A comparison of saliva testing to urinalysis in an arrestee population.

Past studies have concluded that individuals under criminal justice supervision often underreport their recent use of illicit drugs. To address this underreporting, objective biological measures, such as urine, saliva, and hair testing, have been used to gain better estimates of illegal drug use. While urinalysis is generally recognized as the reference standard, a method recently introduced in nonlaboratory settings for ascertaining drug use-saliva testing-may offer an alternative to urinalysis. To date, however, no studies have compared saliva testing to urinalysis among criminal justice populations. In the current study, urine and saliva specimens were collected from 114 adult arrestees interviewed as part of Maryland's Substance Abuse Need for Treatment among Arrestees (SANTA) project. With urinalysis as the reference standard, analysis of the saliva test results indicated sensitivity of 100% and specificity of 99% for cocaine and sensitivity of 88% and specificity of 100% for heroin. For marijuana, however, the saliva results indicated a sensitivity of only 5%. Anecdotal reports from the field suggest that saliva may have some advantages over urine because of the ease of collection, invulnerability to adulteration, and minimal personal invasiveness. These findings suggest that a more comprehensive study to evaluate the efficacy of saliva testing in field research may be warranted.

Comparing the impact of standard and abbreviated treatment in a therapeutic community. Findings from the district of Columbia treatment initiative experiment.

This study examines the efficacy of providing Enhanced Abbreviated or Standard Inpatient treatment and Outpatient treatment to drug-abusing clients. The experiment randomly assigned 412 clients to two therapeutic community programs, which differed primarily in planned duration. This study addressed limitations of prior research, as it used random assignment of clients to treatment programs, achieved high follow-up rates and used objective measures of drug use and criminal history. Self-reports and objective measures of criminal activity and substance abuse were collected at pre- and posttreatment interviews. Completing the entire 12-month program (inpatient and outpatient) was more important than duration of inpatient program attended. Regardless of program, completers had substantial reductions in posttreatment drug abuse and arrests. A 12-month course of treatment including at least 6 months in a therapeutic community followed by outpatient treatment can produce marked reductions in drug abuse and crime among persons who complete both phases.

Therapeutic community treatment for substance abusers with antisocial personality disorder.

This study compared treatment outcomes of substance abusers with and without antisocial personality disorder (APD) randomly assigned to two therapeutic communities, differing primarily in length of inpatient and outpatient treatment. We hypothesized that APD clients would be less likely to complete treatment, more likely to test positive for drugs and recidivate at follow-up, and that APD clients in the Standard program would have more favorable outcomes than those in the Abbreviated Inpatient program, because of the Standard program's longer inpatient treatment. Self-reports and objective measures of criminal activity and substance abuse were collected at pre- and posttreatment interviews. APD clients were as likely to complete treatment as other clients, and they exhibited the same patterns of reduced drug use and recidivism as did non-APD clients. Treatment program attended was unrelated to outcomes. Substance abusers diagnosed with APD can benefit from treatment in a therapeutic community combined with outpatient care.

The validity of self-reports of drug use at treatment admission and at followup: comparisons with urinalysis and hair assays.

Studies conducted in the 1970s and early 1980s concluded that people will provide valid information about their illicit drug use when research interviews are conducted under appropriate conditions. Recent studies of treated and untreated populations using improved urinalysis techniques as well as hair analysis techniques indicate that the validity of respondents' self-reports of recent drug use may be considerably less than previously reported and may differ according to a number of factors. Results are presented from a study of clients participating in the Washington, DC, Treatment Initiative study who were assessed for drug use by interview, urinalysis, and hair analysis. At intake, almost all clients who tested positive had reported their use of heroin but fewer clients had reported their cocaine use. At posttreatment followup, clients underreported both heroin and cocaine use. Findings from treatment outcome studies that fail to validate and adjust their estimates of self-reported recent drug use should be interpreted with considerable caution.

A structural model examining the relationship between physical child abuse, sexual victimization, and marijuana/hashish use in delinquent youth: a longitudinal study.

A structural model of the relationships among physical abuse and sexual victimization experiences, marijuana/hashish use (measured by self-report and urine test data) and self-reported delinquent behavior (theft crimes, index offenses, crimes against persons, drug sales and total delinquency) over time was tested in a longitudinal study of juvenile detainees. The hypothesized model was supported by the data. Theoretical, research and policy implications of the results are drawn.

Recidivism among high risk youths: a 2 1/2-year follow-up of a cohort of juvenile detainees.

We report some results from a longitudinal study of juvenile detainees. Analyses were directed toward determining whether the youths' alcohol or other drug use and their emotional/psychological problems at entry into the detention center predicted subsequent arrests for new offenses during the 24 and 30 months following their initial interviews. Statistically significant relationships were found between the youths' demographic characteristics (age, race, gender), referral history, reason for placement in the detention center, cocaine use (as measured by urinalysis), and recidivism. The magnitude of these relationships increased with the length of the follow-up period.

Recidivism among high-risk youths: study of a cohort of juvenile detainees.

We report some results from an ongoing, longitudinal study of juvenile detainees. Analyses were directed toward determining whether the youth's alcohol or other drug use and their emotional/psychological problems at entry into the detention center predicted subsequent arrests for new offenses. Statistically significant relationships were found between the youths' demographic characteristics (age, race, gender), referral history, reason for placement in the detention center, and cocaine use (as measured by urinalysis) and recidivism. However, the magnitudes of these relationships were low to moderate in value, suggesting that a longer follow-up period is needed to more meaningfully study this issue.

Juvenile crime and drug abuse: a prospective study of high risk youth.

Results from an ongoing, longitudinal study of juvenile detainees focusing on the relationship between their drug use and delinquency/crime, are summarized. Three hundred and ninety-nine youths were first interviewed in 1986/87, and 41 percent were found to be urine positive for recent drug use at the time of detention. We reinterviewed 305 of the youths approximately one year later, and found their drug use and delinquency persisted, and in some cases increased, over time. Treatment intervention is needed for the drug involved youths in the study to reduce their cycle of drug use and crime.

Examination of the relationships among drug use, emotional/psychological problems, and crime among youths entering a juvenile detention center.

Urine testing and confidential interviews of youths entering a juvenile detention center in a southeastern city produced some striking results in regard to their drug use, delinquent behavior, and emotional/psychological problems. Recent users of marijuana/hashish and cocaine had higher rates of referral to juvenile court for property and drug offenses than nonusers. The results suggest that interviewing and urine testing of youthful detainees for drug use at the point of entry into secure detention is a promising method for screening youngsters with histories of delinquent behavior. Implications of these findings are drawn.

A longitudinal study of the relationships among alcohol use, marijuana/hashish use, cocaine use, and emotional/psychological functioning problems in a cohort of high-risk youths.

There is increasing recognition that children involved in the justice system often have serious, multiple problems in the areas of physical abuse, sexual exploitation, and alcohol/other drug use (ADM). Using data collected in a longitudinal study of detained juveniles, we test a model of the relationships of these problems. Significant over-time interrelationships are found among these problems. Research and policy implications of these important findings are drawn.

U.S. drug policy in the 1990s: insights from new data from arrestees.

What has been overlooked in recent years, and what the new findings presented in this paper indicate, is that even as there has been a welcome and dramatic drop in middle-class and causal drug use in the United States, revealed by the National Household Survey and the High School Senior Survey, there remains a stubborn hard core of drug use in criminals. Data from the newly established Drug Use Forecasting (DUF) program suggest that the arrestee population contains many of the frequent users of cocaine in the United States. These arrestees are part of a deviant segment of the population having multiple behavioral, vocational, and educational deficits. The danger exists that as drug use declines in the middle class, this residual group of dysfunctional drug users will become a national scapegoat subject to extremely harsh societal reactions, or alternatively, be neglected and "written off" by the larger society. A more humane alternative is to take advantage of the access to these persons that the criminal justice system affords to address their drug use and associated problems.

Physical abuse, sexual victimization, and illicit drug use: replication of a structural analysis among a new sample of high-risk youths.

Mounting evidence of serious adverse consequences of childhood physical and sexual abuse has important implications for public health officials and care providers. Given the potential impact on social policy of this area of inquiry, programmatic research is needed for the validation of theoretical models across populations and over time. This study, based on a sample of high-risk youths, replicates a structural model that specified the influence of child physical and sexual abuse on self-derogation and drug use. Results suggest that for male and female youths, physical abuse and sexual victimization had a direct effect on self-derogation and illicit drug use, and an indirect effect on drug use that was mediated by self-derogation. Moreover, structural coefficients for the model were found to be identical across gender. Subsequent analyses demonstrated the equivalence of the structural model of child physical and sexual abuse on drug use across two study cohorts. Implications for the identification and treatment of youths in high-risk groups are discussed.

The relationship between physical and sexual abuse and illicit drug use: a replication among a new sample of youths entering a juvenile detention center.

The relationship between child physical and sexual abuse and illicit drug use are little understood and underinvestigated. Our previous study of this association found that a sample of detained youths' physical and sexual abuse experiences were related significantly and positively to their use of illicit drugs. Data gathered from a new sample of detained juveniles, interviewed 3 years after our first study, relating to this issue were examined and our previous findings were replicated.

Identifying drug-abusing criminals.

In a criminal justice setting, urine testing is the most feasible and accurate method now available for screening large numbers of drug-using offenders. Self-report and record information can be effectively used to verify and extend information about the seriousness of use for those who test positive. The newer RIAH methods offer promise for delineating patterns of drug use over time if the method is valid, can be standardized, and gains acceptance from the scientific and judicial communities.

Daily marijuana use and problem behaviors among adolescents.

Previous research by Johnston has shown that high school seniors who are daily marijuana users are distinct from the larger population of seniors in a variety of ways. This paper focuses on adolescent daily marijuana users. It replicates Johnston's work and also qualifies it in an important way. We find that level of marijuana use does not make a significant independent contribution to school problems when such critical factors as lifetime cigarette smoking, lifetime multiple drug use, whether respondent has ever used an illicit drug, rebelliousness, and gender, are taken into account. It is concluded that use of marijuana is only one element in a large and complex picture of interrelated problems and behaviors.