted in select comisaras in three
municipalities of the capital city of Santiago: the First Police Station of
Santiago, the Fifth Police Station of Conchal in the northern part of the
city, and Lo Espejo in the southern part of the city. Data collection sites
were selected based on their case flow and neighborhood characteristics.
One site is in the heart of a thriving downtown commercial area that has
arrestees from all socioeconomic levels; another site is an active
drug-trafficking area; the third site has many drug addicts. Future research
sites will include police detention centers in either Valparaiso or
Inquinque. Collaboration among the Ministry of Health, the director
general of the Carabineros, and police station commanders made access to
selected research sites easier.

E. Drug Testing Issues

Because of the relative scarcity of high-volume drug-testing equipment in
Chile, drug testing is expensive in the country. After a search, it was
determined that PharmChem, the U.S. laboratory that conducts the U.S.
ADAM drug testing, offered the most affordable option for the I-ADAM
group in Chile. PharmChem used the EMIT[TM] (enzyme multiplied
immunoassay testing) system--the same system used by the U.S. ADAM
program--to screen for the presence of drugs in urine. Samples were tested
for alcohol, amphetamines, barbiturates, benzodiazepines, cocaine,
marijuana, methadone, methaqualone, opiates, PCP, and propoxyphene.

F. Instrument Issues

The questionnaire used in the I-ADAM Chile study was based on the early
Drug Use Forecasting (DUF) questionnaire.[20] The National Institute of
Justice (NIJ) translated the DUF questionnaire and sent it to the Chilean
research team for review. Minor edits and adaptation to the Chilean idiom
were made, and it was deemed necessary to add as well as remove a few
questions on the basis of cultural applicability. Several drug market
questions were dropped, and the list of drugs to be queried on the drug
grid was revised. The self-report survey includes the following drugs:
alcohol, marijuana, coca paste, crack cocaine, powder cocaine,
heroin/opiates/dilaudid, amphetamines, methamphetamines, inhalants, and
tranquilizers. Some housing questions, illegal income questions, and the
ethnicity question were removed.

Cultural applicability

Spanish is the official language of Chile, and virtually everyone is
conversant in Spanish. Therefore, it was decided to use only one
questionnaire designed in Spanish. Arrestees who could not speak Spanish
were deemed ineligible and were excluded from the survey.

Standardization versus local utility

The same questionnaire is used across all sites in Chile. It was not found
necessary to adjust the questions for local cultural differences. Because
cultural standardization is particularly relevant when making comparisons
across countries, the I-ADAM Chile survey includes a series of core
questions that are used in the ADAM surveys in the United States and
other I-ADAM participating countries.

VII. Barriers to Developing I-ADAM

To date, the development of the Vigilencia Epidemiologica Drogas en
Chile has run smoothly. Nonetheless, barriers arose at the onset of the
program. The primary barrier to establishing I-ADAM in Chile has been
obtaining funding and establishing the legitimacy of the research. Full
government support and funding is needed to implement the program.
Although the Ministry of Health earmarked funds for the program in 1999,
2000, and 2001, long-term funding has not yet been obtained. As noted
earlier, program managers are soliciting the Ministry of Health, the
Ministry of Justice, and foreign sources of funds such as CICAD, the
United Nations Drug Control Programme, and the American Embassy in
Chile.

VIII. National Stakeholders Involved in the Development of I-ADAM

The key players involved in developing and implementing I-ADAM in
Chile are the Ministry of Health (the minister and undersecretary), the
Ministry of Justice (the Ministry's representative to CONACE, the acting
undersecretary, and the division directors), and the Carabineros (the
director of the Departamento Control Drogas y Prevencin Delictual--
Department of Drug Control and Crime Prevention).

A cooperative relationship has been established among representatives of
these Government agencies. The Ministries of Health and Justice have
expressed an interest in ADAM as a platform for developing
policy-relevant research pertaining to drug control activities and the health
consequences associated with drug use. The director of the Department of
Drug Control and Crime Prevention has expressed a special interest in
international research, especially the potential for comparative data
applications.

IX. Research Methods

The I-ADAM program in Chile has two fundamental components: a
questionnaire administered in a booking facility by a trained interviewer to
an arrestee within 48 hours of the arrest and a urine specimen collected
from the respondent that is used to corroborate statements about recent
drug use.

Each of Santiago's 49 municipalities has its own police force. Chile has a
uniformed police force (Carabineros) and a nonuniformed police force
(Policia de Investigaciones) similar to the U.S. Federal Bureau of
Investigation. Nonuniformed officers work at the federal level and deal
with national issues. A judicial order must be issued before nonuniformed
officers can initiate an investigation. Uniformed officers staff comisaras
and make arrests. Only persons arrested by uniformed officers are eligible
for inclusion in the I-ADAM study.

Anyone arrested for a crime, including the least serious nontraffic offense,
is brought to the municipal police station for at least 1 hour. The arrest
information is entered in a logbook and recorded electronically. All
persons arrested are eligible to be interviewed by I-ADAM research staff.
Using the police station's computer, a list of all cases for any time period
can be easily reproduced and used for sampling.

Given that the 1999 I-ADAM Chile study was a pilot test, the main
purpose of which was to resolve implementation issues,
nonprobability-based sampling methods were used. The three sites were
selected intentionally because of their locations and neighborhood
characteristics; they do not represent the population of arrestees in the
nation or in Santiago. As mentioned earlier, some effort was made to
choose a varying group of catchment areas. At the site level, all cases that
met the study eligibility criteria were interviewed. Interviews were done
from 8 a.m. to 10 p.m.; no provision was made to compare cases that were
not sampled from 10:01 p.m. to 7:59 a.m.

The eligibility criteria for I-ADAM in Chile are the same as in the other I-
ADAM participating countries. Data were collected from adult
booked/processed arrestees detained long enough to be interviewed (but
less than 48 hours). Study participants generally were interviewed before
they saw a magistrate or judge, but they had access to legal counsel to ask
about the voluntary and confidential nature of the study. Arrestees who did
not speak Spanish or who were deemed too intoxicated, violent, or
mentally unstable did not participate. The 1999 Chile pilot study included
only men.

X. Training Issues

The goal of the I-ADAM training in Chile is to convey to a team of
interviewers the practices and procedures required to conduct scientific
research surveys. The training curriculum for the Chilean I-ADAM data
collection team was based largely on the U.S. ADAM training manual.
The development of the curriculum was a joint effort between NIJ and the
Chilean Ministry of Health. Each Chilean interviewer received training
using a standard curriculum and manual that addressed basic and advanced
interview skills and site operating procedures. Training was conducted 2 to
3 days before actual data collection. The training curriculum covered the
roles and responsibilities of key site personnel, a question-by-question
review of the survey, the handling and shipping of urine specimens, paired
mock exercises, editing exercises (e.g., editing the survey instrument for
proper skip-pattern usage during the interview), interviewer safety, and a
review of the concept of informed consent. Interviewers were required to
complete and demonstrate competence in basic interviewing skills and an
understanding of project operating procedures.

NIJ staff met with staff from the Ministry of Health in November 1998 to
visit the facilities, develop a data collection plan, and meet with
stakeholders from the Ministries of Health and Justice. In January 1999,
shortly before data collection started, a U.S. training team was sent to
Chile to help implement the first training of the Chilean field staff. Nurses
from the Ministry of Health conducted the I-ADAM interviews.

The group of nurses selected for I-ADAM Chile had extensive experience
with arrestees, having been involved in an earlier study of drug use among
detainees. Using nurses to conduct inter-views had advantages and
disadvantages. Arrestees are reluctant to trust the police and to participate
in a research project that looks as if it is sponsored by the police. Using
nurses clearly shows the arrestees that the program is sponsored by the
Ministry of Health and the information will not be used against them. The
Ministry of Health is seen as nonrepressive and has a positive image as a
healing organization. One belief was that if the research team did not use
uniformed nurses, few arrestees would participate and give honest
responses. The disadvantage to using nurses, especially in uniforms, is that
some comparability problems will emerge with other countries. That
disadvantage, however, is offset by the need to collect valid local data.

XI. Data Analytic Results

The initial I-ADAM study in Chile took place January 22-28, 1999, in
three detention centers in the capital city of Santiago: the First Police
Station of Santiago (First of Santiago), the Fifth Police Station of
Conchal, and Lo Espejo.

Uniformed nurses employed by the Ministry of Health conducted the
interviews. Every eligible male arrestee, regardless of the offense with
which he was charged, was interviewed. Interview hours were from 8 a.m.
to 10 p.m. Interviews were conducted within 6 hours of the arrestees'
arrival at the detention center and lasted an average of 10 minutes. The
interview process went smoothly; the police took no action that could have
influenced the number of respondents or the quality of the data collected.

Sample Characteristics

Interviews were conducted with 134 adult males in three locations. The
largest number (n = 99) of respondents interviewed were brought to the
First of Santiago detention center. When asked, 92 (68.7 percent) of 134
respondents provided urine samples. Two samples were too small to be
analyzed, however, so only 90 samples were tested. 

The age range of the study respondents was from 12 to older than 45; the
average age was 29. Comparisons of the detention centers show that 12- to
19-year-olds made up more than 23 percent of the sample in Conchal, but
30- to 44-year-olds made up more than 71 percent of those interviewed at
Lo Espejo and about 50 percent of those interviewed at First of Santiago.
As seen in exhibit 3, most arrestees interviewed (50.8 percent) were single.
Most interviewees (61.3 percent) had a full- or part-time job. 

Only 1.5 percent of arrestees reported having no formal education; 48.1
percent had attended high school. Although none of the respondents at
either First of Santiago or Lo Espejo reported receiving assistance from
government programs, 6.3 percent of those interviewed at the Conchal
detention center were on public assistance. Exhibit 3 shows that the largest
group of respondents were arrested for drug or alcohol offenses in
Conchal and Lo Espejo. In First of Santiago, the largest group of
respondents were arrested for illegal street vending.

Urine Test Results 

Exhibit 4 shows the test results from the urine samples taken from
interviewees. Approximately 48 percent of the respondents tested positive
for at least one illicit drug (excluding alcohol), and 12.2 percent tested
positive for two or more illicit drugs (9 of the 11 multiple drug users tested
positive for cocaine and marijuana). The highest drug prevalence rate was
for marijuana, followed by cocaine, alcohol, benzodiazepines, and
amphetamines. No prevalence was detected for the six other drugs tested
(barbiturates, propoxyphene, methaqualone, PCP, opiates, and
methadone).

Respondents' Self-Reported Drug Use

Exhibit 5 shows respondents' self-reported drug use during the 3 months
before the I-ADAM interview. Forty-one percent reported having used an
illegal drug other than alcohol; 66.4 percent reported having consumed
alcohol. Rates of use of illegal drugs ranged from 32.8 percent for
marijuana to 0.7 percent for inhalants. No interviewees reported having
used amphetamines or methamphetamines in the previous 3 months,
although one interviewee tested positive for amphetamines (see exhibit 4).

Exhibit 6 shows information gathered about arrestees who used all drugs,
including coca paste, powder cocaine, or cocaine in any other form.
Information gathered includes marital status, age, education levels, rates of
treatment, and rates of multidrug use. Cocaine users also reported
significant levels of use of marijuana, amphetamines, and tranquilizers.
This was the case even though no interviewees reported having used
amphetamines in the previous 3 months (see exhibit 5). Exhibit 7 shows
the reported mean age of first use of certain drugs, ranging from age 15 for
inhalants to age 24 for coca paste.

XII. Policy Implications and Applications of Data

The initial I-ADAM pilot data for Chile show a high level of drug and
alcohol use (60 percent of participants tested positive for drugs and/or
alcohol) among arrestees in the three Santiago sites. The data may
overstate the level of drug use among all arrestees, however, given that
two of the three pilot sites (Conchal and Lo Espejo) were chosen in part
because of the high levels of drug- related activity in those areas and that,
in those two areas in particular, a majority of those interviewed had been
arrested for drug-related offenses (see exhibit 3). As the number of
interview sites increases and as the I-ADAM project moves into
metropolitan areas outside Santiago, the interview samples will become
more representative of the arrestee population as a whole, and
comparisons of arrestee drug use among metropolitan areas can be made.

One unique factor of Chile's I-ADAM program is the use of uniformed
nurses from the Ministry of Health to interview the arrestees. The rationale
behind this has been to gain the confidence of the arrestees and to
encourage participation in the project. Nonetheless, urine testing of
arrestees found that, as in other countries, a higher proportion of arrestees
tested positive for drugs (47.8 percent) than admitted to drug use within
the previous 3 months (41.9 percent). This indicates that some portion of
arrestees will not be forthcoming about current drug use, even if there is
no incentive for them to conceal their drug use.

The involvement of the Ministry of Health in the I-ADAM program at a
basic level may have another benefit, however, in fostering closer
cooperation between the Ministry of Health and other I-ADAM
stakeholders (the Carabineros, CONACE, and the Ministry of Justice) in
the development of drug policy in general. In particular, this may lead to
greater cooperation among the stakeholders in making drug treatment and
drug education programs offered by the Ministry of Health available to
arrestees and to the prison population.

Notes

1. The current Constitution of Chile was approved by a plebiscite on
September 11, 1980, and became effective March 11, 1981. The
Constitution was again approved and amended by referendum on July 30,
1989, and amended in 1993. (Constitution of the Republic of Chile,
Santiago: Government Junta, 1980, retrieved October 24, 2000, from the
World Wide Web: http://www.richmond.edu/~jpjones/confinder/
Chile.htm; Central Intelligence Agency, The World Factbook--Chile,
Washington, DC: Central Intelligence Agency, 2000, retrieved August 15,
2001, from the World Wide Web: http://www.odci.gov/cia/publications/
factbook/geos/ci.html; Hudson, Rex A., Chile--A Country Study,
Washington, DC: Library of Congress, Federal Research Division, 1994,
retrieved October 24, 2000, from the World Wide Web:
http://lcweb2.loc.gov/frd/cs/cltoc.html.) 

2. Hudson, Chile--A Country Study (see note 1).

3. United Nations Development Programme, Human Development Report
2001, New York, Oxford University Press, 2001, retrieved August 30,
2001, from the World Wide Web: http://www.undp.org/hdr2001.pdf.

4. Instituto Nacional de Estadsticas, Compendio Estadstico 2000,
Santiago: Instituto Nacional de Estadsticas, Departamento de Servicios al
Usuario y Difusin, 2000, retrieved August 15, 2001, from the World
Wide Web: http://www.ine.cl/chileci/compen/compind.htm.

5. U.S. Census Bureau, Statistical Abstract of the United States 2000: The
National Data Book, Washington, DC: U.S. Department of Commerce,
Economics and Statistics Administration, U.S. Census Bureau, 2000,
retrieved August 30, 2001, from the World Wide Web:
http://www.census.gov/prod/www/statistical-abstract-us.html.

6. Hudson, Chile--A Country Study (see note 1).

7. Ibid.

8. Ibid.

9. Bureau of Democracy, Human Rights, and Labor, Human Rights
Report, U.S. Department of State--Chile Country Report on Human Rights
Practices for 1997, Washington, DC: U.S. Department of State, 1998,
retrieved August 15, 2001, from the World Wide Web:
http://www.state.gov/www/global/human_rights/1997_hrp_report/
chile.html.

10. Hudson, Chile--A Country Study (see note 1).

11. Ibid.

12. Bureau for International Narcotics and Law Enforcement Affairs,
International Narcotics Control Strategy Report, 2000--South America,
Washington, DC: U.S. Department of State, 2001, retrieved August 30,
2001, from the World Wide Web: http://www.state.gov/g/inl/rls/
nrcpt/2000/index.cfm?docid=883.

13. Ibid.

14. Bureau for International Narcotics and Law Enforcement Affairs,
International Narcotics Control Strategy Report, 1998--South America,
Washington, DC: U.S. Department of State, 1999, retrieved August 30,
2001, from the World Wide Web:
http://www.state.gov/www/global/narcotics_law/1998_narc_report/samer9
8_part2.html. 

15. Ibid.

16. Ibid.

17. Ibid; Hudson, Chile--A Country Study (see note 1).

18. Bureau for International Narcotics and Law Enforcement Affairs,
International Narcotics Control Strategy Report, 2000--South America
(see note 12).

19. The Drug Abuse Warning Network (DAWN) is a large-scale, ongoing
drug abuse data collection system sponsored by the Substance Abuse and
Mental Health Services Administration of the U.S. Department of Health
and Human Services. DAWN's major objectives are to identify substances
associated with drug-related episodes and deaths reported by emergency
departments and medical examiners, monitor trends in drug use
consequences, detect abuse of new drugs, and assess health hazards
associated with drug use. DAWN abstracts data from records of
drug-related visits to emergency departments of acute care hospitals in the
United States and drug-related deaths reported by 145 medical examiner
jurisdictions in 43 metropolitan areas. Since 1988, DAWN emergency
department data have been collected from a representative sample of 685
hospitals, including 21 oversampled metropolitan areas. DAWN medical
examiner data are not nationally representative.

20. The Drug Use Forecasting (DUF) program was the predecessor to the
ADAM program. Starting in eight U.S. cities in 1987, DUF was the first
program to examine the prevalence of drug use among arrestees using a
combination of interviews and drug testing of a sample of arrestees. For a
history of DUF, see Reardon, Judy A., Drug Use Forecasting Program:
Measuring Drug Use in a Hidden Population, Washington, DC: U.S.
Department of Justice, Office of Justice Programs, National Institute of
Justice, 1993, NCJ 144784. 

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

England and Wales

Trevor Bennett

Trevor Bennett is the director of the New England and Wales Arrestee
Drug Abuse Monitoring (NEW-ADAM) Program. He is a university
lecturer at the Institute of Criminology, University of Cambridge, and a
fellow of Wolfson College, Cambridge. He has served as acting director
and deputy director of the Institute of Criminology. 

I. Overview of Demographic Profile of Nation

The United Kingdom is a union of four countries: England, Wales,
Scotland, and Northern Ireland. The New England and Wales Arrestee
Drug Abuse Monitoring (NEW-ADAM) Program operates, as the name
suggests, in England and Wales. Scotland is operating its own pilot
program, and Northern Ireland has not yet begun to implement a program.
NEW-ADAM is a national program that interviews arrestees and tests
them for drugs. Surveys are conducted in 16 locations in 13 of the 43
police force areas in England and Wales. Fifteen of the 16 locations are in
England; 1 is in Wales. In one force area, the Metropolitan Police District
in London, four sites were selected. The survey sites are evenly spread
geographically and cover a range of metropolitan and large urban areas as
well as some smaller and rural districts.

The United Kingdom is a parliamentary democracy. The Parliament in
London has full responsibility for England and Wales and partial
responsibility for Scotland and Northern Ireland, which are developing
their own national assemblies or parliaments as part of the national
devolution of power. Local governments, which are accountable to the
central government, decide how counties and cities are administered.

England and Wales have a combined population of approximately 51
million (see exhibit 1), of which nearly 25 million are men and slightly
more than 26 million are women. About 25 percent of the population is
younger than age 20. Ninety-four percent of the population is white. The
major nonwhite ethnic groups are black (1.7 percent), Indian (1.6 percent),
Pakistani and Bangladeshi (1.2 percent), and Chinese and other (1.2
percent). 

Exhibit 2 shows crime trends over the past decade using data from the
British Crime Survey (BCS), a national household survey of self-reported
crime victimization, and officially recorded crimes submitted by the police
to the Home Office. The BCS is based on a nationally representative
sample of the population aged 16 years and older (19,411 persons in 2000)
and ascertains the number of personal and household victimizations.
Police-recorded crimes include only those offenses reported to and
recorded by the police.

The two data sources show similar movements in crime rates during the
past 10 years. Crime increased during the first half of the 1990s, peaking
in 1992 for police-recorded crime and 1995 for BCS-reported crime
victimization, then declining. Although the BCS covers far fewer offense
types than police-recorded crimes, the number of self-reported
victimizations it records far exceeds the number of crimes recorded by the
police.

The findings of the 1998 BCS on self-reported drug misuse (see exhibit 3)
show that one-third (32 percent) of the general population ages 16-59 had
tried an illicit drug at some time in their lives. About 11 percent had done
so in the previous 12 months.[1] The most widely used prohibited drugs
were cannabis (marijuana) and amphetamines. One-quarter (25 percent) of
the general population had used cannabis and 10 percent had used
amphetamines at some time in their lives. Use of other drugs--e.g., LSD,
mushrooms, cocaine, and heroin--was much less common in the general
population. No more than 5 percent of the population reported that they
had ever used any of these drugs.

II. Description of Criminal Justice System, Arrest Process, and Detention
System

The criminal justice system in England and Wales comprises the police
service, prison service, probation service, judiciary, and various criminal
justice agencies, including the Crown Prosecution Service and the legal
profession.[2] The criminal justice system costs more than 12 billion
pounds per year to run. Nearly two-thirds of all Government expenditures
for the criminal justice system is spent on the police.

The process of arrest and detention is specified by the Police and Criminal
Evidence Act of 1984 and its later additions and amendments.[3] A police
officer may arrest without a warrant anyone who is guilty of an arrestable
offense, who the officer has reasonable grounds to suspect is guilty of such
an offense, or who is about to commit an offense. 

Arrestees are held and processed in a section of a designated police station
known as the custody suite or custody block. The custody suite looks like
a small prison. At the entrance is a custody desk, which is often slightly
elevated. This desk is staffed by two or three custody staff, usually one or
two custody sergeants and a police or civilian jailer. Computer terminals
on the custody desk are used to monitor arrestees and obtain Police
National Computer (PNC) checks.

The rest of the custody block includes routine cells designated for use by
males and females or adults and juveniles and special cells designated for
use when special surveillance or special conditions are required. Two or
three designated interview rooms and some nondesignated interview
rooms are usually available for solicitors and other outsiders to use. The
block also includes a doctor's room, a photography and fingerprinting
room, an intoximeter room, a kitchen, lavatories, offices, and storage
rooms. 

All NEW-ADAM surveys are conducted in police stations that are
designated to receive and process arrestees. Their design follows Home
Office guidelines, and they operate under the constraints of the Police and
Criminal Evidence Act of 1984 and its Codes of Practice.[4] This design
and these constraints strongly affect the research process and how
interviews are conducted.

In conducting interviews and drug testing, researchers must take note of
the Act's requirements that all persons in custody must be dealt with
expeditiously and released as soon as the need for detention ceases to
apply. The key issue is whether interviewing and collecting voluntary
urine samples from arrestees delays official processing. The primary
method used to avoid delaying proceedings is to approach arrestees shortly
after their arrival at the police station and before their police interrogation
begins.

A second legal problem concerns disclosure. The law relating to disclosure
requires the prosecution to make available to the defense any evidence on
which it intends to rely in making its case. Information collected during
the interview, the urine sample, and the urinalysis results could
conceivably be used as evidence in court. In England and Wales, the
Crown Prosecution Service has agreed not to use the materials collected as
evidence. This does not, however, constrain the defense from asking for
them. 

III. Status of National Drug Policy

National drug policy in the United Kingdom, including England and
Wales, is determined primarily by the U.K. Anti-Drugs Coordinator in
collaboration with the Government. In April 1998, the Government
published a parliamentary paper, Tackling Drugs to Build a Better Britain,
based on a report by the U.K. Anti-Drugs Coordinator. This paper defines
the Government's strategy on drugs for the subsequent 10 years.[5] The
paper reported the four main elements of the strategy:

 o To help young people resist drug misuse.

 o To protect communities from drug-related antisocial and criminal
behavior.

 o To enable people with drug problems to overcome them.

 o To minimize the availability of illegal drugs on the streets.

The U.K. Anti-Drugs Coordinator's first annual report, published in
1999,[6] announced that the Government had allocated 217 million
pounds in new money to tackle drug misuse. The report said that a large
proportion of this money would be aimed at treatment and education
during the next 3 years; 6 million pounds would be allocated to research
and information gathering, some of which was used to fund the NEW-
ADAM Program.

Evidence exists that the Government has drawn heavily on research
findings in devising its antidrug strategy and will continue to do so in
evaluating the strategy's effectiveness. The Guidance Notes that
accompanied the publication of the parliamentary paper identified the
research basis for some of its initiatives.[7] Evidence of the link between
drugs and crime was drawn in part from the report on the first
developmental stage of the NEW-ADAM Program.[8] Program results
will be used as a performance measure of at least one of the Government's
key objectives--to reduce opiate and cocaine use among arrestees--and
possibly other objectives, including the key objective to reduce the
proportion of high-rate drug-misusing offenders.[9]

IV. Background History to I-ADAM in England and Wales

The NEW-ADAM Program can be traced to the launch of the previous
Government's antidrug strategy in a parliamentary paper published in
1995.[10] The paper stressed the need to generate high-quality indicators
of drug misuse and develop research on the connections between drug
misuse and crime. The successor strategy, published by the Government in
1998, continued this focus on the effective monitoring of drug misuse and
the need for appropriate performance measurements.[11] 

In 1995, the Home Office commissioned the University of Cambridge to
conduct a feasibility study on interviewing and collecting urine specimens
from arrestees. The project report reviewed the literature on the U.S. Drug
Use Forecasting (DUF) Program--the predecessor to the ADAM Program.
The review concluded that an ADAM-type program was feasible and that
much could be gained from developing such a program in England and
Wales.[12]

In the same year, the Home Office received funds to commission the first
stage of developmental research. The primary goals of the research were to
develop a procedure for interviewing and testing arrestees based on the
DUF Program in the United States and to generate information about the
prevalence of illegal drug use in police force areas selected as survey sites.
The first stage was conducted from January 1996 to August 1997 in five
locations: Cambridge, London (Hammersmith), Manchester (Trafford),
Nottingham, and Sunderland. The research report was published in 1998
and showed what was widely thought to be a high level of drug misuse
among current samples of arrestees.[13]

In 1998, the Home Office commissioned the next stage of developmental
research, which was conducted from July 1998 to May 1999. The research
aimed to build on the early developmental work and move closer to a
research design that might be used as the basis for a national research
program. Surveys were conducted in London (South Norwood), Liverpool,
and Nottingham. Because Nottingham had been surveyed 2 years earlier,
the second survey provided an opportunity to test some of the principles
involved in measuring trends in drug misuse over time.

In 1999, the Government allocated funds for monitoring drug misuse. Part
of these funds was set aside to develop a national, voluntary program of
drug testing and interviewing arrestees. After a competitive bidding
process, the research program contract was awarded to the University of
Cambridge. The NEW-ADAM Program was launched on July 1, 1999.

V. Goals and Objectives of I-ADAM in England and Wales

The goals and objectives of the NEW-ADAM Program have not yet been
formally stated, but some of the program's broad aims can be identified
based on knowledge of current and past thinking. One aim of present and
past Government antidrug strategies has been to devise a national measure
of drug misuse that can be used in conjunction with other measures of
illegal drug consumption. One formal goal of the NEW-ADAM Program
will likely be to generate a measure of drug misuse that can monitor
changes in drug misuse over time and compare prevalence rates of drug
misuse across locations as ADAM does in the United States. 

Another program goal is to understand more fully the connection between
drug misuse and crime. One of the main reasons for devising a measure of
arrestee drug misuse is to understand patterns of stability and change in
drug misuse among actual and potential offenders. Of particular interest is
the extent to which offenders commit crimes to fund drug misuse and to
which these drug-misusing offenders contribute to the total number of
crimes committed.

A third goal of the NEW-ADAM Program is to help monitor the
effectiveness of the Government's overall antidrug strategy. It is expected
that one or more performance targets of the strategy will be linked to
information generated by NEW-ADAM. The Government is interested in
monitoring the extent to which its strategy reduces the prevalence of
drug-misusing, high-rate offenders, especially those who commit crimes to
fund their drug use.

A fourth goal is to help monitor the effectiveness of particular initiatives
within the Government's antidrug strategy. The BCS results can be used to
monitor the spread and utility of the new Arrest Referral Schemes and
Drug Testing and Treatment Orders. The NEW-ADAM Program would
provide broad support to evaluations designed specifically to monitor
these initiatives. 

VI. Getting Started

A. Obtaining Funding

The NEW-ADAM Program is funded by a central Government reserve
administered by the Home Office Research, Development, and Statistics
Directorate. It is expected that funding will be awarded in a series of
3-year research contracts. Funds are allocated on the basis of individual
contracts, so long-term funding is not guaranteed. It is hoped that the
program will demonstrate its usefulness in the first 3 years and attract
Government funds in the future. 

B. Contracting for Data Collection

The Home Office contracted for data collection and the entire research
program through the research tender to the University of Cambridge. The
university directly administers data collection. A team of researchers under
contract travels to each survey site and establishes a base in the area for
the duration of the research. 

C. Facility Access

Access to each research site was secured through a multistage process.
During the first stage, under the first 3-year contract, the Home Office
wrote letters to all police force areas in England and Wales to determine
interest in hosting the research. The responses to these letters and
information on the number of arrestees processed through the custody
suites were assessed, and a sample of forces was provisionally selected. In
the second stage, the Home Office contacted the police forces selected to
arrange preliminary meetings. The meetings typically included
representatives from the Home Office, the University of Cambridge, and
senior and junior police officers in the potential host force. Following the
meetings, the representatives, usually without the most senior officers,
visited each force's custody suite to determine whether it was suitable for
the research.

D. Knowing the Catchment Area

The catchment area of each NEW-ADAM survey is the arrest catchment
area of the custody suite, which is usually an entire police division. The
police usually provide researchers with a map of the area. In most cases,
the catchment area has boundaries similar to those of the local government
administrative areas. This is not always so, however; in these cases, it is
difficult, but not impossible, to identify the demographic characteristics of
the research area. 

Exhibit 4 shows the catchment areas of the first eight sites surveyed during
the first year of the NEW-ADAM Program. Most were based in city center
police divisions that covered geographic areas of about 5-10 square miles.

E. Drug Testing Issues

The Forensic Science Service (FSS) Urine Testing Unit at Chepstow
conducted screening tests for both developmental stages of the NEW-
ADAM research. During the early stages of the research, FSS provided
information on the correct procedures for collecting urine specimens. The
FSS's collection equipment and recommended chain-of-custody
procedures have been used throughout. Important decisions had to be
made about the method of drug testing, including whether to use
confirmatory tests in addition to screening tests, the number and nature of
the package of drugs to be tested, the type of screening test, and the cutoff
levels to be used to determine a positive result. To allow flexibility in
making comparisons across areas, FSS was asked to provide the raw data
from the screening test to allow the results to be recalculated using
different cutoff levels.

F. Instrument Issues

The questionnaire used in the surveys was based on the early DUF and
ADAM questionnaires. Questions were added or subtracted, and the
wording of some questions was changed slightly as appropriate. The
questionnaire is in continual development, and small refinements are often
made. Such changes exact a penalty in time and effort at the analysis
stage. Researchers embarking on I-ADAM programs need to decide when
to stop revising the questionnaire. The NEW-ADAM questionnaire
currently includes a main questionnaire and two followup questionnaires,
each of which is administered to alternating interviewees.

Cultural applicability 

English is the main spoken language in England and Wales. Relatively
few cultural minority groups do not speak English either as a first or
second language. Hence, it was decided to use one questionnaire designed
in English. Arrestees who did not speak English were excluded from the
survey.

Standardization versus local utility 

The same questionnaire is used across all locations. It has not been found
necessary to change the questions to adjust for local cultural differences.
The issue of cultural standardization is more relevant when making
comparisons across countries. Therefore, the NEW-ADAM questionnaire
includes a series of core questions that are used in the ADAM surveys in
the United States.

VII. Barriers to Developing I-ADAM

The development of the NEW-ADAM Program has run fairly smoothly,
but a number of potential barriers had to be tackled from the outset.

The main potential barrier to setting up an I-ADAM program was
obtaining the funding and the legitimacy to carry out the research. The
program requires full Government political and administrative support and
central, typically Government, funding.

Another potential barrier to developing the program in England and Wales
was the legal issue of disclosure in court of materials collected during the
surveys. To avoid researchers being subpoenaed and having the research
materials used as evidence (which would be impracticable on a regular
basis), it was necessary for the Crown Prosecution Service to grant the
research staff immunity from disclosure. It is hoped that this reviewable
privilege will be given legal status through an act of Parliament, such as
the confidentiality regulations that have been codified in the United
States.[14]

Another potential barrier was the cooperation of the police. It is important
that police at the most senior level agree to host the research, that
middle-ranking officers agree to the procedures proposed in their police
stations, and that lower ranking police in the custody suite provide full
access to arrestees and to the confidential materials relating to them. One
sensitive issue that had to be negotiated was the need to interview arrestees
shortly after their entry into the custody suite and before their police
interview. Another was the need for full access to custody records and
relevant information from the Police National Computer.

VIII. National Stakeholders Involved in the Development of I-ADAM

The key players in developing the NEW-ADAM Program have been the
Government, the Home Office, the police, and the University of
Cambridge. The Government has provided the central funds used to
administer NEW-ADAM. Its interest is in monitoring drug misuse and
reducing the number of crimes committed by drug-misusing offenders.
The Home Office's Research, Development, and Statistics Directorate, the
Government's criminal justice research arm, administers the central funds
set aside for monitoring drug misuse and evaluating Government strategy.
Both the Research, Development, and Statistics Directorate and the
Institute of Criminology at the University of Cambridge are interested in
funding and carrying out high-quality, policy-relevant research. The police
are interested in generating policing policy and supporting police research
related to tackling drug misuse, which is administered through the central
committee of the Association of Chief Police Officers (ACPO).

Other criminal justice organizations also have an interest in the results of
the NEW-ADAM Program. The Crown Prosecution Service has granted
immunity from disclosure of research materials in prosecuting arrestees
taking part in the program. The Forensic Science Service provides advice
and conducts all screening tests on urine specimens collected as part of the
research. The local police forces that host individual surveys and their
local partners have an interest in using published survey reports to inform
local drug strategies.

IX. Research Methods

Selection of Police Forces

The NEW-ADAM surveys use two-stage sampling. Each of 16 locations
will be surveyed once every 2 years. The first stage is selecting the police
force areas to be included in the research. During the first year of the
program, surveys of arrestees were conducted in eight locations; during
the second year, surveys will be conducted in eight additional locations.
During the third year, surveys again will be conducted in the eight
locations visited during the first year. If the fourth year is funded, surveys
will be conducted in the eight locations visited during the second year. 

For several reasons, the choice of police forces to include in the survey
could not be based on random sampling. Sampling sites must process a
large number of arrestees, be willing to host the research, and together
make up an even geographic spread across England and Wales and across
metropolitan and other urban areas. Because the level of accuracy
increases with the number of survey respondents, single-site surveys can
be conducted only in custody suites where a high number of arrestees are
processed. In England and Wales, the number of high-volume sites is
limited. The first review of police force areas identified 16 forces (15 plus
the Metropolitan Police District in London) that had custody suites with
sufficient numbers of arrestees for data analysis. Additionally, surveys can
be conducted only in police force areas that agree to host the research and
are fully cooperative and committed to it. The chief constable has sole
responsibility for agreeing to provide researchers with access to the
custody areas; the Home Office cannot overrule this decision. Finally,
although nearly all the eligible high-volume police force areas were
selected for the program, the final choice was made on the basis of having
an even geographic spread. 

Selection of Arrestees for Surveys

The second stage of sampling--the selection of arrestees in the custody
block--is based on random or probability sampling. The research is
conducted on a 24-hour, 7-day-a-week basis for approximately 30 days.
During this period, all arrestees who pass through the custody suite are
potentially eligible to be selected for an interview, although certain
categories of arrestees are rejected from the outset as ineligible based on
the criteria shown in exhibit 5. 

All remaining arrestees are eligible for interview and should be
approached by an interviewer. The method adopted is a 100-percent
sample of eligible arrestees, or a census. In theory, all eligible arrestees
have an equal probability of being approached for an interview. In
practice, there are several practical reasons why all eligible arrestees are
not approached and why all arrestees approached do not agree to be
interviewed or provide a specimen. These are considered as losses in terms
of the sampling procedure and reduce the research contact rates (i.e., the
approach rate, the interview rate, and the specimen collection rate).

X. Training Issues

The NEW-ADAM Program does not recruit new researchers for each
survey (although this was done in the first few surveys) or subcontract data
collection. The program uses a trained and dedicated team of researchers
who travel to each site. Because each site is surveyed only once every 2
years, it was not practical to set up a local team of the type used in the
United States. Because England and Wales are relatively small
geographically, researchers also can travel from one location to another
relatively quickly.

Researchers are typically recent graduates, usually at a master's or
second-degree level, who have some experience in criminology (including
criminal justice) or the disciplines that make up criminology (e.g.,
psychology, sociology, and other social sciences). No formal policy exists
on who can be recruited as interviewers, but the job advertisements usually
state as qualifications an educational background in a social science and
research or professional experience working with offenders or drug users.
No formal policy seeks to match interviewers with arrestees in any way. 

In practice, the team does not remain stable over time. Members of the
team leave to pursue their careers, and new team members are recruited.
These new members undergo a similar initial training before replacing
outgoing members.

This method of recruiting a dedicated team of researchers has implications
for training. All new recruits are required to visit program headquarters at
the University of Cambridge for an intensive 1-day training session to
learn the principles of interviewing and collecting specimens from
arrestees. They are also given study materials to learn on their own.

Training continues through briefing and debriefing meetings for each
survey. Briefing meetings are typically held at each survey location the
day before a new survey starts. Debriefing meetings are typically held
shortly after a survey. General issues relating to the survey site and the
methods used are evaluated. Team members regularly meet individually
with the program director or manager to discuss individual training needs
and personal development.

XI. National Data Analytic Results

The results of both the first and second developmental stages of the
research have been published in Home Office reports.[15] The results of
the first annual NEW-ADAM report are currently being assembled. It is
hoped that this will be published in the second half of 2001. In addition to
the program reports, individual force reports are produced, but not for
general distribution.

The most recent published report is the second developmental stage report,
which covers four sites surveyed in 1998-99. In total, 740 arrestees were
interviewed. The proportion of males in the samples ranged from 83 to 94
percent across the four survey locations. The percentage ages 16-20 ranged
from 16 to 29 percent. The percentage of nonwhite arrestees ranged from 1
to 39 percent.

The surveys showed that 69 percent of arrestees across the four sites tested
positive for one or more drug types (excluding alcohol) and 36 percent
tested positive for two or more drugs. The most common drug identified
was cannabis (49 percent tested positive), followed by opiates (29
percent), alcohol (22 percent), cocaine (20 percent), benzodiazepines (12
percent), amphetamines (12 percent), and methadone (8 percent).
Liverpool had the highest prevalence rate for positive tests for both opiates
(50 percent) and cocaine (40 percent).

About one-quarter (23 percent) of all arrestees admitted injecting at least
one illegal drug at some time in their lives. One-fifth (20 percent) reported
injecting one or more drugs in the previous 12 months. One third (33
percent) said that they were currently dependent on one or more drugs.
One-fifth (20 percent) of the total sample said that they were not receiving
treatment for drug dependence but would like to receive treatment.
Forty-two percent of arrestees who reported using drugs in the previous 12
months believed that their drug use and crime were connected. The
connection cited most often was the need for money to buy drugs. 

XII. Policy Implications and Applications of Data 

Policy Implications

Evidence indicates that the published findings of the first NEW-ADAM
developmental stage report have already had an effect on Government
policy. The guidance notes that accompanied Tackling Drugs to Build a
Better Britain acknowledged the first report as a source of research
information.[16] Evidence on the link between drugs and crime was also
drawn in part from the findings of the first developmental stage report.[17]
At least one of the key performance measures used to assess the
effectiveness of the Government's drug strategy will be derived from the
NEW-ADAM Program.

There are also general policy implications from the findings. The results
show that a high proportion of arrestees admits taking more than one type
of drug and test positive for more than one type of drug. A notable
proportion tests positive for opiates, including heroin, and cocaine,
including crack. Almost half of drug-misusing arrestees state that their
drug use and offending are connected, and many of the measures of drug
use correlate strongly with many of the measures of crime.

Data Applications

NEW-ADAM data will be used to monitor drug misuse trends among
arrestees to inform Government drug policy. The data will also be used to
evaluate both the Government's drug strategy as a whole and individual
programs.

These data have many other potential applications. The program has
identified a range of problems experienced by arrestees, including health,
housing, educational, and employment problems. It may be possible to
monitor these problems and perhaps take advantage of the arrestees'
contacts with the criminal justice system to address them.

The data also can be applied to develop fundamental knowledge about
drug misuse and crime and how they are linked. Basic knowledge can be
generated from ADAM surveys about drug use patterns, drug epidemics,
injecting behavior, health issues, ownership and use of guns, dependency
and treatment, and arrestee lifestyles. This knowledge can advance the
general understanding of drug misuse and its related problems.

The data generated by the I-ADAM partnership can be used to compare
international trends in drug misuse. The program allows for monitoring
changes in drug misuse across countries and over time. This evidence can
then be used to inform national and international drug policies.

Notes

1. Ramsay, Malcolm, and Sarah Partridge, Drug Misuse Declared in 1998:
Results From the British Crime Survey, London: Home Office, 1999.

2. Home Office, Digest 4: Information on the Criminal Justice System,
London: Home Office, 1999.

3. Home Office, Police and Criminal Evidence Act 1984, London: Her
Majesty's Stationery Office [HMSO], 1986.

4. Home Office, Police and Criminal Evidence Act 1984: Codes of
Practice, London: Home Office, 1995.

5. Her Majesty's Stationery Office, Tackling Drugs to Build a Better
Britain: The Government's 10-Year Strategy for Tackling Drug Misuse,
London: HMSO, 1998 [hereinafter Tackling Drugs: The Government's
10-Year Strategy].

6. U.K. Anti-Drugs Coordination Unit, Cabinet Office. Tackling Drugs to
Build a Better Britain: United Kingdom Anti-Drugs Coordinator's Annual
Report 1998/99. London: Central Office of Information, 1999. Ref. J99-
4196/9905/040.

7. Her Majesty's Stationery Office, Tackling Drugs: The Government's
10-Year Strategy for Tackling Drug Misuse (see note 5).

8. Bennett, Trevor, Drugs and Crime: The Results of Research on Drug
Testing and Interviewing Arrestees, London: Home Office, 1998
[hereinafter Drugs and Crime: The Results of Research].

9. Her Majesty's Stationery Office, Tackling Drugs to Build a Better
Britain: United Kingdom Anti-Drugs Co-ordinator's National Plan
2000/2001, London: HMSO, 2000.

10. Her Majesty's Stationery Office, Tackling Drugs Together: A Strategy
for England 1995-98, London: HMSO, 1995.

11. Her Majesty's Stationery Office, Tackling Drugs: The Government's
10-Year Strategy (see note 5).

12. Bennett, Trevor, A Feasibility Study of Drug Testing of Arrestees in
England and Wales, Report to the Home Office, Cambridge: University of
Cambridge, Institute of Criminology, 1995.

13. Bennett, Drugs and Crime: The Results of Research (see note 8).

14. 28 Code of Federal Regulations Part 22.

15. Bennett, Drugs and Crime: The Results of Research (see note 8);
Bennett, Trevor, Drugs and Crime: The Results of the Second
Developmental Stages of the NEW-ADAM Programme, London: Home
Office, 1998.

16. Her Majesty's Stationery Office, Tackling Drugs to Build a Better
Britain: The Government's 10-Year Strategy for Tackling Drug Misuse,
Guidance Notes, London: HMSO, 1998.

17. Bennett, Drugs and Crime: The Results of Research.

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

Malaysia

Visweswaran Navaratnam 
Vicknasingam Balasingam 
Hilal Hj. Othman

Visweswaran Navaratnam is a professor at the Center for Drug Research,
Universiti Sains Malaysia, where Vicknasingam Balasingam and Hilal Hj.
Othman are members of the project staff.

I. Overview of Demographic Profile of Nation 

Malaysia was created in 1963 through the merger of Malaya (which
became independent of Britain on August 31, 1957), the former British
Singapore (which later seceded from Malaysia in 1965), and the provinces
of Sabah and Sarawak in northern Borneo. The country is divided into two
main regions 650 kilometers apart, separated by the South China Sea:
Peninsular Malaysia and East Malaysia (Sabah and Sarawak). Peninsular
Malaysia borders Thailand to the north and Singapore to the south. Sabah
and Sarawak border Kalimantan (the Indonesian part of Borneo) and
Sarawak surrounds the tiny enclave of Brunei. The peninsula's west coast
borders the Andaman Sea (Strait of Malacca). The east coast of the
peninsula, Sabah, and Sarawak all adjoin the South China Sea.

Malaysia has a land area approximately the size of New Mexico and a
population of more than 23 million. Its capital, Kuala Lumpur, has a
population of more than 1 million. The country's three largest ethnic
groups are Malay, Chinese, and Indian, and the main languages spoken
there include Bahasa Malaysia (the official language), English, Chinese
dialects, Tamil, and indigenous dialects. Malaysia has 13 States and 2
Federal Territories, one of which contains the capital. Exhibit 1 shows
demographic information for Malaysia. 

Several decades of sustained economic growth and political stability have
made Malaysia one of Southeast Asia's wealthiest countries. It ranks
among the medium nations (61st) in worldwide human development.
Exhibit 2 shows economic and development information for Malaysia.

Penang, a relatively small but economically developed island State located
in the Andaman Sea off the northwestern coast of the Malay peninsula,
was chosen as the site for Malaysia's I-ADAM pilot program. The State
was chosen not only for convenience but also because it had a
compar-atively high rate of drug use and the crimes committed there are
similar to those in Malaysia's larger cities.

As of 1998, the main drug abused in Malaysia was heroin (54.7 percent of
recorded cases of drug abuse). In Penang, 557 cases of heroin abuse were
reported in the first 3 months of 2000. In 1998, 4,821 cases of substance
abuse[1] were reported in Penang, most of which were among 20- to
39-year-olds.[2] From January to November 1999, Penang recorded 4,959
drug users, more than any other State.[3] These high prevalence rates
indicate the need for appropriate intervention strategies to address
substance abuse.

Little is known about the prevalence of alcohol abuse in Malaysia. Only
recently was a law passed against drunk driving. Enforcement agencies in
Penang rarely test arrestees' alcohol levels. ADAM could help clarify the
extent of the alcohol abuse by obtaining basic background information.

II. Description of Criminal Justice System, Arrest Process, and Detention
System 

Malaysia is a federal parliamentary democracy with three branches:
executive, judicial, and legislative. The head of state, the Yang di-Pertuan
Agong (paramount ruler), is a constitutional monarch who is elected to a
5-year term by and from among the hereditary rulers of nine States. The
Parliament (Parlimen) has two houses: the lower house, the Dewan
Rakyat, to which representatives are elected, in principle, to 5-year terms,
and the upper house, the Dewan Nagara, to which senators are appointed
by the paramount ruler and the state legislatures for 3-year terms. The
leader of the party who wins a plurality of seats in the House of
Representatives becomes the prime minister and head of the Government.
Judges of the Supreme Court are appointed by the paramount ruler on the
advice of the prime minister.[4]

In colonial times, Malaysia was confronted with the problem of opium
use. The British colonial Government introduced the Dangerous Drug
Ordinance and Poisons Ordinance in 1952. Malaysia's current antidrug
laws, especially those dealing with drug sales, are among the world's
toughest. Anyone arrested with more than 15 grams of heroin faces a
mandatory death sentence. Today, Malaysia has five main statutes on
substance abuse:

 o Dangerous Drug Act, 1952.
 o Poisons Act, 1952.
 o Drug Dependence Act (Treatment and Rehabilitation), 1983.
 o Dangerous Drug Act (Special Preventive Measures), 1985.
 o Dangerous Drug Act (Forfeiture of Properties), 1988. 

When someone is detained for an offense, a remand order is obtained from
the court within 24 hours after the arrest to facilitate investigations. An
arrestee can be detained under remand for up to 14 days, after which
formal charges must be made or the arrestee released.

Most arrestees are tested for drug use. If an arrestee tests positive for
drugs, a medical officer will determine whether the arrestee is drug
dependent, usually through urine tests and physical examinations. If an
arrestee is found to be drug dependent, the National Narcotics Agency
(NNA) recommends the most appropriate treatment to the court. The two
types of treatment are community supervision and institutional
rehabilitation, both of which normally last for 2 years, and both of which
are discussed in more detail in Section III. First-time drug offenders and
those who are found to have strong family support are normally
recommended for community supervision. Habitual and hardcore drug
users are sent for institutional rehabilitation. After 2 years of institutional
rehabilitation, the drug user is placed under community supervision for
another 2 years. If the supervision rules are broken during this period, the
offender can be sent to prison for not less than 3 years.

III. Status of National Drug Policy 

In 1996, the NNA approved the new strategies of the National Drug
Policy, in the following priority order:

 o Prevention.
 o Enforcement.
 o Treatment and rehabilitation.
 o Regional and international cooperation.

Prevention, enforcement, and treatment and rehabilitation are the three
main strategies; international cooperation is sought to support these
strategies. 

Prevention 

Prevention is a long-term strategy aimed at protecting individuals from
drugs. Prevention programs emphasize individual resistance to drug use
and efforts to create an environment that will protect individuals and
community from drug abuse. These efforts include--

 o Encouraging young people to reject the drug lifestyle.
 o Changing society's perception of and attitude toward drugs. 
 o Mobilizing the community in drug abuse prevention programs.
 o Providing alternatives to drugs and encouraging healthier lifestyles.

This strategy has two components: primary and general prevention.
Primary prevention involves developing an individual's inner strengths
through education in positive religious, moral, cultural, and social attitudes
and values. Programs that have been implemented include preventive drug
education in schools, teacher training, and guidance and counseling
services. General prevention involves the community in drug control and
prevention. General prevention strategies have been implemented through
information campaigns, publicity programs, and workplace prevention
initiatives.

Enforcement 

Enforcement has three main components: interdiction, legislation, and
intelligence. Interdiction aims to reduce the supply of drugs on the market
by preventing the smuggling of illicit drugs into the country. The strategy
emphasizes strengthening and intensifying enforcement measures to curb
the entry of illicit drugs by land, sea, and air. At the same time, aggressive
efforts are carried out continuously to stop trafficking and sales of illicit
drugs within the country. 

Legislation complements prevention efforts by imposing severe penalties
that make it dangerous to possess, supply, traffic in, or abuse drugs. As
noted above, Malaysia's drug laws are among the world's toughest.

Intelligence from inside and outside the country can be a major asset in
combating syndicates and individuals involved in drug smuggling.
Intelligence gathering has been strengthened by the establishment of a
Special Intelligence Team in border areas with Thailand and in the States
of Sabah and Sarawak, which can carry out joint operations with the
intelligence services of other countries to curb the supply of illicit drugs at
the source.

Treatment and Rehabilitation 

This strategy has two goals: eliminate drug dependency and prevent
recidivism. To eliminate drug dependency, addicts are ordered to
participate in one of two treatment and rehabilitation programs:
community supervision or institutional rehabilitation. Community
supervision is rehabilitation in a community setting. Drug users under
community supervision must report weekly to the district NNA officer for
urine testing and counseling. Anyone found to be using drugs will be sent
into institutional rehabilitation.

Institutional rehabilitation occurs at one of 25 residential drug
rehabilitation centers. These centers treat drug addiction through a
combination of "cold turkey" methods, counseling, and vocational therapy.
Treatment normally lasts 2 years. 

Antirecidivism efforts focus on strengthening the attitudes and behavior of
ex-addicts to prevent relapse and to enable them to live drug-free lives.
The programs implemented include supervision, counseling, and social
support programs at district-level service centers operated by the NNA.

International Cooperation 

The national drug strategy needs international support and cooperation. Its
objectives are to enhance regional and international cooperation in efforts
to control and prevent drug abuse and trafficking and to strengthen
national efforts toward international drug control and prevention. 

IV. Background History to I-ADAM 

The relationship between alcohol and other drugs (AOD) and crime has
not been studied much in Malaysia. Although drug issues manifest
themselves at every level of the criminal justice system, from street crime
to international trade in drugs, the relationship between AOD and crime is
difficult to specify because most crimes result from a combination of
situational, personal, cultural, and economic factors. There are not enough
data currently available to provide definitive evidence to law enforcement
authorities, service providers, and researchers of the link between drug use
and the drug trade and crime in general.

The National Institute of Justice, the research arm of the U.S. Department
of Justice, invited representatives of the Center for Drug Research,
Universiti Sains Malaysia, to participate in the first International Arrestee
Drug Abuse Monitoring (I-ADAM) conference in Chicago in 1999. As a
result of that meeting, Malaysia decided to implement an ADAM pilot
project in Penang. The project designers hope to show the feasibility of
implementing the ADAM mechanism as an ongoing activity in Malaysia.
By measuring AOD use among arrestees, they hope to take the first steps
to reduce AOD-related crimes, which is an important component to
reducing crime in Penang.

V. Goals and Objectives 

The general aims of the ADAM project are as follows:

 o To assess the feasibility of implementing and sustaining an ADAM
project in the State of Penang.

 o To investigate the relationship between alcohol and other drugs and
crime.

 o To better understand the prevalence of drug use among hidden
populations (subsets of the general population whose membership cannot
be readily distinguished or enumerated based on existing knowledge or
sampling capabilities) and its relationship to crime.[5] 

 o To disseminate the data collected from the project to local health and
law enforcement agencies.

 o To participate in an international network of ADAM sites in order to
share information and develop new methods of measuring arrestee drug
use and of applying the information learned to the problems of reducing
drugs and crime.

The project's specific objectives are to--

 o Identify the extent of AOD use among recent arrestees in Penang.

 o Identify patterns of substances abuse among arrestees in Penang.

 o Investigate the extent of alcohol and substance abuse among cases
referred to the hospital by --police (e.g., automobile accidents where
alcohol or drugs may have contributed).

 o Assess the influence of environmental conditions on AOD use.

 o Obtain a profile on arrestees (e.g., sociodemographic data, arrest
history, types of offenses).

 o Investigate the correlation between AOD use and crime.

 o Understand arrestees' perceptions of crime and attitudes toward law
enforcement.

 o Test U.S. survey instruments in local populations.

 o Develop and validate reporting techniques such as self-report and
biological measures (urine testing).

 o Develop specific intervention techniques for various sectors (e.g.,
health, criminal justice, welfare, corrections).

VI. Getting Started

A. Obtaining Funding 

Funds for the pilot phase were obtained through a grant application by the
NNA to the national research program known as IRPA (Intensified
Research in Priority Areas). IRPA supports research that it believes is a
national priority and has the potential to contribute to the formation of
local policies.

B. Data Collection 

NNA officers and a research officer have been appointed to collect data
from participating police stations. Police officers will notify the research
team daily on how many arrests were made the day before, and the data
collectors will visit the police station daily to collect data from arrestees. 

C. Facility Access 

To ensure that the project would be implemented in accordance with
ADAM procedure, the Center for Drug Research, Universiti Sains
Malaysia, collaborated with NNA and the police in Penang. Once this
collaboration was established, access to facilities was arranged by NNA
officers and the local police. 

The plan is that the police stations involved in the study will call the NNA
office daily to tell how many arrestees were brought into each station the
day before. The research officer from the Center for Drug Research will
randomly pick every 10th arrestee brought in the day before to be
interviewed. The research officer will conduct the interview at the police
station within 48 hours of the arrest. A voluntary urine test will also be
carried out to determine whether the interviewee recently used drugs.

D. Knowing the Catchment Area 

Penang has two police divisions, the northeast and southwest divisions.
The northeast division was selected as the catchment area for this study.
The division has 4 teams with a total of 12 police stations, all of which
will participate in the study. Exhibit 3 lists the participating police
stations.

E. Drug Testing Issues 

Urinalysis

The validity of interviews and self-reported data can be verified by
chemical drug testing of biological specimens (urine). Litmus paper is
being used for the initial test on the urine sample. The litmus paper used is
in accordance with U.S. National Institute on Drug Abuse (NIDA)
standards; its detection sensitivity is 50 mg/mL or greater. Results are
received in 5 minutes. If the litmus paper shows a positive result, the urine
is sent to a Government pathologist for confirmatory tests.

Because the police collect the urine specimens, arrestees may not give the
specimen voluntarily, which introduces bias into the testing. The test
results of arrestees who refuse to participate in the study are not examined
and, hence, cannot be compared with the results of those who agree to
participate.

F. Instrument Issues 

Questionnaire

The ADAM questionnaire to be used in this study was translated into
Bahasa Malaysia, then translated back into English as a check on the
accuracy of the translation. A pretest was carried out among a few
arrestees to determine the clarity of the translation. 

VII. Barriers to Developing I-ADAM 

The research team established a collaborative effort to ensure that
administrative barriers do not hamper the implementation of the project.
Because this study is a pilot project, the actual barriers can be identified
only after the study is completed. Several potential problems can be noted,
however, including the following:

 o As noted above, the police will administer the urine testing, which may
reduce participation by interviewees. 

 o A sample of every 10th arrestee may yield too few participants to get a
truly representative sample of arrestees (see section IX for a discussion of
the potential sample size). 

 o Because the arrestees will have already been in jail for a day when the
researchers are notified of the arrest, the researchers have less opportunity
to interview the arrestees before 48 hours have passed since the arrest.
This could become more of a problem if several stations process a larger
than usual number of arrestees at once or if not enough research officers
are available to handle all 12 stations at a given time.

VIII. National Stakeholders Involved in the Development of I-ADAM 

The Center for Drug Research, Universiti Sains Malaysia, is collaborating
with the NNA to implement the ADAM project in Penang. Researchers
from the center and NNA officers also have met with the police to brief
them and to obtain their permission to conduct the study. As the source of
the funding for the study, IRPA is a stakeholder, as are the national and
local entities that form IRPA's constituencies.

IX. Methodology 

Study Design 

The Penang I-ADAM project is a 1-year pilot project with a
cross-sectional design to assess the feasibility of developing an ADAM
system.

Sample Size 

As the study is still ongoing, the actual sample size is not yet known. It is
hoped that approximately 150 arrestees will be interviewed and tested in
the first 6 months of the study. The arrestees are being selected randomly
for interviews and testing (see section VI, D).

Men 18 years of age and older are being selected for the study. Persons
younger than 18 are defined as juveniles in Malaysia, so they come under
a different jurisdiction. Because only a small fraction of those arrested in
Penang for AOD offenses are women, it would not be practical to include
women in the sample.

All arrestees in the selected police stations who have been in custody less
than 48 hours and are not considered violent or mentally ill are eligible to
be recruited for the study (with their consent). The 48-hour limit will
ensure the validity of the urinalysis. Exhibit 4 lists the crimes that are to be
included in the sample.

The following arrestees will not be eligible for inclusion in the study:

 o Children or juveniles.
 o Persons who are mentally ill.
 o Persons who are considered violent.
 o Persons who have been detained longer than 48 hours.

X. Training Issues 

The research officer from the Center for Drug Research and the officers
from NNA were trained by the principal investigators on conducting
interviews and the survey methodology. In addition, police officers were
briefed about the project to ensure that they understand its objectives. The
research officers from the Center for Drug Research and NNA have
experience dealing with the addict population and are familiar with the
ADAM interview techniques.

XI. National Data 

No national data are available yet.

XII. Policy Implications and Application of Data 

The I-ADAM pilot project will complement the existing Asian Multicity
Epidemiology Network and the National Drug Information System. The I-
ADAM project is unique because it will provide data on drug use among
the arrestee population; the two existing programs provide data from the
addict population. The data from this study will provide an indicator to
policymakers of the extent of drug and alcohol use among those arrested
for crimes. It is hoped that this study will be used and accepted as an
indicator and, in the long run, will influence existing policy regarding
drugs and crime.

Notes

1. In Malaysia, substance abuse (known as "daddah" in Bahasa Malaysia)
does not refer to alcohol abuse or dependency.

2. National Narcotics Agency, National Narcotics Report, Kuala Lumpur:
Ministry of Home Affairs, 1998.

3. National Narcotics Agency, National Drug Information System, Kuala
Lumpur: Ministry of Home Affairs, 2000.

4. Central Intelligence Agency, The World Factbook: Malaysia,
Washington, DC: Central Intelligence Agency, 2000.

5. See Weibel, W.W., "Identifying and Gaining Access to Hidden
Populations," in The Collection and Interpretation of Data From Hidden
Populations, ed. E.Y. Lambert. NIDA Research Monograph 98. DHHS
Publication No. (ADM) 90-1678. Rockville, MD: U.S. Department of
Health and Human Services, National Institute on Drug Abuse, 1990.

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

The Netherlands

Peter Klerks
Janine Plaisier
Willemijn Garnier

At the time this chapter was written, Peter Klerks was a researcher for
Eysink, Smeets, and Etman in The Hague, the Netherlands. He currently
works for the Dutch Police Academy. Janine Plaisier and Willemijn
Garnier were research coordinators for WODC, the research and
documentation center of the Ministry of Justice, The Hague, the
Netherlands. Willemijn Garnier now works for the Ministry of Justice in
The Hague.

I. Overview of Demographic Profile of Nation

The Netherlands, a small country in Western Europe bounded by Germany
to the east, Belgium to the south, and the North Sea to the west, is one of
the most urbanized and densely populated countries in the world. With an
area of only 41,526 square kilometers (approximately twice the size of
New Jersey), it had a population of about 15.8 million in 1999 (7.8 million
men and 8.0 million women). There are 662,000 foreign nationals living in
the country, and 17.1 percent of the Dutch population are first- or
second-generation immigrants. Basic demographic information is provided
in exhibit 1, and a more detailed demographic breakdown is given in
exhibit 3.

A prosperous country, in 1999, the Netherlands had a GDP of 842 billion
guilders ($365.1 billion), an unemployment rate of 3.3 percent, a poverty
rate (the percentage of families with an income at or below the social
minimum) of 10.5%, and a literacy rate--excluding functional illiterates
(people who can read but do not understand what they read)--of 87
percent.[1] Basic economic information for the Netherlands is given in
exhibit 2.

The I-ADAM pilot program in the Netherlands took place in one of the
country's 25 police regions, The Hague (Haaglanden), which is the seat of
the national government and has about 450,000 inhabitants.

Crime Statistics

In 1999, there were 86,587 violent crimes in the Netherlands, a 13-percent
increase from the previous year and a continuation of the upward trend
since 1995, when there were 64,606 violent crimes (see exhibit 4).[2]
There were 872,362 property crimes in 1999, a 4-percent increase from the
previous year, but still below the 1995 figure of 903,871. The number of
Drug Act crimes has increased from 3,473 in 1995 to 7,613 in 1999. This
category reflects only violations of the Opium Act, according to which
drugs are categorized as "hard" and "soft." Hard drugs include heroin,
cocaine, and synthetic drugs such as MDMA (also known as Ecstasy or
XTC); soft drugs include cannabis derivatives such as marijuana and
hashish.

Drug Use Statistics in the General Population

The first National Drug Use Survey was carried out in 1997 among 22,000
persons 12 years and older using a computer-assisted personal interview.
The design allows prevalence data to be broken down into four
metropolitan areas (Amsterdam, Rotterdam, Utrecht, and The Hague) and
five areas with different population densities. Data from the second
survey, which was carried out in 2000, will be available by the end of
2001 (see exhibit 5).[3]

It is evident from exhibit 5 that cannabis was by far the most popular illicit
drug both in terms of lifetime use and in terms of usage in the last month.
Looking at lifetime prevalence rates, cocaine was the most popular drug,
followed closely by amphetamines, Ecstasy, and hallucinogens; only 0.5
percent of the respondents had reported using any "hard drug" in the
month preceding the interview. Mushrooms were used at a similarly low
rate. Heroin use was so low as to be hardly measurable, but population
surveys are not suitable to quantify levels of heroin use. For all drugs, the
difference between lifetime and recent use indicates that most people who
experiment with a drug do not continue to use it. This has been expressed
in a so-called continuation rate: Some 16 percent of the lifetime cannabis
users continued to use it in the past month. In contrast, continuation rates
for alcohol and tobacco were 80 and 51 percent, respectively.

If prevalence rates of last-month use are extrapolated to the general
population age 12 years and older, one may obtain a "lower bound" or
minimum estimate of the number of drug users in the country (see exhibit
6). This is a minimum estimate because some groups of drug users, such
as homeless youth, prisoners, opiate addicts, and frequent visitors of
coffee shops,[4] are likely to be underrepresented in the survey. For
example, cocaine is used by the large majority of opiate users, who are
generally not captured sufficiently in the sample of a population survey.
The actual number of cocaine users is probably much higher.

Political System

Since 1848, the Netherlands has been a constitutional monarchy in which
the government--the Council of Ministers under the leadership of the
prime minister--is responsible for government policy and responsible to
parliament. The Queen enjoys a position of immunity.

Parliament consists of an upper house (the First Chamber), and a lower
house (the Second Chamber). The 150 members of the Second Chamber
are chosen directly by the people in elections that are, in principle, held
every 4 years. The Second Chamber's most important function is to
supervise the government's actions. To do so, it has several powers, one of
the most important of which is the right to amend bills proposed by the
cabinet. The minister responsible for a proposed bill can adopt such an
amendment, submit it to a vote in the Second Chamber, or reject it. If a
parliamentary amendment is rejected, the lower house may bring a motion
of no confidence against the minister or the cabinet, which, if carried, will
force their resignation. The lower house also has the right of initiative (i.e.,
the right to propose bills), the right of interpellation (i.e., the right to
demand clarification from a minister), the right of inquiry, and the right to
accept or reject the Government's budget.

The 75 members of the First Chamber are elected indirectly for 4-year
terms by the members of the country's 12 provincial councils. The First
Chamber shares in the legislative function and monitors government
policy. All bills that have been passed in the Second Chamber must also
be approved by the First Chamber, but the First Chamber cannot propose
or amend bills. Members of the First Chamber have the same rights as
those of the Second Chamber.

The Netherlands has 13 government ministries, each of which is headed by
a minister who is politically responsible for that ministry's policy. Each
minister is supported in this task by one or occasionally two politically
appointed state secretaries. Civil servants, who maintain an apolitical
stance and do not lose their jobs with a change in government, assist
ministers and state secretaries in their work.

II. Description of Criminal Justice System, Arrest Process, and Detention
System[5]

The cornerstone of Dutch criminal law is Article 1 of the Criminal Code,
which states that no offense is punishable if it does not violate a previously
existing statutory penal provision. Only conduct that was punishable when
the act occurred is subject to sanctions. A punishable offense is an action
that meets the statutory description of the offense, is wrongful, and is due
to an imputable fault. Crimes are divided into offenses (more serious
crimes) and violations.

Criminal proceedings are held in phases, the first of which is prosecution
in the first instance. This phase commences with the police investigation,
the results of which are set out in a police report stating the nature of the
offense, when it took place, and the suspect's name.

A suspect can be brought to the police station for interrogation, which can
take place during a maximum of 6 hours. If the investigation requires it,
the suspect can be taken into custody (only for punishable offenses for
which pretrial detention is allowed) for a maximum of 3 days.[6]

Sometimes (e.g., in the case of minor violations), the police do not draw
up an official report. If the police do not offer a transaction (a deal under
which the offender voluntarily pays a sum of money to the Treasury to
avoid further criminal prosecution and public trial), however, and decide
to press charges, the official report is passed on to the Public Prosecutions
Department. Once the criminal investigation has been closed, the Public
Prosecutor may drop the case, settle it by means of a transaction, or serve
the suspect with a writ of summons if he believes sufficient evidence
exists to reach a conviction.

The trial in court concludes the first phase. In the Netherlands, there is no
trial by jury; independent, professional judges who serve for life decide
both the law and the facts of the case. Lay people are not involved in either
the course of criminal proceedings or the appointment of judges. Hearings
take place in public whenever possible. In principle, juvenile court cases
are heard in closed chambers. If a punishable offense has been proved and
the offender is found guilty, the judge decides which penalty or measure
should be imposed and imposes a sentence.

The second phase involves appellate proceedings in either the Court of
Appeal (appeal) or the Supreme Court (appeal in cassation). Both
prosecution and defense have the right to bring a one-time appeal to a
higher court. Appeals against a judgment given by a district court can be
lodged with the Court of Appeal. Taking a case (appeal in cassation) to the
Supreme Court differs from lodging an appeal because it does not result in
an (entirely) new hearing of the case but serves merely to establish
whether the sentence challenged is in accordance with the law and in
compliance with the requirements.

The third and last phase involves the enforcement of a sentence. When
appeals are exhausted, the sentence becomes final and conclusive and can
be enforced. The Public Prosecutions Department is responsible for
implementing the criminal sentence. It does not impose the sanctions
itself, but delegates imposition to judicial or private institutions.

The sanctions contained in the Dutch Criminal Code are classified as
penalties and measures. Penalties are retaliatory or deterrent in nature,
while measures focus on protecting the interests of society or the
perpetrator. Unlike penalties, measures need not establish a direct
relationship between the gravity of the offenses committed and the
severity of the legal response to it. Legal articles set the maximum
sanction the judge can impose for any given offense. The most common
sanctions for adults are as follows:

 o Imprisonment, the most substantial and severe penalty in the Dutch
Criminal Code, can be imposed only for criminal offenses. Prison
sentences can be for life or of temporary duration. For any given offense,
judges have the freedom to impose prison sentences within minimum 
and maximum limits. The maximum sentence for theft, for example, is 4
years, whereas the maximum sentence for murder is 20 years.

 o Detention can be imposed for a minimum of 1 day and a maximum of 1
year and 4 months and is generally imposed for summary offenses.
Detention is lighter than a prison sentence and, as a rule, is spent in a
remand prison.

 o A community service order (taakstraf) can also be imposed on minors
who have committed a punishable offense. The accent is on first
offenders and those who have committed less serious offenses. Under a
community service order, an offender can be sentenced to up to 240 
hours of community service (werkstraf), to follow a social training course
(leerstraf), or a combination of the two. Both the judge and the Public
Prosecutions Department can impose the penalty. Strictly speaking, only
the community sentence imposed by a judge has the status of a court
sanction.

 o A fine can be imposed for all punishable offenses, even those for which
the judge could impose a life sentence.

In certain exceptional cases, such as if the offender is mentally ill, the
judge can impose a measure (e.g., a psychiatric hospital order or an
entrustment order) instead of a penalty. 

III. Status of National Drug Policy

Health issues are of primary importance in Dutch drug policy.[7] A broad
approach is taken, in which attention is given to both prevention and care
(demand) and combating the sale of drugs (supply). The demand for drugs
is discouraged and the risks of drug use to individuals and their
environment are diminished by a professional care and prevention policy.
The Government seeks to prevent young people, in particular, from
unthinkingly using drugs in the first place and to make medical and social
assistance available to problem drug users to alleviate their plight (harm
reduction). Harm reduction is most obvious in the criminal justice system
in the imposition of relatively low sentences for possession of small
amounts of drugs, but harsh sentences for persons involved in the drug
trade. The supply of drugs is fought against by combating organized drug
crime. Dutch drug policy is also aimed at maintaining public order and
reducing the nuisances caused by drug use.

Assistance is given not only to "normal" drug users but to criminal drug
users as well. The judicial authorities have followed the principle that drug
addicts who commit minor crimes should be offered the opportunity to
undergo medical treatment rather than serve a custodial sentence. This
makes it easier to persuade drug addicts to participate voluntarily in
special programs that help them regulate or stop their drug use and reenter
society. The aim of care services is to reach as many addicts as possible to
help them rehabilitate or limit the risks caused by their drug habit. Social
rehabilitation is an essential element.

In investigations and prosecutions, the expediency principle is applied
(i.e., a public prosecutor may decide not to prosecute if prosecution is not
in the public interest). A distinction is made between hard drugs, which
pose an unacceptable hazard to health, and soft drugs, which constitute a
far less serious hazard. The highest priority is given to the investigation
and prosecution of international drug trafficking; the possession of small
quantities of drugs for personal use is accorded a much lower priority.
Possession of either soft or hard drugs is considered an offense. Possession
of more than 0.5 grams of hard drugs is an indictable offense. Firm action
is taken in such cases. Possession of smaller amounts of soft drugs is a
summary offense and therefore has low priority in policies on
investigation and prosecution. The expediency principle is applied to the
sale of cannabis in coffee shops to separate the markets for hard and soft
drugs and to keep young people who experiment with cannabis away from
hard drugs.

Combating drug-related crime is aimed at the fight against the trade and
production of drugs, especially hard drugs. One action recently taken was
the foundation of the Synthetic Drugs Unit, which is specifically aimed at
the fight against the production of, and trade in, Ecstasy, amphetamines,
and other synthetic drugs.

Research on drug use is of great importance in the Netherlands. More and
more information is being gathered because of the accessibility of drug
treatment services and better data registration systems. First of all,
research is done to obtain information about trends in drug use, drug users,
and the supply of drugs and related dangers. Studies are regularly
conducted on drug use in general and among students in particular (all
forms of research are applied: field research, investigative research,
evaluation research and policy-oriented research). In the past few years,
multidisciplinary research has been conducted into the use, effects, and
risks of Ecstasy and other synthetic drugs on the basis of, for example,
data obtained from tablet tests at rave clubs.

Much information is available because of field research.[8] Less
information is available, however, on persons who use more than one kind
of drug (including alcohol) and the relationship of such use to criminal
behavior. One way to obtain more information about this could be through
the I-ADAM project. The following sections describe the pilot program
conducted in the Netherlands in 1999.

IV. Background History of I-ADAM in the Netherlands

In 1998, WODC, the Research and Documentation Center of the Dutch
Ministry of Justice, was contacted by the U.S. National Institute of Justice
(NIJ) about the ADAM project. NIJ wanted to expand ADAM
internationally (in a project called International ADAM, or I-ADAM) and
asked whether WODC would be interested.

A senior advisor of the Dutch Ministry of Justice and a police
commissioner of the Hague police were invited to attend the first I-ADAM
conference in Miami in April 1998. On returning to The Hague, they
decided to join forces and managed both to secure both the funds to
finance a feasibility study (from WODC) and to persuade the Hague
regional police force to serve as a testing ground for an ADAM
experiment. WODC could then start a feasibility study and a pilot.

V. Goals and Objectives of I-ADAM in the Netherlands

As previously stated, the Netherlands has a well-established tradition of
research on drug consumption patterns. The initiators of the new I-ADAM
pilot program would have to prove that it could bring new insights to the
field. Starting carefully, they decided that a feasibility study would first
have to show that the major stakeholders were prepared to allow a "live"
experiment involving arrestees. The burgomaster of The Hague, who is the
head of the regional police force; senior decisionmakers from the Public
Prosecutions Department and the Ministry of Justice; the chief
commissioner of the police; health care officials; and the Bar Association
(orde van advocaten) were all consulted. With the exception of the Bar
Association, they reacted positively to the idea. The Bar Association
demanded a very strict privacy regime under which each arrestee would
have to confirm his willingness to participate in the program by signing an
informed consent form.

Another objective of the feasibility study was to ascertain what kind of
information the stakeholders desired and expected to learn from the I-
ADAM study. It turned out that most respondents thought that the
innovative approach could give new insight into the drug consumption
patterns of people who normally remain outside the established drug
research studies, either because they do not feel they have a drug problem
or because they have become so marginalized that even field workers
cannot reach them anymore. The prospect of discovering a connection
between specific forms of criminal behavior and drug consumption habits
also stimulated enthusiasm, as did the possibility that new trends could be
identified at an early stage and that of making international comparisons
through the I-ADAM research network. The realistic and most frequently
expressed opinion, however, was that the experiment was aimed primarily
at determining--

 o Whether such a method could be carried out with success.

 o Whether I-ADAM in the Netherlands would produce policy-relevant
information.

 o Which barriers would be encountered and how could they be overcome.

The actual results of the interviews and urine tests would be less important
than the process evaluation of the experiment itself and the experiences of
the interviewers involved. The experiment would have to produce insight
on how I-ADAM could best be implemented on a large scale in this and
other facilities throughout the country.

The feasibility study (and a mini-pilot that tested 11 arrestees) took place
in December 1998. The pilot experiment was scheduled to start in the
spring of 1999, but after the Bar Association objected, it was necessary to
review certain procedural arrangements to comply with its demands. In the
end, all the Bar Association's objections were satisfied and the experiment
was allowed to proceed under strict guarantees of anonymity and
voluntary participation. Preparations were completed in the summer, and
on August 16, 1999, the first arrestees were interviewed.

The intention was for the pilot study to obtain 250 completed interviews in
an estimated 6 weeks of interviewing. After a full month of interviewing,
however, fewer than 100 interviews had been completed, mainly because
there was limited time during the day when arrestees could be interviewed
(only during the morning, after showering). The supervisory commission
therefore decided to stop after the 125th interview. On September 27, after
125 interviews were held, the gathering of data was terminated, and
evaluation and data analysis began.

VI. Getting Started

A. Obtaining Funding

Funding for the I-ADAM pilot came from the research budget of WODC,
the Dutch Ministry of Justice's in-house research department. WODC's
research in the broad field of criminal justice is carried out in part by its
own researchers and in part by contracted researchers from universities
and research companies. WODC's director decided to fund the pilot
because the objectives of a Dutch I-ADAM project fit into WODC's
research program and the project could produce interesting results for
Dutch policymakers on drug-related subjects. 

B. Contracting for Data Collection

The work for the feasibility study and mini-pilot to establish whether the I-
ADAM concept would be acceptable to stakeholders in the Netherlands
was granted to Eysink, Smeets, and Etman (ES&E), an independent
research and consultancy firm specializing in crime prevention and
security matters that has an extensive track record researching difficult and
inaccessible groups.

C. Facility Access

Since the Hague regional police force had been involved in the project
from the beginning, gaining access to the cell block facilities posed no
problem at all. The chief of the cell block staff was cooperative and
interested in the experiment, as were most of his staff. In the interest of the
arrestees' privacy and the professional detachment required of the research
staff, the initially very informal atmosphere had to be restrained by a set of
guidelines involving strict instructions not to discuss anything related to
the interview subjects. Since the normal daily routine in the cellblock is
based on an efficient and optimal use of personnel and requires a tight
schedule, however, it was not always easy to get access to the arrestees
themselves.

D. Knowing the Catchment Area

Arrestees were brought in from the entire region covered by The Hague
regional police force. Since not all the arrestees in the region participated
in the I-ADAM pilot program, the results cannot be compared with the
general population of arrestees in this area. The following statistics give
some general indications of the area's total arrestee population. In 1998,
14,605 persons, 15 percent of whom were female, were arrested for one or
more offenses. Approximately 60 percent of arrestees in The Hague were
of Dutch nationality, whereas 10 percent were from Suriname, 4 percent
were Turkish, 4 percent were from the Netherlands Antilles, and 7 percent
were Moroccan. The mean age was 33 years. The main offenses were theft
and burglary without violence (53 percent), traffic offenses (38 percent),
criminal damage (32 percent), and violent crime (27 percent).[9] In 1998,
1,007 hard-drug addicts (7 percent of all arrestees) were arrested for one or
more offenses, accounting for 15 percent of all known offenses, mostly
theft and burglary without violence.

E. Drug Testing Issues

Drug testing was performed by one of Holland's leading laboratories in
this field, the Delta Laboratory of the Psychiatric Hospital in Poortugaal,
near Rotterdam. The methods and standards applied in this project are
equivalent to those of the U.S. ADAM program. Processing of the urine
samples was done at the laboratory, usually within 3 days after the
samples were obtained.

F. Instrument Issues

The standard U.S. ADAM interview list was translated into Dutch and
adapted to match Dutch circumstances, (e.g., changes were made to the
survey for the categories of housing, education, cultural background, and
the like). Some questions were dropped at the request of the Bar
Association, which believed that these questions would be too intrusive or
that they could interfere with the judicial process. Among the questions
dropped were those on how illegal income was obtained, the purchase of
drugs shortly before arrest, and the time of arrest. Some new questions
were added, such as reason for arrest, place and town district of residence,
mode of use of drugs (e.g., injection or inhalation), use of medicines
(some prescription drugs can cause false positives in testing), and more
categories of nationality. Finally, the Dutch questionnaire was translated
back into English and French. Interviews usually went smoothly, although
for users of multiple drugs, the repetitive questions could become
somewhat tedious. 

Cultural applicability

With the adaptations mentioned above, the questionnaire proved to be
quite user-friendly. Some interviews were held in other languages (English
and French). Some respondents were not native speakers of any of these
languages, and some of these were also illiterate; in these cases, explaining
the questions and obtaining the right answers sometimes proved difficult.

Standardization versus local utility

Most of the material obtained in the pilot test can be compared with that
collected in other countries, especially the United States. This applies to
both the urinalysis and the encoded answers. Since the questionnaire used
in the Dutch I-ADAM was adapted to fit standard categories used in other
addiction programs and studies, local utility should be guaranteed as well.

In interpreting the comparative results, however, differences in legal and
socioenvironmental conditions should be considered. Prison conditions,
for example, may differ from country to country. Police stations in the
Netherlands are spacious, clean, and relatively comfortable. Arrestees
there may be less willing to cooperate in a research project than arrestees
in countries such as the United States, where circumstances in police cells
are less pleasant. Another difference among countries is whether the use of
soft drugs is forbidden. In countries such as the Netherlands, Belgium
(since 2001), and Switzerland, where the use of cannabis is not seen as a
crime anymore, people obviously will be more willing to tell researchers
that they have used cannabis. In countries such as the United States or
Malaysia, where the use of soft drugs is seen as a crime, people are more
reluctant to admit drug use, even in an anonymous research setting.

VII. Barriers to Developing I-ADAM

The Bar Association's objections resulted in an arrangement under which
every candidate had to grant written permission to be interviewed. This
introduced a formal element in the introduction procedure involving a
routine (i.e., the signing of an informed consent form) that many people in
police custody presumably have negative associations with. Several people
could not read or write any of the four languages used. The need to hand
out and collect informed consent forms added yet more work to the
time-consuming and sometimes irritating formalities that were part of the
I-ADAM procedure. The researchers believe that the obligation to obtain
written consent from the arrestees resulted in a lower response rate. An
additional problem is that, whereas normally, after the interviewing
period, the research organization would not have any data that could ever
be traced to individual persons, there is now a collection of 125 signed
statements on which arrestees have quite often put their full name in
legible writing. Under the agreement reached with the Bar Association,
these statements have to be kept for a certain period of time in case any of
the arrestees were to claim that he or she had been forced into participating
in the project.

Other barriers were more technical in nature. Interviewers were not able to
interview many potential candidates because they had been removed from
the premises to be presented to the investigating magistrate very early in
the morning after having been brought to the central holding facility at
police headquarters late the previous night. In such cases, they remained
out of reach for the interviewers, who could not visit them earlier in the
day at a district police station or during the night, when the holding facility
functions with only a limited number of guards. To cover all the potential
candidates, researchers would have to interview at all of the more than 20
police stations in the region and at all hours at the central facility. This
would pose substantial financial problems for both the research project and
the police force, which would have to bring in additional guards if it were
to grant interviewers access to the cells.

Another issue that emerged was the language barrier: Some of those
approached for an interview spoke only Turkish, Moroccan (Berber), or an
African or Eurasian language not spoken by the researchers. It would seem
infeasible and impractical to prepare for interviewing in all possible
languages.

VIII. National Stakeholders Involved in the Development of I-ADAM

As was mentioned before, all stakeholders whose approval was required
for the pilot to be carried out were interviewed, and their permission was
obtained in the fall of 1998. These stakeholders included the Ministry of
Justice, WODC, the Public Prosecutions Department, the chief
commissioner of the police force, the local police where the pilot tests
took place, the Bar Association, and the Burgomaster of The Hague.
Simultaneously, the relevant senior officials at the Ministry of Justice and
the Procurator General responsible for narcotics issues on a national level
in the Public Prosecutions Department were informed as well.

IX. Research Methods

To establish which subgroups would have to be represented in a selected
arrestee sample, the characteristics of the overall population of arrestees in
the Hague region had to be understood. Because such information is not
available from police figures, there was no reason to draw up criteria for a
weighted sample of candidates. Since the overall number of arrestees in
any one Dutch police region is lower than that in typical U.S. ADAM
sites, it was considered best simply to approach every arrestee who met the
established criteria until the agreed number of interviews was obtained.
Because this was a pilot project, as many persons as possible had to be
tested in a relatively short time, so the easiest (rather than the most
representative) sampling scheme was selected. Subjects in the pilot project
had to meet the following criteria:

 o No persons under the age of 16.

 o No persons who had been arrested more than 48 hours before.

 o Only persons arrested on suspicion of a crime.

 o Only persons who understood and spoke Dutch, English, German, or
French.

 o No persons who were mentally unstable, incoherent, or extremely
aggressive.

 o No persons arrested for traffic violations.

X. Training Issues

The interviewers were junior researchers and students working for ES&E
who received instructions on how to do the interview from senior ES&E
researchers with extensive interviewing experience. No other persons
(including law enforcement officers or court personnel) were allowed to
participate in the interviews with the arrestees. In preparing for the
instruction sessions, the I-ADAM training material was put to good use,
but no extensive training exercise sessions were held to establish whether
interviews observed by multiple interviewers would produce similar
reports. During the interviews, interviewers were asked to keep a logbook
to record every remarkable or unusual experience they encountered or
observation they made. These were analyzed, but no substantial problems
influencing the integrity or professionalism of the research work were
recorded.

XI. Analysis of Interview Data

Although obtaining and analyzing the interview data was, in fact, of
secondary importance in the initial pilot study, some results were worth
mentioning. Readers have to keep in mind, however, that at this early
stage, the small sample size (only 125 interviews) and the relatively low
response rate can result only in indicative data that should be interpreted
with the greatest caution. Any comparisons with I-ADAM data from other
countries should perhaps be restricted to hypothesis-forming impressions
and should not be used to form conclusions about the drug situation in the
Netherlands. In this brief report, only a limited part of the results is
presented.

A. Response Rate

Thirty-eight percent of the total number of arrestees fell outside the agreed
category of arrested suspects taken into legal custody (such as suspects
arrested and then released) (see exhibit 7). Of those that would qualify on
this condition, another 20 percent could not be interviewed because they
did not meet other criteria (such as age or length of time after arrest). Of
those who met all the criteria, 23 percent were missed because they were
either in transport or in interrogation and therefore could not be
interviewed. Finally, 49 percent of those who met the criteria and were
approached refused to cooperate.

Those who refused to cooperate gave the following reasons: An estimated
70 percent said that they saw no benefits in cooperation; about 20 percent
objected to giving permission in writing (a condition required by the Bar
Association); and about 10 percent were approached by a guard in a way
that did not motivate them to cooperate. Of the 125 respondents (51
percent of those approached), 80 (64 percent) provided urine samples for
analysis, 43 refused to give a sample, and 2 were incapable of urinating. A
total of 111 men and 14 women were interviewed. The age breakdown of
program participants is shown in exhibit 8.

B. Offenses

The grounds for arrest (category of primary offense) are presented in
exhibit 9.

C. Reported Drug Use

None of those who declared themselves addicted reported currently being
in any drug rehabilitation program, although many stated that they would
like to participate in such a program. Respondents were asked if they had
ever used drugs, and if they used drugs during the past 12 months and or
during the past 3 days. The results are shown in exhibit 10.

Approximately 45 percent of the arrestees reported using alcohol in the 3
days before the interview, and 34 percent said that they used cannabis
during that time. Percentages for other drugs are lower--approximately 13
percent for cocaine and opiates.

In total, 48 of the 125 respondents (38 percent) reported some form of
addiction, and 26.4 percent have been treated for some kind of addiction at
some time in the past. There are many "poly-users," mostly combinations
of heroin and cocaine or crack, but also quite a few persons addicted to
only one narcotic. Apart from the 48 self-declared addicts, about 10 people
have a daily and often substantial drug intake but do not consider
themselves addicted.

When the results of the urine tests are compared with self-reported use, a
big difference can be seen in the results for alcohol. Although
approximately 45 percent of the arrestees told researchers that they had
used alcohol in the past 3 days, only 4 percent tested positive for alcohol
in urine tests. This clearly shows that urinalysis is not an effective way to
test for alcohol. For cannabis, cocaine, and opiates, however, urinalysis
results showed a higher rate of use than did self-reports from arrestees. For
cannabis, the difference is relatively small (34 percent of arrestees said
that they used it, but 41 percent tested positive in the urinalysis). As
expected, differences for cocaine and heroin were much larger.
Approximately 13 percent of the arrestees said that they had used cocaine
in the past 3 days, but urine tests showed 32 percent testing positive; 13
percent of the arrestees reported using heroin, whereas urine tests showed
17 percent testing positive. Apparently, arrestees are more honest about
their use of cannabis. This is not a surprise, since the use of cannabis is not
considered to be an offense.

When compared with the lifetime use of drugs in the country (exhibit 5),
one can see that arrestees use drugs more frequently than the general
population. Many of the arrestees in the sample were arrested for theft and
violent offenses, and the relatively high rate of cocaine use may be related
to this. Research shows that cannabis use in the Netherlands is not higher,
and may even be lower, than in other countries, such as the United States.
It will be interesting to compare the results for arrestees in these two
countries.

D. Tested Drug Use

The results of the urine tests of the 80 persons who gave a urine sample
are given in exhibit 11. Because many more respondents (28 percent)
reported drinking alcohol shortly before being arrested than is reflected in
the urine test, this test cannot be considered very useful. In view of the
importance of the relationship between alcohol and crime, the
administrators of the program will have to determine how to deal with this
problem and whether alcohol can be measured in some other way.

Of the 80 arrestees willing to give a urine sample, 61 percent tested
positive for some drug. Given the limited quantitative basis of 125
interviews, however, and the relatively low response rate on the urine
sample, these data should be interpreted with the greatest caution.

E. Drug Use Before Committing the Offense

Respondents were asked whether they had used alcohol or drugs shortly
before committing the offense. The results are shown in exhibit 12.

Those who reported that they used drugs shortly before committing the
offense (44 percent) were asked which drugs they used. The results are
shown in exhibit 13.

F. Offenses and Drug Use

The relationship between offenses and drugs found in the urine samples
was examined. The results are shown in exhibit 14, an overview of the
primary offenses (of which 46 percent were theft, 27 percent violent
offenses, 2 percent sexual offenses, 13 percent opium, and 1 percent other
offenses) of the 80 arrestees who were willing to give urine samples. From
this overview, one can see that 19 of the 37 persons arrested for theft (51
percent) tested positive for cocaine. Persons arrested for theft and violent
offenses test positive for a relatively large number of drugs. Persons
arrested for other offenses test positive for relatively fewer drugs. Again,
these data should be interpreted with the greatest caution, since the number
of urine samples and the response rate were relatively low.

G. Previous Arrests

Of those interviewed, 41.6 percent reported having been arrested at least
once in the past year; 55.8 percent of these had been arrested once before,
the others more frequently. Going back even farther, 59.2 percent of all
respondents reported having been arrested before the past year and 52.7
percent of all respondents reported having been detained in prison.

H. Cultural Origin and Nationality

More than three-quarters of all respondents (77.2 percent) claimed Dutch
citizenship, although 57.7 percent were of a non-Dutch ethnic background
(i.e., their parents were, or had originally been, citizens of other countries).
Most of these were Moroccan, Surinamese, or Turkish.

XII. Policy Implications and Applications of Data

This I-ADAM pilot project has shown that research on arrestees may
produce valuable information that could be useful for the further
development of Dutch drug policy, both from the standpoint of
maintaining public order and in terms of the treatment of drug addiction.
The low response rate (51 percent), however, gives reason for concern.
The experience of running the pilot project has given researchers some
ideas on how to improve the response rate, but additional testing would be
required to prove that a higher response will be possible. The relatively
costly and time-consuming procedure is another cause for concern. 

After the pilot program concluded, it was up to the Ministry of Justice to
decide whether I-ADAM would be continued on a broader scale in the
Netherlands. The report of the pilot program were presented to the persons
involved from the Ministry of Justice and the Ministry of Health, Welfare,
and Sports, and the results were discussed within the two ministries and
with Dutch health care officials. If these persons are interested, the results
will be brought to the attention of other interested parties (such as policy
and care organizations) in other police regions in the Netherlands. A
possible next step could then be to test I-ADAM in three other police
regions to find out whether the response rate would be higher and whether
more data would be received. After that, the Ministry of Justice could
decide whether to expand the program further.

The results of the pilot study were made available at the end of 1999 and
were discussed with policymakers at the Ministries of Justice and Health,
Welfare, and Sport in 2000. The study report held that if the pilot program
were to be continued, the response rate would have to be higher and
arrestees would have to be tested for alcohol as well. If so, the project
could provide interesting data.

Policymakers in these ministries, however, decided not to continue the
project. One reason for this may be that much is already known about
Dutch drug users. The main reason for not continuing the project was that
policymakers did not see that response rates could be improved enough to
generalize results to the whole population of arrestees. Much is already
known about drug users in the Netherlands. Policymakers thus chose to
give priority (and allocate funding) to other research, including research
on a new system of compulsory treatment for the most persistent
drug-related offenders (the "SOV" project), in which offenders who have
committed numerous offenses are now forced to join a 2-year program, in
which they spend the first 6 months in jail and then go to other
surroundings, where they are helped to stop using drugs (or at least to use
them in a more controlled way), and to find work and housing. This
project will be evaluated extensively and will provide information about
the group of arrestees.

Although SOV will give information about arrestees, the authors regret
that I-ADAM will not be continued, especially because I-ADAM could
have produced important international comparative data. The only chance
for the ADAM project to be resumed in the Netherlands is if those running
the program can work out a reliable way to test arrestees for alcohol, or, if
it turns out that I-ADAM can generate information needed by parliament,
it is possible that the project may be continued after all.

If it were expanded to more regions on a regular basis, the Dutch I-ADAM
program promises to become an important information resource that
would--

 o Produce better and more policy-relevant information on drug use
(quantities and sorts of narcotics, monitoring specific user groups and
risk groups) and on the relationship between drug use (including alcohol)
and specific forms of crime.

 o Help to discover and confirm new drug use trends.

 o Provide more and better information on local trends and relationships
between drug use and crimes and eventually lead to the development of
user/perpetrator profiles.

 o Improve understanding of user groups that have so far escaped the focus
of addiction and drug treatment programs, with the possibility of
improving the range and effectiveness of narcotics care for criminal
users.

 o Supply the material needed for international comparative studies within
the broader I-ADAM framework.

Additionally, if the questionnaire currently used can be expanded with
some of the questions that had to be removed earlier at the request of the
Bar Association, operationally relevant information on local drug markets
and channels and ways of distribution would become available.

In summary, the results of the I-ADAM pilot in the Netherlands suggest
that the program would improve understanding of drug use among people
committing crimes and help shape future drug policy. The relatively low
response rate and the difficulties in measuring alcohol in urine samples,
however, are reasons for concern that cannot be easily overcome. In
countries where response rates were higher, however, I-ADAM has the
potential to provide new information about the relationship between drug
use and crime. The authors believe that international data collection and
comparison should be encouraged.

Notes

1. U.S. Census Bureau, International Database, 2000.

2. Department for Statistical Information and Policy Analysis, Registered
Crime in the Netherlands, 1995-1999, The Hague: Ministry of Justice,
2000.

3. National Drug Monitor: 2000 Annual Report, Utrecht: Trimbos
Institute, 2001: 24-25.

4. Coffee shops can best be described as cafs (which are not allowed to
sell alcohol) in which soft drugs may be sold under the following
conditions:

 o No more than 5 grams per person may be sold in any one transaction.
 o No hard drugs may be sold.
 o Drugs may not be advertised.
 o No selling to minors may take place.
 o No more than 500 grams may be kept in stock.
 o Coffee shops must not create a nuisance.

5. Information in this paragraph is based on Tak, P.J.P., The Dutch
Criminal Justice System: Organization and Operation, The Hague:
Ministry of Justice, Research and Documentation Center (WODC), 1999.

6. Arrestees participating in the I-ADAM pilot were all taken into custody.

7. Information in this paragraph is based on the following Dutch
Government publications: Drugs Policy in the Netherlands:
Documentation 1, The Hague, Ministry of Health, Welfare and Sport,
1997; Drugs Policy in the Netherlands, Continuity and Change, The
Hague, Ministry of Foreign Affairs, Ministry Health, Welfare and Sport,
Ministry of Justice, Ministry of the Interior, 1995; Nederlandse bijdrage
inzake de implementatie van het Gemeenschappelijk Optreden Drugs,
rapportage 1999; Drugbeleid, voortgangsrapportage September 1997-
September 1999, The Hague: Ministry of Health, Welfare, and Sport,
1999.

8. For example: Korf, D.J., Dutch Treat: Formal Control and Illicit Drug
Use in the Netherlands, Amsterdam: Thesis Publishers, 1995; and
Grapendaal, M., E. Leuw, and H. Nelen, A World of Opportunities:
Life-Style and Economic Behavior of Heroin Addicts in Amsterdam,
Albany: State University of New York Press, 1995. Much information on
drugs research can be found at the Netherlands Institute of Mental Health
and Addiction (Trimbos-Institute) in Utrecht (http://www.trimbos.nl).

9. These numbers add up to more than 100 percent because they include
offenders who committed one or more of the listed offenses.

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

Scotland

Neil McKeganey 
Clare Connelly
John Norrie
Janusz Knepil

Neil McKeganey is the director of the Centre for Drug Misuse Research at
the University of Glasgow. Clare Connelly is a lecturer at the School of
Law, University of Glasgow. John Norrie is the assistant director of the
Robertson Centre for Biostatistics, University of Glasgow. Janusz Knepil
is an honorary lecturer in the Department of Pathological Biochemistry at
the University of Glasgow and a member of the Department of
Biochemistry at Gartnavel General Hospital, Glasgow.

Introduction 

This chapter describes research piloting the Arrestee Drug Abuse
Monitoring (ADAM) Program in Scotland and covers the following
background: 

 o Negotiation of access to Scottish police stations.

 o Development of the research instrument.

 o Drug testing procedures used in the pilot.

 o Extent of drug abuse identified among arrestees.

 o Practical difficulties of undertaking the pilot.

 o Policy implications arising from the pilot and the next stage of ADAM
research in Scotland. 

I. Overview of Demographic Profile of Nation 

Scotland is a devolved part of the United Kingdom. Although it shares
some powers of government with the Parliament in London, Scotland has
its own Parliament and distinctive legal system. Exhibits 1 and 2 present
some basic demographic and economic information about Scotland.

Police in Scotland recorded 432,000 crimes in 1998, up from 421,000 in
1997. In 1999, 118 murders and 712 attempted murders were committed in
Scotland; 6,323 serious assaults and 5,075 incidents of robbery and assault
were reported to police.

Although little information exists on the size of the problematic
drug-misusing population within Scotland, it is clear that the country has a
substantial and growing drug problem. A comparison of the results of
national household surveys conducted in 1993 and 1996[1] shows that
self-reported lifetime drug use increased for all drugs and use in the
previous 12 months increased for all drugs except LSD (see exhibit 3). In
1996, 22.5 percent of the Scottish population had ever used illegal drugs,
compared to 9 percent in the previous year. Cannabis was by far the most
widely used illegal drug, followed by amphetamines and LSD. The drugs
with the largest proportionate increases in use were temazepam
(benzodiazepene) and Ecstasy (MDMA); lifetime use rates for both
doubled from 1993 to 1996 (see exhibit 3). On the basis of the 1996
Scottish Crime Survey, approximately 679,000 people within Scotland
have tried at least one illegal drug, 560,000 have used cannabis, and
41,000 have used opiates.[2]

Research has identified high levels of drug misuse among young people in
Scotland. By age 15, 40 to 50 percent of young people have started to
experiment with illegal drugs.[3] Recent research has also shown that
young people in Scotland are starting to use illegal drugs at an
increasingly young age; McKeganey and Norrie have reported that 10
percent of 11- to 12-year-olds in Scotland have already begun to use
illegal drugs.[4]

The rates of injection drug use, drug-related mortality, and hepatitis C and
HIV infection among injection drug users (IDU) are sources of concern in
Scotland. Glasgow, Scotland's largest city, has an estimated 9,500
injecting drug users (IDU).[5] Dundee, Scotland's third-largest city, has an
estimated 3,500 opiate and benzodiazepine misusers.[6] Drug-related
mortality has been increasing in Scotland over the past several years.[7]
An estimated 60 percent of IDUs in Scotland may be hepatitis C
positive.[8] Approximately 20 percent of IDUs in Edinburgh (Scotland's
capital and second-largest city) and 26.8 percent of IDUs in Dundee are
thought to be HIV positive.[9] In Glasgow, however, only 1 to 2 percent
of IDUs are thought to be HIV positive.[10]

Relatively little research has been undertaken to quantify drug-related
crime within Scotland. Recent research has estimated that IDUs in
Glasgow spend approximately 94 million pounds each year on drugs. To
support that level of drug purchasing, an estimated 129 to 258 million
pounds worth of goods is being stolen each year.[11]

II. Description of Criminal Justice System, Arrest Process, and Detention
System 

Police in Scotland can make arrests when they witness, or are called to the
scene of, a crime and the accused is present. In these circumstances, the
suspect is often immediately charged with an offense and either detained
in custody in the police station, to appear in court the next morning, or set
free on an undertaking to appear in court at a future date. If a warrant is
issued for an accused's arrest, the accused is detained in the police station
and appears in court the next day. If an offense is committed over the
weekend, the accused is held in custody until Monday morning, when the
first court sits. Courts in Scotland do not sit on Saturday or Sunday.

Following an arrest or a charge, a report is sent to the procurator fiscal,
who decides whether a prosecution should take place and, if so, what the
charges should be. Procurator fiscals are civil servants who prosecute
crimes in the lower courts in Scotland and draw up charges for the higher
courts, where a case is prosecuted by an advocate depute. The case is
prosecuted if the procurator fiscal decides that sufficient evidence exists
and that prosecution is in the public interest. The procurator fiscal decides
whether or not there should be a jury trial; an accused has no right to
demand a jury. In cases of rape and murder, however, trial must be by
jury.

An arrestee held in police custody is given a statement of the charges on
which he or she is to be prosecuted in the court appearance the next day.
At this hearing the arrestee is either remanded to custody (prison) to await
trial or set free, pending trial. If the arrestee is remanded to custody, the
trial must start within 110 days; if the arrestee is set free, the trial must
start within 1 year of the date of appearance. If the prosecutor fails to bring
the case to trial in a timely fashion, the accused is set free, and no future
trial on the same charges can occur. If not detained in police custody, an
arrestee is set free on an undertaking to attend a specified court at a
specified time. 

Scottish criminal law is mainly a body of common law; hence, limited
criminal statutes and no criminal code exist. For all common law crimes
except murder, sentence following conviction is at the judge's discretion.
Murder carries a mandatory life sentence, with release being on life
license. For statutory offenses (e.g., all drug offenses within the Misuse of
Drugs Act, 1971), judges' sentencing powers are detailed in the legislation.

III. Status of National Drug Policy 

The primary U.K. legislation relating to drug abuse is the Misuse of Drugs
Act, 1971. Section 1 of the Act authorizes the creation of the Advisory
Council on the Misuse of Drugs, a group of Government officials and
external experts who advise the Government on the changing nature of the
drug problem in the United Kingdom. Section 2 of the Act identifies the
range of drugs falling within the terms of the Act and places these in one
of three classes. Exhibit 4 sets forth the drugs in each class and the
penalties for possession for personal use and possession with intent to
supply. 

Government anti-drug-abuse policy is set forth in the documents, Tackling
Drugs to Build a Better Britain[12] and Tackling Drugs in Scotland:
Action in Partnership.[13] Both documents present Government goals
under four key headings: young people, treatment, communities, and
availability (see "Objectives of Scottish Drug Misuse Strategy").

IV. History of I-ADAM in Scotland

The idea of conducting an ADAM study within Scotland came from John
Hamilton, Chief Constable of Fife Constabulary. Chief Hamilton had
attended the first annual I-ADAM meeting in Miami in April 1998 and
saw the value of applying the ADAM methodology in Scotland. Following
discussions with government officials, funding was provided for a pilot of
the ADAM approach in two police jurisdictions in Scotland. 

Shortly after the first annual I-ADAM meeting, National Institute of
Justice (NIJ) staff from the U.S. Department of Justice visited Scotland in
June 1998 to provide government officials with details of ADAM
operations in the United States and gain a better understanding of how
ADAM would operate in Scotland. In August 1998, Scottish officials
conducted a press briefing with the Fife police force regarding their work
in developing an I-ADAM site in Fife and the process for selecting a
research team. In October 1998, the Scottish Office conducted a second
press briefing to announce the inclusion of the Strathclyde Police Force in
the I-ADAM project. 

The pilot was carried out over 6 months from June to November 1999.[14]
Both police forces were actively involved at all stages of the research and
both sent representatives, along with the research team, to the 1999 and
2000 I-ADAM annual meetings. 

V. Goals and Objectives of I-ADAM in Scotland 

The Scottish ADAM pilot aimed to--

 o Test the feasibility of using the ADAM methodology within the Scottish
context. 

 o Consider the requirements of ADAM data collection sites and their
application in Scotland.

 o Consider the value of using the ADAM methodology to monitor and
assess changes in drug use over time.

 o Gather information about the type and extent of drug use among recent
arrestees in the selected areas.

 o Compare self-reported drug use with the results of urine testing.

 o Consider the ways in which arrestees describe and justify their behavior.

 o Assess the utility of additional questionnaires for identifying and
exploring issues potentially related to drug use.

VI. Getting Started 

Although there was considerable support for an ADAM pilot at the
planning stage, all key stakeholders involved in the research (police,
officials from the Crown Office, and senior civil servants from the Health
and Criminal Justice Departments) were acutely aware of the problems
and sensitivities that the study was likely to involve. Never before in
Scotland had an independent agency undertaken research interviewing
individuals within hours of their arrest. The concerns voiced were of
several kinds, including--

 o Human rights concerns:

    - How to ensure that arrestees provide free and full informed consent to
take part in the study.

    - How to ensure that no one participating in the study would be held in
custody for longer than would otherwise occur. 

 o Practical concerns:

    - Whether to interview arrestees in the cells or in an adjacent area. 

    - How to ensure that no other arrestees could overhear answers to
specific questions. 

 o Interviewer safety concerns:

    - What kind of arrangements would be needed to reduce the possibility
of interviewers being assaulted during face-to-face interviews with
arrestees. 

 o Concerns with obtaining and analyzing urine samples:

    - What kind of collection devices to use to obtain urine samples.

    - How to avoid possible risks of injury from sharp edges on collection
devices, and how to keep collection materials from being bent or
manipulated to create a sharp edge for use as a possible weapon.

 o Confidentiality issues:

    - What level of confidentiality to afford the interviewee who admits to a
serious crime.

A number of key stakeholder agencies, including the police, were
concerned as to how an ADAM interviewer should respond if an arrestee
admitted to having recently carried out a serious offense (e.g, murder) of
which the police were unaware. Police and government officials believed
that such information should be passed on to the police, but such a
stipulation was problematic from a research standpoint because it would
provide arrestees with only limited confidentiality when taking part in the
interviews. 

In the light of these and similar issues, a set of protocols was prepared that
specified the procedures to be followed at each stage of the research.
Topics covered by the protocols included the following:

 o Selecting arrestees for interviews.

 o Developing sample inclusion criteria.

 o Scheduling interviews in the police stations.

 o Recruiting arrestees into the pilot.

 o Obtaining informed consent.

 o Collecting and analyzing urine samples.

 o Responding to inappropriate arrestee behavior during interviews.

 o Recording information on all arrestees with participating custody areas
over the period of the ADAM pilot. 

Once the protocols had been agreed to by the commissioning group (which
contained representatives of the Crown Office, senior civil servants from
the Health and Criminal Justice Departments, and representatives of both
police forces), the research was authorized to proceed and the research
instrument was designed. After the team of interviewers for the research
had been recruited and trained, letters were sent to all defense solicitors
operating in the pilot areas informing them about the nature of the research
that would soon be under way. Only two responses were received to the
letters sent out from the research team: one congratulated the team on the
valuable research they were doing, and the other requested a copy of the
questionnaire and stated that the firm would be advising its clients to
refuse to collaborate with the research. As it turned out, no clients of this
particular law firm were knowingly involved in the pilot. 

Facility Access 

The ADAM pilot was carried out in Strathclyde and Fife. Strathclyde
represents the largest area within Western Scotland and contains Glasgow,
Scotland's largest city and home to some three-quarters of a million
people. Fife, by contrast, is a predominantly rural area with small towns in
eastern Scotland. Both Strathclyde Police and Fife Constabulary were
actively involved at all stages of the research, including identifying the
police stations where the ADAM program would be undertaken. At the
outset, these were identified on the basis of the number of arrestees
received. Two out of 115 police stations were identified in Strathclyde. All
three of Fife's police stations were identified, but, in practice, the pilot was
confined to the two main stations. The small number of arrestees
processed in the third station would have required the fieldwork to be
extended over a very considerable time period in order to recruit arrestees
in sufficient numbers.

Both police forces requested an indemnity against possible legal action in
the event of an interviewer being attacked by an arrestee in the course of
this pilot. The University of Glasgow granted this indemnity on the
condition that, when interviews were taking place, a police officer or force
support officer would be positioned to see what was happening at all times
and able to speedily intervene if an arrestee behaved aggressively toward
an interviewer.

Once the participating police stations were identified, it was necessary to
meet with the station commanders and their senior management staff to
outline the nature of the proposed research. Each shift commander was
briefed on the research procedures. In addition, police liaison officers
associated with this research prepared a set of written protocols for
custody officers to follow. 

It would be difficult to overestimate the importance of this phase of the
research. Clearly, the pilot could not have been conducted without the
support of senior officers in both areas. Even with such support, however,
this study also required the active support of all custody area staff who
would be working directly with the interviewing team. Securing the
involvement of this staff was not a once-and-for-all process. The ADAM
pilot involved a continuous balancing between the needs of the research
and the day-to-day demands of the police officers involved in the pilot.
The following field note illustrates how the normal work of the custody
area could affect the ADAM fieldwork:

When Inspector Adams and I were going through the Arrestee Monitoring
Forms (which provide details on all individuals arrested during each shift),
we noticed that a substantial number of individuals had been arrested but
had apparently not been considered for interview. When Inspector Adams
spoke to the shift concerned, it was explained that an operation was under
way within the station to target shoplifters and that, although a large
number of shoplifters had been arrested, they had been processed very
quickly and then released, leaving no time for them to be approached
about a possible interview. Clearly, from a research point of view, it was
disappointing to see so many arrestees being lost to interview, but to have
held onto the individuals for the purposes of the research would have been
unethical. Within such circumstances, there was nothing that could be
done. 

Drug Testing Issues 

The key drug testing issue faced in the Scottish ADAM pilot was whether
to rely on generic testing procedures or to undertake further confirmatory
analyses of positive urine samples. It was decided to combine generic and
confirmatory testing in the Scottish pilot for two reasons. First, because
the study was a pilot, it was important to identify whether the confirmatory
analysis would be necessary in any wider extension of the ADAM
program in Scotland. Second, a variety of medicines containing low levels
of opiates can be legally bought within Scotland; ingestion of these
medicines can produce a positive result under generic urinalysis. Only by
undertaking further confirmatory work could possible innocent opiate use
be differentiated from more problematic forms of opiate misuse. 

Clearly, one cannot, in this short report, discuss at length the results of
generic and confirmatory drug testing analyses. Of the 87 urine samples
that tested positive for opiates on the basis of the generic screening, four
were reclassified as negative on the basis of the confirmatory analysis. Of
the 21 urine samples that tested positive for amphetamines, no samples
were reclassified on the basis of the confirmatory analysis. Two samples,
however, that had been categorized as opiate positive but amphetamine
negative were found, on further testing, to be amphetamine positive. One
sample that had been classified as opiate negative but amphetamine
positive was found to be opiate positive. These results are interesting but
not conclusive, and they may indicate that combined generic and
confirmatory analyses of urine samples are necessary. 

Instrument Issues 

The questionnaire used in this pilot was similar to that used in the first
U.K. pilot (the New England and Wales Arrestee Drug Abuse Monitoring
[NEW-ADAM] pilot). A copy of that questionnaire had been made
available to the Scottish research team. In particular, the questionnaire
covered the following areas:

 o Demographic characteristics--age, education, employment.

 o Legal and illegal drug use over the previous 12 months, 30 days, and 3
days.

 o Drug buying activities.

 o Arrestee's views of a possible link between his or her drug use and
offending behavior.

 o Extent of drug use and needle and syringe sharing.

 o Personal expenditure on drugs.

 o Sources and amounts of legal and illegal income.

 o Past offending behavior.

 o Use of drug treatment facilities and self-perceived need for help.

 o Access to and carrying of weapons.

 o Involvement in and experiences of domestic violence.

In addition to the standardized survey instrument, an arrestee monitoring
form was designed and used for this pilot. This form, completed by the
custody staff, recorded details on all individuals arrested during the pilot
period. Through this means, the sample of arrestees who were interviewed
could be compared with the broader population of arrestees in each
custody area. 

VII. Barriers to Developing I-ADAM in Scotland 

There were no barriers as such to conducting the ADAM pilot in Scotland;
however, the research raised many problems and difficulties that needed to
be resolved in the execution of the pilot. At one level the ADAM
methodology is very simple; indeed, what could be simpler than
interviewing and drug testing members of a captive population? In fact,
the research involves a complex array of problems, many of which could
not be anticipated. Examples of issues that surfaced in the course of the
pilot follow.

Security Cover

As stated earlier, the University of Glasgow granted an indemnity to
police forces on the basis that, at all times when an interview was taking
place, a police officer or force support officer would be in the vicinity of
the interview, able to see what was happening but not able to overhear
what was being said. An unanticipated consequence of this arrangement
was that, during periods when the police stations were busy processing
large numbers of arrestees, it was often impossible to release an officer to
provide the necessary security cover. Conversely, when the custody areas
were not particularly busy, it was easy to identify an officer who could
provide security cover, but few arrestees were available for interview. The
field note below illustrates this problem:

On my usual trip to the station this afternoon, I spoke to one of the
interviewers, who was sitting rather glumly in the room that had been
allocated to us for the interviews. He said that there was a football match
on in the area, that there had been considerable crowd trouble, and whilst a
number of arrests had been made, the officer in charge of the shift had said
that his staff were simply too busy to spare somebody to provide security
cover to enable any interviewing to take place. When I then spoke to the
officer in charge, he said that whilst he was sympathetic to the needs of the
study, there was simply nothing he could do because all of his staff were
fully committed to policing the football match. I then spoke to the
interviewer and said that, although it looked unlikely that any interviewing
would take place on his shift, he would still have to remain in the custody
area in case the situation changed. When I asked if he wanted me to pick
up a newspaper for him, the enthusiasm with which he greeted that
suggestion spoke volumes about the prospect of another 4 hours sitting on
his own in this tiny office. 

The research often involved a complex negotiation with custody staff as to
what was possible. Sometimes potential blockages in the interviewing
could be resolved by reference to higher authority (a more senior officer);
at other times, the interviewer simply had to recognize that other events
occurring within the custody area were going to take precedence over the
research. At such times, it was necessary to take a step back and wait for a
more opportune moment when the interviewing could resume. 

Confidentiality 

At an early stage in this fieldwork, both police forces expressed the
concern that, if an arrestee disclosed to the interviewer that he or she had
committed a serious crime--for example, a murder or a kidnaping, this
information would have to be passed on to the police as soon as possible at
the conclusion of the interview. In effect, then, arrestees could be provided
with only limited confidentiality. Clearly, it was essential that this limited
confidentiality be explained to all arrestees. The research team agreed to
provide arrestees with both written and verbal statements of the limited
basis on which confidentiality could be granted to them in connection with
their involvement in the ADAM pilot. This meant that arrestees' answers
to questions covered on the research instrument could be considered
confidential; however, any additional information volunteered by arrestees
was not covered by the confidentiality clause. It was further explained to
the arrestees that unsolicited disclosures would be regarded as
inappropriate behavior and would result in the termination of the
interview. In the planning stage of this research, this arrangement was
considered to be a way of ensuring that the research team would not find
themselves in the position of passing information to the police that had
arisen in the course of an interview thought to be confidential by arrestees.
As the following field note illustrates, however, even this arrangement was
less than wholly adequate: 

At around 6 a.m., I received a telephone call from one of the interviewers
who was clearly in an agitated state over an interview she had just
completed. I said I would drive down to the custody area immediately,
and, when I met her, she explained that midway through an interview, the
arrestee had stated that his stepfather had abused him over many years.
This was not an area covered by the questionnaire; the interviewer asked
the arrestee to confine himself only to the questions that would be put to
him and repeated that any additional information could not be regarded as
confidential. The arrestee said that he understood this and wanted to
continue with the interview and would stick only to answering the
questions that were put to him. However, when the interviewer came to the
section of the questionnaire that asks about the arrestee's access to guns, he
indicated that he did indeed have access to a gun and that it was his
intention, on being released from the police station, to kill his stepfather.
The interviewer had then become very concerned about this disclosure.
Unsure of whether she should have alerted the police to this threat, she had
telephoned me. I was also unsure of how to respond to this occurrence.
Since murder had not taken place the incident, as such, was not of the
same kind as had been anticipated in the planning stage for the pilot.
However, a threat to murder someone made within the context of a police
station by an arrestee who has admitted access to a gun hardly seemed the
kind of thing that one could simply ignore. Following a more general
discussion with our police liaison officer and discussions with a colleague
within the University, I made the decision that we had to alert the police to
the nature of the threat that had been made. Since only one arrestee had
been interviewed on that shift, it was not difficult to indicate to the
relevant police officer which arrestee had made the threat. 

It is important to recognize that, in responding to this incident, no clear
guidelines existed as to how to proceed. As a result, the interviewer and
her supervisor had to determine a response largely on the basis of what
seemed right at the time. At the simplest level, it would have been
intolerable to have been warned about a murder in advance of its
occurrence and done nothing to prevent it. Since the likelihood that the
individual would act in accordance with this threat could not be assessed,
the only sensible option was to pass the information on to the police
authorities.

VIII. National Stakeholders Involved in the Development of I-ADAM 

Numerous parties have been involved in the development of I-ADAM in
Scotland. These include the Scottish Executive, which funded this pilot
program through a grant; the Fife Constabulary and the Strathclyde Police,
which were the local police forces who cooperated in the program; the
University of Glasgow, which sponsored the study and provided the
interview team; and the Scottish Advisory Committee on Drug Misuse,
which is the group responsible for setting and reviewing Scottish drug
policy. 

IX. Research Methods 

The ADAM pilot in Scotland entailed a combination of research methods.
First, custody staff were asked to complete an Arrestee Monitoring Form
on all arrestees passing through each of the custody areas participating in
this research. The form recorded key information to allow comparison of
the arrestees who were interviewed and had their urine tested against the
broader arrestee population within the study areas. Second, a sample of
arrestees was interviewed about their drug use, using a standardized
instrument (questionnaire). Third, the interviewees' self-reports of their
drug use were confirmed by a laboratory examination of urine samples
provided by those interviewed who consented to a urine test.

Sampling 

The original plan was to have an interviewer available in each of the
custody areas over the full 24 hours of each day of data collection. As a
result of staffing difficulties, it was necessary to revise the interview
schedules so as to make interviewers available 18 hours a day, 7 days a
week. For each day of data collection, interviewer shift times were
constructed so as to minimize the loss of any arrestees from this study as a
result of the reduced coverage. The shift times used in this research were
from 11 a.m. to 8 p.m. and from 9 p.m. to 6 a.m. in Strathclyde, and from
7 a.m. to 4 p.m. and from 6 p.m. to 3 a.m. in Fife. It became evident that
most arrestees were in the custody area for longer than 2 to 3 hours, which
meant that even if someone had been arrested in the period when no
interviewer was present, the interviewer could usually request an interview
when he or she came on shift.

Eligibility Criteria 

The Scottish ADAM pilot included adult arrestees (age 16 and older) who
could provide informed consent to participate in the research. The
following arrestees were excluded from the pilot:

 o Arrestees younger than 16.

 o Arrestees who could not provide fully informed consent to participate in
the research. These included arrestees who were impaired by alcohol or
drug use, and individuals arrested on suspicion of murder. These last were
excluded on the advice of the Crown Office because they are routinely
assessed by a psychiatrist and, therefore, could not be assumed to be of
sufficiently sound mind to provide fully informed consent to the research.

 o Arrestees who the custody officer determined posed a threat of violence
to the interviewer or whose interview might interfere with an ongoing
police investigation.

 o Arrestees in connection with drunk driving charges. Drunk drivers tend
to be processed very quickly through police stations, and their recent
alcohol use might impair their ability to provide informed consent to
participate in the research.

Over the period of data collection in the Scottish ADAM pilot, 581
individuals were deemed ineligible for inclusion within the pilot. Exhibit 5
shows the reasons for the exclusion. 

X. Training 

A team of eight interviewers was recruited for this pilot, all of whom were
either current or recently graduated students at the University of Glasgow.
It was felt that using young people in this capacity would help in building
up a rapport with arrestees and would counter any suggestion that the
interviewers were undercover police officers. All interviewers were trained
to use the research instrument and underwent rigorous security checks by
the two police forces involved in this pilot. The police requested the
security checks, given that the interviewers would be spending a
considerable amount of time within secure areas of the police stations
chosen as pilot sites. 

The interviewing team comprised four men and four women. At the time
the interviewers were selected, there was no way of knowing how well
they would relate to arrestees or how close or distant they would be from
the social background of arrestees. As it turned out, the vast majority of
arrestees were from the poorer classes, while the interviewers generally
had more middle-class backgrounds. More important than class, however,
was the interviewers' ability to adopt a nonthreatening stance toward
arrestees and to reassure them that they were not undercover police
officers. All interviewers wore visible identity cards noting their
employment at the University of Glasgow.

XI. National Data Analytic Results 

For this pilot program, 427 arrestees were interviewed, 220 in Strathclyde
and 207 in Fife. In addition, urine samples were successfully collected
from 67 percent (280) of interviewed arrestees. See exhibit 6 for
demographic information on arrestees. 

Exhibit 7 shows the results of urine testing in the Scottish ADAM pilot.
Overall, 71 percent of urine samples were found to be positive for any
drugs (excluding alcohol and volatile substances), as compared with 61
percent in the NEW-ADAM pilot.[15] Of the 280 arrestees who provided
usable urine samples, 52 percent tested positive for cannabis. Cannabis use
for male arrestees was 54 percent, compared to 42 percent for female
arrestees. More than 50 percent of male arrestees tested positive for
cannabis in only 1 of 35 U.S. ADAM sites (53.1 percent in Oklahoma);
and more than 30 percent of female arrestees tested positive for cannabis
in only two U.S. ADAM sites (31.9 percent in St Louis and 31.2 percent in
Indianapolis).[16] These results indicate that cannabis use appears to be
more prevalent among male and female arrestees in Scotland than among
their counterparts in the United States. 

Thirty-one percent of urine samples in the Scottish ADAM pilot tested
positive for opiates (29 percent in Fife and 33 percent in Strathclyde).
Opiate misuse was more common among female arrestees (51 percent)
than male arrestees (26 percent) (p = 0.0009). Methadone use rates were
also twice as high among female as male arrestees in Scotland (see exhibit
7). More than 10 percent of adult male arrestees tested positive for opiates
in only 8 of the 35 U.S. ADAM sites; none of the U.S. sites identified
levels of opiate misuse greater than 20 percent among adult males. Twenty
percent or more of female arrestees tested positive for opiates in only four
U.S. ADAM sites (the highest figure was in Chicago, where 27 percent of
female arrestees tested positive).

Exhibit 8 shows the results of the ADAM pilot interviews. In interviews,
89 percent of arrestees in the Scottish ADAM pilot reported having used
an illegal drug at some time, 80 percent within the last 12 months. The
self-reports confirmed the data from urine testing that cannabis was by far
the most widely used illegal drug among arrestees; 71 percent reported
having used cannabis within the past 12 months. Arrestee self-reports also
confirmed the high prevalence of injection drug use in Scotland and of
needle sharing among injection drug users. Twenty-six percent of arrestees
reported that they had injected drugs; 22 percent had done so within the
past 12 months. Of those who had injected drugs (110), 20 percent had
used another individual's injecting equipment within the past 12 months,
and 33 percent had passed on their own injecting equipment for another's
use.

Exhibit 9 reports arrestees' self-reports of their own drug dependence, their
perceptions of the links between drug use and crime and drug use and
violence, and their access to weapons. These reports confirm the high rates
of drug misuse among offenders in Scotland: 52 percent of arrestees stated
that they felt they had been dependent on a drug other than alcohol at some
point in the past, and 40 percent said that they had recently been drug
dependent. IDUs were more than twice as likely as other arrestees to
perceive a connection between their drug use and their offending behavior
(84 percent for IDUs compared with 32 percent for all arrestees) and to
own or have access to a gun (56 percent compared with 25 percent for all
arrestees). Arrestees also strongly perceived links between drugs,
especially alcohol, and violence (see exhibit 9). A significant minority of
arrestees (20 percent) had carried a knife when committing a crime.

Exhibit 10 shows arrestees' self-reports of receiving treatment for drugs
and alcohol misuse. The percentage of arrestees who stated that they
would like to receive treatment for an alcohol or drug problem was
considerably higher than the percentage of those who were receiving
treatment currently or had received treatment in the past (see exhibit 10).
This indicates a significant unmet need for drug and alcohol treatment
among arrestees, which is of concern given the high proportion of
arrestees, especially IDUs, who saw a link between their drug use and their
offending.

XII. Policy Implications and Applications of Data 

A number of policy implications flow from this pilot. First, the pilot has
shown that the ADAM methodology can be applied in Scotland. It also has
shown that a very high proportion (71 percent) of arrestees in at least
certain parts of Scotland have used illegal drugs and that nearly one-third
(31 percent) may have used opiates. It is not now known whether the close
link between drug misuse and crime identified in the two areas of the pilot
would be replicated elsewhere in Scotland. The second key policy
implication of this research is to underline the importance of extending the
ADAM work to other areas within Scotland.

The third key policy implication arising from this limited pilot concerns
what one might do to reduce the link between drugs and crime in Scotland.
The Scottish Drug Enforcement Agency has recently been created,
modeled along similar lines to the U.S. Drug Enforcement Administration.
The Scottish Drug Enforcement Agency arose out of a growing
recognition of the need to coordinate drug enforcement initiatives at a
national level rather than at the level of individual police forces in
Scotland (Scotland does not have a national police force, as such, but a
collection of regional police forces of which Strathclyde is by far the
largest).

The ADAM pilot, however, also has implications in terms of drug misuse
treatment and prevention. The results of the pilot illustrate the need to
integrate treatment and prevention initiatives better into the criminal
justice arena. The ADAM pilot has shown that a high percentage of
arrestees perceive a link between their drug misuse and their offending
behavior, but few arrestees received help for a drug and/or alcohol
problem while in custody. There may be merit in ensuring that drug
counselors can access arrestees during their confinement and can provide
the necessary support to try to reduce the cycle of offending that so many
of the arrestees appear to be locked into as a result of their dependence.
Very little is known about the likely success of such an initiative;
however, the close link between drug misuse and offending that this pilot
has identified in two areas in Scotland underlines the importance of
strengthening enforcement, treatment, and prevention initiatives with
regard to drug-related offending.

The Future 

Following publication of the results of the ADAM pilot, the deputy
minister for justice in Scotland announced that there will be a national
rollout of the ADAM program in Scotland. Before this takes place,
however, the authors are carrying out a scoping study to assess the
logistics of initiating a national program involving the interviewing and
drug testing of arrestees. This study is investigating sampling methods and
what can be done to ensure that a representative sample of arrestees is
interviewed, the cost of a nationwide ADAM program, the likely value of
combining generic and confirmatory testing of urine samples, and the
possible impact on future ADAM work in Scotland of recent legislative
changes, including the European Convention on Human Rights. 

Acknowledgments 

The research described in this chapter was funded by a grant from the
Scottish Executive; the views expressed in the chapter are those of the
authors and should not be ascribed to the funding body. The interviewers
on this study deserve special thanks for the energy and commitment they
brought to the project; they were: David Boyd, Anne Broderick, Emily
Duizend, Peggy Dwyer, Pablo Jelic, Daniel Martin, Daniel Sumpton, and
Shanti Williamson. Dr. Trevor Bennett of the University of Cambridge
provided advice to the research team, for which we were very grateful. In
undertaking the pilot we owe a debt to Superintendent John McNab (Fife
Constabulary) and Inspectors Jo McGallagly and Brian Dunn (Strathclyde
Police). The research would not have been possible without the active
support of police officers in each of the custody areas or of the arrestees
who agreed to be interviewed and to provide urine samples. We are
grateful to all of the arrestees who agreed to be interviewed in this
research.

Notes

1. Anderson, S., and M. Frischer, "Drug Misuse in Scotland: Findings
from the 1993 and 1996 Scottish Crime Surveys," Crime and Criminal
Justice Research Findings, No. 17, Edinburgh: The Scottish Office,
Central Research Unit, 1997.

2. Advisory Council on the Misuse of Drugs, Tackling Drugs to Build a
Better Britain: The Government's Ten-Year Strategy for Tackling Drugs
Misuse, London: Her Majesty's Stationery Office, 1998. 

3. Miller, P., and M. Plant, "Drinking, Smoking and Illicit Drug Use
among 15 and 16-year-olds in the United Kingdom," British Medical
Journal 313 (1996): 394-397.

4. McKeganey, N., and J. Norrie, "Pre-Teen Drug Users in Scotland,"
Addiction Research 7 (1999): 493-507.

5. Frischer, M., A. Leyland, R. Cormack, D.J. Goldberg, M. Bloor, S.T.
Green, A. Taylor, R. Covell, N. McKeganey, and S. Platt, "Estimating the
Population Prevalence of Injection Drug Use and Infection with Human
Immunodeficiency Virus Among Injection Drug Users in Glasgow,
Scotland," American Journal of Epidemiology 138 (3) (1993): 170-181.

6. Hay, G., and N. McKeganey, "Estimating the Prevalence of Drug
Misuse in Dundee, Scotland: An Application of Capture-Recapture
Methods." Journal of Epidemiology and Community Health 50 (4) (1996):
469-472.

7. Frischer, M., D. Goldberg, M. Rahman, and L. Berney, "Mortality and
Survival Among a Cohort of Drug Injectors in Glasgow, 1982-1994,"
Addiction 92 (4) (1997): 419-427; Hammersley, R., M.T. Cassidy, and J.
Oliver, "Drugs Associated With Drug-Related Deaths in Edinburgh and
Glasgow, November 1990 to October 1992," Addiction 90 (1995): 959-
965; Neale, J., "Experiences of Illicit Drug Overdose: An Ethnographic
Study of Emergency Room Attendances," Contemporary Drug Problems
(Fall 1999): 505-530.

8. Goldberg, D., S. Cameron, and J. McMenamin, "Hepatitis C Virus
Antibody Prevalence Among Injecting Drug Users in Glasgow Has Fallen
but Remains High," Communicable Disease and Public Health 1 (2)
(1998): 95-97.

9. Davies, AG., N.J. Dominy, A. Peters, G.E. Bath, S.M. Burns, and A.M.
Richardson, "HIV in Injecting Drug Users in Edinburgh--Prevalence and
Correlates," Journal Of Acquired Immune Deficiency Syndromes and
Human Retrovirology 8 (1995): 399-405.

10. Taylor, A., M. Frischer, S. Green, D. Goldberg, N. McKeganey, and L.
Gruer, "Low and Stable Prevalence of HIV Among Drug Injectors in
Glasgow," International Journal of STD and AIDS 5 (1994): 105-107.

11. Hutchinson, S., S.M. Gore, A. Taylor, D.J. Goldberg, and M. Frischer,
"Extent and Contributing Factors of Drug Expenditure by Injectors in
Glasgow: A Multi-Site Citywide Cross-Sectional Study," British Journal
of Psychiatry 176 (2000): 166-172.

12. Advisory Council on the Misuse of Drugs, Tackling Drugs to Build a
Better Britain: The Government's Ten-Year Strategy for Tackling Drugs
Misuse (see note 2).

13. Scottish Office, Tackling Drugs in Scotland: Action in Partnership,
Edinburgh: The Scottish Office, 1999.

14. McKeganey, N., C. Connelly J. Knepil, J. Norrie, and L. Reid,
Interviewing and Drug Testing of Arrestees in Scotland: A Pilot of the
Arrestee Drug Abuse Monitoring Methodology, Edinburgh: Scottish
Executive, Central Research Unit, 2000.

15. Bennett, Trevor, Drugs and Crime: The Results of Research on Drug
Testing and Interviewing Arrestees, London: Home Office, 1998.

16. National Institute of Justice, Arrestee Drug Abuse Monitoring
(ADAM) Program: 1997 Annual Report on Drug Use Among Adult and
Juvenile Arrestees, Research Report. Washington, DC: U.S. Department
of Justice, National Institute of Justice, 1998, NCJ 171672.

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

South Africa 

Elna van Niekerk
Charles Parry
Andreas Pluddemann
Antoinette Louw
Gina Weir-Smith
D. Locke

Elna van Niekerk is project manager at the Division of Roads and
Transport Technology of the Council for Scientific and Industrial
Research in Pretoria, South Africa. Charles Parry is director of the
Medical Research Council in Cape Town, South Africa. Andreas
Pluddemann is a scientist at the Medical Research Council in Cape Town,
South Africa. Antoinette Louw is head of the Crime and Justice
Programme at the Institute for Security Studies in Pretoria, South Africa.
Gina Weir-Smith works at the Human Sciences Research Council,
Pretoria, South Africa. D. Locke is with the South African Police Service's
Crime Information Analysis Centre in Pretoria, South Africa.

I. Overview of Demographic Profile of Nation

The Republic of South Africa occupies the southernmost part of the
African continent. The geographic size of South Africa is 1,219,090
square kilometers (757,543 square miles). It has common boundaries with
the republics of Namibia, Botswana, and Zimbabwe; the Republic of
Mozambique and the Kingdom of Swaziland lie to the northeast.
Completely enclosed by South African territory in the southeast is the
Kingdom of Lesotho. To the west, south, and east, South Africa borders
on the Atlantic and southern Indian Oceans, which gives South Africa a
lengthy coastline that is swept by two major ocean currents: the
Mozambique Agulhas and the Benguela systems. Isolated, 1,920
kilometers southeast of Cape Town in the Atlantic, lie Prince Edward and
Marion Islands, which were annexed by South Africa in 1947. 

Exhibit 1 shows general demographic information for South Africa; the
country has an estimated population of 43 million people,[1] 54 percent[2]
of whom live in urban areas. South Africa's nine provinces have varying
degrees of urbanization, from 11 percent in the Northern Province to 97
percent in Gauteng. Economic information is provided in exhibit 2.

Crime Rates 

A current moratorium on the publication of police statistics prevents
analysis of crime statistics for 2000. Some statistics are available for
previous years, however. Exhibit 3 presents crime statistics for 1999.
Crime levels are measured as a ratio per population and, in the case of car
theft and hijacking, the number of licensed vehicles.[3] Between 1998 and
1999, the number of reported violent crimes increased by 9.3 percent.
Between 1994 and 1999, this figure increased by 21.6 percent.[4]

Prevalence of Drug Use 

Various studies by the Human Sciences Research Council (HSRC)
document drug use and its socioeconomic correlates. Findings are based
on different household surveys of self-reported use.

Illicit drug[5] use generally manifests as a male phenomenon, but women
are overrepresented as users of prescription drugs, such as tranquilizers,
amphetamines, and sedatives. Illicit drug use tends to concentrate in urban
areas. The ratio of past-year alcohol use to cannabis use seems to be about
10:2. An increase in drug use may have emerged among adults in both the
lowest and highest socioeconomic categories. On average, 30.9 percent of
African male drinkers and 16.4 percent of African female drinkers may be
involved in risky drinking. Cannabis is the most popular illicit drug,
especially among offenders and among males in low socioeconomic urban
sectors. The use of cocaine, mandrax (or mixtures of mandrax and
cannabis), LSD, and heroin also occurs, but to a lesser extent, and it is
seemingly more prevalent among subsectors such as offenders.

II. Description of the Criminal Justice System Arrest Process and
Detention System 

The Criminal Justice System 

The criminal justice system, based on Roman Dutch Law and common
law, is administered nationally. The Constitution of the Republic of South
Africa[6] (Act 108 of 1996) is the supreme law of the country and binds
all legislative, executive, and judicial organs of state at all levels of
government. The judicial authority of the Republic of South Africa is
vested in the courts, which are independent, impartial, and subject only to
the Constitution and the law. The administration of justice is a function of
the national Government. Fundamental rights (in terms of chapter 2 of the
Constitution) bind all legislative and executive bodies of state at all levels
of government; they apply to all laws, administrative decisions taken, and
acts performed during the period in which the Constitution is in force.

Court structures

The Constitutional Court is the highest court in cases regarding the
interpretation, protection, and enforcement of the Constitution. The
Supreme Court of Appeal is the highest court in cases dealing with final
appeals on all other matters. High courts are divided into 13 divisions. A
provincial or local division has jurisdiction in its own area over all persons
residing or present in that area, in all causes of action arising and all
offenses triable within that area, and over all other matters of which it may
take cognizance according to law. These divisions hear matters that are
usually of such a serious nature that the magistrate's or regional courts
would not be competent to make an appropriate judgment or impose an
appropriate penalty. Other courts include special superior courts, regional
courts, and magistrate's courts. In terms of statutory law, jurisdiction may
be conferred upon a chief (or headman) or his deputy to try and punish an
African person who has committed an offense under common law or
indigenous law and custom, with the exception of certain serious offenses
specified in relevant legislation.

The Attorney-General

The authority to institute and conduct a prosecution in the case of an
offense that falls within the jurisdiction of a lower court or the high court
is vested in the state. The function of deciding whether or not a
prosecution should be instituted is, by law, vested in the attorney-general
and the public prosecutors under his or her control. The attorney-general
exercises his or her function independently and is accountable only to
Parliament. The authority of the attorney-general is delegated to public
prosecutors in order to conduct prosecutions in the lower courts.

Juveniles

A child is a person under the age of 18 years. Every child who is in
detention shall, in addition to other rights, have the right to be detained
and treated in a manner that takes account of his or her age. The South
African Law Commission is currently attending to policy and legislation
for a new juvenile justice system, under which juveniles can be diverted
from the formal court system.

The Arrest Process 

The arrest process is based on rules laid down by the Constitution, the
Criminal Procedure Act (Act 51 of 1977), other legislation, and a police
standing order. As a general rule, the object of an arrest is to secure the
attendance of such person at his or her trial. There are, however,
exceptions to this rule: arrest for the purpose of further investigation, arrest
to verify a name and/or address, arrest to prevent the commission of an
offense, arrest to protect a suspect, and arrest to end an offense. The
requirements of a lawful arrest are that--

 o The arrest must have been properly authorized.

 o The individual who effected the arrest must exercise physical control
over the person who has been arrested.

 o The person who has been arrested must be informed of the reason for
the arrest and of the rights that he or she has as an arrested person in terms
of the Constitution.

 o The person who has been arrested must be brought to the appropriate
place as soon as possible.

The information to be furnished to the arrested person is printed in the 11
official languages in the formal police pocket book. 

The Detention System 

On arrival at the police station, the arrested person must be handed over to
the community service center commander or the member in charge of the
detention facilities, and the arresting officer should provide information
regarding the arrest and complete the Arrest Statement. The fact that the
person has been arrested and has arrived at the police station must be
recorded in the Occurrence Book. This entry contains the name of the
individual who arrested the person; the name of the arrested person; the
reason for arrest and, if possible, the case number; and whether the
arrested person has any visible injuries, is sick, or is under the influence of
intoxicating liquor or any other substance with narcotic effect (in the
opinion of the community service center commander). The same
information is also entered into the Custody Register.

The community service center commander issues a Notice of
Constitutional Rights to every person who is admitted into a police cell.
The reference number of the notice, together with other information, is
recorded in the Custody Register. A person in custody has the right to
choose and consult with a legal practitioner or to have a legal practitioner
assigned to him by the state and at state expense. A juvenile (a person
below the age of 18) may be detained only as a last resort and should be
detained separately from adults.

The arrested person must be brought before a lower court as soon as
reasonably possible, but not later than 48 hours after the arrest or, if the
48-hour period expires outside ordinary court hours, the end of the first
court day after the expiration of 48 hours.

III. Status of National Drug Policy

In the past, efforts to address substance abuse in South Africa focused
largely on control measures that fell under the jurisdiction of the law
enforcement and justice sectors. In addition, through welfare agencies
such as the South African National Council on Alcoholism and Drug
Dependence (SANCA), the state provided resources for the treatment of
persons with substance abuse problems. The health and education sectors
were minimally involved and scant resources were spent on prevention.
Although a number of national plans or strategies to address substance
abuse were formulated during the 1980s and early 1990s, the government
failed to implement such plans. This resulted in fragmentation of effort
and a failure to secure sufficient resources to combat substance abuse. 

Under the previous government, South Africa became a signatory to the
1961 U.N. Single Convention on Narcotic Drugs, the 1972 Protocol
(which amended the Single Convention), and the 1971 Convention on
Psychotropic Substances.[7] In 1992, the South African Drugs and Drug
Trafficking Act came into being, making it an offense to supply certain
substances to any person knowing or suspecting that the substances will be
used for the manufacture of illegal drugs, prohibiting any person from
converting property that is known or suspected to be gained from the
proceeds of drug trafficking, and making dealing in dangerous and
undesirable drugs an offense punishable by up to 25 years' imprisonment.
The maximum sentence for possession of drugs is 15 years. There are no
prescribed minimum sentences.[8]

Since 1994, Parliament has signed into law several pieces of legislation
that have strengthened the legislative basis that would allow the country to
sign the 1988 U.N. Convention Against Illicit Traffic in Narcotic Drugs
and Psychotropic Substances (1988 U.N. Convention). Two of the most
important of these laws are the International Co-operation in Criminal
Matters Act of 1996 and the Proceeds of Crime Act of 1996. The former
provides formal procedures to be used in obtaining and providing
information during a criminal investigation that spans international
borders, as well as procedures for the repatriation of criminal proceeds.
The latter criminalizes money laundering in general and provides
procedures for the restraint and confiscation of criminal proceeds. The
Extradition Amendment Act of 1996 further defines extraditable offenses
and provides for the designation of states to which extradition may be
effected in the absence of formal agreements. The Money Laundering
Control Bill of 1997 makes certain bodies and institutions "accountable
institutions." Bodies and institutions that receive money on behalf of
clients in the normal course of business are required to identify their
clients and keep proper records of business transactions with them. Certain
transactions that have the potential of being used for money laundering
purposes will have to be reported to a central authority[9]; this bill has yet
to be passed by Parliament.

In 1995, the National Crime Prevention Strategy (NCPS) was approved by
Cabinet. This strategy draws together a range of government departments
to develop a holistic approach to fighting crime. Organized crime was
listed as one of seven priority areas. The NCPS has been criticized,
however, for not adequately confronting the issue of illegal substance
abuse and its links to crime. In 1997, the Minister of Safety and Security
announced that the Government would introduce strict measures to tighten
South Africa's ports of entry in a bid to stem the influx of drugs and arms.
He stated that bulk commercial traffic would be cleared through only 19 of
the 52 existing border posts and that cargo would be cleared at only 8 of
the 36 ports of entry.[10] The Department of Justice has indicated its aim
of increasing the number of offenders referred to and entering treatment by
way of arrest referral schemes; the court process and post-sentencing
provisions and various initiatives are under way to move this initiative
forward.

In December 1998, South Africa signed the 1988 U.N. Convention in New
York. It was hoped that the Money Laundering Control Bill would be
enacted before signing the Convention, but legal opinion was that the
legislative basis was sufficient to go ahead without that step having been
accomplished. The Prevention of Organised Crime Act of 1998 provides
for drastic new powers for police and prosecutors including the forfeiture
of criminals' assets on the grounds of "a balance of probabilities" rather
than "beyond a reasonable doubt." The focus here is on civil rather than
criminal prosecution. The legislation allows the state to confiscate assets
gained through illegal means regardless of whether the suspects are
convicted. February 2000 saw the first deposit of monies confiscated from
alleged drug dealers into the Criminal Assets Recovery Fund. The money
is to be used to support law enforcement initiatives. The legislation
initially ran into difficulty in the courts, which overturned several
forfeitures of property belonging to alleged drug lords by the Scorpions'
Asset Forfeiture Unit, resulting in amendments to the legislation.

In terms of regional cooperation, South Africa also signaled the Protocol
on Combating Illicit Drug Trafficking in the Southern African
Development Community (SADC) Region,[11] which was ratified by
Parliament in July 1998. The Protocol provides a policy framework that
allows the SADC region to cooperate to ensure that it does not become a
producer, consumer, exporter, and distributor of illicit drugs or a conduit
for illicit drugs destined for international markets.[12] Although the
SADC Regional Drug Control Programme[13] focuses mainly on drug
supply reduction, Article 7 of the SADC Protocol gives special attention to
demand reduction by requiring member states to "develop, implement and
evaluate policies and strategies aimed at establishing a comprehensive and
integrated demand reduction programme" that will include the
development of community prevention, public and school education, and
research activities to address the underlying causes of drug abuse.[14]

Although an accurate determination of the amount of government
spending on supply and demand reduction activities is not possible, one
can be almost certain that a drop in spending on demand reduction
activities relative to supply reduction has occurred during the past few
years. Treatment centers have been closed and the plan to handle more
substance abuse cases through the primary health care system has not been
implemented. Without an increase in the budget for prevention activities,
the national and provincial departments of welfare have generally had to
reduce their support to nongovernmental agencies (NGOs) involved in
prevention activities while initiating few prevention activities themselves.
One exception to this outcome is the national "I'm addicted to life"
campaign, which was launched in 1995 and is aimed at youths between
ages 11 and 20. The campaign uses television, radio, information leaflets,
and posters and has been expanded to include video and a teachers'
manual.

A major reason for the failure to redirect resources to drug demand
reduction activities has been the delay in formulating and implementing a
national drug master plan. A committee was established toward the end of
1996 by the national Drug Advisory Board to formulate such a plan; after
a lengthy period of consultation and drafting, the National Drug Master
Plan (1999-2004) was approved by Cabinet in 1999.[15] Implementation
began in 2000 following the appointment of members of the Central Drug
Authority. 

The vision of the plan is to "build a drug free society together and to make
a contribution to [addressing] the global problem of substance abuse"; it
focuses on crime, youth, community health and welfare, research and
information dissemination, international involvement, and communication.
The plan recommends the establishment of--

 o A national central drug authority to oversee and monitor its
implementation.

 o A secretariat to oversee its administration. 

 o Action committees in 382 magisterial districts to ensure its
implementation and the uniform spread of information and policies in
every part of the country. 

 o Provincial substance abuse forums to strengthen member organizations
in carrying out their existing functions and to keep substance abuse high
on the public and political agenda. 

Among the key activities to be implemented within the first year are
establishing a secretariat, developing a database of research and a national
clearinghouse, developing and implementing a mass media campaign
aimed at youths, developing recommendations regarding alcohol
advertising, formulating model drug policies for schools, and initiating a
radio program aimed at educating the public. 

The plan focuses on demand reduction but recognizes the importance of
harm reduction without setting out detailed harm reduction approaches.
Further research is recommended before reaching any policy decision on
the issue of decriminalization of cannabis. With regard to the relationship
between drugs and crime, the plan recognizes that drug issues manifest
themselves at every level of the criminal justice system but that the precise
relationship between drugs and crime is hard to determine. Recognition is
given to the fact that there are three main ways in which the two are
linked: crimes committed due to the psychopharmacological effects of
drugs ingested by perpetrators, crimes committed to feed a drug habit, and
crimes committed as a byproduct of involvement in drugs and/or drug
trafficking.[16]

IV. Background History to SA-ADAM 

In 1996, the Human Sciences Research Council (HSRC), together with the
Crime Information Analysis Centre (CIAC) of the South African Police
Services, conducted a pilot study in the Hillbrow police station (in
Johannesburg), based on the Drug Use Forecasting (DUF) program
principles. (DUF was superseded by the ADAM program in 1997.) In
1998, a researcher of the Medical Research Council (MRC) and the
Institute for Security Studies (ISS) attended the first annual I-ADAM
conference in Miami.

During 1998, the Department of Arts, Culture, Science and Technology
extended an invitation to consortiums of research partners to submit
substantial proposals for innovative research in various categories, one of
which was crime prevention. HSRC joined with CSIR to form a
consortium and ISS joined with MRC. A strategic decision was taken to
form a consortium of all four organizations--HSRC, CSIR, MRC, and ISS-
-and to partner with CIAC to develop an integrated proposal based on the
ADAM model. This proposal was successful and the project was awarded
in December 1998.

The South African ADAM program is based on four waves of data
collection: three phases of data collection in three sites, done
approximately 6 months apart, and one national data collection phase. The
three ADAM sites are: 

 o Three police stations in the province of Gauteng, within or in close
proximity to Johannesburg.

 o Four police stations in Cape Town (in the Western Cape Province).

 o Two police stations in Durban (KwaZulu-Natal Province).

Cape Town, Durban, and Johannesburg are among South Africa's largest
cities. Both Cape Town and Durban are port cities, and Johannesburg,
with South Africa's largest airport, is also a common port of entry for
drugs. In addition, drug problems are known to be most prevalent in these
three cities, and they are already part of an ongoing drug abuse
surveillance system, the South African Community Epidemiology
Network on Drug Use (SACENDU). The ADAM survey, therefore, would
feed into this system. The national survey was conducted in 150 police
stations countrywide and based on a stratified random sample.

V. Goals and Objectives 

The goals and objectives of the South African ADAM program should be
understood within the context of the broad funding principles of the
Department of Arts, Culture, Science and Technology. The current
undertaking is a 30-month project. The main goal is to establish a South
African ADAM program but with some objectives not necessarily directly
related to the U.S. ADAM model. The principal aims of this study are
listed below:

 o Establish a monitoring system based on the U.S. ADAM model to
monitor trends in drug use and crime and the crime/drugs nexus.

    - Establish a database to provide tactical and strategic information to
combat crime, support intervention strategies, and support policy.

    - Identify correlates of substance abuse with other factors (firearms,
HIV/AIDS infection).

    - Compare different methodologies (national/sentinel, urinanalysis with
extrapolation, rural surveillance, alternative drug screening).

 o Communicate data to practitioners in an innovative way.

 o Explore the relationship between serious drug traffic crimes and other
criminal activities.

 o Explore how different law enforcement agencies, supported by
information from this program, could work cooperatively on drug-related
issues. 

 o Establish a framework of reference and interpretation of arrestee data
within the context of other databases. 

  o Develop a training course for arresting officers regarding arrestees
under the influence of drugs.

The study timed data collection as follows:

 o The first phase of data collection (sentinel sites or Three Metro Study)
took place during August and September 1999, and some results are
available.

 o The second phase of data collection for the Three Metro Study was
scheduled for February and March 2000.

 o The third phase of data collection for the Three Metro Study was
scheduled for August and September 2000.

 o Data collection for the national study was scheduled for February and
March 2000. 

VI. Getting Started 

A. Obtaining Funding 

As stated earlier, funding for this project was obtained through the South
African Department of Arts, Culture, Science and Technology. Because
the project's funding did not come from the most important stakeholders in
this project, the challenge of funding a sustained effort remains.

B. Contracting for Data Collection 

A request for bids to perform data collection was put out to
research/fieldwork/market research companies. Data collection for the
national survey was done by a different company than the one that
collected data for the Three Metro Study, but the latter was somewhat
involved in the areas of training and quality control. 

DRA Development was chosen to do the Metro study and A.C. Nielsen to
do the national study. The fieldwork companies were selected on the basis
of pricing, experience in the field of social research, and capacity.

C. Facility Access 

Access to police stations was negotiated through CIAC. Police stations
were informed of the survey and instructed to cooperate with field
workers. CIAC representatives visited most of the police stations, and the
project leaders of the ISS/MRC made personal followup visits. For the
most part, the problems experienced dealt with communications (e.g., the
duty roster or procedures on arrival at the police station). Results of the
August-September survey were shared with the police at the site level to
sustain support for future data collection phases.

Access to police stations for the national data collection phase was more
complicated from a logistical point of view because high-level personal
visits were not always possible. Supervisors of each fieldwork team
telephoned the police station and visited at least 1 day before the fieldwork
was due to start. CIAC developed protocols to be followed by fieldwork
teams in order to ensure security for themselves, members of the police,
and people in custody.

D. Knowing the Catchment Area 

Brief description of the three sites for the Three Metro Study 

Cape Town is a port city on the southwestern coast of South Africa with a
population of about 2.7 million. It is the legislative capital of the country
and the capital city of the Western Cape Province, which has the second
highest per capita income, the highest rate of students passing the national
high school matriculation examination, and an unemployment rate of
approximately 17 percent. Cape Town has the second busiest harbor in the
country and the number of international flights handled by its airport has
dramatically increased during the past few years. Approximately 51
percent of the population of Cape Town is colored,[17] with the remainder
being African (26 percent), white (22 percent), and Asian (1 percent).[18]

Durban, located on the east coast in the province of KwaZulu-Natal, is a
port city with a population of more than 1.8 million persons, of whom 55
percent are African, 24 percent are Asian, 17 percent are white, and 4
percent are colored.[19] Durban hosts the busiest harbor in South Africa
and also has an increasingly busy international airport. Unemployment
rates are roughly twice those of Cape Town, and rates of poverty are much
higher. 

Gauteng Province comprises 7.3 million persons; 97 percent live in urban
areas. The majority of the residents of Gauteng are Africans (70 percent),
followed by whites (23 percent), coloreds (4 percent), and Asians (2
percent). Gauteng is the most economically developed of South Africa's
nine provinces; its two main cities are Pretoria (the administrative capital
of South Africa) and Johannesburg, a cosmopolitan city that is close to
Soweto (a large so-called township). Eight percent of the population of
Gauteng Province aged 20 years or older have higher than a grade 12
education. Just over 25 percent of the population is classified as being
unemployed, substantially more than in Cape Town. Of employed persons,
16 percent earn less than R500 per month ($73.53).[20]

Police stations were chosen on the basis of their arrest flow (i.e., only
stations with larger numbers of arrestees processed weekly were chosen to
facilitate the progress of interviewing) and their geographic area (i.e., an
attempt was made to cover all population groups by including police
stations in various residential areas). Four police stations were chosen in
Cape Town, three in Johannesburg, and two in Durban.

National survey

The sampling of police stations was based on the latest available census
data. Socioeconomic categories were identified for use in the analysis of
arrestee data. The results are representative of the entire nation, including
rural areas. Arrest flow data for 1 year have been collected and analyzed.

E. Drug Testing Issues 

Panel of drugs tested 

The panel of drugs tested included dagga (cannabis), mandrax
(methaqualone), cocaine, amphetamines, benzodiazepines, opiates, and
LSD. South African drug usage differs from other countries with respect to
the high use of mandrax (usually together with cannabis).

The fact that no LSD was found in the sample of 878 arrestees in the
Three Metro Study led to discussion about excluding LSD in the national
sample. The test for LSD costs double that of the tests for other drugs. A
decision was made, however, to include LSD in the national study because
the market for LSD may have shifted from urban to rural areas and a
national study of this size and budget will possibly never be conducted
again and should be as inclusive as possible, within budget constraints.

Laboratory responsible for testing of urine samples 

Choice of laboratory in the Three Metro Study was based on the lowest
bid (University of Cape Town). The bid for the national survey was
awarded to a private laboratory with a national network and infrastructure.
Both laboratories used the same drug testing methodologies and cutoff
points.

F. Instrument Issues 

The survey used two slightly different questionnaires, which have been
calibrated to enable comparison.

Cultural applicability

In the Three Metro Study, providing multicultural interview teams solved
the problem of cultural diversity. The national study was translated into
three languages other than English. The focus was on languages not close
to the languages normally spoken, and that may not be as well known to
field workers. 

Differences between U.S. and South African surveys 

The survey used in the Three Metro Study was based largely on items
included in the adult ADAM interview, but the South African instrument
differs from the U.S. instrument in the following ways:

 o Response categories for several items differ to account for different
terminology use (e.g., on the item of race).

 o Additional items were included in the South African questionnaire to
address issues that were felt to be not adequately covered in the ADAM
questionnaire (e.g., regarding binge drinking, the type or style of dwelling
structure, and knowledge of HIV/AIDS and sexual practices).

 o Some items were excluded from the South African instrument, either to
allow space for including other items felt to be of greater relevance or
because they were thought to be irrelevant in the South African context.

 o Some items from the U.S. instrument were included but set out
differently in the South African instrument (e.g., on the issues of legal and
illegal income and sources of drugs).

 o Many items from the U.S. instrument were included but placed in a
different position on the South African instrument.

 o The South African instrument also included some items from the U.S.
Addenda on the main questionnaire (e.g., those relating to firearm use).

VII. Barriers to Developing ADAM 

Other than operational restrictions, few obstacles existed to developing the
South African ADAM. Because this project ended in March 2001,
however, the long-term implementation of the project is the real issue at
stake. The main barriers are expected to be:

 o Future funding. SA-ADAM was conducted with funds from the
Department of Arts, Culture, Science, and Technology, which allocates
funds to research and other organizations to stimulate new research ideas
that may have national value. The Department has formal ownership of the
projects it funds only until the funding period of such projects expire.

 o Strategic ownership. The results from this project can provide useful
information to many relevant departments (Safety and Security, Justice,
Welfare, and Correctional Services). One of these departments or the
Central Drug Authority would have to take ownership of the program to
ensure future data collection and analysis.

VIII. National Stakeholders Involved in the Development of I-ADAM 

The two main national stakeholders in the development of this project are
the Department of Arts, Culture, Science and Technology, which provided
the funds for development; and the Department of Safety and Security,
which provided the infrastructure of its Crime Information Analysis
Centre to ensure access to police stations. Other departments, such as the
Departments of Health and Welfare, are also seen as stakeholders to be
approached once the results of the project's first phase are known.

IX. Research Methods (Sampling) 

Sampling Within Police Stations 

The sampling frame included all persons arrested during the time period
for which fieldwork was planned (e.g., 1 week). The practical
methodology was based on suggestions of the U.S. National Institute of
Justice (NIJ): Choose from a calculated proportion of the arrestees already
within the holding cells at the start of the shift (using systematic sampling)
and supplement this group with arrestees as they are brought in. This was
not practical in all cases because the arrest flows were often very low, and
interviewers had to take whoever was in the cells and corresponded to the
selection criteria of age and time lapsed since arrest.

Sampling of Police Stations 

For the national survey, which had to be representative of the country,
Statomet (a statistical analysis group affiliated with the University of
Pretoria) was requested by the HSRC to design and draw a scientific
sample of the catchment area population of police stations. All police areas
were classified into 20 homogeneous groups by the HSRC Geographic
Information System (GIS) center. A sample of 150 police stations was
drawn and a total of 2,000 arrestees interviewed at these stations.

Sample Design 

The population consisted of 1,089 points (police stations). The 1998 data
of the South African Police Services (SAPS) were used to decide on the
number of arrestees to be interviewed at each police station. Police stations
were arranged so that, when drawn, a systematic sample would be
representative of province, police areas, and the 20 homogeneous groups
of police stations.

To make the sample cost effective, a minimum of five arrestees per station
were interviewed. 

For the urine sample, every third police station was selected. A total of
717 urine samples were taken (budget constraints did not allow
100-percent testing of urine samples).

X. Training Issues 

Three Metro Study 

All field workers were trained during a 2-day training period in Cape
Town. NIJ supported the training by sending experienced personnel to
assist. Training covered a study overview, questionnaire guidelines,
models for setting up at police stations, urine handling protocols, and
shipment of urine samples.

National Survey

Training began on January 24, 2000. Although a different fieldwork
company has been contracted for the national study, the company involved
in the Three Metro Study was contracted to play a mentoring role in the
training process. This decision was made to ensure that the national study
would benefit from the learning gathered in the first round of data
collection. Both studies produced a training manual.

XI. Data Analysis Results for the Three Metro Study 

Demographics 

Interviews were done at three sites, which included nine police stations. A
total of 970 arrestees were interviewed; of these, 878 (90.5 percent)
consented to urine tests (see exhibits 4 and 5 for the number and
percentage of arrestees tested at each site). Eighty-three percent of
arrestees were male. Most (64 percent) were African, 20 percent were
colored, 3 percent were white, and 12 percent were Asian/Indian. More
than 70 percent of arrestees were 30 years old or younger (see exhibit 6 for
general demographic information about arrestees and exhibits 7 and 8 for
information about arrestees by gender and age). 

Offense Categories 

Violent offenses include murder and attempted murder, assault, weapons,
rape (including attempted rape), robbery/theft, and other violent offenses.
The category of robbery/theft posed a problem because, although theft is a
nonviolent offense, the investigating officer often must decide under
which offense to seek prosecution.

Property offenses include shoplifting, theft of motor vehicle, theft from
motor vehicle, housebreaking, and other property offenses.

Drug/alcohol-related offenses include drug dealing/possession and alcohol
offenses (including driving under the influence of alcohol).

Miscellaneous offenses include illegal immigrant/deportation, fraud, false
ID, and others (e.g., obstruction of police, prostitution, gambling, reckless
driving).

Prevalence of the main offense categories per site is shown in exhibit 9.
For all three metropolitan areas, violent crimes were the most prevalent.

Use of Drugs 

Overall, 48.6 percent of arrestees tested positive for any drug. Site-specific
figures were 34.8 percent for Gauteng, 52.2 percent for Durban, and 60.1
percent for Cape Town.

In Gauteng, especially, a substantial number of arrests were made for
immigration offenses (i.e., a person was arrested only for being an illegal
immigrant). Because this group of offenders showed relatively low drug
use, figures were also calculated with the exclusion of immigration
offenses, as follows: 53.7 percent overall, 41.9 percent in Gauteng, 55.5
percent in Durban, and 60.9 percent in Cape Town.

Exhibit 10 shows the prevalence of use of different drugs by offenders,
and exhibit 11 shows a breakdown of offenses by drug use and crime type.
Seventy-seven percent of housebreaking offenders tested positive for at
least one drug, with a high prevalence for dagga (marijuana) of 70.8
percent and for mandrax (methaqualone) of 56.3 percent. Although results
were positive for cocaine in 3.7 percent of the tested sample, 12.5 percent
of those arrested for housebreaking tested positive for cocaine. Among
those arrested for drug/alcohol offenses, 70.9 percent tested positive for at
least one drug. Seven percent of those arrested for murder or attempted
murder tested positive for cocaine.

Combination Drug Use 

In Cape Town, 53.5 percent of the sample tested positive for both dagga
and mandrax, followed by 35.9 percent in Durban and 15.3 percent in
Gauteng. Drugs that were found in combination were (in numbers rather
than percentages) dagga, mandrax, and benzodiazepines (11) and dagga,
mandrax, and cocaine (12). Smaller numbers were found for dagga,
mandrax, and opiates; mandrax and cocaine; dagga and cocaine; mandrax
and benzodiazepines; and a few other combinations. Sixty-three percent of
arrestees in Cape Town, 49 percent of arrestees in Durban, and 31 percent
of arrestees in Gauteng tested positive for more than one drug.

Comparison Between Phase 1 and Phase 2 Results 

The proportion of arrestees testing positive for any drug was fairly
consistent over the two study phases. Overall, the proportion of arrestees
testing positive for dagga (marijuana) or mandrax (methaqualone) was
slightly lower in phase 2 results from 44 percent in phase 1 to 36 percent
in phase 2 for dagga, and from 25 percent in phase 1 to 19 percent in phase
2 for mandrax. However, a slightly higher proportion of arrestees (2
percent) tested positive for amphetamines in phase 2, compared with none
during phase 1. 

Although overall prevalence of arrestees testing positive for any drug and
for the various drugs separately was lower in phase 2, some offense
categories in phase 2 data showed a higher prevalence of drug-positive
arrestees than in phase 1 data. Most notably, the proportion of persons
arrested for the motor vehicle theft testing positive for dagga, mandrax, or
any drug was considerably higher in phase 2 (74 percent versus 35 percent
in phase 1). The proportion of persons arrested for shoplifting testing
positive for any drug and for dagga were also higher in phase 2 (37
percent) than in phase 1 (27 percent). The proportion of those arrested for
housebreaking testing drug positive remained high (70 percent) in phase 2,
although not as high as in phase 1 (74 percent). 

XII. Policy Implications and Applications of Data 

Although the data have not been analyzed yet, some thought about their
application and policy implications seems appropriate. Specifically,
consideration should be given to the following: 

 o Strategies to reduce drug use and drug-related crime must be area
specific.

 o Combination drug use seems to be normal for arrestees, especially in
Cape Town.

 o Crack/cocaine is highly addictive and socially damaging; users should
possibly be targeted at police stations.

 o Police officers should be sensitive to the fact that the person arrested
(especially for housebreaking) is possibly under the influence of dagga
and/or mandrax. Police training should include how to recognize the
presence of drugs in a suspect and how to handle such a person.

 o The crime patterns found are a reflection of police activity. 

 o The focus on immigration offenses should be reconsidered. 

 o This project would benefit greatly from the computerization of police
arrest data.

 o Although alcohol's role in criminal behavior has been better researched
and understood than that of drugs, the possibility of alcohol use (alone and
in combination with other drugs) should be kept in mind, especially in
rural areas, where alcohol is perceived to figure in high violent crime rates.

Notes

1. Updated current population figures by Statistics South Africa, Census
1996 in Brief, Pretoria: Statistics South Africa, 1998.

2. Where not otherwise stated, the information is from the 1996 census.
Statistics South Africa, Census 1996 in Brief (see note 1).

3. Institute for Security Studies, "Comparing Crime in the Provinces:
Trends Since 1994," Nedbank ISS Crime Index 4 (2000): 7-14.

4. Institute for Security Studies, "A Battle Lost? Violent Crime Trends in
1999," Nedcor ISS Crime Index 4 (2000): 1-5.

5. Lee da Rocha-Silva, "The Nature and Extent of Drug Use and Related
Problems in South Africa: SARPA National Surveillance Project," Annual
Report, South African Researcher Practitioner Association (SARPA),
December 1997, available online at http://www.hsrc.ac.za/sarpa/
smain.htm.

6. In 1961, when South Africa became a republic, the constitution adopted
in 1910 remained in place. In 1983, white voters approved a new
constitution that created separate chambers in the legislature for Asians
and coloreds. In 1993, a year before the first universal voting in South
Africa, a majority rule interim constitution was approved. The current
constitution, approved in 1996, was written through a process of
consultation and guarantees a broad range of political, social, and
economic rights for all the peoples of South Africa. 

7. Drug Advisory Board, National Drug Master Plan. Pretoria: Department
of Welfare, 1999.

8. Omar, D., "The Drug Trade in Southern Africa." Paper presented at a
workshop organized by the South African Institute of International Affairs
on "The Illegal Drug Trade in Southern Africa," Johannesburg, June 5-6,
1997. 

9. Ibid.

10. Kibble, S., Drugs and Development in South Africa: How Europe
Could Help. London: Catholic Institute for International Relations, 1998.

11. Southern African Development Community, Protocol on Combating
Illicit Drug Trafficking in the Southern African Development Community
(SADC) Region, Gaborone: SADC, 1996.

12. Omar, D., "The Drug Trade in Southern Africa" (see note 8).

13. Southern African Development Community. SADC Regional Drug
Control Programme 1998-2002, Gaborone: SADC, 1998.

14. Southern African Development Community, Protocol on Combating
Illicit Drug Trafficking in the Southern African Development Community
(SADC) Region (see note 11), 7.

15. Drug Advisory Board, National Drug Master Plan (see note 7).

16. Ibid.

17. "Colored" now refers to a person of mixed white and African or Malay
descent. Historically, this group originated in unions between white men
and slave women or slave men and Khoikoi or Bushman women. Slaves
were from Madagascar, Malaysia, Sri Lanka, and India.

18. Statistics South Africa, Census 1996 in Brief (see note 1).

19. Ibid.

20. Ibid.

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

United States of America

Bruce Taylor

Bruce Taylor is the deputy director of the Arrestee Drug Abuse
Monitoring (ADAM) Program in the Office and Research and Evaluation
at the National Institute of Justice (NIJ).

I. Overview of Demographic Profile of Nation

The United States of America is a federal republic on the continent of
North America. It has an area of 9,629,047 square kilometers (3,717,796
square miles) and is the fourth largest country in the world after Russia,
Canada, and China. The United States consists of 48 contiguous States, the
noncontiguous States of Alaska and Hawaii, and the District of Columbia.
Dependent areas and territories include the Commonwealth of Puerto Rico
and the U.S. Virgin Islands in the Caribbean Sea, and the islands of
American Samoa and Guam and the Commonwealth of the Northern
Mariana Islands in the Pacific Ocean. Political power in the United States
is divided between a central governing authority and individual State
governments. The Federal Government consists of three branches:
executive, legislative, and judicial. Executive power is vested in the
President, who conducts the Nation's administrative business with the aid
of a Cabinet consisting mainly of the secretaries of the executive
departments. The Congress of the United States, the legislative branch, is
bicameral, consisting of a Senate and a House of Representatives. The
judicial branch comprises the Federal courts. The highest court in the land
is the nine-member Supreme Court, which also functions as the court of
last resort for the 50 State judiciary systems.

The U.S. population is approximately 281 million, which makes the
United States the third most populous country in the world, after China
and India (see exhibit 1 for demographic information). Its economy is by
far the world's largest, and it ranks sixth in the world in terms of human
development (see exhibit 2 for economic information).

Two main sources track victimization and crime in the United States:
official police records and research victimization surveys completed by a
sample of households. The Federal Bureau of Investigation's (FBI's)
Uniform Crime Reports (UCR) program collects information from local
law enforcement agencies about crimes reported to police. The UCR crime
index includes seven offenses: homicide, forcible rape, robbery,
aggravated assault, burglary, larceny/theft, and motor vehicle theft.
According to the UCR, the crime index rate fell for the seventh straight
year in 1998 and is down almost 14 percent from 1994's rate. Murder was
the least frequent violent victimization--there were about 6 murder victims
per 100,000 persons in 1998, a rate not seen since the late 1960s.[1]

The National Crime Victimization Survey (NCVS) interviews a nationally
representative sample of approximately 49,000 households (about 100,000
persons). In this survey, members of these households who are at least 12
years old are interviewed. The NCVS collects information on crimes
suffered by the individuals within those households, whether or not those
crimes were reported to law enforcement. Survey data tell how many
rapes, assaults, sexual assaults, robberies, thefts, household burglaries, and
motor vehicle thefts U.S. residents age 12 or older experience each year.
According to the NCVS, U.S. residents age 12 or older experienced
approximately 31.3 million crimes in 1998: 73 percent were property
crimes, 26 percent were crimes of violence, and 1 percent were personal
thefts. Serious violent crime levels decreased from a high of 4.2 million
violent victimizations in 1993 to 2.8 million violent victimizations in
1998. Property crime rates also fell, from 552 property victimizations per
1,000 households in 1974 to 217 per 1,000 in 1998.[2]

Self-reported national data on the prevalence of drug use are collected
from two main sources: the National Household Survey on Drug Abuse
(NHSDA) and the Monitoring the Future (MTF) study. The NHSDA is an
annual survey of a nationally representative sample of the civilian,
noninstitutionalized population of the United States age 12 and older;
25,500 persons were interviewed in 1998. This survey has been the
primary source for estimates of the prevalence and incidence of illicit
drug, alcohol, and tobacco use in the United States since the early 1970s.
According to the NHSDA, the fraction of today's U.S. population using
illicit drugs is well below the peak of the early 1980s. Initiation into the
use of illicit drugs rose through the late 1970s and into the early 1980s,
then began a sharp decline around 1983. First-time drug use started to rise
again in 1992, but in 1997, it was still well below the peak of the early
1980s. Although the number of people who continued using drugs may
have risen steadily into the mid-1980s, it almost certainly decreased after
1987. Since 1990, the percentage of the population using drugs has
remained essentially the same.[3]

According to the NHSDA, the number of current illicit drug users did not
change significantly from 1996 to 1997. In 1997, 6.4 percent (13.9 million
persons) of the population age 12 and older reported using an illicit drug
during the previous month, down from 14.1 percent (25.4 million persons)
in 1979. In 1997, an estimated 0.7 percent (1.5 million persons) of this
population group reported using cocaine at least once in the previous
month. Overall, the reported use of cocaine, including crack, has not
increased significantly since 1991. In 1997, the percentage of Americans
age 12 and older reporting the use of marijuana at least once in the
previous month was 5.1 percent (11.1 million persons), which was
statistically unchanged from 1996.[4]

The other main source of nationally representative drug use data is the
MTF study, an ongoing study of the behaviors, attitudes, and values of
American secondary school students, college students, and young adults.
Each year, approximately 50,000 8th-, 10th-, and 12th-grade students are
surveyed (12th graders have been surveyed since 1975, 8th and 10th
graders since 1991). In addition, annual followup questionnaires are
mailed to a sample of each graduating class for a number of years after
their initial participation. At each grade level, the students surveyed are
chosen to represent all public and private secondary school students
nationwide. Nearly 50,000 students in 422 public and private secondary
schools were surveyed in 1998. When this survey began in 1975, 30.7
percent of high school seniors surveyed reported that they had used some
type of illicit drug in the previous month. This figure declined gradually to
14.4 percent in 1992 but increased to 25.6 percent in 1998.
Previous-month drug use increased from 5.7 percent in 1991 to 12.1
percent in 1998 for 8th graders and from 11.6 percent in 1991 to 21.5
percent in 1998 for 10th graders.[5]

II. Description of Criminal Justice System, Arrest Process, and Detention
System

Origin of the U.S. Criminal Justice System

The U.S. criminal justice system is founded on the principles of English
common law and is based on a complex series of laws, procedures, and
decisionmaking processes. The system stems from the premise that crimes
against individuals are crimes against the state as well and are therefore
punishable through state prosecution. The United States does not have a
single criminal justice system; systems vary from State to State, county to
county, and city to city. All these systems are governed by the broad
principles of due process as defined by the U.S. Constitution and as
interpreted by U.S. Supreme Court rulings, but legislation and judicial
interpretation can vary from State to State.

Types of Offenses

Most offenses committed in the United States are under the jurisdiction of
State and local criminal justice systems. Laws are most commonly
enforced by cities, counties, and other local jurisdictions; the court
systems are most commonly directed by State governments with regional
or county jurisdictions; and corrections is primarily the responsibility of
county and State governments. Additionally, all but the smallest cities
engage in some type of corrections enterprise.[6]

Federal crimes (e.g., kidnaping or transportation of stolen goods across
State lines) account for only a small proportion of crimes in the United
States. For the most part, State and local authorities investigate and
respond to crimes. Of 1,901,773 justice system employees, 8.5 percent
(161,058) are Federal and 91.5 percent (1,740,715) are State and local.[7]

Offenses against the state are categorized according to seriousness. The
distinction between a felony and a misdemeanor is one of the oldest in the
criminal law. In general, a felony is distinguished from a misdemeanor by
the punishment that may be exacted for the crime. Conviction on a felony
charge usually means that a prison sentence of more than 1 year is
authorized. Punishments for felonies range from 1 year in prison to, in
some States, a sentence of death. Misdemeanors are usually dealt with
more leniently and in many cases do not carry a prison sentence. In
general, the maximum prison sentence for a misdemeanor is 1 year in
prison plus a fine.

Arrest Through Supervision

An offender's participation in the criminal justice system most often
begins when a victim or witness reports a crime to the police. Crimes are
also discovered by police officers in the field, through the use of
informants, and from investigations and intelligence.

Once it is determined that a crime has been committed, law enforcement
personnel will try to identify and apprehend the suspect. In cases in which
a suspect is identified, apprehended, and charged with a crime, the police
will work in conjunction with the prosecutor (representing the
government) to determine whether formal charges will be filed. When
charges are not filed, the accused is released.

If formal charges are filed, the suspect must be taken to court, where a
judge or magistrate will determine whether the police and the prosecutor
have obtained enough information or have "probable cause" to detain the
suspect. If there is insufficient information, then the charges will be
dropped. If the charges hold, the suspect will obtain or will be assigned
counsel to represent him or her throughout the remainder of the process.
(A defendant in a criminal case has the right to represent himself or
herself, but in the majority of such cases, an attorney will be assigned by
the court to help the defendant prepare his or her defense.) The suspect can
be released at this point to await his or her next court appearance.
Commonly, suspects are released on their own recognizance, to the
custody of a third party, or under conditions imposed by the court.

A preliminary hearing may follow the initial court appearance, depending
on the jurisdiction. This hearing is held to discover if there is probable
cause to believe that the accused committed the known crime. If the judge
does not determine probable cause, the case is dismissed. If there is a
finding of probable cause, the case will likely go to trial.

The first segment of the adjudication process is the arraignment. The
accused is formally charged with a specific criminal violation, advised of
his or her rights as a criminal defendant, and asked to enter a plea to the
charges against him or her. The defendant can plead guilty, not guilty, or
nolo contendere (accepting the penalty without admitting guilt). The judge
can either accept or reject the plea. A judge may choose to reject a guilty
plea if he or she believes the defendant was coerced or did not understand
the consequences of the plea bargain.

If the accused pleads not guilty, the case proceeds to trial. At trial, the
prosecution and the defense present their evidence to the judge or a jury of
the defendant's peers. Defendants accused of serious crimes have a right to
a trial by jury (as do all criminal defendants in Federal court), but even in
these cases, the defendant can waive that right in favor of having the judge
determine the outcome. The trial will result in a finding that the defendant
is guilty or not guilty. If the defendant is found not guilty, he or she is
acquitted of all charges and released immediately. If convicted, the
defendant is sentenced. Once convicted, a defendant has the right to appeal
the conviction. Appeals, however, are often rejected if there is insufficient
evidence to show that the offender did not receive a fair trial. In certain
cases, such as those in which the death penalty is imposed, the right to
appeal is automatic.

The judge most often determines the sentence, but in many States a jury
may hand down the sentence at a separate hearing. Sometimes the same
jury is used, and in some cases a new panel is convened for sentencing
purposes.

Common sentences include fines, restitution, probation, and incarceration.
Alternatives to traditional sentencing are often less restrictive than
incarceration but are designed to provide more supervision, and are more
punitive, than regular probation. In some jurisdictions, the law mandates
specific sanctions for certain types of offenses. For example, many States
have imposed mandatory sentences for drug offenders.

III. Status of National Drug Policy

The Federal Government plays a significant role in developing drug
control policy. On behalf of the President, the Office of National Drug
Control Policy (ONDCP) and disseminates broad national policies and
strategies designed to affect drug use on a national scale. Additionally, the
Federal Government is actively involved in enforcing Federal drug laws
through several of its Federal law enforcement agencies, principally the
Drug Enforcement Administration, the Federal Bureau of Investigation,
and the U.S. Customs Service. The Department of Transportation, through
the U.S. Coast Guard, and, to a lesser extent, the Department of Defense
are also actively involved in the Nation's counter-drug efforts. Offenders
who violate Federal laws are prosecuted in the Federal court system.

In addition to Federal criminal and regulatory law concerning the
transportation, sale, possession, and use of drugs, each of the 50 States has
enacted its own criminal laws on this subject. State law enforcement
agencies enforce these laws under the direction of the Governor, often
through a State attorney general. In many cases, Federal and State law
enforcement agencies work together to combine investigative and
enforcement resources. In some areas of the country, these joint efforts
have been systematized into formalized agreements. Offenders who
violate State laws are prosecuted by the respective State court system.

In some instances, both Federal and State drug laws apply to individual
violations. In such cases, Federal and State prosecutorial authorities often
coordinate with each other as to which level of government will initiate
the prosecution of the offender. The caseload of the State and Federal
courts and the likely punishment are often determining factors as to who
will take the lead.

Federal Responsibilities for Drug Control Policy

The central coordinating agency for U.S. national drug policy is the
ONDCP. The Director of ONDCP is a presidential appointee who is
confirmed by the U.S. Senate and serves on the President's Drug Policy
Council and National Security Council for drug-related issues. Since the
late 1980s, ONDCP has been mandated to coordinate Federal efforts to
reduce the use of illegal drugs in the United States. The Anti-Drug Abuse
Act of 1988, which established ONDCP, requires the Office to develop an
annual strategy for reducing illegal drug use and to incorporate goals and
measurable objectives for monitoring its progress. In early 1992, underage
alcohol use was included among the drugs to be addressed by ONDCP.
The Act mandates ONDCP to develop an annual National Drug Control
Strategy; a consolidated National Drug Control Budget; and guidelines for
cooperation among Federal, State, and local drug control entities. The Act
further requires the Director of ONDCP to evaluate, coordinate, and
oversee the international and domestic antidrug efforts of executive branch
agencies and to ensure that those efforts sustain and complement State and
local antidrug activities. The ONDCP Director advises the President
regarding changes in the organization, management, budgeting, and
personnel of Federal agencies that could affect the Nation's antidrug
efforts.[9]

The Violent Crime Control and Law Enforcement Act of 1994 and the
Reauthorization Act of 1998 extended ONDCP's mission to include
budget and resource powers related to formulating and implementing the
President's National Drug Control Strategy, and established new reporting
requirements for ONDCP. This new authority gives ONDCP influence
over agency budgets to ensure they carry out the priorities, goals, and
objectives of the Strategy. ONDCP's reporting requirements under the
Crime Control Act include assessing the following areas: prevalence of
drug use, reduction in drug availability, and reduced consequences of
illicit drug use and availability.[10]

The National Drug Control Strategy is designed to reduce illicit drug use
and its consequences, building on five goals first proposed as part of the
1996 National Drug Control Strategy:[11]

 o Goal 1: Educate and enable America's youth to reject illegal drugs,
alcohol, and tobacco.

 o Goal 2: Increase the safety of America's citizens by substantially
reducing drug-related crime and violence.

 o Goal 3: Reduce the health and social costs to the public of illegal drug
use.

 o Goal 4: Shield America's air, land, and sea frontiers from the drug
threat.

 o Goal 5: Break foreign and domestic drug sources of supply.

The Strategy is intended to prevent and deter first-time use among children
and youth, prevent casual users from becoming addicts, remove violent
criminals from the streets, dismantle drug networks in the United States
and abroad, provide treatment to drug abusers, and reduce the supply of
illicit drugs entering the United States. To assess the effectiveness of this
strategy, ONDCP has instituted a National Performance Measures of
Effectiveness system. This system provides feedback for refining antidrug
strategy and allocating resources to antidrug efforts.

IV. Background History of the ADAM Program

The history of the Arrested Drug Abuse Monitoring (ADAM) program can
be traced back to the 1980s. In 1984, the National Institute of Justice (NIJ)
funded arrested pilot studies in Washington, D.C., and Manhattan to assess
the utility of pretrial drug testing and the feasibility and effectiveness of
assessing pretrial risk. Together, these two projects involved data
collection on 14,000 arrestees.[12] In both studies, urinalysis revealed that
more than half of those tested were positive for drugs.[13] This level was
far higher than other estimates in 1984 suggested.[14] The results of this
pilot work also challenged the validity of self-reported information on
drug use and confirmed the usefulness of drug testing for arrestees. More
than half of those who tested positive for illicit drug use by urinalysis
failed to admit using drugs during a face-to-face research interview.[15]
NIJ funded a followup study in Manhattan in 1986 that revealed that
cocaine use was rising rapidly; double the percentage of people who tested
positive for cocaine in 1984 (42 percent) tested positive in 1986 (83
percent).[16] Had self-reports been relied on exclusively, this increase
might never have been detected; the proportion who admitted to ever
having used cocaine was about the same for both years.[17]

The high levels of cocaine use detected in these two pilot cities and the
steep increase in use over a short period of time (1984-86) raised the
question of whether the trend might be an anomaly of these two large East
Coast cities. To gauge drug use among arrestees in other urban areas, NIJ,
with co-funding from the Bureau of Justice Assistance (BJA), created the
Drug Use Forecasting (DUF) program in 1987.

DUF initially collected data in only eight large cities. Adult male arrestees
were interviewed in all eight locations and adult female arrestees were
interviewed in five locations. In 1988, DUF expanded to include juvenile
arrestees in five DUF sites, and a separate interview instrument for
juveniles was created. In 1989, the DUF program established 14 new adult
male interview sites for a total of 22 sites. The following year (1990), the
program expanded to include 21 female sites and 11 juvenile sites. Also in
1990, a special addendum designed to track the spread of "Ice"
(methamphetamines) from Hawaii was fielded in the DUF sites. During
1992 and 1993, DUF operations and funding were consolidated within
NIJ, and in 1994, DUF moved into NIJ's Office of Research and
Evaluation (ORE).

In spring 1995, NIJ proposed the development of the ADAM program.
The ADAM program preserves many of DUF's features but includes a call
to do the following:

 o Expand operations to 75 sites.

 o Redesign the data collection and sampling methodology to provide
policymakers and practitioners with a rigorous basis from which to assess
local arrested drug use and crime patterns.

 o Establish an outreach program through which ADAM will monitor the
leading and trailing edges of drug problems in targeted populations, such
as suburban, rural, or Indian Nation populations.

 o Develop local coordinating councils that will generate research
addenda, guide the selection of outreach sites, and disseminate each site's
findings.

At its core, however, ADAM preserves DUF's simple concept:
interviewing and drug-testing arrestees. Between 1995 and 1997, the DUF
program carried out a number of projects, including the following:

 o Revising the main interview instrument.

 o Developing a Spanish version of the interview instrument.

 o Piloting TELEDUF (an automated version of the DUF instrument).

 o Developing and fielding the Gun Addendum.

 o Conducting a special study (in collaboration with ONDCP) on
cocaine/crack and heroin drug markets and drug procurement patterns in
six DUF sites.

 o Studying methamphetamine markets in five western DUF sites.

In 1997, the President included ADAM in the Administration's 1998
budget request to Congress and the formal transformation of DUF into
ADAM began. In that year, ADAM began to develop a sampling protocol,
review interview instruments, and develop a process for selecting new
ADAM sites.

In 1998, 12 new sites were added to the ADAM program for a total of 35
sites (see exhibit 3). During 1998 and 1999, the new ADAM instrument
was developed and tested from several perspectives: cognitive testing,
experiments on diagnostic validity, and field tests of the interview
package.

Other ADAM projects completed during 1998 and 1999 include--

 o An analysis of the impact of specimen handling and storage procedures
on test results.

 o An assessment of opiate testing that confirmed its ability to differentiate
heroin use from the use of medications containing opiate compounds.

 o Tests for metabolites and markers that indicate crack as well as general
cocaine use.

Also during this period, ADAM hosted a series of meetings on publication
and communication approaches with local, regional, and national
representatives. Finally, this period marked the release of four
drug-specific reports that moved away from the community level to assess
regional, subgroup, and other issues evident in the trend data.

In 2000, NIJ began to incorporate two new elements that significantly
strengthen the value of the data collected. First, ADAM introduced a new
sampling strategy that provides representative samples at the county level
for each site. Second, the new ADAM instrument was implemented.
Pending congressional approval, ADAM is expected to begin enrolling 15
new sites in fiscal year (FY) 2002 and 25 new sites in FY 2003 for a total
of 75 sites. When fully funded at 75 sites, ADAM will include the largest
U.S. cities with populations of 200,000 or more and the largest city in each
State where no city has a population greater than 200,000. By collecting
drug use data in these sites nationwide, the program will cover more than
40 States, represent more than 20 percent of the U.S. population, and
encompass an offender base that is responsible for more than 45 percent of
the UCR Part 1 crimes. At full projected size, interviews will be
administered to more than 75,000 adult males, 30,000 adult females, and
45,000 juveniles.

V. Goals and Objectives of ADAM

Although the goals of the ADAM program are not formally stated, some
of its broad aims can be identified. The ADAM program is an information
system on drugs, crime, and related social/public health issues that can be
used to meet the following five goals:

1. Provide insights into the link between drugs and crime. By sampling
arrestees, the ADAM program can assess the extent to which those
involved in criminal activity consume illicit drugs. ADAM data can help
enhance understanding of the drug use patterns of actual or potential
offenders, the extent to which offenders commit crime to fund drug
misuse, and the extent to which these drug-misusing offenders inflate the
total number of crimes committed.

2. Monitor the prevalence of hardcore drug use. Research addressing the
prevalence of drug use typically does not include those in jail or prison
and, therefore, may underestimate levels of drug use in the United States.
ADAM is one of several drug indication systems that operate in the U.S.
(e.g., National Household Survey on Drug Abuse, Monitoring the Future,
Drug Abuse Warning Network). Monitoring drug use among criminal
suspects is important not only because of the links between drug use and
crime but also because arrestees are likelier than household members and
schoolchildren to be heavily drug involved. ADAM contributes to research
on the prevalence of drug use by sampling persons who are not sampled
by other drug surveys. By focusing on a hardcore population such as
arrestees, NIJ can provide estimates of low-base-rate drugs, such as heroin,
that are not typically used in the general population. As an ongoing
surveillance system, ADAM can monitor changes in drug use over time
and compare rates of use across U.S. sites and regions.

3. Assess the dimensions of particular local substance abuse problems at
the county level. ADAM is one of the few ongoing drug surveillance
systems that provides local estimates of drug use. The vast majority of the
crimes committed in the United States fall under the jurisdiction of county
or city governments. National, and even regional, drug surveillance
statistics tend not to be useful for local policymakers. ADAM responds to
the needs of local law enforcement, judicial, and government entities by
providing data that is representative of their local areas. The ADAM
program has been useful in illustrating local variations in drug use (e.g.,
methamphetamine use is much more prevalent in many of the western
ADAM sites than in East Coast sites).

4. Evaluate, in a low-cost manner, programs and interventions that serve or
target criminally active populations. The ADAM program offers a rare
opportunity to collect primary data without absorbing the basic operational
costs already funded by ADAM. The ADAM data can be used as a source
of preintervention data for a before-and-after design. For example,
Birmingham, Alabama's Breaking the Cycle (BTC) program is being
evaluated through a quasi-experimental design in which the control group
is made up of ADAM arrestees selected before the implementation of
BTC. Other programs can be evaluated with the ADAM platform. For
example, ADAM could be useful for evaluating jail-based programs
designed for arrestees, pretrial diversion programs, communitywide
initiatives, public awareness campaigns for drugs, and specialized criminal
courts. Rigorous experimental evaluations can be integrated into the basic
ADAM platform. At the Sacramento, California, ADAM site, an
experimental evaluation is being conducted on a treatment program for
detained domestic violence arrestees.

5. Provide the necessary data for policy responses appropriate for the
arrested population. The ADAM program provides useful drug
epidemiological data for many components of Federal, State and local
governments that are tackling the problem of drug abuse. Law
enforcement, treatment providers, prevention specialists, and other service
providers can use ADAM data to assess the impact of their interventions.
For example, the congressionally created Methamphetamine Interagency
Task Force, co-chaired by the Attorney General and the ONDCP Director,
collected information on and proposed strategies to address the growing
methamphetamine problem in the United States. ADAM data have been
used to support the work of this task force and provide data for the
Attorney General to launch a variety of initiatives.

VI. Getting Started

A. Obtaining Funding

The ADAM program is based in the NIJ's Office of Research and
Evaluation (ORE). NIJ is based within the U.S. Department of Justice's
Office of Justice Programs (OJP). The original funding for the former
DUF program was supported by base funds from NIJ's general research
budget. In 1998, NIJ received a congressional appropriation to increase
ADAM from 23 to 35 sites. Along with a base budget of $2.3 million,
ADAM received $4.4 million for a total FY 1998 budget of $6.7 million.
This $6.7 million budget remained basically the same in FYs 1999, 2000,
and 2001.

ADAM has been designated for expansion to 50 sites in FY 2002 and 75
sites in FY 2003. To obtain the funds needed for expansion, NIJ has
assembled a budget proposal that must be approved by officials within
OJP, the U.S. Department of Justice, the Office of Management and
Budget (OMB), the President, the Senate, and the House of
Representatives. Each of these "budget hurdles" requires the careful
documentation of past accomplishments and future potential of the ADAM
program.

Additional funding for new ADAM sites could come from other Federal
sources. In the past, the Centers for Substance Abuse Treatment (CSAT)
has funded a number of State data collection programs similar to ADAM.
Also, the ADAM program has recently started an ADAM affiliate
program. ADAM-affiliated sites operate like other ADAM sites, using all
NIJ/ADAM protocols, instruments, and training materials; receiving
technical assistance from NIJ/ADAM staff as well as contractor staff; and
accessing data from the other ADAM sites. Most of the funding for the
ADAM-affiliated sites will not come from NIJ. Funding for these sites
may come from State or other Federal sources (e.g., the Federal Byrne
grant program). The first ADAM-affiliated site was Albany, New York.
Other sites have opened in Charlotte, North Carolina; Kansas City,
Missouri; and Tulsa, Oklahoma.

B. Contracting for Data Collection

The ADAM program has four main administrative components: NIJ's
internal ADAM program staff (including the ADAM Director), a national
data collection contractor (currently Abt Associates Inc.), a laboratory
contractor for urinalysis testing (currently PharmChem), and 35 local data
collection teams.

NIJ's internal staff

NIJ's internal staff manage the ADAM program, oversee the work of
contractors, conduct intramural research, work on ADAM developmental
projects (e.g., new survey instruments and using ADAM as an evaluation
platform), establish and maintain partnerships with other governmental
agencies, and promote the use of ADAM data to a variety of
constituencies.

National data collection contractor

The contractor was selected through a competitive solicitation process and
is responsible for data collection, consistency, integrity, and management.
The contractor collaborates with NIJ on the design and management of
ADAM data collection and processing. The current data collection
contract is for 4 years and covers responsibilities in the following task
areas:

1. Managing all 35 ADAM sites. 

 o Identify potential sites.

 o Assess readiness to collect data.

 o Staff all sites through subcontracts with local data collectors (e.g.,
university data collection teams).

 o Train all site personnel.

 o Monitor sites for adherence to specified procedures, collection
deadlines, data integrity, expenditures, and staff performance.

2. Specific data collection procedures.

 o Subcontract with local data collectors to carry out data collection

 o Ensure that local data collectors properly identify potential research
participants, secure participants' informed consent, conduct interviews
with appropriate surveys, and collect urine specimens according to
specified procedures.

3. Maintaining and organizing data.

 o Edit and enter data into database.

 o Process the ADAM urine specimen data.

 o Maintain ADAM data files.

4. Analyzing data.

 o Prepare the ADAM data findings for semiannual/annual reports, special
topic monographs, and proposed specialized research studies/analyses.

 o Conduct NIJ-approved studies.

Drug testing laboratory contract

This contract provides for urinalysis testing for all 35 sites, a flexible drug
testing program that responds to changing substance abuse trends, and a
U.S. Department of Health and Human Services (HHS)-certified
laboratory partner that has been tasked with keeping NIJ apprised of
changing drug technologies and their relevance to ADAM's policy-related
research. The current laboratory contract is for 4 years and covers the
following task areas:

 o Supply sites with necessary materials (cups, bar coded labels, protective
gloves, shipping cartons and materials, mailing labels, etc.).

 o Develop and update a specimen handling procedures manual and
training plan.

 o Analyze urine specimens according to flexible 10-drug panels.

 o Maintain routine communications with the data collection contractor
and NIJ on data reporting discrepancies.

 o Report the results of the drug tests to the data collection contractor and
all 35 sites.

 o Assist NIJ with special requests to support special research projects
(including providing the expertise of a Ph.D. chemist who writes brief
technical papers that explain or analyze drug testing).

 o Ensure proper quality-control systems to provide valid and reliable
urinalysis testing.

Local data collection teams

Each of the 35 ADAM sites have local teams of interviewers and
managers that have been hired through subcontracts with the national data
collection contractor. Many of these data collection teams come from local
universities and research firms. The key personnel that make up the local
data collection teams include a site director, a site coordinator,
interviewers, and security officers. Their roles are outlined in the ADAM
training manual and are briefly reviewed below.

The site director has direct responsibility for all site work, and negotiates
and executes the subcontract with the national data collection contractor,
establishes and maintains contact with the booking (jail) facilities, hires
and maintains adequate staff for project performance, oversees data
collection and monitors site adherence to national data collection
standards, coordinates and communicates with the national data collection
contractor and NIJ on implementing changes to ADAM protocols,
oversees proper invoicing and fiscal monitoring of the site budget, and
works with the local coordinating council.

The site coordinator has day-to-day operating responsibility for collecting
data. This includes scheduling data collection, obtaining supplies,
preparing questionnaire materials, training and supervising interviewers,
editing data, coordinating the activities of the security officer, packaging
and shipping questionnaires and specimens, and filling out all of the
necessary log and transmittal sheets on completion of data collection.
Although some of these tasks may be delegated to others (e.g.,
interviewers may help prepare questionnaire materials), the coordinator
has operational responsibility for and firsthand knowledge of the data
collection process. Some sites require more than one site coordinator.

Interviewers conduct the interviews in a manner that is consistent with the
procedures and maintain scientific standards of accuracy and objectivity.
Security officers move the arrestees to and from the interviewing area
while not discussing the nature and scope of the study. In some sites, a
detention facility guard, reserve deputy sheriff, or private security officer
is used.

C. Facility Access

Without facility access, there would be no ADAM program. Each U.S.
ADAM site voluntarily joined the program through competitive
solicitation to NIJ. NIJ funds all elements of data collection, including the
cost of officers who provide security for the interviewers. Typically, NIJ,
contractor, and local data collection staff have worked together to get the
necessary approvals from local government officials for access to specific
local facilities. Although the Federal Government does not have the right
to mandate participation, NIJ can set the rules for participation in the
ADAM program.

To be an ADAM site, each participating jurisdiction and system of
facilities needs to be able to--

 o Ensure that interviewers have access to all of the facilities necessary to
obtain a sample of arrestees from the total arrested population that
corresponds with the population of interest to the ADAM program.

 o Ensure that site staff have access to information at the time of each
interview period that describes the total arrested population so that
appropriate arrestees can be selected for interviewing and appropriate
statistical adjustments, such as sample weighting, can be accomplished.

 o Ensure that the interview staff have access to interview rooms where
they can conduct confidential and anonymous interviews and to toilets for
collecting urine specimens.

 o Make booking data available to ADAM site staff so that an
informational cover sheet can be completed prior to the interview.

 o Provide arrestees for interviewing within 48 hours of arrest.

The participating facilities are told that they will need to provide this level
of access four times per year for approximately 2-week intervals for data
collection.

D. Knowing the Catchment Area

To interpret ADAM data, analysts need to understand the population from
which the ADAM sample has been drawn. One criticism of DUF was the
lack of standardization across the sites and the lack of a consistent
catchment area unit. Some sites used city borders and others used county
borders to define their samples. The larger county area often drew more
nonurban arrestees than if the catchment area had been the city. Without
this common unit, comparisons across sites may be difficult or, in some
cases, impossible. Another problem with some of the earlier DUF sites
was a lack of understanding of the catchment area parameters. In
designing the new ADAM sampling scheme, it became apparent that jails
that were believed to have arrestees from only one county drew from
surrounding counties as well. In these cases, DUF produced city- or
county-level estimates that were partially confounded by cases from
nonparticipating jurisdictions.

To address this issue, the ADAM program intensively examined the flow
of arrestees from the participating counties to ensure that a representative
sample of the designated county was drawn. For ADAM to succeed,
evaluators need to understand how and when arrestees arrive at the jails
and how these factors affect or limit the ability to conduct interviews. Are
arrestees held in precinct houses or other facilities prior to booking? When
do arrestees make their first court appearance or make bond? The answers
to these questions can affect the timing or location of the interview.

A key element of ADAM is that it standardizes data collection at the
county level.[18] Therefore, although most ADAM sites are referred to by
the name of the largest city in the area, the catchment area of most sites is
substantially larger than the named city. Using the county as the ADAM
catchment area offers a number of advantages. First, in many counties, the
largest city operates its own jail, and the county sheriff operates a jail for
the smaller cities and towns in the county. Often, then, it is relatively
simple to expand data collection to the county level. Second, county
populations often differ from city populations along such demographic
lines as employment, socioeconomic status, and ethnicity. Therefore,
county-level data can produce a more mixed population than city-level
data can. Finally, counties are easier geopolitical boundaries to track,
particularly with respect to the processing of arrestees. The population in
city jails tends to change not only because of annexations and population
growth but also because cities may start and stop jailing service contracts
with smaller surrounding municipalities depending on jail capacity and
other factors. County boundaries tend to be more fixed, with little
movement of arrestees across county borders. Thus, counties are an easier
unit of analysis to monitor over time.

The change from DUF to ADAM has occurred incrementally at many
sites. Catchment areas were gradually expanded to the county level during
1998. Therefore, for sites that were not previously operating at the county
level, the catchment area may have changed during the 1998 data
collection year. In certain complicated sites with multiple jails, sites
gradually increased the number of facilities where they collected data as
they added interview staff and gained access to additional jails.

E. Drug Testing Issues

As discussed in the Research Methods section of this chapter, drug testing
is a key element of the ADAM program because it reveals with a high
degree of certainty whether a person has used drugs within 48 hours of
testing. During the course of operating the ADAM program, it has been
periodically necessary to change laboratory firms that test the urine
specimens because Government regulations require rebidding contracts.
As a result, the program has had four drug-testing laboratories in the past
decade. The most recent change occurred in 1998 when the laboratory
services contract was again rebid. In addition, program data collection
procedures have changed substantially over time. Through mid-1998,
specimens were not shipped for analysis until the end of the 2-week data
collection period. There was substantial concern that this delay in shipping
could lead to the degradation and decay of urine specimens, resulting in
skewed test results. Beginning with the laboratory services contract
awarded in 1998, data collection staff were required to send specimens to
the laboratory daily or every other day.

NIJ staff undertook a research exercise during the most recent change in
laboratory service providers.[19] The goal of the project was to determine
the consistency of the urinalysis results when the same urine specimens
were analyzed by two independent laboratories (the new and the old
laboratory). A total of 931 specimens were collected from four locations
and four demographic groups (adult males, adult females, juvenile males,
and juvenile females). The samples were analyzed first by the incumbent
laboratory and then by a new laboratory using the EMITTM (enzyme
multiplied immunoassay testing) screening assay to test for the presence of
the 10 common drugs with the same cutoff levels. The experimental
results revealed that the concordance rate was approximately 97.4 percent.
The highest concordance rates (100 percent) occurred for methadone,
methaqualone, and phencyclidine (PCP).

F. Instrument Issues

The original DUF survey included only basic demographic and drug use
questions, because the main focus of DUF was on the urinalysis results.
As discussed in the Research Methods section of this chapter, the new
ADAM survey includes a wider array of questions than the old DUF
survey. There are still a number of inherent limitations in the ADAM data
collection environment. First, many things that we would like to know
about the arrested population cannot be addressed in this survey. Interview
time is limited and certain types of questions cannot be asked in a setting
in which extensive development of rapport is not possible. A long and
unmanageable survey with many threatening questions will not work in
this environment. The process of selecting a limited number of topical
areas for the survey included consultation with a variety of policymakers
and drug policy researchers. The ultimate product includes a variety of
questions that are important to meet the monitoring needs of policymakers
and assist researchers in modeling the dynamics of drug use.

Cultural applicability

The United States is often referred to as the "great melting pot" of
different ethnic groups. This mixture of ethnic groups can present a serious
challenge to researchers interested in collecting standardized data across
35 different cities. There are often fairly substantial cultural differences
among the types of participants that can be found in these 35 sites. A
substantial proportion of ADAM participants in the Hawaii site is of
Pacific Island descent, and in Los Angeles the largest group of male
arrestees is Hispanic. The Pacific Islanders have a very different culture
from the Hispanic arrestees.

A variety of assumptions are often embedded within surveys. These
assumptions can be based on a set of unfamiliar norms that members of
minority groups may not understand. To the extent that members do not
understand the ADAM survey, the problem of measurement error is
introduced. Therefore, when designing the ADAM survey, careful
attention was paid to making sure that it applied to the widest group
possible. In some cases, non-English versions of the ADAM survey were
developed (currently a Spanish-language version of the ADAM survey is
in place). In other cases, extensive pretest consultation was undertaken
with members of these minority groups to make sure that the nuances of
the ADAM survey would be understood. ADAM staff will continue to
monitor and assess the issue of cultural applicability. In some cases, these
issues can be addressed through training and related protocols; in other
cases, specialized studies will need to be conducted to accurately measure
the drug use of these other groups.

Standardization versus local utility

Related to the issue of cultural applicability is maintaining ADAM as a
useful local research platform. To the extent that ADAM cannot accurately
measure the drug use of local ethnic groups, its local utility is diminished.
To allow for cross-site comparisons, ADAM has instituted training
procedures and related protocols to ensure that each site collects and
measures the same data. The core ADAM survey ensures that sites can be
compared across a number of key variables. Through the ADAM
addendum program, however, each site is given the opportunity to collect
supplementary data outside the core areas. For more than a decade, a
number of sites have been collecting data on gun use. Other topical areas
for addenda that sites have used include gangs, domestic violence, human
immunodeficiency virus (HIV), drug markets, specific drugs, and
gambling. As a participant in the International Arrestee Drug Abuse
Monitoring (I-ADAM) program, the U.S. ADAM program has agreed to
collect a smaller subset of core questions to allow for international
comparisons.

VII. Barriers to Developing ADAM

One key issue that NIJ has had to contend with in running its drug
monitoring program is revising the former DUF program into ADAM.
Building on an established program like DUF has many advantages over
creating an entirely new program. Many policymakers and other
stakeholders were already familiar with the concept of monitoring the drug
use patterns of arrestees. The ADAM program did not need to "sell"
people on the importance of the arrested population as an interesting
hardcore population worthy of monitoring; DUF had already done that. A
number of practices and conventions, however, that had developed over
the years with the former DUF program needed to be reformed.

In 1993, the General Accounting Office (GAO) reviewed the major
national drug data collection programs (including the former DUF
program).[20] GAO's report heavily criticized the sampling methodology
of
the former DUF program. The problems detailed in the report were major
barriers that NIJ had to address. As a response to this report, NIJ
reengineered DUF into ADAM.

Although heavily criticized by researchers, the non-probability-based
sampling scheme of the DUF program was accepted by many stakeholders
at the site level. The rationale for changing to a more representative
sampling scheme did not always translate well. The new sampling method
sometimes required access to additional jail sites, additional floors or
locations within the existing jails, or additional time shifts. These new
access issues could be difficult to accommodate at jails where the primary
concern was detaining persons suspected of committing crimes. The
ADAM program staff and site staff have had to work to convince all of the
involved parties of the necessity of the new scheme and why it is worth
the extra trouble.

VIII. National Stakeholders Involved in the Development of ADAM

The U.S. ADAM program is based within NIJ, which is the research arm
for the U.S. Department of Justice. Within DOJ, NIJ is part of the Office
of Justice Programs, which is headed by an Assistant Attorney
General.[21] A number of DOJ components are key users of ADAM data,
including the Attorney General, the Drug Enforcement Administration,
and the Federal Bureau of Investigation. These Justice components have
used ADAM data to help allocate resources to drug enforcement and
identify drug hot spots.

The ADAM program has developed partnerships with other Federal
agencies. NIJ has been working with CSAT to estimate the need for
treatment among the arrested population. NIJ has partnered with the
Centers for Disease Control and Prevention (CDC) to develop an HIV
addendum instrument for use with ADAM arrestees. The addendum
focuses on risk behaviors for HIV, sexually transmitted diseases (STDs),
hepatitis, and tuberculosis. It includes items measuring unprotected sex
and needle sharing, history of HIV testing, and exposure to HIV
prevention messages. The HIV addendum was piloted in Miami in
December 1999 and three other ADAM sites were designated as data
collection sites in 2000. Finally, ADAM works closely with ONDCP on
coordinating the interests of NIJ with those of other Federal agencies
involved in drug control policy. In 1997, ONDCP helped provide bridge
funding for ADAM's expansion from 23 to 35 sites. ONDCP has
sponsored a number of joint ADAM-related projects with NIJ, including a
study of drug markets[22] and the price elasticity of demand and supply
for illicit drugs (grant 99-IJ-CX-K004).

These organizations and others have been important in the development of
the ADAM program. In particular, these groups supported budget
authority and congressional approval for the expansion of the ADAM sites
to 35. Support from the highest levels of these groups and from the Office
of Management and Budget (OMB) will continue to be important for the
ADAM program as it plans to expand to 75 sites.

IX. Research Methods

The ADAM program has two fundamental components. The first is a
questionnaire administered by a trained interviewer to an arrested in a
booking facility within 48 hours of arrest. The second is a urine specimen
collected from the respondent that is used to corroborate claims about
recent drug use. Together, these two techniques provide a powerful
research platform.

The Survey

Trained interviewers administer the ADAM questionnaire to arrestees in
booking facilities within 48 hours of arrest. Interviews with arrestees are
conducted in the jails of 35 participating counties. Information is obtained
from respondents with the assurance that it will be kept confidential and
will not be used to influence the outcome of their arrest. An informed
consent statement is read to all the participants requesting their voluntary
participation in an interview and informing them that a urine specimen
will be taken. The interviews are conducted by trained personnel over the
course of approximately 14 consecutive days.

In 1999, the program began redesigning and testing a new ADAM survey
that would focus more specifically on issues of interest to policymakers
and practitioners. In FY 2000, the new instrument will allow researchers to
estimate the proportion and number of arrestees who use a variety of
illegal drugs, estimate the need for treatment and dependence on
substances in the arrested population, describe drug markets in an area
over time, and establish links to other datasets (such as the National
Household Survey on Drug Abuse and the Treatment Episode Data Set) to
facilitate development of more comprehensive and integrated national
estimates of drug use. Another innovative element of the new ADAM
instrument is its use of a "calendar" or "life events" method of collecting
data. The calendar method is designed to collect data using a visual cue (a
calendar) to better characterize complex behaviors or events and to
increase the accuracy of recall. With the new instrument, each face-to-face
interview will last approximately 25 minutes (twice as long as the former
DUF instrument). A more detailed discussion of the ADAM instrument
can be found in the 1998 Annual Report on Drug Use Among Adult and
Juvenile Arrestees.[23]

The Drug Test

Drug testing is an important component of the ADAM program because it
reveals, with a high degree of certainty, whether a person has used drugs
recently. ADAM is the only national drug research program in the United
States that utilizes drug testing. The ADAM program uses the EMIT
system to screen for the presence of drugs in urine. The EMIT system
provides an inexpensive, yet reliable, drug testing method for screening for
a wide variety of drugs. EMIT is highly accurate, with low false-positive
rates.[24] Moreover, EMIT has been extensively studied so that
cross-reactivity (the sensitivity of the test to drugs that are not actually
being tested for) is well documented. The ADAM program uses
confirmation testing methods only where the EMIT screening method
cannot sufficiently differentiate among drugs that are of interest for policy
purposes. For example, policymakers as well as researchers and
practitioners have an interest in distinguishing between methamphetamine
and amphetamine use. EMIT is specific only to amphetamines as a class of
drugs. To determine whether methamphetamine was used, the ADAM
program conducts confirmatory testing on specimens that screen positive
for amphetamines.

Sampling

Data are collected from male and female arrestees in 35 jurisdictions in the
United States. Respondents represent offenders arrested from all crime
categories, including property crimes, drug crimes, and violent crimes.
The ADAM program introduced a new sampling strategy in 2000 that
provides representative samples at the county level and greater ability to
make site-to-site comparisons. The DUF program collected data using
nonprobability sampling.[25] ADAM's redesigned sampling methodology
allows policymakers and planners to generalize ADAM data to all arrest
and booking activity that occurs in the catchment area. Use of probability
samples provides policymakers with more accurate ADAM estimates and
allows them to quantify the uncertainty associated with those estimates. In
addition, local policymakers will be able not only to report the proportion
of arrestees testing positive for illegal drugs in their counties, but to
estimate the number of arrestees who would test positive, which is a
powerful tool for resource allocation and planning.

The goal set in establishing sample sizes across sites was to provide an
adequate number of cases to each site so that all sites would have a similar
level of precision in estimating the proportion of arrestees who test
positive for a drug. Cases are sampled with known probability of selection
within each 24-hour period (to capture types of cases over the entire day)
and on each day of the week (to capture variation in types of cases over
different days). Simple sites with a single facility in the catchment area
can thus collect a random sample of arrestees, determine the proportion
with the characteristic of interest (e.g., dependency for drugs), and, using
data on the total number of arrests in the target area for the data collection
period, estimate the number of arrestees with that characteristic. The
sampling problem is little more complicated in sites with just a few jails.
Site staff would sample arrestees from every jail, developing
proportionately more cases in large jails than in small jails. In the case of a
few jails, the standard error associated with a given sample size would be
about the same as in places with a single jail. Sites with many booking
facilities, however, have a more complex problem. To capture variation in
arrestees across facilities requires that all sites be represented and adequate
numbers of cases (representing times and days as discussed earlier) be
collected. For sites with many facilities, this requires clustering or
grouping them in some logical fashion. This clustering of facilities reduces
the precision of the estimates and necessitates collecting a larger sample.
In both the simple and complex sites, the overall number of cases is
determined in part by the volume of arrest activity. Sites with fewer annual
arrests but numerous facilities may collect a larger proportion of their total
flow than large, high-volume sites.

The Data Collection Process

Sites collect data on specific populations (adult males, adult females,
juveniles) for 2 weeks, four times a year. Data collection is done quarterly
for several reasons. First, quarterly data collection helps the program
maintain access to jail facilities. Quarterly collection is frequent enough
that jail facility staff become familiar with program operations but not so
frequent that data collection becomes intrusive. Because continuous data
collection is not practical due to the interference it would generate,
quarterly data collection ensures that interviewers get frequent
opportunities to hone their skills in a live interview environment.
Quarterly collection also helps account for potential seasonal variations in
arrest and crime patterns that occur in some sites. One byproduct of
quarterly data collection is that it generates new information more
frequently than many other national data collection programs. Quarterly
collection allows policymakers and analysts to view trends as they
develop, potentially permitting earlier intervention against problems that
may occur.

During data collection periods, a random selection of arrestees is
approached and asked to participate in the study. Prospective respondents
are read an informed consent statement that notes that no identifying
information will be requested and that a urine specimen will be requested
at the end of the interview. Bar code strips are placed on both the
interview form and the urine specimen bottle to ensure that the interview
form is matched to the correct specimen. In some cases where the facility
staff permit it, a small incentive, such as a candy bar, is given to
respondents who complete the interview. In most sites, more than 80
percent of the individuals approached agree to the interview and, of those,
more than 80 percent agree to give the urine specimen. The decision not to
collect identifying information is an essential component to achieving such
high response rates. With the knowledge that the interview is anonymous
and confidential, respondents feel more confident in giving honest answers
about sensitive topics.

In addition, the ADAM program ensures that interviewers have no
potential conflicts of interests with the respondents. Police officers,
whether off duty or on, court workers, and pretrial services staff are not
allowed to be ADAM interviewers. Their job-related duties may present
potential conflicts of interest with information that may be disclosed
during the interview process. Equally important, respondents may be less
likely to want to talk to interviewers they see working around the jail in
other capacities or who they encounter during pretrial release interviews.

At the conclusion of the interview and the collection of the urine
specimen, site staff may ask additional questions of the respondent. It is
important that the ADAM interview process be completed prior to asking
supplemental questions so that all ADAM arrestees are exposed to the
same stimulus and interviewed under the same circumstances. These
supplemental questions, called addenda, are usually oriented around a
specific topic that policymakers want to address. Examples of addenda
administered in the past include: patterns of acquiring and attitudes about
firearms;[26] patterns of acquiring and using crack, powder cocaine, and
heroin;[27] and patterns of acquiring and using methamphetamines.[28]

X. Training Issues

Training is an important component of the ADAM program. The goal of
ADAM training is to convey the practices and procedures required to
conduct scientific research surveys to a team of interviewers. Each ADAM
site receives training using a standard curriculum and manual that
addresses basic and advanced interview skills and site operational
procedures. The ADAM training covers the issue of maintaining
interviewer safety. Interviewer safety is a team effort between the holding
facility personnel and ADAM data collection staff. A key step in the
interview process is securing the arrestee's informed consent to participate
in the study. The training staff review the concept of informed consent.
Each interviewer must understand the principle of informed consent and
should be prepared to secure informed consent from the arrestees.
Interviewers are required to complete and demonstrate competence in
basic interviewing skills and an understanding of project operating
procedures. Their continued competence is monitored through quarterly
evaluations and site error rates.

ADAM training is conducted by the ADAM national contractor, who
works with the local site directors and interviewers to provide one core
training per year per site and enhancement training as needed. NIJ
oversees the national contractor and sets priorities for the training
program.

XI. National Data Analytic Results

For more than a decade, the DUF/ADAM program has published an
annual report of the basic drug use prevalence findings (based on
urinalysis results) for each of its sites. These reports have shown that the
majority of detained arrestees test positive for recent drug use within 48
hours of their arrest. Interestingly, while drug use in the general U.S.
population declined dramatically in the mid- to late 1980s, drug use rates
seemed to rise among criminal offenders, including arrestees. In
Washington, D.C., the first DUF site, the percentage of arrestees testing
positive for any drug (mostly cocaine) rose from 55 percent in 1984 to
nearly 75 percent in 1989. Throughout the 1990s, however, the rates of
detected cocaine use among arrestees stabilized. By 1997, the rates of
arrestees who tested positive for any drug were below their highest levels,
although the rate of cocaine use remained high.

Aside from playing a key role in tracking hardcore drug use (such as
cocaine, heroin, and, more recently, methamphetamine), the ADAM
program has provided strong evidence that drug use is subject to powerful
cohort effects. For example, cocaine use has declined for the most recent
birth cohort of arrestees (born in the 1970s and sometimes referred to as
"the blunts generation") but has remained at high levels for older cohorts
(born in the 1950s and 1960s). ADAM's trend data show that
cocaine-using offenders are getting older. The percentage of 18- to
20-year-old arrestees who tested positive for cocaine in Los Angeles, for
example, dropped from 47 percent in 1988 to 24 percent by 1996. There
has not, however, been a corresponding decrease in cocaine use by older
cohorts (age 30 and over). More recently, ADAM data have helped point
out the emerging marijuana epidemic among younger arrestees since the
mid-1990s.[29] ADAM data have been very useful for getting drug
policymakers to acknowledge this "aging in" and "aging out" process.

The ADAM program has also demonstrated regional variations in the drug
problem in the United States. For example, methamphetamine use
continues to be seen primarily in Western U.S. cities. In 1998, the
methamphetamine urinalysis positive rate in San Diego was more than 30
percent, in Sacramento about 25 percent, in San Jose about 20 percent, in
Portland about 20 percent, and in Los Angeles about 10 percent. There is
hardly any methamphetamine use among the East Coast ADAM sites, but
cocaine is a major problem in these sites. In 1998, the cocaine urinalysis
positive rate was more than 50 percent in New York, Atlanta,
Philadelphia, and Fort Lauderdale. When the media began suggesting that
methamphetamine use would be the drug epidemic of the 1990s, ADAM
studies demonstrated no material increase.

The ADAM program has been useful in identifying the prevalence of drug
use within a hardcore population of youths. Thirteen ADAM sites also
collect data from juveniles (Birmingham, Cleveland, Denver, Indianapolis,
Los Angeles, Phoenix, Portland, St. Louis, San Antonio, San Diego, San
Jose, Tucson, and Washington, D.C.). Over the years, DUF and ADAM
have found that the ADAM sample of youths are generally more likely to
use "harder" drugs (e.g., cocaine) than those found in high school samples
from the Monitoring the Future study.

The ADAM program has helped many communities understand the
dynamics of their local drug and crime problem. For example, an analysis
of opiate use among arrestees in New York City focused renewed attention
on some of the unique elements of New York's heroin problem. In Los
Angeles, specialized ADAM studies have provided a better understanding
of the correlations between HIV and STDs and drug use among arrestees.
ADAM data were also used to distinguish the differences in use patterns
and purchasing practices among crack, powder cocaine, and heroin in
Chicago; Manhattan; Portland, Oregon; San Antonio; San Diego; and
Washington, D.C. Finally, ADAM data are a key component of the local
evaluations of the OJP-funded Breaking the Cycle programs (in
Birmingham, Alabama; Jacksonville, Florida; and Tacoma, Washington).

XII. Policy Implications and Applications of Data

As a policy tool, ADAM has been used to assist a variety of practitioner
groups. ADAM can help law enforcement better understand changes in
local drug markets and how to police these markets. ADAM can be used to
help treatment providers plan for the number of requests they may receive
for treatment services. The ADAM program has tried to respond to the
needs of policymakers by ensuring the information provided is current
(ADAM provides more than one data collection point per year), timely
(ADAM quarterly reports are delivered to the sites within 30 days after the
ADAM Data Center receives all of the necessary site data), and accessible
(easy-to-read reports).

ADAM data are invaluable to local, State, and national drug policymakers,
courts, law enforcement agencies, treatment providers, and prevention
specialists as they seek the most effective and most efficient ways to
control illicit drug use and to provide necessary substance abuse treatment.
Data collected at ADAM sites inform the decisions of practitioners and
policymakers and are used by the Nation's top criminal justice, drug
control, and substance abuse researchers as they uncover links between
drug abuse, crime, and a variety of other contemporary social issues.

States and localities use ADAM data to better understand the impacts of
drug use in individual communities. ADAM data have proved so useful to
states and localities that California, Maryland, Missouri, and New York
have used other funding sources to expand or replicate the ADAM
program. This localized understanding increases the effectiveness of the
planning and resource allocation processes. States often use ADAM data
in their applications for Federal treatment block and formula grants.

National policymakers use ADAM data to assess larger trends and changes
in drug use, drug trafficking, criminal activity, and treatment needs. Many
agencies have incorporated ADAM data into their strategic planning
processes. ONDCP uses ADAM data to monitor the problem of hardcore
drug use and ADAM results are central to its Performance Measurement
System. CSAT has used ADAM data in its block grant allocation process
and is considering funding programs that correspond to the ADAM
protocols to assess local treatment needs. DEA has used ADAM data to
guide its efforts in allocating agents to drug hotspots. ADAM data have
been linked to the DEA STRIDE (System To Retrieve Information from
Drug Evidence) data set to demonstrate that higher illicit drug prices
reduce demand for illicit drugs among arrestees. ADAM data are a routine
component in the National Institute of Drug Abuse's Community
Epidemiology Work Group's assessment of drugs and drug abuse in
America's communities. Other Federal users of ADAM data include the
Senate Judiciary Committee, the Congressional Budget Office, the
National Institutes of Health, the National Drug Intelligence Center, the
Bureau of Alcohol, Tobacco and Firearms, and the CDC.

ADAM data are used in a variety of different capacities in a variety of
different settings. Between 1995 and 1999, more than 100 articles,
projects, and presentations using ADAM data were reported to NIJ. This
count does not include the multitude of studies, projects, and reports that
cite data from ADAM's annual report or the citations of ADAM data in
support of local, State, or Federal program or policy initiatives. The
following list illustrates some of the ways ADAM data have affected
policymaking, program implementation, resource allocation, and the
overall understanding of drugs and crime:

 o In Louisiana, State legislation on pretrial drug testing programs was
passed in part due to the findings of the ADAM program.

 o In Oklahoma City, Oklahoma, the County Community Sentencing
Commission used ADAM data to determine the extent of drug use among
arrestees before implementing a $4.7 million strategy to take over
probation from the State.

 o In Indianapolis, Indiana, a special committee convened by the mayor's
office that included law enforcement, court officials, and service providers
used ADAM data in developing a plan to address prostitution and drug
and crime issues.

 o In Omaha, Nebraska, the Nebraska Crime Commission and the U.S.
Attorney, in response to legislation, commissioned a special research
project to assess the growing methamphetamine problem. The findings of
this project are being used by the Nebraska State Wide Substance Abuse
Treatment Task Force to assess the need for treatment and by other
organizations and agencies as they plan responses to drug use issues.

 o San Diego, California, continues to use ADAM data to provide
direction for its methamphetamine task force.

 o In Philadelphia, Pennsylvania, ADAM data guide the deployment of
city police officers.

 o ADAM data play a key role in direction taken by the Methamphetamine
Interagency Task Force, chaired by the Attorney General and the Director
of ONDCP.

 o ADAM data have been used to determine the effects of policing
strategies in reducing drug use and associated criminal activity. In New
York City, data were used to assess the effects of "quality of life"
enforcement by the New York Police Department.

 o CSAT's Substance Abuse Need for Treatment Among Arrestees
(SANTA) project used ADAM as its core protocol in early efforts to
develop statewide needs assessments.

 o Cleveland, Ohio, uses ADAM data in specialized treatment programs
for prostitutes.

 o Cook County (Chicago), Illinois, and Orleans Parish (New Orleans),
Louisiana, use ADAM data in their arrested and pretrial drug testing
programs.

Notes

1. Federal Bureau of Investigation, Crime in the United States 1998:
Uniform Crime Reports, Washington, DC: U.S. Department of Justice,
Federal Bureau of Investigation, 1999.

2. Rennison, C.M., Criminal Victimization 1998: Changes 1997-98 With
Trends 1993-98, Washington, DC: U.S. Department of Justice, Office of
Justice Programs, Bureau of Justice Statistics, 1999, NCJ 176353.

3. Substance Abuse and Mental Health Services Administration, Summary
of Findings From the 1998 National Household Survey on Drug Abuse,
Washington, DC: U.S. Department of Health and Human Services,
Substance Abuse and Mental Health Services Administration, Office of
Applied Studies, 1999.

4. Ibid. 

5. Johnston, L.D., P.M. O'Malley, and J.G. Bachman, Monitoring the
Future: National Survey Results on Drug Use, 1975-1999. Volume I:
Secondary School Students, Bethesda, MD: U.S. Department of Health
and Human Services, National Institutes of Health, National Institute on
Drug Abuse, 2000, NIH publication 00-4802.

6. Clear, T.R., and G.F. Cole, American Corrections, 5th ed., Belmont,
CA: Wadsworth Publishing Company, 2000.

7. Maguire, K., and A.L. Pastore, eds., Sourcebook of Criminal Justice
Statistics, 1998, Washington, DC: U.S. Department of Justice, Office of
Justice Programs, Bureau of Justice Statistics, 1999, NCJ 176356.

8. In fiscal year 1999, only 33 percent of the Federal drug budget was
allocated to prevention and treatment; 67 percent was allocated to
supply-side programs. Office of National Drug Control Policy, 1999
National Drug Control Strategy Budget Summary, Washington, DC:
Executive Office of the President, Office of National Drug Control Policy,
1999.

9. Office of National Drug Control Policy, 1999 National Drug Control
Strategy, Washington, DC: Executive Office of the President, Office of
National Drug Control Policy, 1999.

10. Ibid.

11. Ibid.

12. Wish, E.D., Drug Use Forecasting: New York 1984 to 1986, Research
in Action, Washington, DC: U.S. Department of Justice, Office of Justice
Programs, National Institute of Justice, NCJ 107272.

13. Toborg, M.A., and M.P. Kirby, Drug Use and Pretrial Crime in the
District of Columbia, Research in Brief, Washington, DC: U.S.
Department of Justice, Office of Justice Programs, National Institute of
Justice, 1984, NCJ 94073; Wish, Drug Use Forecasting (see note 12).

14. Reardon, J.A., The Drug Use Forecasting Program: Measuring Drug
Use in a "Hidden" Population, Research Report, Washington, DC: U.S.
Department of Justice, Office of Justice Programs, National Institute of
Justice, 1993, NCJ 144784.

15. Carver, J., Drugs and Crime: Controlling Use and Reducing Risk
Through Testing, Research in Action, Washington, DC: U.S. Department
of Justice, Office of Justice Programs, National Institute of Justice, 1986,
NCJ 102668.

16. Wish, Drug Use Forecasting (see note 12).

17. Ibid.

18. Some States, such as Alaska, do not have counties or comparable units
of government. In those States, the catchment area is defined by the city or
municipal boundaries. The New York City site includes all five boroughs
of the city, which are five separate counties.

19. Riley, K.J., N.T. Lu, and B.G. Taylor, "Drug Screening: A
Comparison of Urinalysis Results From Two Independent Laboratories,"
Journal of Drug Issues 30 (1) (2000): 171-186.

20. U.S. General Accounting Office, Drug Use Measurement: Strengths,
Limitations, and Recommendations for Improvement, Washington, DC:
U.S. General Accounting Office, 1993, GAO report PEMD-93-18.

21. The National Institute of Justice funds most basic and evaluative
research through extramural grants and broad investigator-initiated
solicitations or directed solicitations related to such Crime Act initiatives
as community policing, violence against women, boot camps/prisons, or
drug courts. NIJ also funds intramural research by NIJ staff researchers.
NIJ was created by the Omnibus Crime Control and Safe Streets Act of
1968 and was founded in 1968 within the Law Enforcement
Administration Agency.

22. Riley, K.J., Crack, Powder Cocaine, and Heroin: Drug Purchases and
Use Patterns in Six U.S. Cities, Research Report, Washington, DC: U.S.
Department of Justice, Office of Justice Programs, National Institute of
Justice, and Executive Office of the President, Office of National Drug
Control Policy, 1997, NCJ 167265.

23. Arrestee Drug Abuse Monitoring Program, 1998 Annual Report on
Drug Use Among Adult and Juvenile Arrestees, Research Report,
Washington, DC: U.S. Department of Justice, Office of Justice Programs,
National Institute of Justice, 1999, NCJ 175656.

24. Frederick, D.L., J. Green, and M.W. Fowler, "Comparison of Six
Cannabinoid Metabolite Assays," Journal of Analytical Toxicology 9 (3)
(1985): 116-120; Jones, D.W., D. Adams, P.A. Martel, and R.J. Rousseau,
"Drug Population in One Thousand Geographically Distributed Urine
Specimens," Journal of Analytical Toxicology 9 (3) (1985): 125-130;
Willson, N.J., M.J. Kogan, D.J. Pierson, and E. Newman, "Confirmation
of EMIT Cannabinoid Assay Results by Bonded Phase Adsorption With
Thin Layer Chromatography," Journal of Clinical Toxicology 20 (5)
(1983): 465-473; Verebey, K., S.J. Mule, J. Alrazi, and J. Lehr, "One
Hundred EMIT Positive Cannabinoid Urine Samples Confirmed by
BPA/TLC, RIA, and GC/MS," Journal of Analytical Toxicology 10 (2)
(1986): 79-80; Weaver, M.L., B.K. Gan, E. Allen, L.D. Baugh, F.Y. Liao,
R.H. Liu, J.G. Langner, A.S. Walia, and L.F. Cook, "Correlations on
Radioimmunoassay, Fluorescence Polarization Immunoassay, and Enzyme
Immunoassay of Cannabis Metabolites with Gas Chromatography/Mass
Spectrometry Analysis of 11-Nor-Delta-9-Tetrahydrocannabinol-9-
Carboxylic Acid in Urine Specimens," Forensic Science International 49
(1) (1991): 43-56; Dextraze, P., W.C. Griffiths, P. Camara, L. Audette,
and M. Rosner, "Comparison of Fluorescence Polarization Immunoassay,
Enzyme Immunoassay, and Thin-Layer Chromatography for   Urine
Cannabinoid Screening. Effects of Analyte Adsorption and Vigorous
Mixing of Specimen on Detectability," Annals of Clinical Laboratory
Science 19 (2) (1989): 133-138; Fenton, J., M. Schaffer, N.W. Chen, and
E.W. Bermes, Jr., "A Comparison of Enzyme Immunoassay and Gas
Chromatography/Mass Spectrometry in Forensic Toxicology," Journal of
Forensic Science 25 (2) (1980): 314-319.

25. Evidence suggests that DUF program interviewee samples were fairly
representative of their populations. A 1993 study that investigated the
sampling method used by the DUF program concluded that "the current
DUF procedures appear to select a sample of interviewees that is highly
representative of the arrestees who are detained in the particular booking
centers where the DUF program operates" (Chaiken, J.M., and M.R.
Chaiken, "Understanding the Drug Use Forecasting (DUF) Sample of
Adult Arrestees," unpublished report prepared for the U.S. Department of
Justice, National Institute of Justice, Washington, DC, 1993, p. 45). The
authors of the study note, however, that the samples are not wholly
representative of all UCR arrestees because the DUF selection procedures
rule out minor offenses.

26. Decker, S.H., S. Pennell, and A. Caldwell, Illegal Firearms: Access
and Use by Arrestees, Washington, DC: U.S. Department of Justice,
Office of Justice Programs, National Institute of Justice, 1997, NCJ
163496.

27. Riley, Crack, Powder Cocaine, and Heroin (see note 22).

28. Pennell, S., J. Ellett, C. Rienick, and J. Grimes, Meth Matters: Report
on Methamphetamine Users in Five Western Cities, Research Report,
Washington, DC: U.S. Department of Justice, Office of Justice Programs,
National Institute of Justice, 1999, NCJ 176331.

29. Golub, A., and B. Johnson, "The Marijuana Upsurge," unpublished
final report submitted to the U.S. Department of Justice, Office of Justice
Programs, National Institute of Justice, Washington, DC, 2000.

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

Concluding Thoughts

Henry H. Brownstein

Henry H. Brownstein is the director of the Drugs and Crime Research
Division of the National Institute of Justice.

On a political level, the problem of drug using and trafficking is an
international problem. In terms of social welfare and public health and
safety, the problems associated with drug using and trafficking are local
problems. That apparent paradox is precisely what makes the International
Arrestee Drug Abuse Monitoring (I-ADAM) program so interesting and
valuable. In participating nations, I-ADAM provides data about local
problems with drugs and crime and offers an inter-national context
through which to understand and explain those local problems as they
relate to the global drug problem.

For 3 days in September 2000, representatives of 11 different countries
from 6 different continents met in Washington, D.C., at an I-ADAM
conference sponsored by the National Institute of Justice of the U.S.
Department of Justice. Present were researchers and policymakers actively
working on ADAM-type programs in their own nations and researchers
and policymakers from nations that were considering the development and
implementation of such a program.

For 3 days, those present at the third annual I-ADAM meeting in
Washington talked about the status of the project in their own countries,
data availability and the potential for sharing data, the data collection
instrument and how it could be improved, the different laboratory methods
for drug testing, and the future of the I-ADAM program. In turn,
participants spoke about what they were learning about drug use among
arrestees in their own countries. To the extent possible, findings from data
analysis in each country were presented and shared. What was remarkable
was how similar and yet how different were the problems and concerns in
different nations.

Sharing Information

The different drug problems of different nations were plainly delimited in
presentations at the I-ADAM meeting in September 2000. Everyone at the
meeting agreed that data from an ADAM-type program provides useful
information that can inform local policy and practice. It also became clear,
however, that given different systems of criminal justice in different
nations, each nation faces its own limitations and difficulties in
establishing and operating an ADAM-type program.

Representatives from nations with existing ADAM-like programs and
those from nations considering or planning such programs indicated
similar levels and types of interest in the program. Vicknasingam
Balasingam in Malaysia, where the program is "in its infancy," noted that
his minister of justice and the local police chief supported a program that
would substantiate claims that crimes are committed by drug addicts and
provide information to local health and enforcement agencies. In Taiwan,
where the program is still in the planning stage, Shu-Yu Lyu reported that
it has support from the Ministry of Justice, the National Police
Administration, the Department of Health, and the Ministry of Foreign
Affairs. Daleen Lock reported that the South Africa ADAM (SA-ADAM)
program, which was piloted in 1996, has been found useful by the police
for narrowing the focus of their efforts to deal with the problems of drugs
and crime.

According to the I-ADAM presentations, of all illicit substances used by
people in all nations of the world, marijuana in one form or another is the
drug that is most commonly used by arrestees throughout the world. For
example, Toni Makkai reported that, in Australia's Drug Use Monitoring
in Australia (DUMA) sites, from 50 to 66 percent of all arrestees tested
positive for cannabis, 40 percent tested positive for opiates in Sydney
sites, and 20 percent tested positive for opiates in East Perth and
Southport. Luis Caris reported that in Chile, alcohol was the primary drug
used by arrestees, but of all illicit drugs, marijuana was used most often
(by 30 percent of arrestees).

Although some drug problems are commonly shared by many nations,
others are peculiar to particular countries. Trevor Bennett reported that in
England, across the sites in the NEW-ADAM program (New England and
Wales ADAM), from 14 to 50 percent of arrestees tested positive for
opiates. In South Africa, Andreas Plddemann reported that, similar to
other nations, from 36 to 44 percent of arrestees tested positive for
cannabis. However, from 19 percent to 25 percent of arrestees in South
Africa tested positive for mandrax, a blend of methaqualone and
antihistamine that is rarely, if ever, found being used by arrestees in other
nations. Neil McKeganey reported that, in Scotland, drug injection is a
particularly serious problem. Apinum Aramrattana reported that the main
problem in Thailand is opiates.

In addition to the similarities and differences in findings, those present
also reported differences and similarities in terms of the methodologies
nations use and the problems they have in implementing I-ADAM. For
example, in all countries people commit crimes and are arrested and
booked without regard to the time, yet in most countries, including the
United States, it is not possible to conduct interviews 24 hours every day.
In England, interviews are collected for 24 hours, but it is not unknown for
a respondent to doze off during an interview (this may be due to the high
proportion who test positive for opiates). Gina Weir-Smith reported that
SA-ADAM researchers in South Africa have been combining databases
using artificial intelligence to try to develop strategies for extrapolation of
findings to the whole nation. Natalie Lu of the U.S. ADAM program
reported on the results of an experiment that showed that different
laboratory tests used by different nations for testing urine for drugs
produce similar results.

Writing chapters for this compendium offered researchers working on
ADAM-like programs around the world an opportunity to focus on their
own programs in the context of their national system of criminal justice.
Consequently, many of the same researchers who spoke at the I-ADAM
conference were able, for this compendium, to provide greater detail and
more insight into the operation and output of their ADAM effort. The
result is that a number of patterns or themes about both drug problems and
the study of drug problems in different nations can begin to be seen.

Each chapter in this compendium outlines the character and principles of
the criminal justice system in that nation, the processes and problems of
establishing an ADAM-like program, and to the extent they are available,
findings and policy implications of the effort to date. For example, in
Australia there is no central facility for detainees in Sydney, one
laboratory is used to conduct EMIT  (enzyme multiplied immunoassay
testing) testing of urine samples, and arrestees who test positive for
substance use most commonly test positive for cannabis and opiates. In
Chile, where nurses from the Ministry of Health conduct the interviews,
arrestees most often test positive for alcohol, marijuana, and coca paste
(more often than they do for powder cocaine). In England and Wales, tests
are most often positive for cannabis, alcohol, opiates, and, to a lesser
extent, cocaine, and about 23 percent of arrestees admit to having ever
injected at least one substance. Malaysia has yet to implement its planned
ADAM program, but it will do so in a nation with laws that are
particularly tough with regard to drug dealers. In the Netherlands, where
drug policy is focused on health issues, arrestees most often have been
found to be using cannabis or cocaine at the time of their arrest. In
Scotland, where the local police have been actively involved in the
program from the beginning, opiates seem to be a problem. In South
Africa, where the criminal justice system is administered nationally, the
problem drugs among arrestees appear to be marijuana and mandrax. In
the United States, where ADAM programs are operating in numerous sites
around the country, marijuana appears to be used by large proportions of
arrestees in most all sites and there appears to be regional variation in the
use of other drugs.

Generally, the chapters in this compendium show that researchers in those
nations where I-ADAM programs have been implemented or planned
typically have found high levels of interest in the program among
policymakers and practitioners in the areas of criminal justice and public
health. At the same time, most are experiencing problems identifying and
securing adequate funding to support an ongoing program. All must deal
with collecting data in an environment that is inherently hectic, and all
must be able to work with local law enforcement and correctional officials
to ensure that the local ADAM program operates in a way that benefits the
community without disrupting the ongoing operation of the local jail.
Finally, all must be able to produce findings that can be translated into
conclusions that are interesting and valuable to the local community. 

Moving Forward

I-ADAM is a network of researchers from various nations working
together to address problems in each of their countries that are unique in
some ways yet common in others. The drug problem is global, yet the
problems associated with drugs in individual nations are distinctive to the
political, social, and cultural life of that nation. Through statistical
modeling, I-ADAM can produce some interesting comparisons about drug
use among arrestees in different countries. I-ADAM allows researchers to
inform policymakers and practitioners in their own countries about the
problems of drugs and, in turn, to be informed by an international
community of researchers who are committed to addressing those same
problems in their own countries.

On the last day of the 2000 I-ADAM meeting in Washington, D.C.,
everyone at the table came to recognize the same potential for the
program. The focus of the meeting turned to finding ways that the
researchers involved in these efforts could begin to communicate with
each other more routinely and more broadly. The result was the formation
of a number of what might be called "international cybercommittees."
Those present all agreed at some level to participate through the Internet as
a member of such a committee in one or more areas. On an organizational
level, one group would consider strategic planning and coordination, a
second methods and technical support, and a third publications and
dissemination. A mission was identified for each group.

It was decided that the mission of the strategic planning and coordination
group was to ensure the future development and policy relevance of the
work of I-ADAM, and the connectedness of the mutual efforts to national
goals. To these ends, in the months following the meeting, several
researchers from a variety of involved nations began to consider common
themes for cooperative study (e.g., violence and drugs) and different ways
to communicate. These themes and plans will be integrated into the
planning for the next I-ADAM meeting.

The methods and technology group established a multifaceted mission that
included helping I-ADAM participating nations and others planning to
participate through advice, research design support, encouragement,
facilitation of implementation, promotion of common methods, and
mutual planning. In effect, there were two ideas. One was to find within
the context of each national I-ADAM effort something that several, if not
all, nations could do in the same way that would allow an international
comparison. For example, following the meeting, one member of the
group proposed expanding the current core instrument so comparisons
could be done. The second idea was to ensure that participating nations
share what they have learned with other nations planning to start an I-
ADAM program. This is being done through meetings and through e-mail
communications.

Perhaps the most work is being accomplished in the area of publication
and dissemination. The mission of the publications and dissemination
group at the meeting was defined in terms of planning, encouragement,
and promotion of information from I-ADAM that addresses the problems
of drugs and crime. This compendium is certainly an important step in
disseminating the information that is being learned from I-ADAM. There
are others as well. A number of I-ADAM researchers have published
reports and articles from findings in their own countries that are shared
with researchers in other nations. In addition, since the meeting in
Washington, a number of researchers have been regularly communicating
by e-mail to plan joint publications. Trevor Bennett and Bruce Taylor have
been working together to prepare a multiyear publication plan.

In reality, it is not easy for people from different countries with obligations
in their own nations to not only communicate but also plan and cooperate
to do things beyond the scope of their normal responsibilities. In that
sense, the progress of I-ADAM planning may be moving more slowly than
one would like. But in that same sense, it is remarkable that anything is
getting done. The fact that plans and publications exist is a tribute to the
commitment of the people who are involved in I-ADAM. Ultimately, I-
ADAM is a fragile multinational network of people who share a common
interest in the problem and problems of drugs and are trying to work
together to do something about it.