June 2002
What Kind of Drug Use Does School-Based
Prevention Prevent?
Drug-use prevention programs are now commonplace in the nation’s schools. Their aim
is to prevent, or at least delay or diminish, children’s use of a variety of substances, including illicit drugs such as marijuana and cocaine along with legal substances such as alcohol and cigarettes. Most people are instinctively supportive of using such programs to
“save our kids” from addiction. But do these programs actually work? Over the last 15
years, compelling evidence from rigorously conducted evaluations has repeatedly shown
that the better programs—although by no means all programs—yield tangible effects,
often across a variety of substances.
But questions remain about the nature of this success. For example, what are the specific benefits of these programs? And which drugs do these programs affect? To frame
the issues more provocatively, one might ask whether school-based drug prevention programs are better viewed as a weapon in the war against illegal drugs or as a public health
program for decreasing the adverse effects of legal substances.
These concerns are central to a study of school-based drug prevention programs recently completed by DPRC researchers. In School-Based Drug Prevention: What Kind of
Drug Use Does It Prevent? Jonathan Caulkins, Rosalie Pacula, Susan Paddock, and James
Chiesa identify the specific benefits of successful prevention programs—whether in
terms of reducing illicit drug use, drinking, or smoking—and discuss whether all these
benefits combined exceed the costs of running the prevention programs. Insights into
these questions can provide a clearer understanding of the merits of school-based drug
prevention programs, and can also shed light on who should be funding drug prevention.
The study found that the benefits of model school-based programs do exceed their
costs. According to the best estimate, society realizes total quantifiable benefits of $840
from the average student’s participation in drug prevention at this stage of the drug epidemic. This figure is several times the economic cost of one student’s participation in
such programs, which averages $150. The researchers derived the amount of the benefit
by multiplying together three factors: the amount of substance consumed in an average
participant’s lifetime, the percentage reduction in lifetime consumption associated with
prevention, and the social cost per unit of substance consumed. Because these factors are
themselves the result of many other factors, the value of which can often vary, the researchers also derived a conservative benefit estimate, which was $300. But even with the
conservative estimate, the value of prevention is clear relative to the cost of a student’s
participation.
Both the best and the conservative benefit estimates account for school-based prevention’s effect on use of only four drugs—alcohol, cigarettes, marijuana, and cocaine.
These are the only drugs for which data were available to measure prevention’s
4
In This Issue
What Kind of Drug Use Does
School-Based Prevention Prevent?
1
Director’s Message
2
Leadership
3
New Projects
5
New Publications
6
New People
8
Visiting Scholar: Lisa Kennedy
10
Advisory Board
10
2002 Speaker Series
11
1
D I R E C T O R ’ S
M E S S A G E
No Progress on Teen Drug Use:
What Might Be Done?
Remember when teen drug use was news,
back in the mid-1990s? The run-up in
adolescent drug use in the decade’s early
years was big enough news to become an
issue in the 1996 presidential election.
Since then, the media have moved on to
other stories, but the problem remains.
The Problem. Use of illicit drugs by
adolescents did level off after 1996 (see
the figure), and at a percentage that was
about half the former peak in 1978. If that
sounds comforting, consider that teen
drug use over the last five years is almost
twice what it had been in the early 1990s.
One out of every four 12th-graders and
almost as many 10th-graders currently
use illicit drugs. Note that is not the proportion responding to the question “Have
you ever used . . . ?” It is the proportion
just saying “Yes” when asked “Have you
used any illicit drug in the past month?”
The data on specific drugs provide additional reasons for concern. Marijuana is
the illicit drug of choice for teens, so the
answers for current marijuana use tend to
track those for “any drug.” Marijuana use
has almost doubled over the past decade
among 12th-graders and more than doubled among 8th- and 10th-graders. The
1975 peak for 12th-grade heroin use has
now been surpassed by all three grades.
Of course, very few adolescents use
heroin, even now. However, the increases
potentially represent a big future problem, because of the addictive nature of
heroin and the high social and physical
costs associated with its use.
Stimulant use is another concern. Cocaine is a stimulant. The use of cocaine,
both as crack and in other forms, has
risen steadily among 8th-, 10th-, and
12th-graders over the last decade. For
every thousand adolescents between the
Percentage Reporting Use of Any Illicit Drug in the Preceding Month
RANDCP201(6/02)
30
25
12th grade
20
10th grade
15
10
8th grade
5
0
1992
2
1993
1994
1995
1996
1997
1998
1999
2000
2001
ages of 12 and 17 who had not previously
used cocaine, 14 initiated in 1998 (representing approximately 339,000 new users
in this age group); that was the highest
such rate in 33 years of data collection.
MDMA, also called ecstasy, is a stimulant
with hallucinogenic properties. Data on
teen use of ecstasy go back only six years,
but the percentages reporting use have
been steadily increasing for that drug, too.
Teen use of the two most common licit
drugs, alcohol and tobacco, is also problematic. Some 28 percent of high school
students (over all four grades) were current cigarette smokers in 2001. Fortunately, that is down about 8 percentage
points from four years earlier. About 22
percent of 8th-graders used alcohol in
2001, as did 39 percent of 10th-graders
and 50 percent of 12th-graders. For the
8th-graders, the percentage is down
somewhat over the past decade, while for
the others, it’s changed little.
Addressing the Problem. Over the
last decade, then, adolescent use of both
licit and illicit substances has been quite
high, and for some illicit drugs it has been
increasing substantially. So what is being
done to combat adolescent drug use? Prevention programs are funded mostly
through the Safe and Drug-Free Schools
and Communities Act (SDFSCA). Funding under the act was $634 million in
2001—up more than a third in the last
five years but no more than it was in
1992. Moreover, a sizable portion of the
funds is now directed to violence prevention measures, e.g., metal detectors, that
are unrelated to drug prevention.
Recent DPRC research suggests that,
while the amount of money dedicated to
the program as a whole might appear
large, the average per-pupil expenditure is
less than $8 per year. A more significant
and perhaps related problem is that most
of the drug prevention money has gone to
programs whose efficacy has not been
demonstrated. Other research shows that
the fraction of school districts relying on
evidence-based prevention programs is
increasing, though at a slow pace, reaching 27 percent in one recent year.
That trend is encouraging, but much
more can and needs to be done. A recent
tobacco control study in Oregon illustrates this point. Since 1997, a Tobacco
Prevention and Education Program has
been funded from an excise tax on
cigarettes. A portion of the program’s
funds have been used to implement
guidelines from the Centers for Disease
Control and Prevention that are intended
to help schools and their communities to
reduce tobacco use. In the study, it was
found that decreases in 8th-grade smoking rates have been greater in schools with
medium or high adherence to the guidelines than in those with low adherence or
no funding through the Tobacco Prevention and Education Program. These results suggest not only the value of more
prevention but also the value of moreeffective prevention.
Prevention is not the only tool for lowering adolescent substance abuse. Many
adolescents require drug-abuse treatment. Last year, the U.S. Department of
Health and Human Services issued a report to the president on drug-abuse treatment, which estimated that, of more than
a million persons aged 12 to 17 who
needed treatment for illicit drug use, only
11 percent received it. This was a lower
percentage than for everyone over 12 (17
percent), suggesting that the treatment
gap is wider for youths than it is for
adults. And the need is even greater when
youths requiring treatment for nicotine
and alcohol dependence are taken into account.
But as for prevention, it is not simply
that treatment needs to be more available
but that better treatment models need to
be implemented. Most programs deliver
treatment developed for adult drug
abusers rather than adolescents. Such interventions are not optimally configured
for younger drug users and may not address issues relevant to them. Treatments
developed specifically for adolescents
need to consider developmental issues,
peer influences, parental roles and influences, educational needs, and relatively
concrete thinking. Also, drug use by adolescents is more often a symptom of general life problems than the cause, and this,
too, should be taken into account in
treatment program design.
Summary. The available data appear to
indicate several emerging issues. Drug use
by adolescents has been trending upward
over the last decade. Cocaine initiation
rates are reaching alarming levels, and use
of heroin, methamphetamine, and ecstacy
have also increased over the past decade.
An aggressive response is merited. Much
more attention needs to be paid to the use
of evidence-based prevention in our
schools. More attention needs to be paid
to developing ways to detect drug use and
intervene early in educational and health
care settings so that action can be taken
before the adolescent gets involved with
the criminal justice system. Finally, we
need to aggressively expand and improve
the quality of adolescent treatment options, so that more than the current one
in ten can be accommodated by the treatment system, and so that treatment is
available to adolescents outside the criminal justice system. ■
Adolescent substance-use data reported here are
from Monitoring the Future, the National
Household Survey on Drug Abuse, and the
Youth Risk Behavior Survey.
Leadership
After 10 years as director or codirector of
the DPRC, Audrey Burnam (shown above
with Martin Iguchi) returned to full-time
research in July 2001. Audrey had provided strong leadership to the Center as a
whole, as well as guidance and inspiration
to researchers on an individual basis. In
fact, Audrey was largely responsible for
the DPRC’s institutional emphasis on
mentoring and was at one point named
mentor of the year by RAND Health, one
of the Center’s two organizational homes.
Audrey was particularly interested in performing and fostering research on the re-
lations among drug abuse, mental health,
and HIV status, and her health services
orientation helped balance a DPRC research portfolio that has well represented
criminal justice issues. As director and
codirector, Audrey was tireless in discharging her administrative responsibilities, in helping shape presentations, and
in communicating with board members
and other advisors. It is largely as a result
of her efforts that the Center grew and
thrived as it did. Fortunately, she remains
an active resource for the Center and its
researchers. ■
3
1
effectiveness and, thereby, to estimate
lifetime reductions in use. However, if
one were to assume that prevention programs reduce the use of other illicit drugs,
such as heroin or methamphetamines, by
the same proportion that they reduce cocaine use, the best estimate of benefits per
participant would rise to about $1,000.
The results of the study suggest that
model drug-use prevention programs can
be justified on a benefit-cost basis by the
reductions in substance use they produce.
Drug prevention seems to be a wise use
of public funds, at least for those patient
enough to value benefits that accrue some
years in the future.
In terms of specific benefits, the researchers found that most of the benefits
of prevention programs are related to reductions in the use of legal substances
(see figure).
Close to 40 percent of the social value
of drug-use prevention is realized
through reductions in cigarette use, and
over a quarter of the value is in decreased
alcohol use. Most of the remaining third
is associated with cocaine, while marijuana accounts for a very small fraction
of the total. These findings suggest that it
makes more sense to view prevention as
a program with major benefits to public
health—not merely or principally as a
weapon in the war on illicit drugs with
only incidental public health benefits.
Who then should pay for prevention
programs? Considering that at least twothirds of prevention’s benefits fall within
the public health arena, one might ask
whether prevention should be viewed as a
public health intervention rather than a
criminal justice intervention and thus be
funded from health rather than justice
(or education) dollars. DPRC researchers
find some merit in this notion. If public
health funding streams are available to
support drug prevention programs, it
would be foolish not to use them, particularly if criminal justice dollars are going to
support higher-priority law enforcement
interventions. At the same time, concerns
over the source of budgetary support
should not obscure the fact that the dominant costs of running school-based pre-
4
vention programs are not dollar costs but
the diversion of scarce class time from
traditional academic subjects into drug
prevention.
The low dollar cost of such programs
is central to their value. Prevention is a
wise use of public funds mainly because it
is relatively cheap
while drug use is so
Most of School-Based Prevention’s Benefits
costly to society—not
Are in the Form of Reductions in the Use of
because even the
Legal Substances
model programs eliminate a large proportion
of use. On this point,
the researchers caution
Cocaine
that, while the best
Alcohol
20%
drug-use prevention
28%
Marijuana
programs do provide
3%
benefits, such efforts
Opiates
should not be under8%
taken with the expectation that they will
Other illicit
Cigarettes
result in striking—or
substances
39%
even noticeable—
2%
declines in the rate
of overall drug use.
According to DPRC
researchers’ best estimates, prevention reduces lifetime consumption of cigarettes by 2.1 percent, of
alcohol by 2.2 percent, and of cocaine by
3.0 percent. While these numbers may
seem relatively low, even small reductions
in use can cause large decreases in social
costs.
And small reductions may be all that
anyone should expect from prevention.
Visit Our Web Site and
With only thirty hours of prevention proJoin Our E-Mail List!
gramming, one would be hard-pressed to
overpower the many thousands of hours
The home page for the Drug Policy
youth spend with other influences such
Research Center is located at
as peers or television. Prevention is thus
http://www.rand.org/multi/dprc
a cost-effective tool for improving the
public health and making incremental
The Web site includes a description of the
DPRC, its research agenda, and the
progress in efforts to manage a mature
latest
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demic in the United States. ■
DPRC publications.
Send e-mail to DPRC@rand.org
and request to be added to the
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on upcoming publications.
New Projects
Partner-Oriented Drug Treatment
and HIV Risk Reduction
Methadone maintenance is an effective
tool for reducing HIV risk and incidence
among injection drug users. All too often,
however, individuals in methadone treatment continue to use opiates and other
drugs, usually with a close friend or family member who is not currently enrolled
in treatment. One response to this problem is to encourage at least one member
of the methadone client’s personal drugusing network to also enter treatment,
thereby reducing the number of individuals offering drug-use opportunities.
Under the sponsorship of the National
Institute on Drug Abuse, the DPRC is
seeking to determine whether treatment
outcomes can be improved and HIV risk
behaviors reduced by involving at least
two network members in drug treatment
simultaneously. In the study, researchers
are interviewing 268 new methadone
treatment entrants, each of whom is encouraged to recruit a drug-using partner
for an interview. Half the drug-using
partners are selected at random and offered 13 weeks of free methadone maintenance, while the other half is not being
offered subsidized treatment. Self-reports,
clinic retention rates, urinalysis records,
and other data are being collected from
study participants at baseline and four
months later to assess treatment outcomes,
change in HIV risk behaviors, and change
in personal drug-using network characteristics for both the initial methadone
clients and their partner referrals.
Implementation and Impact of
California’s Proposition 36
In November 2000, California voters approved Proposition 36, which mandates
probation and community-based drug
treatment—instead of prison—for nonviolent drug possession offenses. In light
of the initiative’s passage into law, some
have raised concerns about the ability of
the criminal justice and drug treatment
systems to form an effective partnership
capable of meeting the challenges posed
by Proposition 36. DPRC and Orange
County, California, have established a
collaboration to evaluate the implementation of Proposition 36 at the county level.
With a population of 2.8 million, Orange
County is larger than many states and
thus serves as an ideal model for systemwide implementation of Proposition 36.
Researchers are focusing on several issues,
including the response of law enforcement to Proposition 36; the impact of
Proposition 36 on prosecutorial discretion and case filing, the courts, probation,
and the treatment delivery system; and
the collaborative planning efforts of treatment and criminal justice system actors in
the county. The analysis, which is funded
by the Robert Wood Johnson Foundation,
is taking advantage of Orange County’s
sophisticated automated data systems and
is also using interviews and focus groups.
Quality of Care in the Therapeutic
Community
The effectiveness of substance abuse treatment is well established. Data show that
clients who successfully complete treatment generally decrease both their drug
use and criminal behavior while increasing their social functioning. What is lacking, however, is an understanding of the
treatment process that is responsible for
producing client outcomes. Such an understanding is critical to evaluating and
improving the quality of care. In research
sponsored by the National Institute on
Drug Abuse, DPRC is refining and validating a treatment process monitoring
tool and examining how treatment programs make use of information from such
a tool within a framework of continuous
quality improvement. The tool is based
on an instrument previously developed by
RAND in collaboration with Phoenix
House, the largest therapeutic community for substance abuse treatment in the
United States. Input from clients in
Phoenix House treatment programs
throughout the United States will be used,
together with state-of-the-art techniques,
to refine and validate the tool.
Examining the Consequences of
Reducing Afghanistan’s Heroin
Production
While in power, the Taliban effectively
enforced an edict against opium production in most of Afghanistan—the source
of two-thirds of the global supply in recent years. The fall of that regime led to a
resurgence of opium production. The international community now aims to find
programs that will again drastically reduce opium production in Afghanistan.
Such a cutback, if sustained for even two
years, would have profound and varied
effects in many parts of Asia and Europe,
where the consumption and/or trafficking
of heroin are major problems. DPRC is
participating in an international collaborative effort aiming to project the effects
of an Afghan cutback, help policymakers
identify opportunities for effective interventions, and put in place the capacity to
monitor the long-term effects of the ban.
RAND is developing a simulation model
of the global drug trade, while local researchers in affected areas are being asked
to provide data about such issues as prices
in key markets and average consumption
levels by addicts. The Max-Planck-Institut
für Informatik in Germany is responsible
for the primary data collection. Resulting
data will be used to refine the model and
generate results, which will be disseminated to decisionmakers in affected countries, while the model itself will be made
available to interested governments. This
project is sponsored by the Smith
Richardson Foundation with additional
funding provided to the Max-PlanckInstitut by the Ministry of Justice of the
Netherlands.
Drug Prosecutions and Drug Policy
Reform: The Hidden Connections
Americans have become increasingly concerned about the equity and severity of
drug sentencing, particularly for offenders whose only crime is drug possession
or use. Recently, ballot initiatives have
passed in both California (Proposition
36) and Arizona (Proposition 200) that
seek to divert low-level drug offenders
from incarceration to treatment. In California, opposition to Proposition 36 was
5
led by prosecutors, who argued that few
low-level drug offenders actually receive
prison sentences. They said that offenders
who appeared to be incarcerated on lowlevel drug offenses either had complicated
criminal histories that would have excluded them from Proposition 36 eligibility or had pled down from more serious
drug charges in exchange for a certain
sentence. Prosecutors claimed that under
Proposition 36 they would have no choice
but to send the latter type of case to trial,
as a sentence of community-based treatment is not appropriate for drug traffickers. DPRC, in partnership with researchers at Arizona State University
West, is examining the critical issue of
prosecution and, in particular, the extent
to which those imprisoned on low-level
drug charges have engaged in some form
of plea bargaining prior to incarceration.
The study will identify the types of pleabargaining activities that occurred and
examine the extent to which pleabargaining practices are the same across
drug types. The project, which is sponsored by the Robert Wood Johnson
Foundation, will look at defendants in
both California and Arizona.
The Effects of Marijuana
Depenalization
During the mid-1970s, 11 states in the
United States passed laws removing incarceration as a penalty for certain marijuana
possession offenses. Between 1980 and
1995, state activity in this area was relatively limited; however, in recent years the
debate about marijuana reform has been
reignited, in part due to significant increases in marijuana-related arrests,
heightened attention to the use of marijuana for medicinal purposes, and policy
actions in other nations aimed at depenalizing marijuana offenses. Marijuana has
been depenalized in several nations, including Italy, Spain, the Netherlands,
Portugal, some regions of Australia, and
parts of Germany. DPRC is seeking to inform the debate about marijuana depenalization by analyzing the variety of depenalization systems in the United States
and abroad, assessing the variations in
6
implementation and enforcement of these
systems, and examining the consequences
for marijuana use and other outcomes.
The study, which is funded by the Robert
Wood Johnson Foundation, will provide
a broader understanding of the likely
consequences of a range of alternative
policy options for cannabis law in the
United States, at the federal, state, and
local levels. ■
New Publications
ImpacTeen Illicit Drug Team, Illicit
Drug Policies: Selected Laws from the 50
States, Berrien Springs, Mich.: Andrews
University, 2002.
The federal government has attempted
to contain illicit drug use and its associated costs in a wide variety of ways, primarily relying on the use of criminal law
to influence both the supply and demand
for drugs. At the same time, each of the
individual states and the District of
Columbia has been experimenting with
its own laws that influence the implementation of drug policies within these jurisdictions. Although these interstate variations are often overlooked, state law
matters because the majority of drug offenders in the United States are tried in
state courts. Illicit Drug Policies provides
the first comprehensive reference guide to
selected drug laws in all 50 states and the
District of Columbia. This report, prepared by the ImpacTeen Illicit Drug
Team, is designed to serve as a resource
guide for policymakers, legislators, and
researchers across the country. The report
demonstrates that substantial variation
exists in state statutory approaches to
drug policy, as is indicated by their
scheduling of specific drugs, penalties associated with possession and sale of specific drugs, and medical marijuana allowances. While not inclusive of all drugs
or laws, Illicit Drug Policies is an essential
first step in this process because it documents where variation does and does not
exist in several key areas. It provides data
that can be used by policy analysts and researchers to examine the association between specific criminal justice approaches
and the negative consequences and outcomes associated with illicit drug use.
This document forms the foundation for
future research on state-level illicit drug
policy to be conducted by the ImpacTeen
Illicit Drug Team.
ImpacTeen is an interdisciplinary partnership between DPRC researchers and
other nationally recognized substance
abuse experts with specialties in such
areas as economics, etiology, epidemiology, law, political science, public policy,
psychology, and sociology. It is part of
the Bridging the Gap Initiative, a program
supported by the Robert Wood Johnson
Foundation and administered by the University of Illinois at Chicago.
Ricky N. Bluthenthal, Alex H. Kral,
Lauren Gee, Jennifer Lorvick, Lisa Moore,
Karen Seal, and Brian R. Edlin, “Trends
in HIV Seroprevalence and Risk Among
Gay and Bisexual Men Who Inject Drugs
in San Francisco, 1988 to 2000,” Journal
of Acquired Immune Deficiency Syndromes,
Vol. 28, 2001, pp. 264–269.
This article identifies trends in HIV infection and risk behaviors among streetrecruited self-identified gay and bisexual
male injection drug users (IDUs) in San
Francisco from 1988 through 2000. The
researchers found that HIV seroprevalance decreased among this population from 1988 to 1996, but increased
from 1996 to 2000. Injection and sexrelated HIV risk behaviors declined modestly during this period. The authors conclude that gay/bisexual men who inject
drugs continue to be at elevated risk for
HIV, suggesting the need for interventions targeted at this population.
Jonathan P. Caulkins, “Drug Prices and
Emergency Department Mentions for Cocaine and Heroin,” American Journal of
Public Health, Vol. 91, September 2001,
pp. 1446–1448.
Most U.S. drug control spending seeks
to restrain supply, which—unless it
makes drugs physically scarce—affects
use primarily through prices. Thus, a key
question concerns the extent to which
drug prices affect use. In this study, drug
price series were correlated with data on
emergency department mentions for the
Drug Abuse Warning Network for cocaine and heroin. Using a simple model,
the author demonstrates that fluctuations
in prices are an important determinant of
adverse health outcomes associated with
drugs, explaining more than 95 percent of
the variation in emergency department
mentions.
Jonathan P. Caulkins, “Law Enforce-
ment’s Role in a Harm Reduction
Regime,” Crime and Justice Bulletin, No.
64, NSW Bureau of Crime Statistics and
Research, Sydney, January 2002.
Harm reduction has typically been
seen as the province of drug treatment
and public health interventions, while use
reduction has been considered the
province of law enforcement. This paper
shows how law enforcement might also
play a valuable role within a harm reduction paradigm. This author outlines five
specific roles for law enforcement: partnerships with treatment and other interventions, constraining supply, timefocused intervention early in an epidemic,
reducing control costs and associated
harms, and exploiting drug markets’
inherent adaptability.
Phyllis L. Ellickson, Joan S. Tucker,
David J. Klein, and Kimberly McGuigan,
“Prospective Risk Factors for Alcohol
Misuse in Late Adolescence,” Journal of
Studies on Alcohol, Vol. 62, November
2001, pp. 773–782.
This study identified Grade-7 and
Grade-10 risk factors for alcohol misuse
at Grade 12. Alcohol misuse was conceptualized as problem-related drinking (e.g.,
missing school), high-risk drinking (e.g.,
drunk driving), and high consumption.
The results of the study indicate that predictors of misuse in late adolescence can
be identified by Grade 7 and are generally
visible and modifiable. While the high social acceptability of alcohol use makes
prevention difficult, curbing alcohol misuse may be a more attainable goal. The
authors make recommendations for more
effective prevention efforts.
R. MacCoun, B. Kilmer, and P. Reuter,
“Research on Drug-Crime Linkages: The
Next Generation,” in H. Brownstein (ed.),
Drugs and Crime: A Research Agenda for
the 21st Century, Washington, D.C.: U.S.
Department of Justice, 2002 (in press).
This literature review begins with Paul
Goldstein’s three-part taxonomy of the
connections between drugs and violence:
psychopharmacological, i.e., violence due
to the direct acute effects of a psychoactive drug on the user; economic compulsive, i.e., violence committed in order to
generate money to purchase expensive
drugs; or systemic, i.e., violence associated
with the marketing of illicit drugs. The review points to the need for further analyses in several areas, including the role of
drug use in criminal victimization; longterm trends in drug use, drug arrests, and
drug-related crime; the effects of drug
price changes on drug-related criminality;
and heterogeneity in drug-crime relationships.
Maria Orlando, Phyllis L. Ellickson, and
Kimberly Jinnett, “The Temporal Relationship Between Emotional Distress and
Cigarette Smoking During Adolescence
and Young Adulthood,” Journal of Consulting and Clinical Psychology, Vol. 69,
2001, pp. 959–970.
There are three competing hypotheses
regarding the relationship between tobacco use and emotional distress among
adolescents and young adults: Emotional
distress leads to tobacco use, tobacco use
leads to emotional distress, or the presence of a third factor leads to both. Using
a model with three waves of data from
2,961 adolescents followed into young
adulthood, the authors demonstrate that
the relationship between tobacco use and
emotional distress is a dynamic one in
which distress initially leads to use but
then becomes exacerbated by it over time.
The addition of third factors as predictors
of distress and smoking did not alter this
pattern of results.
Peter Reuter, “The Limits of Supply
Side Drug Control,” The Milken Institute
Review, Vol. 3, No. 1, 2001, pp. 14–23.
U.S. drug policies are heavily supplyside oriented—that is, they aim primarily
to restrict the availability of illegal drugs.
These enforcement policies have provided
mixed results. The author discusses how
the nature of the market limits the effectiveness of supply-side policies such as attacking production in source countries,
seizing drug shipments, or locking up
dealers. He concludes that policymakers
will need to focus less on eliminating the
drug problem than on finding ways to
manage it better.
Peter Reuter and Victoria Greenfield,
“Measuring Global Drug Markets: How
Good Are the Numbers and Why Should
We Care About Them?” World Economics,
Vol. 2, No. 4, 2001, pp. 159–173.
The continuing demand for measures
of the size of global drug revenues has
produced a supply of numbers that consistently overstate international financial
flows. As with many refined agricultural
products, most drug revenues go to the
distributors rather than to primary producing countries. The authors explore the
need for estimates of the global drug markets, address the difficulties of obtaining
“good” numbers, and describe opportunities for developing better estimates of
flows and revenues.
I. Van Beusekom and Martin Y. Iguchi,
A Review of Recent Advances in Knowledge
About Methadone Maintenance Treatment,
2001, Santa Monica, Calif.: RAND.
Since the early 1970s, methadone
maintenance treatment has been used in
Switzerland as a substitute for heroin addiction. In order to improve the uniformity and quality of methadone maintenance practices, the Swiss Federal Office
of Public Health plans to develop clinical
guidelines and asked RAND Europe to review the recent literature (1995–2000) on
methadone treatment. This review describes the advances in knowledge that
have been achieved in understanding the
interactions of methadone and other
drugs, treatment outcomes associated
with methadone maintenance, the use of
methadone by special populations (e.g.,
7
people with HIV infection or tuberculosis), psychosocial treatment and motivational interventions, addicts’ perceptions
of treatment, and the use of other substitution drugs.
New People
Katherine Watkins, Harold Alan Pin-
cus, and Terri L. Tanielan, Evidence-Based
Care Models for Recognizing and Treating
Alcohol Problems in Primary Care Settings,
2001, RAND MR-1491-SAMHSA.
Although primary care physicians
(PCPs) are in an ideal position to screen
for alcohol problems, begin treatment,
and monitor progress, primary care systems are not set up to support PCPs in
recognizing and treating such disorders.
The authors discuss a chronic disease
management model that can be adapted
to improve the detection, treatment, and
management of alcohol-related problems
in primary care settings. The model has
four essential components: practice/
delivery system redesign, collaborative
management, decision support for providers, and clinical information systems.
Suzanne L. Wenzel, M. Audrey Bur-
nam, Paul Koegel, Sally C. Morton, Angela Miu, Kimberly J. Jinnett, and J. Greer
Sullivan, “Access to Inpatient or Residential Substance Abuse Treatment Among
Homeless Adults with Alcohol or Other
Drug Use Disorders,” Medical Care, Vol.
39, No. 11, 2001, pp. 1158–1169.
This study examines access to in
patient or residential treatment among
homeless adults with alcohol or drug use
disorders. Using data collected from a
random sample of 797 homeless adults in
Houston, Texas, the researchers found
that persons with public health insurance
and a history of treatment for substance
problems had greater odds of receiving at
least one night of treatment, while contact
with service sectors was not predictive of
treatment access. Schizophrenia and having a partner appeared to hinder access.
Greater need for treatment was associated
with fewer nights of treatment. The authors conclude that enhancing access to
care may require a strengthening of referral relationships across different service
sectors. ■
8
Jeremy Arkes is an associate economist
at RAND. His primary interest in drug
policy concerns the determinants and
consequences of adolescent drug use.
Jeremy has recently contributed to several
proposals on drug-use research, including
one to study how changes in local
economies affect adolescent drug use. He
has also conducted research in many
other areas, including workplace injuries,
school accountability, employer training,
and military retention and recruiting.
Jeremy was previously a research analyst
at the Center for Naval Analyses. He has
published in such journals as the Review
of Income and Wealth and the Economics
of Education Review. Jeremy received his
Ph.D. in economics from the University
of Wisconsin.
Deborah Cohen is a senior natural scientist at RAND with expertise in behavioral research and public health program
development. She is interested in the role
of structural factors on health, including
housing, parks, alcohol policies, supervision of youth, and school quality. Deborah was previously chief of the Section of
Public Health and Behavioral Medicine in
the Department of Public Health and Pre-
ventive Medicine at the Louisiana State
University Health Sciences Center. There,
she led several alcohol-related studies, including two funded by the Robert Wood
Johnson Foundation to study the relationship between alcohol policy and
alcohol-related mortality. She also led a
community intervention, funded by the
Center for Substance Abuse Prevention,
to increase enforcement of existing alcohol control polices, a project that involved undercover compliance checks
and a billboard campaign to reduce alcohol sales to underage youth. Deborah
holds an M.D. from the University of
Pennsylvania School of Medicine and an
M.P.H. from the University of California,
Los Angeles, School of Public Health. She
was a Fulbright senior scholar in Salvador, Brazil, and completed a postdoctoral fellowship in health behavior at the
University of Southern California.
Sarah Hunter is an associate behavioral
scientist at RAND. Since coming to
RAND, Sarah has worked on an evaluation of a mental health intervention tool
for substance abuse treatment providers
in Los Angeles. She is also collaborating
with the Oakland Police Department to
conduct a community survey about racial
profiling. Sarah’s interests include race
and ethnicity, program evaluation, and
the social psychological factors that influence health and behavior. She has experience with experimental, quasiexperimental, and qualitative methods.
Sarah received a Ph.D. in social psychology from the University of California,
Santa Barbara, in 2000.
Jerry Jacobson is a doctoral fellow at
the RAND Graduate School for Policy
Studies (RGS). He specializes in spatial
analysis and geographic methods, as well
as urban service delivery. Jerry is currently developing statistical methods for
evaluating claims of environmental injustice and is also evaluating the impact of
California’s Proposition 36 on drug offenders in Orange County. His doctoral
research examines the impact of patient
and facility location on substance abuse
treatment outcomes. Jerry has also collaborated on an analysis of the Indonesia
Family Life Survey and in the design,
fielding, and analysis of a nationwide survey of emergency response organizations.
He is a recipient of the Rotary Ambassadorial Scholarship for 2002–03. Jerry
holds an M.Phil. in policy analysis from
RGS and a B.S. in industrial engineering
and operations research from the University of California, Berkeley.
Nelson Lim is an associate social scientist
at RAND and research director of the Los
Angeles Family and Neighborhood Survey (L.A.FANS). He is the primary investigator on a pending proposal to examine
how the likelihood of drug use among
Asian American youths is influenced by
the effects of acculturation and selfidentity, parental characteristics and
familial relationships, and environmental
factors. Nelson is also the leader of a proposed study to investigate the impact of
neighborhood characteristics on the risktaking behaviors of immigrant children.
As research director of L.A.FANS, Nelson
has taken the lead on the neighborhood
key-informant survey and in constructing
a contextual data file to be used with the
statistical models that estimate qualities of
community and neighborhood on individual life chances. He has extensive
training in spatial statistics and in geographic information systems. Nelson
holds a Ph.D. in sociology from the University of California, Los Angeles.
Jennifer Magnabosco Bower is currently an associate policy researcher in
management sciences and health at
RAND. She has more than a decade of experience as a researcher, administrator,
and clinical practitioner in public and private human service organizations. Jennifer is currently working with other
DPRC staff to develop new grant proposals that will continue RAND’s collaborative working relationship with Phoenix
House. She is applying her clinical experience with children and families and her
research experience in designing and conducting child and adult decisionmaking
experiments to explore the behavioral
contingencies that are associated with
successful adolescent drug interventions
and programs. Jennifer is also involved in
studies of managed behavioral health care
patterns in state Medicaid programs, geographic and racial disparities and children’s mental health needs, and best practices in mental health and public
administration. Jennifer is coeditor, with
Ed J. Mullen, of the best-selling volume
Outcome Measurement in the Human Services: Cross-Cutting Issues and Methods
(NASW Press, 1997). She received a Ph.D.
in social policy and administration from
Columbia University.
Steven Martino is an associate behavioral scientist at RAND. His research interests include health cognition and decisionmaking; developmental patterns of
substance use and their associated causes
and consequences; and adolescent health
behavior. Steve has experience with a variety of research approaches, including
survey methods, latent variable modeling,
growth modeling, regression techniques,
cluster analysis, and multilevel modeling.
He received a Ph.D. in psychology from
the University of Minnesota in 2001.
Julie Straus is working with DPRC as a
research assistant. Julie has participated
on a variety of studies on such topics as
partner-oriented drug treatment and HIV
risk reduction, the evaluation of chronic
illness care, and the impact of changing
health care markets on vulnerable populations. She is particularly interested in
the impact of drug policy on the homeless. Julie holds B.A. degrees from the
University of Pennsylvania in both economics and psychology. ■
9
Visiting Scholar: Lisa Kennedy
Advisory Board
Lovida H. Coleman, Jr. (Chair)
Partner, Sutherland, Asbill & Brennan
The Drug Policy Research Center hosts
scholars from other institutions to take
advantage of different experiences and
outlooks and to provide a means of sharing RAND research with others. The
visitor for 2001–02 was Lisa Kennedy,
a Ph.D. student at the University of
Queensland in Australia, who came to
RAND to learn more about cost-effective
responses to crime and illicit drug use.
Her reflections on her experience at
RAND follow:
As Thoreau said, “Be not merely good;
be good for something.” That’s the difference between the Drug Policy Research
Center and institutions with a more theoretical orientation and thus, necessarily,
less importance to people in the community. Illicit drug use pervades communities
all over the world and while many policy
responses are driven by ideology and values, the notion that evidence can, and
should, drive policy is gaining currency.
The DPRC is at the forefront of providing
policy-relevant research.
I came to the DPRC to develop my understanding of cost-effective responses to
crime and illicit drug use. While I learned
about cost-effectiveness research I also
learned about the energy that drives the
agenda at RAND.
It’s hard to explain how the energy at
RAND is generated. It must have something to do with recruiting a group of educated, bright people from diverse profes-
Stephen M. Duncan
Tone N. Grant
President, Refco Group, Ltd.
Pedro José Greer, Jr.
Assistant Dean, Homeless and Poverty Education,
University of Miami School of Medicine
Calvin Hill
Fred C. Iklé
Distinguished Scholar, Center for Strategic
and International Studies
David J. Mactas
Norval Morris
Julius Kreeger Professor of Law and Criminology
School of Law, University of Chicago
sional and cultural backgrounds, putting
them in a rabbit-warren of a building, and
telling them to work really hard. And to
collaborate—mostly collaborate. It also
helps to have mavens (people who love to
teach) such as Martin Iguchi and connectors (people who know everyone), to use
terms coined by Malcolm Gladwell.
The mavens and connectors at the
DPRC have a collective understanding that
their research can influence policy, hence
their emphasis on getting research into the
public domain. For more insight, a social
network analysis could help uncover what
it is that distinguishes the DPRC—what
drives policy-relevant research and collaboration and how the DPRC has harnessed
these elusive elements. ■
Amy Pascal
Chairman, Columbia Pictures
Janet L. Robbie
Former Executive Vice President
Miami Dolphins and Joe Robbie Stadium
Cynthia Telles
Director, Spanish Speaking Psychosocial Clinic
Department of Psychiatry, University of California,
Los Angeles
Barbara R. Williams
Vice President Emeritus, RAND
Hubert Williams
President, Police Foundation
Judith B. Willis
Health Care Consultant
Richard B. Wolf
James H. Woods
Professor of Pharmacology and Psychology
Department of Pharmacology, University of Michigan
Former Advisory Board Members
James E. Burke
Chairman, Partnership for a Drug-Free America
Norman A. Carlson
Senior Lecturer, Department of Sociology
University of Minnesota
Mathea Falco
President, Drug Strategies
Daniel P. Garcia
Herbert D. Kleber
Professor, Department of Psychiatry
Columbia University
P. Michael Timpane
Senior Advisor for Education Policy, RAND
The Honorable John P. White
Lecturer in Public Policy, John F. Kennedy
School of Government; Senior Partner,
Global Technologies Partners
James Q. Wilson
Collins Professor of Management
The John E. Anderson Graduate School of
Management, University of California, Los Angeles
10
2002 Grant Hill Speaker Series
Science and Drug Policy
This series provides a forum for decisionmakers and scientists to discuss policies concerning drug supply
demand and control. The series is supported by a gift from Houghton Mifflin Company on behalf of
Janet and Calvin Hill.
February 6
12:00 pm
The Iowa Managed Substance Abuse Care Plan
(IMSACP): Access, Utilization, and Expenditures for
Medicaid Recipients
Dennis McCarty, Department of Public Health
and Preventive Medicine, Oregon Health
Sciences University
February 27
3:00 pm
Tobacco: Pros, Cons, and Approaches to Harm Reduction
Jerome Jaffe, University of Maryland School of
Medicine
April 8
12:00 pm
From Mountains to Molehills: Reducing the Harms
Associated with Injection Drug Use in America
Stephanie Strathdee, Johns Hopkins School of
Public Health
May 31
4:00 pm
Forces of Habit: Why We Make War on Some Drugs but
Not on Others
David Courtwright, University of North Florida
June 21
12:00 pm
The Ethical and Policy Implications of Vaccines Against
Cocaine and Nicotine
Wayne Hall, Institute for Molecular Bioscience,
University of Queensland
September 24
12:00 pm
Punishment and Prejudice: Judging Drug-Using Pregnant
Women
Lynn Paltrow, National Advocates for Pregnant
Women
October 10
12:00 pm
Describing Illicit Drug Use in America: Design and Findings of the National Survey on Drug Use and Health
Don Goldstone, Office of Applied Studies,
SAMHSA
November 22
12:00 pm
Networks and the Population Dynamics of HIV
Martina Morris, Department of Sociology,
University Of Washington
December 2
12:00 pm
Powder Brokers: The Art of Survival in Colombian
Cocaine Trafficking Organizations
Rick Fuentes, New Jersey State Police
The 2002 Speaker Series is held at RAND, 1700 Main Street, Santa Monica, California. For more
information, call Nelie Gill at (310) 393-0411, ext. 6330. ■
RAND is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND® is a registered trademark. RAND’s publications
do not necessarily reflect the opinions or policies of its research sponsors. The Drug Policy Research Center, established in 1989, is supported by
The Ford Foundation, other foundations, government agencies, corporations, and individuals.
THE RAND DRUG POLICY RESEARCH CENTER
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