R
October 2003
Using Marijuana May Not Increase the Risk
of Hard Drug Use
Marijuana is widely regarded as a “gateway” drug, that is, one whose use results in an increased likelihood of using more dangerous drugs such as cocaine and heroin. The gateway effect has frequently been cited by policymakers in defense of laws prohibiting the
use or possession of marijuana. For example, many arguments against the decriminalization or legalization of marijuana have been based on the premise that the use of marijuana causes youths to have an increased risk of progressing to other, more serious drugs.
Many observers conclude that available evidence makes a case for the gateway effect.
Studies have shown that marijuana users are many times more likely (85 times more
likely, in one study) than nonusers to progress to hard drug use. Other studies have
found that almost all who have used both marijuana and hard drugs used marijuana
first, and that, as the frequency of marijuana use increases, so too does the risk of initiating hard drug use.
But these associations in themselves do not prove that marijuana use causes hard
drug initiation. Moreover, a recent DPRC analysis by researchers Andrew R. Morral,
Daniel F. McCaffrey, and Susan M. Paddock provides the first quantitative evidence that
the associations between marijuana use and hard drug use can be explained without resort to the gateway effect. Using survey data from the U.S. population, the researchers
found that these associations can be accounted for by an alternative theory: Those who
use drugs may have an underlying propensity to do so that is not specific to any one
drug. This “common-factor” model has implications for evaluating marijuana control
policies that differ significantly from those supported by the gateway model.
An Alternative Explanation for Associations Between Marijuana
and Hard Drug Use
To understand whether drug-use associations could be explained by a common-factor
model, the research team first examined the drug-use patterns reported by more than
38,000 U.S. residents between the ages of 12 and 25 who participated in the National
Household Surveys on Drug Abuse (NHSDA) between 1982 and 1994.1 Using a statistical model, the researchers then tested whether the observed patterns of drug-use initiation might be expected if drug-initiation risks were determined exclusively by
●
●
●
1
the time of the youths’ first opportunity to use each drug
individuals’ drug-use propensity, which was assumed to be normally distributed (i.e.,
some people have a high or low propensity, but most have a propensity near the middle of the range)
chance (or random) factors.
4䊳
In This Issue
Using Marijuana May Not Increase
the Risk of Hard Drug Use
1
Director’s Message
2
New Book Provides a Comprehensive
View of the Public Health and Public
Policy Issues Associated with
Marijuana Use
3
Study Addresses the Safety and
Effectiveness of Ephedra
5
New Project
5
New Publications
6
New People
9
2003–4 Speaker Series
12
In subsequent years, respondents have not been asked about their first opportunity to use various drugs.
1
D I R E C T O R ’ S
M E S S A G E
Exploring Drug Use and Drug Policy Futures
The last 10 to 15 years have seen few dramatic developments in America’s drug
use. While the period from the 1960s to
the 1980s saw the spread of marijuana,
the heroin epidemic, the explosion of cocaine initiation, and the spread of crack
and street markets, the past several years
have seen America’s drug problem settle,
at least superficially, into a time of stability or, at most, predictable change. This
stability in drug problems has been
mirrored by an even longer-standing stability in drug policy, in which America’s
primary response to illicit drug use has
been an emphasis on enforcement and
punishment.
But history suggests that the stability
of the past decade is likely to be more the
exception than the rule. For this reason, it
can be useful to seek insights into potential drug use and drug policy futures. In
other words, we need to ask why and how
drug problems and policy might be different in the future from what they are now.
To explore this question, the DPRC held a
colloquium, “Drug Use and Drug Policy
Futures,” at RAND in August 2002. The
colloquium, attended by scholars from
RAND and other institutions, was supported with discretionary funds provided
to the DPRC by The Ford Foundation.
change in the future, there might be corresponding changes in drug use and policy. To cite another example, new trends
in the use of licit substances, such as
cigarettes, might also affect future illicit
drug use. Cigarette smokers are more
likely to use marijuana than are nonsmokers. If this relationship reflects
causality and not just coincidence, and if
tobacco use keeps falling, marijuana use
could also fall.
Other drivers of future drug use and
policy trends include
The Factors Driving Drug Use and
Drug Policy Could Change
Assumptions Underlying Drug
Policy Might Be Challenged
How might drug problems and policy
look different in the future from how they
do today? One possibility is a shift in one
of the factors driving drug use and drug
policy. For example, in terms of morality,
although the past 40 years have been
marked by a shift toward individualist,
relativist, secular values, this shift has
not—so far—extended dramatically to
illicit drug policy. However, if codes of
morality regarding drug use were to
Trends in drug use and drug policy might
also change because of shifts in some of
the assumptions underlying current
trends. For example, drug policy in the
United States is currently focused on the
use of cocaine, heroin, and marijuana,
since collectively, these drugs account for
nearly 90 percent of drug use, as well as
most of the associated addiction, morbidity, mortality, and crime. But how might
the drug policy context shift if there were
2
●
●
●
●
●
●
the influence of interest groups, particularly as such organizations gain political savvy
the level of illicit drug experience
among the voting populace
state drug laws that come into conflict
with federal policy, particularly if a
case pitting federal control against
state prerogatives were to come before
the U.S. Supreme Court
counterterrorism policies
globalization of trade, which contributes to the availability of drugs and
complicates their control
increases in violent crime, since, in the
United States, violent crime has traditionally been associated with drug use.
a dramatic increase in the use of another
drug, such as ecstasy or methamphetamine? Such a shift in usage would
mean that the United States was facing
the contagious spread of an important
drug, with consequent stresses on the enforcement and treatment system.
Current drug policy is also based on
the assumption that incarceration, and
the threat thereof, is the mainstay of prohibition. Some alternative policies have
been implemented, such as drug courts
and California’s Proposition 36, which
mandates treatment for persons convicted of simple use or possession. But the
impact of both these alternatives has so
far been limited: Drug courts can process
only a small fraction of drug offenders,
and it is too soon to evaluate the success
of the California law. In the future, however, a carefully thought-out alternative
drug policy might be found to significantly reduce drug use at lower government cost. The success of any such variation in one jurisdiction could serve to
challenge long-held assumptions about
the benefits of incarceration, thus encouraging states and even the federal government to experiment or imitate successful
alternative policies.
Other current assumptions are also
subject to challenge. Will all drugs continue to be addressed under a single “drug
policy,” or will an individual drug (e.g.,
marijuana) become a candidate for differential treatment? What if greater enthusiasm were shown for drug treatment programs, resulting in increased investment
in effective programs? What would happen if public attitudes, including those
among racial and ethnic minorities, began
to shift against the current policy of strict
prohibition?
Wild Cards Might Come into Play
Any attempt to explore possible futures
of drug use and drug policy needs to consider the possibility that a low-probability
but highly consequential event—a “wild
card”—might come into play. What
might these wild cards be? Developments
in neuroscience might result in a treatment
model, perhaps based on medication, that
is dramatically more effective than those
currently employed or even contemplated.
A celebrity death attributed to ecstasy or
another club drug could have a significant
effect on initiation for that drug. Some
yet-to-be-invented “helpful” drug (e.g.,
intended to help people improve memory, lose weight, treat depression) could
result in a new epidemic. Or significant
advances in technology related to drug
testing might make such testing more
routine, with potential consequences for
criminal justice, workplace rules, and
even family relationships.
Conclusion
The colloquium on drug use and policy
futures demonstrated that a semistructured approach to thinking about the future of drug problems and policy can
yield some interesting alternative visions.
The concepts explored in the colloquium
can help focus attention on elements of
policy or other influences that, if addressed now, could reduce the chances of
an unwanted turn of events. Moreover, by
playing out some of the specific scenarios
to their ultimate conclusions, policymakers have the opportunity to identify
complex issues whose eventual resolution
could benefit from immediate attention.
The examples highlighted above suggest
that the approach to futures analysis taken
in the RAND colloquium could be of real
value in reviewing current drug policy. A
useful next step would be to infer a comprehensive set of policy implications from
the futures envisioned here. ■
For further information see Jonathan P. Caulkins,
Peter Reuter, Martin Y. Iguchi, and James Chiesa,
Drug Use and Drug Policy Futures: Insights from
a Colloquium, Santa Monica, Calif.: RAND,
IP-246-DPRC, 2003, www.rand.org/publications/
IP/IP246/.
New Book Provides a Comprehensive View of the Public Health and
Public Policy Issues Associated with Marijuana Use
The marijuana policy debate in developed
societies is often represented as if it involved a choice between only two positions:
on the one side are those who believe that
marijuana use is harmless (or at least much
less harmful than alcohol) and therefore
should not be prohibited; on the other
side are those who say that marijuana use
is harmful to health, and therefore its use
should continue to be prohibited. As a
consequence of this polarization, the
policy discussion has often been reduced
to a single question: “Does marijuana adversely affect the health of those who use
it?” The simplification of the policy debate has led to distorted appraisals of the
health risks of marijuana use and created
a major obstacle to effective public education about its health risks.
A new book by Wayne Hall and DPRC
economist Rosalie Liccardo Pacula aims
to move beyond such policy simplifications. Cannabis Use and Dependence: Public Health and Public Policy (see box) seeks
to provide a fairer and fuller picture of the
costs of marijuana use and of the policies
that have been adopted toward marijuana.
Focusing on data from the United
States, Europe, and Australia, the study
cites evidence on a range of harms probably caused by marijuana use, including
respiratory disease, dependence, adverse
effects on adolescent development, the
exacerbation of psychosis, and an increased risk of car accidents. The study
also discusses evidence on the harms associated with marijuana prohibition, including the loss of liberty to use marijuana, the creation of a black market,
disrespect for a widely broken and minimally enforced law, harm to users’ reputations, impaired health education about
marijuana and other drugs, the loss of
benefits from marijuana including medical use, and the inefficient use of law enforcement resources.
The authors note that even if all the
costs and benefits of marijuana use could
be quantified, in order to decide upon a
policy, societies would still need to make
trade-offs among incommensurable
values, weighing, for example, the adverse
effects that marijuana use has on the
health and well-being of adolescent and
adult users versus the individual liberty of
adult marijuana users or the economic
costs of enforcing prohibition.
The authors do not attempt to decide
how such trade-offs should be made.
They do argue, however, that marijuana
policies need to be more responsive to evidence on both the adverse health effects
of marijuana and the costs and effectiveness of marijuana control policies. Better
public policy on marijuana will require
investments both in epidemiological research on the long-term health consequences of use and in rigorous research
on the costs and benefits of current and
alternative policy options.
The larger public health and social
policy communities also need to be more
involved in the debate. As the authors of
this new book demonstrate, policies on
marijuana use are too important to be
left, as they so often have been, to those
who proffer only the falsely simplified
forced choices that are usually represented
in public debates on marijuana policy. ■
New Book Cannabis Use and Dependence:
Public Health and Public Policy by Wayne
Hall and Rosalie Liccardo Pacula (Cambridge
University Press, forthcoming) provides the
first comprehensive examination of the costs
of marijuana use and of the policies that have
been adopted toward marijuana. Drawing on
evidence from the United States, Europe, and
Australia, the authors examine what is known
about cannabis as a drug along with patterns
of recreational use in developed societies; they
also review evidence on the adverse health
and psychological effects of use, including the
effects on adolescents, and consider the harms
and benefits of use. The book surveys several
key areas of the policy debate, including the
potential deterrent effects of the prohibition
on marijuana use, the economic costs of enforcing the current prohibition on marijuana
use and supply, and alternative marijuana
control policies. The authors conclude by
suggesting some ways to move the policy debate forward by developing support for incremental policy changes—the costs and effects
of which would be systematically evaluated.
3
Without assuming any gateway
effect, the model produced patterns of
drug use and abuse remarkably similar to
what is experienced across the nation,
demonstrating that a marijuana gateway
effect is not needed to explain the observed associations between marijuana
and hard drug initiation. For example,
even though marijuana use had no effect
on hard drug use in the model, it faithfully reproduced U.S. drug initiation
patterns in which marijuana users are
much more likely to try hard drugs than
nonusers (Figure 1).
Moreover, the model reproduced the
strong propensity among young people in
the United States to use one drug (marijuana) before initiating use of another
(hard) drug—chiefly because opportunities to use marijuana routinely precede
opportunities to use hard drugs, often by
many years. The model predicted that
only a small fraction of hard drug users
would have tried a drug other than marijuana first. Whereas in the NHSDA data,
1.6 percent of adolescents tried hard
drugs before marijuana, the model predicted an even stronger sequencing of
drug initiation, with just 1.1 percent trying hard drugs first.
Finally, the modeled relationship between the frequency of marijuana use and
hard drug initiation closely matched the
actual relationship. Figure 2 shows the actual (colored bars) and modeled (gray
bars) probabilities that marijuana users
will initiate hard drugs in the current year
in relation to the frequency of their marijuana use in the past year.
Policy Implications
The results of the DPRC model of drug
initiation do not disprove the gateway effect; they merely show that another explanation is plausible. In fact, the researchers
note that something like a gateway effect
probably does exist, if only because marijuana purchases bring users into contact
with a black market that increases access
to hard drugs. However, it is possible that
any true marijuana gateway effects can
explain only a tiny fraction of individuals’
risk of hard drug use in comparison with
4
the risk attributable to
Figure 1—Actual Versus Modeled Probabilities of
their propensities to
Marijuana Users and Nonusers Initiating Hard
use drugs. Moreover, it
Drug Use
is possible that mariActual
juana use could inNonusers
crease the risk of hard
drug use for some
Users
youths while decreasing
that risk for others,
Modeled
thus resulting in an inNonusers
significant effect from
Users
marijuana use on drug
use when looking at
0
0.1
0.2
0.3
0.4
0.5
the entire population
Probability of initiating hard drugs by age 21
of adolescents.
Some might argue
that as long as the gateFigure 2—Actual Versus Modeled Probabilities of
way theory remains a
Hard Drug Initiation, Given Marijuana Use
possible explanation,
Frequency in the Preceding Year
policymakers should
retain current stric0
Actual
tures against mariModeled
1–2
juana use and possession. However, while
3–11
the authors do not
argue that marijuana
12–51
should be legalized or
52+
decriminalized, they
note that the common0
0.02
0.04
0.06
0.08
0.10
factor model has quite
Probability that marijuana users will initiate hard drugs
different policy impliin the current year, youths 12–21
cations for reducing
drug use and its harms. Specifically, it
of increased marijuana availability and
suggests that policies aimed at reducing
use, including the potential for adverse
or eliminating marijuana use are unlikely
effects on the health, development, eduto have any effect on hard drug use,
cation, and cognitive functioning of
except insofar as such policies affect
marijuana users.
either an individual’s propensity to use
However, as the DPRC study indicates,
any drugs or result in hard drugs bethe harms of marijuana use can no longer
coming less available (or available later)
be viewed as necessarily including an exin youths’ lives.
pansion of hard drug use and its associIn addition, prohibition policies are
ated harms. This shift in perspective
not cost-free, and their harms can be sigought to affect the overall balance benificant. The more than 700,000 maritween the harms and benefits of different
juana arrests per year in the United States
marijuana policies. ■
burden individuals, families, neighborFor further information, see Using Marijuana
hoods, and society as a whole. Decisions
May Not Raise the Risk of Using Harder Drugs,
about marijuana policy must necessarily
Santa Monica, Calif.: RAND, RB-6010, 2002,
take into account many other factors in
www.rand.org/publications/RB/RB6010/. See
addition to whether or not marijuana is
also Andrew R. Morral, Daniel F. McCaffrey, and
Susan M. Paddock, “Reassessing the Marijuana
a gateway drug. The authors suggest
Gateway Effect,” Addiction, Vol. 97, 2002, pp.
that marijuana policies should weigh the
1493–1504.
harms of prohibition against the harms
Frequency of marijuana
use in past year
1䊳
Study Addresses the Safety and Effectiveness of Ephedra
New Project
Products that contain the herb ephedra
have been promoted and used in the
United States since the 1980s to increase
weight loss and enhance athletic performance. Yet despite manufacturers’ claims,
little research has been done to assess
the safety and effectiveness of ephedracontaining dietary supplements, and the
research studies that have been done have
been too small to allow any firm conclusions to be drawn. To address these issues,
researchers from RAND Health recently
completed an exhaustive review of health
studies involving products containing the
herb ephedra or the drug ephedrine. The
study was conducted at the request of the
U.S. Department of Health and Human
Services.
The analysis of available evidence suggests that ephedra and ephedrine promote modest short-term weight loss although their long-term effect is
unknown. Ephedrine plus caffeine was
found to boost immediate physical performance for fit young men; however,
there was no evidence that ephedra or
ephedrine improves long-term physical
performance of athletes or would work
for the general public.
The evidence also showed that these
products are related to a two- or threefold increase in side effects such as nausea, vomiting, jitteriness, and palpitations. Moreover, the review found that
there may be a link between these products and catastrophic events such as sudden death, heart attack, or stroke. The existing evidence in itself is insufficient to
link these products conclusively with
death and other serious health problems.
However, the analysis of the existing studies and their shortcomings suggests that a
more definitive answer to questions about
ephedra’s safety could be obtained
through further study.
In response to the RAND report, the
federal government quickly moved to
propose stricter labeling of ephedra products and solicited public comment on
whether the safety evidence thus far warrants further restrictions.
Getting to Outcomes: A
Community-Based Participatory
Approach to Preventive
Interventions
The review was conducted within the
Southern California Evidence-Based
Practice Center (SCEPC), which is based
at RAND. The SCEPC is one of 13 federally sponsored evidence-based practice
centers nationwide that specialize in
seeking answers to important health care
questions through assessing and synthesizing evidence from large numbers of research studies. Statistically combining the
findings of many similar studies increases
researchers’ confidence that small apparent differences in the effects of two treatments are real.
Only controlled clinical trials and randomized controlled trials of effectiveness
were included in the analysis. Randomized controlled trials are clinical trials in
which participants are assigned randomly
to one of two or more treatment groups.
Controlled clinical trials are those in
which participants are assigned to a treatment group using a semi-random procedure, such as participant’s date of birth or
a patient identification number. In all, researchers reviewed the results of 52 clinical trials. ■
For further information, see Ephedra: Is It Worth
the Risk? RAND: Santa Monica, Calif., RB-4556,
2003, www.rand.org/publications/RB/RB4556/.
See also P. Shekelle, M. Hardy, S. C. Morton, M.
Maglione, M. Suttorp, E. Roth, L. Jungvig, W.
Mojica, J. Gagne, S. Rhodes, E. McKinnon, and S.
Newberry, Ephedra and Ephedrine for Weight Loss
and Athletic Performance Enhancement: Clinical
Efficacy and Side Effects, prepared for the Agency
for Healthcare Research and Quality, 2003,
www.ahrq.gov/clinic/ephedinv.htm. See also P.
Shekelle, M. Hardy, S. C. Morton, M. Maglione,
W. Mojica, M. Suttorp, S. Rhodes, L. Jungvig,
and J. Gagne, “Efficacy and Safety of Ephedra and
Ephedrine for Weight Loss and Athletic Performance: A Meta-Analysis,” Journal of the American Medical Association, March 26, 2003, Vol.
289, No. 12, pp. 1537–1545.
Substance abuse prevention programs can
improve community health, but only
when they are implemented well. Effective implementation is difficult given the
advanced skills required, causing a gap
between the positive outcomes achieved
by prevention science and those observed
in practice. A new DPRC study seeks to
address this gap through a model that
emphasizes collaboration between science
and practice. The model, called “Getting
to Outcomes” (GTO), is based on the
premise that preventive interventions
should be consistent with the principles
of community-based participatory research (CBPR). In CBPR, community
members are directly involved in research, leading to outcomes that are often
more relevant, more widely utilized, and
of better quality. GTO includes both a
prevention process and a corresponding
technical assistance package that can be
used to develop community-based participatory interventions.
GTO involves a ten-step process to
enhance practitioners’ prevention skills
while empowering them to plan, implement, and evaluate their own programs.
To test GTO, the researchers recently
began a Centers for Disease Control–
funded participatory research project in
two substance abuse prevention coalitions
in the United States. Coalitions organize
interventions on multiple levels (individual, organizational, and policy) and
across sectors (parents, youth, criminal
justice, and education). The project includes GTO training and significant technical assistance. GTO’s impact will be assessed through evaluation of individual
programs as well as surveys administered
to all coalitions before GTO implementation, and at 12 and 24 months following
implementation. Standard assessment
techniques will be used to track GTO utilization. After seven months, 48 persons
from the coalitions have been trained and
four programs have begun to receive
5
technical assistance on completing the
GTO steps. Although it is too early for results, field notes show that GTO is already
changing the way the prevention programs are implemented. ■
New Publications
Drug Policy and Trends
䊳Jonathan P. Caulkins and Robert Mac-
Coun, “Limited Rationality and the Limits of Supply Reduction,” Journal of Drug
Issues, Vol. 33, No. 2, 2003, pp. 433–464.
According to economics, interventions
that restrict supply typically drive prices
up; in drug markets, however, retail prices
for cocaine and heroin have fallen by 70
to 80 percent even as these markets have
been targeted for increasingly tough enforcement. This paper explores the possibility that part of the explanation for this
paradox may lie in the failure of drug
dealers to respond to risk in the way predicted by the simplest “rational-actor”
models. According to such models, increasing enforcement risk deters people
from selling drugs at prices that provide
less than a certain monetary reward; the
authors suggest, however, that for the decision to sell drugs, deviations from such
a notion of rationality are likely to be
large, whether because of bounded rationality or even “less rational” behavior.
䊳Martin Y. Iguchi, Jennifer A. London,
Nell Griffith Forge, Laura Hickman, Terry
Fain, and Kara Riehman, “Elements of
Well-Being Affected by Criminalizing the
Drug User,” Public Health Reports, Vol.
117, Suppl. 1, 2002, pp. S146–S150.
This article describes eight elements of
personal and community well-being that
may be affected by state and federal policies on drug felons: children and families,
access to health benefits, access to housing benefits, access to assistance for
higher education, immigration status,
employment, eligibility to vote, and drug
use or recidivism. Because minorities
have a high chance of felony conviction
and an increasing lack of access to re-
6
sources, minority communities will be
disproportionately affected as large numbers of drug offenders complete their
terms and reenter these communities.
Without resources (education, job opportunities, insurance, health care, housing,
and the right to vote), drug abusers face a
higher risk of recidivism and increase the
burden on their communities.
䊳Rosalie Liccardo Pacula, Jamie F.
Chriqui, Deborah A. Reichmann, and
Yvonne M. Terry-McElrath, “State Medical Marijuana Laws: Understanding the
Laws and Their Limitations,” Journal of
Public Health Policy, Vol. 23, No. 4, 2002,
pp. 413–439.
This paper provides a comprehensive
view of state medical marijuana laws. The
authors identify four types of provisions
enabling the medical use of marijuana
and discuss the tensions these approaches
have with federal law as well as their implications for patient access. They suggest
that the legality and viability of state laws
will likely be made on a case-by-case
basis, although two overarching issues
are the federal courts’ refusal to accept a
medical necessity exception for marijuana
and the need for states to create a legitimate supply mechanism for patients
without overburdening law enforcement.
䊳Peter Reuter and Jonathan P. Caulkins,
“Does Precursor Regulation Make a Difference?” Addiction, Vol. 98, No. 9, 2003,
pp. 1177–1179.
This editorial was prompted by a recent study that found that three different
methamphetamine precursor regulations
each led to sharp reductions in methamphetamine-related hospital admissions in
three western U.S. states. A brief examination of other indicators (prices, treatment admissions, prevalence among arrestees, survey results, and emergency
department mentions) provided only ambiguous support for these findings. The
authors indicate that a follow-up study
considering the interrelationships among
a broader set of indicators would be instructive. Granting that precursor control
can affect the market, the key question
becomes whether the benefits of those ef-
fects are large or small relative to the costs
of producing them.
Prevention
䊳James Zacny, George Bigelow, Peggy
Compton, Kathleen Foley, Martin Iguchi,
and Christine Sannerud, “College on
Problems of Drug Dependence Taskforce
on Prescription Opioid Non-Medical Use
and Abuse: Position Statement,” Drug
and Alcohol Dependence, Vol. 69, No. 3,
2003, pp. 215–232.
This paper reviews the epidemiology
of prescription opioid use and abuse, the
availability of laboratory testing to determine abuse liability, the role of regulatory
agencies, and the range of treatment options. A central theme is the need to strike
a balance between the need for physicians
and patients to have appropriate access to
opioid pharmaceuticals for the treatment
of pain and risk management strategies to
prevent and deter prescription abuse.
Treatment
䊳Chloe E. Bird, Kimberly J. Jinnett, M.
Audrey Burnam, Paul Koegel, Greer Sullivan, Suzanne L. Wenzel, M. Susan
Ridgely, Sally C. Morton, and Angela
Miu, “Predictors of Contact with Public
Service Sectors Among Homeless Adults
With and Without Alcohol and Other
Drug Disorders,” Journal of Studies on Alcohol, Vol. 63, No. 6, 2002, pp. 716–725.
The authors examined predictors of
contact with health, mental health, social
welfare, and criminal justice service agencies among a sample of homeless adults in
Houston, Tex., finding that key aspects of
need (e.g., a chronic physical condition)
were significant predictors of utilization
among those without an alcohol or drug
problem, but not for those with such a
problem. For the latter group, contact
with one sector was not predictive of contact with other sectors. This study highlights substantial unmet needs for services
among homeless persons in general and
among those with alcohol and other drug
disorders in particular.
䊳Lisa H. Jaycox, Andrew R. Morral, and
Jaana Juvonen, “Mental Health and Medical Problems and Service Use Among
Adolescent Substance Users,” Journal of
the American Academy of Child and Adolescent Psychiatry, Vol. 42, No. 6, 2003,
pp. 701–709.
This study examined the mental health
and medical services received by youths
ages 12 to 19 who were admitted to substance abuse treatment programs between
1998 and 2001. High levels of mental
health problems were found at both time
points, but few youths received mental
health treatment, suggesting that more
could be done to link youths with these
services. In contrast, there were lower
rates of medical problems, but more than
half of youths received such services.
䊳Maria Orlando, Kitty S. Chan, and
Andrew Morral, “Retention of CourtReferred Youths in Residential Treatment
Programs: Client Characteristics and
Treatment Process Effects,” The American
Journal of Drug and Alcohol Abuse, Vol.
29, No. 2, 2003, pp. 337–357.
The authors interviewed youths referred to residential treatment programs
by the Juvenile Court of Los Angeles in
order to identify the factors that influence
youths to stay in treatment. Significant
predictors of retention included youth
pretreatment characteristics (e.g., motivation and substance use severity) as well as
treatment program factors (e.g., safety
and perceived over- and under-provision
of services), the latter implying that
changes in program delivery may increase
retention rates. Pretreatment environmental risk factors and ratings of program counselor and resident support
were marginally significant.
䊳Kara S. Riehman, Martin Y. Iguchi,
Michelle Zeller, and Andrew R. Morral,
“The Influence of Partner Drug Use and
Relationship Power on Treatment Engagement,” Drug and Alcohol Dependence,
Vol. 70, No. 1, 2003, pp. 1–10.
Researchers interviewed 64 heroin
users (42 men and 22 women) receiving
methadone detoxification treatment in
Los Angeles to determine the influence of
relationship dynamics between intimate
partners (power, control, dependence, insecurity, and decisionmaking power) on
substance abuse treatment engagement,
and to determine whether this differs by
gender and partner drug use. The study
found that women were more likely to
have substance-abusing partners and to
report greater power over a partner and
greater household decisionmaking power
in their relationships. Among individuals
with heroin-using partners, greater
household decisionmaking power was
associated with more days of abstinence.
䊳J. S. Tucker, M. A. Burnam, C. D.
Sherbourne, F. Kung, A. L. Gifford, “Substance Use and Mental Health Correlates
of Nonadherence to Antiretroviral Medications in a Sample of Patients with
Human Immunodeficiency Virus Infection,” The American Journal of Medicine,
Vol. 114, No. 7, 2003, pp. 573–580.
This study investigated associations of
antiretroviral medication nonadherence
with specific types of psychiatric disorders
and drug use, and varying levels of alcohol use. Patients with depression, generalized anxiety disorder, or panic disorder
were more likely to be nonadherent than
were those without a psychiatric disorder.
Nonadherence was also associated with
use of cocaine, marijuana, amphetamines,
or sedatives in the previous month;
drinkers were also more likely to be nonadherent.
䊳Susan Turner, Douglas Longshore,
Suzanne Wenzel, Elizabeth Deschenes,
Peter Greenwood, Terry Fain, Adele
Harrell, Andrew Morral, Faye Taxman,
Martin Iguchi, Judith Greene, and Duane
McBride, “A Decade of Drug Treatment
Court Research,” Substance Use and
Misuse, Vol. 37, Nos. 12 and 13, 2002,
pp. 1489–1527.
This article explores a decade of drug
treatment court research conducted at
RAND, starting with the experimental
field evaluation of Maricopa’s drug testing and treatment options to the most
current 14-site national evaluation of
courts funded in 1995–1996 by the Drug
Court Program Office. The article presents summaries of findings, a brief description of a drug treatment court typology, and suggestions of where future
research might focus.
䊳Glenn Wagner, Martin Iguchi, Stephan
Schneider, James Scott, and David Anderson, “Placebo Practice Trials: A Tool to
Assess and Improve Adherence Readiness,” HIV Clinical Trials, Vol. 3, No. 6,
2002, pp. 475–481.
HIV antiretroviral therapy is now increasingly delayed until later stages of illness, and providers are emphasizing the
need for patients to be ready to adhere to
the treatment regimen. This pilot study
assessed the utility of a series of up to five
one-week placebo practice trials accompanied by adherence counseling as a
clinical tool to both assess and improve
adherence readiness. Nine of 20 participants achieved a 90+ percent adherence
in the first practice trial, with an additional 8 participants demonstrating readiness after two to four practice trials. Of
the 17 who demonstrated adherence
readiness, 15 started on an antiretroviral
regimen, 13 of whom (87 percent)
achieved 90+ percent adherence during
the first month of therapy.
䊳Katherine Watkins and Terri L.
Tanielian, “Using the Chronic Care
Model to Improve Treatment of Alcohol
Use Disorders in Primary Care Settings,”
Journal of Studies on Alcohol, Vol. 64, No.
2, 2003, pp. 209–218.
The chronic-care model (CCM) is a
heuristic model that offers an approach to
increase the ability of primary care physicians to identify, treat, and effectively
manage alcohol use disorders by creating
informed patients, prepared practice
teams, and productive interactions. The
authors propose a three-phase research
agenda for implementing and evaluating
the use of the model in the treatment of
alcohol use disorders.
䊳K. B. Wells, C. D. Sherbourne, R.
Sturm, A. S. Young, and M. A. Burnam,
“Alcohol, Drug Abuse, and Mental Health
Care for Uninsured and Insured Adults,”
Health Services Research, Vol. 37, No. 4,
2002, pp. 1055–1066.
Researchers compared adults with different levels of insurance coverage for alcohol, drug abuse, and mental health
(ADM) problems. The study found that
7
the uninsured have the most problems
with access to and quality of ADM care,
relative to the somewhat comparable
Medicaid population. Persons in fully
managed plans were found to have better
access and quality compared with those in
partially managed plans, while those with
Medicare were found to be satisfied despite low ADM use. Across plans, the
unmet need for ADM care was high.
Drug and Alcohol Use and
Consequences
䊳B. M. Booth, G. Sullivan, P. Koegel, and
A. Burnam, “Vulnerability Factors for
Homelessness Associated with Substance
Dependence in a Community Sample of
Homeless Adults,” American Journal of
Drug and Alcohol Abuse, Vol. 28, No. 3,
2002, pp. 429–452.
The authors examined substance dependence among a sample of 1,185 homeless individuals in relation to other personal and social vulnerabilities linked to
homelessness, including sociodemographics, childhood/adolescent factors,
pre-homelessness factors, multiple
episodes of homelessness, and quality of
shelter. These factors were significantly
concentrated in homeless individuals
with lifetime and recent substance dependence. Profiles of the homeless with alcohol dependence alone were distinct from
those with drug dependence alone or
both, those who were older, those who
were male, those with longer histories of
homelessness, and those with significantly
poorer-quality shelter during the previous
30 days.
䊳F. H. Galvin, E. G. Bing, J. A. Fleish-
man, A. S. London, R. Caetano, M. A.
Burnam, D. Longshore, S. C. Morton, M.
Orlando, and M. Shapiro, “The Prevalence of Alcohol Consumption and Heavy
Drinking Among People with HIV in the
United States: Results from the HIV Cost
and Services Utilization Study,” Journal of
Studies on Alcohol, Vol. 63, No. 2, 2002,
pp. 179–186.
This study found that alcohol consumption is common among people in
care for HIV, with rates of heavy drinking
almost twice those found in the general
8
population. Heavy drinking is especially
high among individuals with lower educational levels and users of cocaine or
heroin.
䊳Robert Heimer, Scott Clair, Lauretta E.
Grau, Ricky N. Bluthenthal, Patricia A.
Marshall, and Merrill Singer, “HepatitisAssociated Knowledge Is Low and Risks
Are High Among HIV-Aware Injection
Drug Users in Three U.S. Cities,” Addiction, Vol. 97, No. 10, 2002, pp.
1277–1287.
This article describes interrelationships
among HIV and hepatitis knowledge,
risky drug preparation and injection practices, and participation in syringe exchange programs (SEPs) among injection
drug users in three inner-city neighborhoods. HIV knowledge was found to be
significantly higher than hepatitis knowledge among SEP customers and noncustomers alike. Elevated hepatitis knowledge was associated with a history of
substance abuse treatment, hepatitis infection, hepatitis B vaccination, and injection practices that reduced contact with
contaminated blood or water. SEP customers were consistently less likely to engage in risk behaviors (with the notable
exception of safely staunching blood
postinjection) but did not show elevated
hepatitis knowledge, suggesting the need
for SEPs to do more in this area.
䊳M. Muñoz, P. Koegel, C. Vázquez, J.
Sanz, and A. Burnam, “An Empirical
Comparison of Substance and Alcohol
Dependence Patterns in the Homeless in
Madrid (Spain) and Los Angeles (CA,
USA),” Social Psychiatry and Psychiatric
Epidemiology, Vol. 37, 2002, pp. 289–298.
This study compared data concerning
alcohol and other drug abuse and dependence among the homeless populations of
Madrid and Los Angeles. The results
show different sociodemographic profiles
for each city, as well as significant differences in social, emotional, and health
problems associated with the consumption of alcohol and other drugs.
䊳Kara S. Riehman, Martin Iguchi,
and M. Douglas Anglin, “Depressive
Symptoms Among Amphetamine and
Cocaine Users Before and After Substance
Abuse Treatment,” Psychology of Addictive Behaviors, Vol. 16, No. 4, 2002,
pp. 333–337.
Amphetamine users tend to have
higher rates of depressive symptoms than
do cocaine users. This study found that
this difference may be due to the great
likelihood of amphetamine users to be
polydrug users, or to have had a major
lifetime depressive episode, or both. The
researchers found no evidence that depressive symptoms persist after discontinuation of use for a longer period among
amphetamine users than among cocaine
users who do not use amphetamines.
Alcohol and Drug Use Among
Adolescents and Young Adults
䊳Phyllis L. Ellickson, Joan S. Tucker, and
David J. Klein, “Ten-Year Prospective
Study of Public Health Problems Associated with Early Drinking,” Pediatrics, Vol.
111, No. 5, 2003, pp. 949–955.
Examining a ten-year period beginning at grade 7, the authors found that
early drinkers and experimenters were
more likely to report academic problems,
substance abuse, and delinquent behavior
in both middle school and high school. By
young adulthood (age 23), early alcohol
use was associated with employment
problems, substance abuse, and criminal
and violent behavior. These findings suggest the need for early interventions that
also address other public health problems
(e.g., smoking and illicit drug use).
䊳Phyllis L. Ellickson, Michal Perlman,
and David J. Klein, “Explaining
Racial/Ethnic Differences in Smoking
During the Transition to Adulthood,”
Addictive Behaviors, Vol. 28, No. 5, 2003,
pp. 915–931.
This study examined the reasons for
differences in smoking rates across
racial/ethnic groups. At age 23, African
Americans and Asians exhibited substantially lower rates of smoking than whites
and Hispanics. These differences could
be accounted for by controlling for social
influences during high school, particularly exposure to prosmoking social
influences (e.g., peers and siblings who
smoked) and parental attitudes toward
smoking. In contrast, social bonding variables, such as levels of religiosity and peer
orientation (e.g., partying and dating),
had a limited effect.
䊳Joan S. Tucker, Phyllis L. Ellickson, and
David J. Klein, “Five-Year Prospective
Study of Risk Factors for Daily Smoking
in Adolescence Among Early Nonsmokers
and Experimenters,” Journal of Applied
Social Psychology, Vol. 32, No. 8, 2002, pp.
1588–1603.
This study investigated the predictors
of daily smoking by grade 12 for 7th grade
nonsmokers and experimenters. Early experimenters scored consistently higher on
predictors of future smoking. Common
risk factors for both groups included
being exposed at an early age to smoking
by an important adult, earning lower
grades, attending more elementary
schools, and being younger for one’s
grade cohort. For 7th grade nonsmokers,
unique predictors of daily smoking included being exposed to pro-smoking social influences (e.g., cigarette offers and a
sibling who smokes), binge drinking, and
being female. For 7th grade experimenters, certain family factors (e.g., not
having an intact nuclear family) were
more important, and African Americans
and Hispanics were also less likely to
progress to daily smoking.
parental support. Risk factors in young
adulthood included younger age relative
to one’s cohort and pro-smoking attitudes.
䊳Joan S. Tucker, Maria Orlando, and
Phyllis L. Ellickson, “Patterns and Correlates of Binge Drinking Trajectories from
Early Adolescence to Young Adulthood,”
Health Psychology, Vol. 22, No. 1, 2003,
pp. 79–87.
Using data from 5,694 individuals who
completed six surveys from ages 13 to 23,
the authors identified five “developmental
trajectories” of adolescent binge drinking:
nonbingers; moderate stables, who had
consistently low levels of bingeing; steady
increasers, who increased from the lowest
to highest level; adolescent bingers, whose
early rise in bingeing was followed by a
decrease to a moderate level; and early
highs, who decreased from the highest
level of bingeing to a high moderate level.
The considerable diversity in binge drinking patterns has implications for development of adolescent substance use prevention programs. ■
䊳Joan S. Tucker, Phyllis L. Ellickson, and
David J. Klein, “Predictors of the Transition to Regular Smoking During Adolescence and Young Adulthood,” Journal of
Adolescent Health, Vol. 32, No. 4, 2003,
pp. 314–324.
This study identified risk factors for
adult smoking among youth in middle
adolescence, late adolescence, and young
adulthood. Risk factors during middle
adolescence included being white, as well
as pro-smoking attitudes, exposure to
friends who smoke, low academic intentions, and less parental support. During
late adolescence, being African American
was protective, whereas risk factors included pro-smoking attitudes, drinking, a
non-intact nuclear family, and less
New People
Visit Our Web Site and
Join Our Email List!
Matthew Chinman (Ph.D., Clinical/
Community Psychology) is an associate
behavioral scientist at RAND and a health
science specialist at the VISN-22 Mental
Illness, Research, and Clinical Center at
the West Los Angeles Veterans Administration (VA). Matt is a coauthor of the
manual Getting to Outcomes 1999: Methods and Tools for Planning, Evaluation,
and Accountability, which was honored as
the best self-help manual by the American
Evaluation Association. At RAND, Matt is
currently leading a project to understand
how the “Getting to Outcomes” system
can help bridge the gap between science
and practice in substance abuse prevention. At the VA, he is developing and
evaluating psychosocial programming to
assist the homeless, mentally ill, and those
suffering from co-occurring substance
abuse disorders. Matt has published on
such topics as program evaluation
methodology, empowerment evaluation,
adolescent empowerment, coalition functioning, and peer support. He was previously an assistant professor in the Department of Psychiatry, Yale School of
Medicine, and the Director of Program
Evaluation Services at The Consultation
Center in New Haven.
The home page for the Drug Policy
Research Center is located at
www.rand.org/multi/dprc
The web site includes a description of the
DPRC, its research agenda, and the
latest issue of our newsletter, as well as
a subject index and abstracts of all
DPRC publications.
Send email to DPRC@rand.org
and request to be added to the
list for research updates and news
on upcoming publications.
Elizabeth D’Amico (Ph.D., Clinical
Psychology) is a licensed clinical psychologist and RAND associate behavioral sci9
entist who is recognized for her developmentally focused prevention research
with youth. Her areas of expertise include
adolescent risk-taking behavior (e.g., substance use, driving after drinking, and unsafe sexual behavior), outcome expectancies, innovative interventions for youth,
and treatment outcomes. Liz has developed and implemented several prevention
programs for high school students that
combine empirically based motivational
techniques and individualized feedback
and has also examined the escalation and
de-escalation of high-risk drinking
among adolescents in order to determine
risk and protective factors for different
drinking trajectories. She is currently
leading a study focusing on help-seeking
behavior among youth in the 6th, 7th,
and 8th grades and on the establishment
and standardization of a developmentally
sensitive intervention program for this
age group.
Todd Helmus (Ph.D., Clinical Psychology) is a postdoctoral fellow at the DPRC
and at the Integrated Substance Abuse
Program at the University of California,
Los Angeles. Todd’s current research endeavors include a meta-analysis on contingency management, an evaluation of
California’s Proposition 36, and studies of
methadone maintenance treatment and
posttraumatic stress reactions. He has
published on such topics as contingency
management treatment interventions for
drug dependence, the consequence of cooccurring cocaine and mood disorders,
the relationship between sensation seeking and treatment outcomes, and the effect of experimentally induced anxiety
states on drug self-administration. He has
also conducted numerous diagnostic eval-
10
uations and maintained a psychotherapy
caseload. Todd was the recipient of a Predoctoral Fellow National Research Service
Award as well as an Early Career Investigator Award from the College on Problems of Drug Dependence.
Allison J. Ober (M.S.W.) has recently
joined RAND as a project associate. Prior
to coming to RAND, she worked at the
University of Colorado Health Sciences
Center, where she served as protocol implementation coordinator and training
director for the Rocky Mountain Region
of the National Institute on Drug Abuse
(NIDA) Clinical Trials Network (CTN).
The NIDA CTN is a nationwide, collaborative consortium of university researchers and drug and alcohol treatment
providers who conduct multisite behavioral and pharmacological trials on drug
and alcohol treatment and HIV/hepatitis
C prevention protocols. Allison was a
NIDA CTN–certified trainer on good
clinical research practice and on a variety
of standardized psychosocial and diagnostic assessments related to substance
abuse and to HIV risk-taking. She has also
worked as outreach supervisor and training and evaluation coordinator for several
NIDA-funded HIV prevention studies,
has recruited and trained research staff
and conducted fidelity monitoring for behavioral interventions, and has developed
training and operations manuals for research protocols related to HIV risk reduction and substance abuse.
Stuart Olmsted (Ph.D., Biophysics) is
an associate natural scientist at RAND.
He earned his Ph.D. from Johns Hopkins
University, where he studied and tested
reproductive technologies, including
microbicides and contraceptives for the
prevention of sexually transmitted diseases
including HIV and unwanted pregnancies.
Stuart completed a postdoctoral fellowship at the Magee-Women’s Research
Institute in Pittsburgh, where he studied
microbiology. Since joining RAND in
2002, Stuart has worked in a wide range
of policy areas, including bioterrorism,
the Army smallpox vaccination program,
future medical technologies for the Army
and Navy, regional health care initiatives,
and the human genome project.
Barbara R. Panitch (M.A., Education)
has worked in the field of policing for
seven years. Her work focuses on improvements to the criminal justice system, with an emphasis on organizational
change and on training and development
in law enforcement agencies and courts.
Barbara serves as project manager on an
Experimental DUI [driving under the influence] Court grant from the National
Institute on Alcohol Abuse and Alcoholism and on a jail study for the Los Angeles Sheriff’s Department. She recently
completed a training and culture study of
the Los Angeles Police Department. Before coming to RAND, Barbara served
as a project director at the Seattle Police
Department and at the King County Drug
Court. She has consulted with a dozen
diverse criminal justice agencies.
Advisory Board
Lovida H. Coleman, Jr. (Chair)
Partner, Sutherland, Asbill & Brennan
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
Terry Schell (Ph.D., Social Psychology)
is an associate behavioral scientist at
RAND. He has conducted numerous investigations into basic psychosocial issues
such as human judgment under uncertainty, the unintended use of racial
stereotypes, the effects of persuasion on
behavior, and the predictors of aggression. He also brings substantial quantitative skills to RAND as a result of a twoyear postdoctoral traineeship in statistics
and psychological measurement. Terry’s
current projects include investigations of
the long-term effects of community violence on mental health, the effects of alcohol advertising on adolescent drinking,
the effectiveness of juvenile rehabilitation
facilities, and the relationship between
traumatic stress and substance use problems.
Elizabeth Williams (M.A., Spanish
Language and Culture) is a research assistant at RAND. She currently serves as
project manager and interviewer on a
study looking at partner-oriented treatment in methadone clinics. She is also a
team member on RAND’s evaluation of
Proposition 36 in Orange County and
previously participated in studies of the
Rio Hondo Court Experiment and DUI
recidivism. Elizabeth holds a master’s degree in Spanish language and culture
from Middlebury College, Middlebury,
Vt. and a bachelor’s degree in sociology
and Spanish from Colby College, Waterville, Me.
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
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
Lara Ward (M.A., English) serves as administrative assistant to Martin Iguchi
and Audrey Burnam. Her responsibilities
include coordinating the Lovida Coleman
Jr. Speakers’ Series and updating the
DPRC web site. Prior to coming to
RAND, Laura served as a full-time sales
assistant. She holds a master’s degree
in English from California State University, Los Angeles, and a bachelor’s degree
in English from San Francisco State
University.
Eunice Wong (Ph.D., Clinical Psychology) is a postdoctoral fellow at RAND
working with Martin Iguchi. Her work at
the DPRC is funded through the University of California, Los Angeles, Integrated
Substance Abuse Programs. Eunice’s interests include the influence of clienttherapist interactions on treatment process and outcome, the development of
culture-specific therapies, and the implementation of empirically supported interventions in community settings. She received her doctorate from the University
of California, Santa Barbara. ■
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
11
2003–2004 Lovida Coleman, Jr., Speakers’ Series
Science and Drug Policy
This series provides a forum for decisionmakers and scientists to discuss policies concerning drug
supply demand and control.
February 7, 2003
Chris McCarty, survey director of the University of Florida
Survey Research Center
“Egocentric Network Analysis”
August 19, 2003
Marsha Rosenbaum, director of the Safety First Drug
Education Project and director of the San Francisco office
of the Drug Policy Alliance
“Getting Real About Teens and Drugs”
September 11, 2003
Warren Bickel, professor of psychiatry and psychology,
and interim chair of the Department of Psychiatry,
University of Vermont
“Computer-Based Drug Abuse Prevention for
Adolescents: A Multisite Evaluation”
November 3, 2003
Thomas Valente, director of the Master of Public Health
Program at the University of Southern California’s Department of Preventative Medicine
“Using Network Analysis to Create More
Effective Interventions”
February 13, 2004
David Vlahov, director of the Center for Urban
Epidemiologic Studies (CUES) at The New York Academy
of Medicine and adjunct professor of public health
at the Joseph L. Mailman School of Public Health at
Columbia University
Topic to be announced
The 2003 Speaker Series is held at RAND, 1700 Main Street, Santa Monica, California. For more
information, call Lara Ward at (310) 393-0411, ext. 6482. ■
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
12
•
1700 MAIN STREET, P.O. BOX 2138, SANTA MONICA, CA 90407-2138
CP-201 (10/03)