Previous studies have indicated that certain illegal drugs are self-reported more readily than others. Respondents are typically more willing to report less serious drugs of abuse, such as marijuana, than they are "hard"drugs of abuse, such as cocaine. To date, however, no comprehensive analyses have examined whether the willingness to self-report illegal drugs fluctuates temporally. In the current study, we examine marijuana-, cocaine-, and heroin-positive Houston arrestees surveyed through the Arrestee Drug Abuse Monitoring (ADAM) Program between 1990 and 1997. Using Kappa statistics, we explore the temporal variation of self-- reported drug use. Little variation is identified. Policy implications are assessed in light of the current findings.
Past studies have concluded that respondents often underreport the extent to which they are involved in the use of illicit drugs (Gray & Wish, 1999; Mieczkowski, Barzelay, Gropper, & Wish, 1991; Wish, 1987). This underreporting is effected by a host of factors, including population subgroup, interviewing environment, methods used to elicit information, and the type of drugs under scrutiny (Hser, 1997; Magura, Goldsmith, Casriel, Goldstein, & Lipton, 1987). Indeed, a number of studies have addressed the issue of whether certain illegal drugs are more readily reported than others (Gray & Wish, 1999; Hser, 1997; Mieczkowski, 1989; O'Malley, Bachman, & Johnston, 1983; Wish, Hoffman, & Nemes, 1997).
O'Malley et al. (1983) examined reliability, stability, and discrepancy ratios of self-reported drug use with data from the Monitoring the Future (MTF)
Project, a national program that surveys approximately 50,000 80`, 10', and 12' grade students annually on drug-using behaviors, beliefs, and attitudes. The analysis was based on data collected from the classes of 1976, 1977, and 1978, with follow-up data collected between 1978 and 1981. O'Malley et al. (1983) reported that reliability decreased as the level of drug seriousness increased. Cigarette use was more readily reported than alcohol use; alcohol use was more readily reported than marijuana use; and marijuana use was more readily reported than the use of more serious drugs of abuse, such as cocaine and heroin.
Mieczkowski (1989) examined the accuracy of self-reported drug use data from Detroit arrestees surveyed through the Drug Use Forecasting (DUF) Program. The objective of the study was to examine the validity of self-reported marijuana, cocaine, and heroin use by correlating self-reported recent use to urinalysis. Mieczkowski (1989) determined that cocaine users were four to five times more likely to underreport their drug use than marijuana or heroin users, suggesting that the type of drug used impacts the willingness of a respondent to self-report its use.
Wish et al. (1997) compared self-reports of cocaine and opiate use with urine specimens and hair samples from 487 clients appearing at a diagnostic treatment unit in Washington, DC. Self-report questions involved lifetime use, frequency of use, and recent use (within the previous 30 days) of cocaine and opiates. The findings were mixed. The urine specimen and hair sample results for opiates were 91% and 83% respectively, with 91% self-reporting opiate use within the previous 30 days (Wish et al., 1997). For cocaine, however, the urine specimen and hair sample results were 69% and 93% respectively, with 71% self-reporting cocaine use with the previous 30 days (Wish et al., 1997).
Hser (1997) assessed the quality of self-report data from a sample (N=3,493) of "high risk" respondents in Los Angeles County, including patients at STD clinics (N=1,134), emergency room (ER) patients (N= 680), and arrestees (N= 1,679). Respondents were asked to report whether they had used a number of illegal drugs within the past three days. The three-day self-report measure was then validated by urinalysis. For both the STD and ER samples, drug denial (the percentage that reported no use among urine positives) increased as the seriousness of substance increased. Denial of marijuana among ER patients was 35.0%, while cocaine was 50.8% and opiates was 83.7% (Hser, 1997).
Finally, Gray and Wish (1999) examined correlates of drug use underreporting from a sample of 437 female arrestees collected through the Substance Abuse Need for Treatment among Arrestees (SANTA) Program. The authors determined that of the thirty-six marijuana-positive arrestees, 92 (Kc=.87) reported recent (three-day) use. In contrast, the conditional kappa was .65 for opiate-positive arrestees (N=170) and only .33 for cocaine-positive arrestees (N=227). These results suggested a drug hierarchy of underreporting and supported the contention that the use of cocaine is a more stigmatizing behavior than the use of marijuana or opiates. As Gray and Wish (1999, p. 102) concluded, "the more benign context of marijuana (generally perceived as a gateway or experimental drug) and heroin abuse (a history framed in a medical context) may not be as much of a barrier to truthful self-reporting as the stigma of cocaine use."
These studies suggest that less serious drugs of abuse are more readily reported than others. They have been limited, however, in that the data have all been cross-sectional in nature. To date, no studies have examined whether the willingness to report the use of certain drugs fluctuates over time. To address this limitation, we examine whether drug use reporting fluctuates temporally with data from the Arrestee Drug Abuse Monitoring (ADAM) Program.
The National Institute of Justice (NIJ) established the ADAM Program -- formerly the Drug Use Forecasting (DUF) Program - in 1987 (Yacoubian, 2000b). The six primary goals are: identifying the levels of drug use among arrestees; tracking changing drug-use patterns; determining what drugs are being used in specific jurisdictions; alerting local officials to trends in drug use and the availability of new drugs; providing data to help understand the drug-crime connection; and serving as a research platform upon which a wide variety of drug-related initiatives can be based (Yacoubian, 2000b).
Arrestees are first asked several demographic questions, including education level, marital and employment status, and income level. Participants are then asked to report whether they have ever used a number of specific drugs (Yacoubian, 2000b). For those drugs the arrestees report having ever tried, they are asked to indicate their age of first use, whether they have used the drug within the past twelve months, the number of times used within the past thirty days, and whether they have used the drug within the past three days. Participants who admit to drug use are also asked whether or not they consider themselves drug-- dependent, and whether they were under the influence or in need of drugs at the time of arrest (Yacoubian, 2000b). Several questions also focused on treatment - whether the person has ever received treatment, is currently in a treatment program, or perceives a need for treatment (Yacoubian, 2000b).
In addition to the survey, a urine sample is obtained to measure recent drug use and to validate self-report data (NIJ, 2000). The Enzyme Multiplied Immunoassay Test (EMIT) screens for ten drugs: amphetamines, barbiturates (e.g.. Phenobarbital), benzodiazepines (e.g., Valium and Xanax), marijuana, metabolite (crack and powder) cocaine, methadone, methaqualone (Quaaludes), opiates, PCP. and propoxyphene (Dar-von). All positive results for amphetamines are confirmed by gas chromatography (GC) to eliminate any over-the-counter look-alike medications.
For no more than 14 consecutive days in a single facility every calendar quarter, research personnel in local jurisdictions obtain voluntary and confidential interviews and urine specimens from a sample of arrestees who have been in custody for no more than 48 hours (Yacoubian, 2000b). Between 1990 and 1997, several methodological requirements influenced the ADAM protocol. First, all sites operated according to a charge priority system, where non-drug felons, drug felons, non-drug misdemeanants, and drug misdemeanants were prioritized hierarchically (Yacoubian, 2000b). That is, the program emphasized serious non-- drug offenders. Second, the number of drug offenders surveyed during a data collection period could not exceed 20% of the total sample (Yacoubian, 2000b). This prevented the oversampling of drug offenders, who, presumably, would report more frequent drug use than their non-drug-offending counterparts. Third, all arrestees were eligible to be interviewed except for those whose primary charges involved vagrancy, loitering, or traffic offenses (Yacoubian, 2000b). These arrestees were excluded from the sample a priori.
These caveats aside, the ADAM data can provide enlightening information about drug use within a facility or set of facilities in an area. Indeed, a number of scholarly works have been generated with the ADAM data (Harrison, 1995; Johnson, Thomas, & Golub, 1998; Kane & Yacoubian, 1998; Rosenfeld & Decker, 1993; Wellisch, Anglin, & Prendergast, 1993; Wish, 1990; Yacoubian, 2000a; Yacoubian, 1999; Yacoubian & Kane, 1998). It is important to note that interviewing arrestees is often an arduous assignment, and one not always amenable to the same standards of scientific rigor possible in other environments.
DATA ANALYSIS AND FINDINGS
Data analysis was accomplished in two phases. First, descriptive statistics were computed. Second, Kappa statistics were generated to examine the self-- reporting of drug use for all marijuana-, cocaine-, and heroin-positive arrestees.
DESCRIPTION OF SAMPLE
A total of 11,095 arrestees were surveyed in Houston between 1990 and 1997. A majority of the sample (67.7%) was male. There was significant representation from three racial categories. African-Americans composed the largest proportion (53.2%), followed by Hispanics (22.9%) and Caucasians (22.5%). Although a slightly larger proportion was over the age of 35 (24.8%), age was evenly distributed throughout the sample. Close to 60% had either completed high school or had obtained a GED. The distribution of criminal charges was relatively equal across the sample of arrestees.
SELF-REPORTED DRUG USE
The percent of self-reported drug use agreement was calculated from the sample of drug-positive arrestees for each of three drugs: marijuana, cocaine, and heroin. The numerator was the total number of drug-positive arrestees who self-- reported use within the past three days, and the denominator was the total number of arrestees who tested positive via urinalysis. When appropriate, identical analyses were accomplished across gender and ethnicity subgroups. To identify overall test-retest agreement, kappa statistics were computed for each substance at separate annual intervals. Kappa, which measures the agreement between the evaluations of two raters (self-report and urinalysis) when both are rating the same object (drug use), is considered an appropriate measure of agreement when the time periods covered by the self-reports and the criterion are similar (Magura & Kang, 1996).
Marijuana results are presented in Table 1. It is important to note that the criteria for marijuana detection changed during the time frame under scrutiny. Prior to 1995, the cutoff was 50 nanograms. After 1995, however, the threshold increased to 100 nanograms. The results that follow reflect this change in testing standard. As indicated by the kappa statistics, agreement is low, but stable over time. The most agreement occurred in 1993 (k=.53), with the least occurring in 1997 (k=.34). This range of. 19 within the entire sample suggests relative stability of marijuana reporting over time. This stability is also indicated within both gender groups. There is, however, temporal variation among Caucasians and Hispanics. Among Caucasians, the most agreement occurred in 1997 (k=.75), while the least occurred in 1994 (k=.47) - a range of.28. The most agreement for Hispanics occurred in 1995 (k=.71) while the least agreement occurred in 1991 (k=.35) - a range of .36. These ranges are considerably higher than that for African-Americans (. 19).
POWDER AND CRACK COCAINE
The results for powder and crack cocaine are shown in Table 2. While the self-reporting of powder cocaine among cocaine-positive respondents is low, the kappa statistics indicate stability. The year with the highest level of agreement for powder cocaine is 1995 (k-.25), while the year with the lowest agreement is 1997 (k=.05). Although females indicated a steady decline in willingness to report powder cocaine use between 1990 and 1995, the range across the entire time frame is only. 12. In contrast, rates increased for male arrestees, from. 12 in 1990 to. 18 in 1995 to .37 in 1997, indicating a greater willingness to report the use of powder cocaine over time. With the exception of a greater reluctance to report powder cocaine use among African-Americans, no discernible trends are evident among the different ethnic groups.
Willingness to report the use of crack cocaine fluctuated between 1990 and 1996, with a high of .46 in 1993 and a low of .26 in 1991. In 1997, however, the rate of self-reporting crack cocaine decreased to .16. Arrestees in all gender groups became more willing to report the use of crack cocaine over time. Moreover, between 1990 and 1997, the rate rose from .41 to .61 for African-- Americans, from .26 to .50 for Caucasians, and from .08 to .44 for Hispanics.
Table 3 illustrates the percentage of opiate-positive arrestees who self-- reported the use of heroin and the respective kappa statistics. The willingness to report heroin use was highest in 1993 (k=.57) and lowest in 1997 (k=.08). With the exception of 1997, however, the willingness to report heroin use was stable over time. The sample size for opiate-positives was too small to allow stratification by gender or ethnicity.
In the current study, self-report and objective measures of drug use were analyzed from a sample of 11,095 Houston arrestees surveyed the ADAM Program between 1990 and 1997. Given that a kappa statistic below .7 indicates poor agreement (Magura & Kang, 1996), the temporal analysis for all three drugs illustrates consistent unwillingness to report their use. Despite this low agreement, however, analyses indicated that the proportion of drug-positive arrestees who self-reported marijuana, heroin, and powder cocaine use remained relatively stable over time. The willingness to report crack cocaine, however, increased over time among all arrestees in the sample.
The data also illustrated several interesting findings across the drug categories. Arrestees were more forthcoming with their heroin and marijuana use than they were with their crack or power cocaine use. There are two potential explanations for this trend. First, a number of studies have shown that the use of cocaine is associated with memory loss (Ardila, Rosselli, & Strumwassler, 1991; Van Gorp et al., 1999). It is entirely possible that arrestees do not intend to deceive, but rather their memory precludes them from being honest about their recent drug use. Second, marijuana is generally considered a non-serious drug of abuse, while heroin is deeply immersed in the American culture (Johnson, et al. 1998; Inciardi & McElrath, 1998). Given these explanations, it is not surprising that the use of marijuana carries less of a stigma than the use of crack or powder cocaine. As both powder and crack cocaine become more ingrained in the minds of the arrestee population, willingness to report their use may increase.
Several methodological limitations should be reiterated. First, arrestees were selected according to the established crime-charge priority system. Given this methodological limitation, the external validity of the study is clearly an issue. It is recommended, therefore, that the current analysis be replicated in other ADAM sites to assess generalizability. Second, the ADAM reporting system collects data solely for arrestees. The findings presented here may not necessarily parallel data from other deviant populations (e.g., prisoners) or non-deviant populations (e.g., respondents in the National Household Survey on Drug Abuse). It is recommended, therefore, that such an analysis be replicated beyond arrestees to assess the broader implications of these drug-reporting trends. Third, the current study was limited in that only marijuana-, cocaine-, and heroin-positive arrestees were examined. The rationale for exploring only these substances is that they are the three most popular drugs of abuse among arrestee populations (NIJ, 2000). Without further research, however, a presumption that the current trends would parallel those for other drugs would be an unsubstantiated one. It is recommended, therefore, that the current study be replicated with less popular drugs of abuse, such as barbiturates, benzodiazepines, and methamphetamine.
While the patterns identified in the current study are curious, their true worth should be assessed in terms of drug changes that inevitably take place over time. New drugs of abuse (e.g., crack cocaine) will, like all fads and behaviors, ease their way into the American drug-using culture. When once such drugs were stigmatized, the passage of time may relax fears to the point of acceptance. This type of evolution suggests that already-herculean efforts at drug prevention and stigmatization should either be increased exponentially or be abandoned altogether. In either case, longitudinal analyses, like the type undertaken in the current study, are invaluable not only because of the specific findings they produce, but because of the broader evolutionary trends they may symbolize.
This research was supported by National Institute of Justice (NIJ) Grant #OJP-97-R-009.
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REGINA J. JOHNSON, ELIZABETH R. BAUMLER, GEORGE S. YACOUBIAN, JR. RONALD J. PETERS, JR., MICHAEL W. Ross
Regina J. Johnson is an assistant professor at Prairie View A & M University, College of Nursing, Houston, TX 77030. Elizabeth Baumler is an assistant professor at the University of Texas Health Science Center at Houston, School of Public Health. George S. Yacoubian, Jr. is a research associate at the Center for Substance Abuse Research (CESAR) at the University of Maryland. Ronald J. Peters is a research fellow at the University of Texas Health Science Center at Houston, School of Public Health. Michael W. Ross is a professor at the University of Texas Health Science Center at Houston, School of Public Health. Address correspondence to Regina J. Johnson, Prairie View A & M University, 6436 Fannin St., Houston TX 77030. Internet: firstname.lastname@example.org.
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