SUBSTANCE ABUSE AND VIOLENT ARREST CHARGES, A STUDY OF MALE ARRESTEES IN SACRAMENTO Amanda Haley Neasbitt B.A., California State University, Sacramento 2007 THESIS Submitted in partial satisfaction of the requirements for the degree of MASTER OF ARTS in SOCIOLOGY at CALIFORNIA STATE UNIVERSITY, SACRAMENTO FALL 2009 SUBSTANCE ABUSE AND VIOLENT ARREST CHARGES, A STUDY OF MALE ARRESTEES IN SACRAMENTO A Thesis by Amanda Haley Neasbitt Approved by: __________________________________, Committee Chair Jacqueline Carrigan PhD __________________________________, Second Reader Bohsiu Wu PhD ____________________________ Date ii iii Student: Amanda Haley Neasbitt I certify that this student has met the requirements for format contained in the University format manual, and that this thesis is suitable for shelving in the Library and credit is to be awarded for the thesis. __________________________, Graduate Coordinator Amy Qiaoming Liu PhD Date Department of Sociology iv ___________________ Abstract of SUBSTANCE ABUSE AND VIOLENT ARREST CHARGES, A STUDY OF MALE ARRESTEES IN SACRAMENTO by Amanda Haley Neasbitt Statement of Problem Despite the many problems associated with methamphetamine manufacturing and use, little empirical evidence exists linking methamphetamine use to violent charges. Researchers have long relied on self-report for their studies on methamphetamine use and its consequences. Many researchers feel that self-report has low accuracy when it comes to illicit substance use. Sources of Data To examine violent charges in Sacramento, the ADAM dataset (2000-2003) was used. This article looks at the urinalysis results in comparison to the primary arrest charges for the respondents to see if there is a correlation between methamphetamine use and violent charges when compared with alcohol positive respondents and all other drug positive respondents. Conclusions Reached After running logistic regressions, it was found that methamphetamine use and previous arrest history are negatively correlated to violent arrests. The only positive correlation with violent arrest found was marital status. _______________________, Committee Chair Jacqueline Carrigan PhD _______________________ Date v DEDICATION To my wonderful and supportive family, I really could not have made it this far without all of your help and encouragement over the years. Yes, that includes attending all of my dance recitals and soccer games in the cold mornings. To my husband Daniel, thank you for letting me disappear into my studies, literature and data for hours on end in the evenings. Your support during this process was more than I could have ever wished for. To my friend Heather, you stuck it out with me through all of the classes and confusing schedules. Our study groups made it possible for me to think “outside the box”, and the memories from them are invaluable. To my committee, your insight and help throughout this entire process has been something I am incapable of thanking you enough for. Thank you all so much! vi TABLE OF CONTENTS Page Dedication ................................................................................................................................. v List of Tables ......................................................................................................................... vii Chapter 1. INTRODUCTION………………. ……………………………………………………….1 2. LITERATURE REVIEW………………………………………………………………….5 Methamphetamine Use and Violent Behavior…………………………………………5 Methamphetamine’s Effects on Behavior……………………………………..……….6 Physiological Effects of Methamphetamine and the Link to Violence…………..…...9 Circumstantial Links between Methamphetamine and Violence……………............12 Non-substance Causes of Violence………………………………………...………...15 Conclusion……………………………………………………………………………17 3. ANALYSIS OF THE DATA……………………………………………………………. 22 Methodology………………………………………………………………………….22 Data……………………………………………………………………………………23 Sampling………………………………………………………………………………24 Variables………………………………………………………………………………25 Limitations……………………………………………………………….……………28 4. FINDINGS AND INTERPRETATIONS………………………………………………… 29 5. CONCLUSION…………………………………………………………………………….52 Discussion of Findings………………………………………………………………..52 Evaluation and Critique of Study……………………………………………………..54 Impact on Future Research……………………………………………………………55 Conclusion…………………………………………………………………………….56 Appendix...........................………………………….………………………………………….58 Bibliography……………………………………………………………………………………61 vii LIST OF TABLES Page 1. Table 1 Descriptive Statistics by Single Substance Positive Urinalysis Results…….. 30 2. Table 2 Descriptive Statistics by Poly Substance Positive Urinalysis Results………..32 3. Table 3 Logistic Regression Predicting Type of Charge for Single Substance Users...35 4. Table 4 Logistic Regression Predicting Type of Charge for Poly-Substance Users…..39 5. Table 5 Logistic Regression Predicting Type of Charges for Single Substance Users in Comparison to Alcohol Users……………………………..43 6. Table 6 Logistic Regression Predicting Type of Charge for Poly-Substance Users in Comparison to Alcohol Users……………………………….47 viii 1 Chapter 1 INTRODUCTION It is reported that over 35 million people worldwide are using methamphetamine and that the numbers are continuing to grow. In comparison, there are only 15 million cocaine abusers and less than 10 million heroin abusers worldwide (Rawson, Anglin & Ling, 2002). Methamphetamine use is growing due to its ability to be manufactured easily. Methamphetamine was once considered the young, white male drug of choice but is currently working its way into the Hispanic and Asian populations (www.samhsa.gov, 2006). Methamphetamine is now being called the next epidemic of the West (Rawson, Anglin & Ling, 2002). Of people currently in treatment for methamphetamine use, 85% of women and 69% of men reported becoming violent, and most of this violence is directed at those they are in a relationship with (www.samhsa.gov, 2006). The uses of the drug methamphetamine and its tie to violent behavior have been noted in the law enforcement community and its affiliates within the court system. One study in Los Angeles brought up that, among methamphetamine users, “almost 2/3 also struggles with skin and dental problems, violent behavior, and legal problems” (von Mayrhauser, Brecht & Anglin, 2002), showing that not only was the drug use a problem but that those using the drug were more likely to exhibit aggressive behavior and possible jail sentencing due to it. It is not just that people are using the drug; it is also that they are pulling other people into the cycle of using, with both the initial drug user and the new drug user becoming violent (physically, verbally or sexually) toward others in turn. One study of women who were 2 abused by partners currently using methamphetamine found that the women themselves often ended up using the drug and then abusing those close to them (James, Johnson & Raghavan, 2004). The aim of this study is to examine the differences between the arrest charges (violent vs. non-violent) for those using methamphetamine versus other illicit substances and alcohol or no substances. This study will explore the different theories of the connections between violent behavior and methamphetamine use and draw conclusions for further study within the field. Due to arrests of those under the influence of methamphetamine federal and state funding for prosecution of methamphetamine related charges has increased in the last 20 years, with $223.5 million going to the Community Oriented Policing Services to slow the spread of methamphetamine use and production (United States Department of Justice, 2002). Communities and criminal justice agencies are currently working on ways to combat the spread of methamphetamine, which is difficult because it is, “developed primarily in clandestine laboratories” (Yacoubian & Peters, 2004). San Diego County was able to slow the spread of methamphetamine creation and use, but later found out that all their aggressive laws were doing was pushing the problem to the outer limits of the county just outside of their jurisdiction (Rawson, Anglin & Ling, 2002). Methamphetamine use has become a problem of law enforcement and public health. It has also affected users’ lives, the social support network in the community, and even the larger society in dealing with the adverse effects of methamphetamine use. Smaller communities are spending more on drug enforcement than in recent history (United States Department of Justice, 2002) and relationships in families are not as stable due to 3 abuse and neglect. Many methamphetamine users are losing control of all aspects of their lives, including jobs, housing and relationships. This is affecting the community at large due to higher rates of arrest from a lack of stable income and instability of relationships from continued methamphetamine use, as well as hospitalization due to side effects and overdoses. Mothers currently using illicit substances (including methamphetamine) are more likely to neglect their children than those not currently using substances (Grella et. all. 2006). These mothers are also more likely to be involved in the child welfare system due to their neglect of their children and often have a history of legal problems, resulting in mandatory stints in drug treatment programs as well. So, there could also be a tie not only between direct physical, emotional or sexual abuse, but also neglect from the usage of methamphetamine. Methamphetamine has several physical effects including hyperactivity, tremors, euphoria and a feeling of increased energy. In large doses it can cause acute paranoia, schizophrenia and even visual and auditory hallucinations (Rasmussen, 2008). The use of methamphetamine has been linked to everything from dental decay to heart tremors and attacks. Much research (Lipsky, Caetano, Field, Bazargan, 2005; Skara, Pokhrel, Weiner, Sun, Dent & Sussman, 2008; Cohen, Dickow, Horner, Zweben, Balabis, Vandersloot, & Reiber, 2003; Sommers, Baskin, 2006; Baskin-Sommers & Sommers, 2006; Wright & Klee, 2001) has been done on the effects of drug use in general, and some papers have expanded it to include methamphetamine use; these fall short due to the generalizations that one drug is equivalent to all other drugs, and that no matter what kind of drug you 4 are taking the behavioral outcomes will be similar (Parker & Auerhahn, 1998). It is only by studying each drug separately that the differences will become apparent. The other major issue with the current research is that it too often does not contextualize the findings for smaller regions (Rawson, Anglin & Ling, 2002). Many of the current findings are for larger western cities, such as San Diego and Honolulu, which are quite difficult to compare to Northern California due to differences in size and population density. For these reasons, it is important to study methamphetamine use in a central northern California city such as Sacramento. By looking at the comparison between violent and nonviolent arrests, and drugs and or alcohol use we will be able to get a better picture as to what is happening in the Sacramento region. 5 Chapter 2 LITERATURE REVIEW Methamphetamine Use and Violent Behavior Methamphetamine, a substance created in makeshift laboratories, has been under the radar of the federal government for years. Those using the drug are reporting violent behavior due to its effects on the nervous system (Logan, Walker & Leukefeld, 2001). This paper details three ideas of how violent behavior could be tied to the use of methamphetamine. First, that methamphetamine use could be one of many precursors to violence, such as a past history of violence, but there may be no tie between the two making violence a socially learned behavior and a spurious correlation. Second, a person’s past dictates methamphetamine use which can lead to violent behavior, so methamphetamine use is an intervening influence on violence. And third, that the drug methamphetamine causes violent behavior due to the changes in neural activities that take place following its usage. These ideas are based on previous research on the connection between alcohol use and violence, and they will be tested in relation to previous studies on alcohol use and violent behavior. Methamphetamine is a stimulant similar to the earlier pharmaceutically made amphetamines that were often handed out to soldiers during times of war to aid in alertness while on extended tours. During the 1950’s it was legally manufactured by pharmaceutical companies under the names of dextroamphetamine (Dexedrine) and methamphetamine (Methedrine) and was used to aid a variety of things, from weight 6 problems to athletic performance, mild depression, and fatigue. Do to the growing misuse of the drug in the 1960’s it came to the attention of the Federal government, who in turn put it under the 1970’s Controlled Substances Act. The more recent adaptation of the drug is no longer the same as the original pharmaceutically produced drug, but has become an illicit substance that is easily created by many makeshift laboratories across the western United States (Anonymous, 2008). Methamphetamine’s Effects on Behavior Methamphetamines, along with other stimulants similar to it, have been associated with violent actions (Logan, Walker & Leukefeld, 2001). Some inmates, when interviewed, even stated that one of the side effects they experienced with the drug was a rise in violent behavior that they could not control (Logan, Walker & Leukefeld, 2001). Cartier, Farabee and Prendergast (2006) state that when looking at clinical studies on stimulants, people may experience an increase of aggression and violent behavior. Because of its long and intense high, methamphetamine also becomes increasingly addictive. Due to its highly addictive nature methamphetamine becomes increasingly important in the life of the user, who begins to feel compelled to use it consistently; this is often where we begin to see evidence of violent behavior occurring. When polled, both women and men pointed to the fact that if they had endured abuse (physical, verbal or sexual in nature) they were more likely to start using drugs such as methamphetamine (James, Johnson & Raghavan, 2004). Thus, it becomes a cycle of violence; when someone endures abuse they become more likely to use illicit substances (such as 7 methamphetamine), and in turn they themselves could possibly become abusive to others (James et al., 2004). Many studies point to the idea that many serious drug use leads to violence, or violent situations (Lipsky, Caetano, Field & Bazargan, 2005; Skara, Pokhrel, Weiner, Sun, Dent & Sussman, 2008; Cohen, Dickow, Horner, Zweben, Balabis, Vandersloot, & Reiber, 2003; Sommers & Baskin, 2006; Baskin-Sommers & Sommers, 2006; Wright & Klee, 2001). The relationship between drug use and violence was especially common among young males, those with low levels of education, those from a lower socioeconomic status and users of “serious” drugs (such as cocaine, PCP, methamphetamine and crank). In one study, the males interviewed reported their violent behavior as a consequence of their use of drugs, illustrating their perception that they had no control over their actions while under the influence of these substances (Cartier, Farabee & Prendergast, 2006). Most of the studies on methamphetamine use are interviews of either people who were not users of the drug but had abuse problems (physical, emotional or sexual) with those that did use, or with actual users of the drug (Cartier, Farabee & Prendergst, 2006; Willson, McFarlane, Malecha, Watson, Lemmey, Schultz, Gist & Fredland, 2000; Mayrhauser, Brecht & Anglin, 2002). In one study, women explain that once you are pulled into the realm of the abuser, and the drugs they use, you can also become a user (James, Johnson & Raghavan, 2004). The women found that once they had been in a relationship with a person that was an active methamphetamine user they often became users. It was not pure fascination with the drug itself that led them to use 8 methamphetamine, but rather their need of an escape mechanism (similar to Durkheim’s idea of escapism from the drain of daily life) (Dubeski, 2001) from the abuse they endured from their partners currently using methamphetamine (James, Johnson & Raghavan, 2004). They learned from their spouses that methamphetamine use had certain behavioral and physical consequences (similar to those seen in studies on alcohol and violent behavior), and one of those consequences was violence against others. When looking at studies of alcohol and violence, Stalans and Ritchie (2007) found that alcohol abuse was a predictor of intimate partner physical violence after controlling for the abuser psychologically abusing the victim. So these women from the James, Johnson and Raghavan (2004) study used methamphetamine as an escape from the violence they experienced at home and then proceeded to enact that same violent behavior towards others, therefore combining the ideas of escapism and social learning. They did not intend to act violently against other people (including those in their own intimate circle), but used the experience they received to create their own idea of what one should act like while on the drug and then proceeded to act in that fashion. And in that instance it is easily seen that by using the drug as an ‘escape’ from your current situation, you could easily be creating a similar situation for another person either by neglect or an actual abusive situation. There are three possible patterns that the use of methamphetamine and violent behaviors might follow and one that alcohol and violent behaviors may follow. The first idea is that there is a physiological change that happens within the body while using methamphetamine and the reaction that happens can explain the violent behavior. The 9 second idea is that things happening around the person could lead them into violent behavior and it may just coincide with drug (specifically methamphetamine) or alcohol abuse. And the third idea is that there are causes of violence that are not tied to any drug or alcohol use. This paper details each of the three ideas to see if there is a correlation between methamphetamine use and violence, violence at the time of methamphetamine use, or that violence is independent of any drug use. Physiological Effects of Methamphetamine and the Link to Violence Some researchers argue that the use of methamphetamine initiates a chemical reaction within the body that prepares the body, in essence, for a violent interaction. We see that when the body is prepared for ‘fight or flight’ mode, due to the large quantity of norepinephrine, there is an increased likelihood of violent behavior. The body is already prepared for it, so the person is also going to be prepared whether it is from lack of control of cognitive behavior or directly from the chemicals contained within methamphetamine and their changes on the body. When methamphetamine enters the body, there are several physical changes that happen. One of the major effects is that there is, “increasing … activity of the norepinephrine system in the periphery and of the dopamine system to the central nervous system” (Simon, Richardson, Dacey, Glynn, Domier, Rawson & Ling, 2002). Because of the changes to these chemoneural transmitters, the body is put into ‘fight or flight’ mode. This includes increased heart rate, agitation, nervousness, and occasionally paranoia. These are the changes that could help to better explain how methamphetamine could be the tied to violent behavior in its users. 10 “Clinical studies indicate that stimulants, including MA, may increase the likelihood of attack behaviors and aggression in humans” (Cartier, Farabee & Prendergast, 2006). Many studies indicate that violence is deemed the outcome of the use of methamphetamine (Baskins-Sommers &Sommers, 2006; Borwn, 2006; Cho, 2002; Cohen, Horner, Zweben, Balabis, Vandersloot & Reiber, 2003; Cartier, Farabee & Prendergast, 2006). There are other indicators that could help to better explain this idea. If we look at violent behavior as a consequence of using the drug methamphetamine, we have to also look at cognitive performance of the person. One such study compared cocaine (COC) users to methamphetamine (MA) users with a control group for both (Simon, Domier, Sim, Richardson, Rawsom & Ling 2002). What they found was that the cognitive performances of those on methamphetamine were severely decreased from the control, and decreased from that of cocaine users as well. Methamphetamine users had problems manipulating information, set shifting, and with preservation (or basic skills in order to keep oneself alive such as obtaining water or nutrients). “These problems suggest that MA abusers would have trouble organizing information from more than one source and have difficulty switching points of view” (Sim, Simon, Domier, Richardson, Rawson & Ling, 2002). They also pointed out that, “anecdotal reports that MA abusers are more violent and paranoid than COC abusers suggest that the physiological differences might cause differences in other areas such as cognition” (Sim et al., 2002). One could conclude after looking at each of these studies that after using methamphetamine an individual’s cognitive performances decreased, so 11 any boundaries they may have had in regard to restraining violent behavior may also be decreased at that point as well. A hospital study in Sweden showed that, “16% of all violent crimes…. were committed by people who had hospital discharge diagnosis of alcohol misuse, and more than a tenth of all violent crimes were committed by patients diagnosed as having misused drugs” (Grann & Fazel, 2004). So it is not just that violent behavior can be tied to other substances, such as alcohol, but that these substances are then tied back to violent behavior as it was shown with the hospital discharge summaries in comparison to their later arrest charges. Physiological effects of other drugs are also important to this study. Marijuana has the subjective feelings of relaxation and wellbeing with a sense of sensory awareness, but some of the effects on the system are slowed psychomotor skills and impaired cognition (as well as cessation of nausea and vomiting). This, in turn could have very different effects on the system than the ones described above for methamphetamine in that the body is not put into ‘fight or flight’ mode, but at the same time the cognition of the person is impaired which could mean that they are not going to make educated or thought out decisions. Opiates, on the other hand, create a release of opiates (dopamine) into the system which can be experienced as pleasure. The effects on motor coordination are similar to marijuana in that cognition and fine motor skills are impaired. The other issue with the use of opiates (such as heroin) is that they become increasingly addictive quickly since they continue to work on the same pleasure receptors, putting them into the same issues as methamphetamine users in that they are constantly looking to continue the 12 feeling. So, in essence, each of these drugs could in fact lead to a violent pattern of behavior due to the nature of impaired cognitive abilities on daily decisions (Rawas, Thiriet, Lardeux, Jaber & Solinas 2009; Ronena, Gershon, Drobiner, Rabinovich, BarHamburger, Mechoulam, Cassuto & Shinar, 2008). Circumstantial Links between Methamphetamine and Violence In looking at violence as a learned behavior, we can also look at drug reactions as a learned behavior. It is not necessarily true that the drug itself causes violent behavior, but that the user learns what it is like to be on the drug methamphetamine and the behavior patterns they may follow while on the drug. Some researchers agree that, “aggression and violence preceded alcohol and drug abuse” (Parker & Auerhahn, 1998). A person’s past will affect their reactions to chemicals. So we would have to examine a person’s expectations about what it is like to be on the substance to see how they would react while under the influence of the substance. If the person associates the drug methamphetamine with violent behavior, then they themselves may enact this behavior. Conversely, if we were to look at the same situation, but with the drug Marijuana, most people assume that they will be calm and relaxed so they enact that behavior (Parker & Auerhahn, 1998). We have to look at the user’s context and learned reactions to the drug to understand their behaviors with the drugs. Violence can even come out of a need for protection. For women in treatment for methamphetamine use this was often the case. “Violence linked to meth use is related to trauma and safety needs which must be addressed in treatment” (www.samhsa.gov, 13 2006). So it is not that the drug dictated violent behavior in these women, but rather that their situation dictated their use and their subsequent needs after their use of the drug methamphetamine. So these women may have used the drug due to their situation then behaved violently to protect themselves or their families. It may not even be that they were violent in the past, but that after the use of methamphetamine and their current situations they felt that violent behavior would be the only means to an end for the violence which they had endured. Therefore, they learned that violent behavior while on methamphetamine was acceptable. So violence may resonate from more than just past learned behavior and may incorporate learned drug behavior as well. Lastly, violence from methamphetamine use could be from a pattern of abuse. Some people begin using the drug methamphetamine to hide feelings or problems after psychological, physical or sexual abuse; but after using they themselves can become the abuser. In one study, women admitted that abuse led to drug use and in turn sometimes violence (James, Johnson & Raghavan, 2004). This also leads us to question the lifestyle behind those that use illicit substances. “Researchers have called for more attention to the drug-dependent lifestyle itself, which may involve dangerous behaviors that increase the risk of violence” (James et al., 2004). So it is not just that these women become involved in the drug-lifestyle, but that they are put at higher risk of not only being the victim of violence but also the perpetrator of violence towards others. These women saw the violent actions of others on methamphetamine, received the abuse from those users and then constructed their own ideas of what it was to be a user of methamphetamine; mainly that use of methamphetamine precedes violent or aggressive interactions. 14 It is in our context and interactions that we create symbols (or understandings of our surroundings), and then we use those symbols within our interactions (Charon, 2007). What we see and interpret becomes what it means. Thus, we are assigning meanings in every interaction. So, if we were to subscribe to the idea that using methamphetamine creates violent interactions, then that interaction would be symbolic of methamphetamine use and would be portrayed in our lifestyle. So it is not just that we see methamphetamine usage as resulting in violence, but we create that very meaning in our daily interactions. It is in these interactions that the idea of violence being tied to methamphetamine use is perpetuated because then it becomes the norm for these interactions to occur. So the behavioral effects of methamphetamine use could be, in the end, a learned behavior. Alcohol use and violent behavior has been looked at in many different studies and most point to the idea that it is a learned behavior linked to past interactions. Most of this stems from a social acceptance of violence when under the influence of alcohol (Stalans & Ritchie, 2007). For an extended amount of time violence has been an acceptable behavior for those under the influence of alcohol, which has continued the idea that this is an unavoidable action caused by its usage. Drinking alcohol in general does not change your chance of acting violently, but that heavy or binge drinking has a much stronger correlation to violence (Stalans & Ritchie, 2007). They argue that there was no difference between whether it was men or women who were perpetrating the violence, but rather it was directly related to the blood 15 alcohol level (the higher it was, the more likely a violent behavior would have taken place). When looking at the social acceptance of the behavior while under the influence of alcohol, we see that violence is almost overlooked. More police departments are interested in drinking in relation to driving than in how a person constructs the idea of what it means to be under the influence of alcohol. But if we look at the physiological change that occurs within the neurological system we see a slowing of a mechanism that helps filter social interaction. So there is a change, but it is doubtful that it is entirely physiological and not learned through social interaction. The same goes for most other drugs as well, whether it be marijuana, opiates or cocaine. Each puts the person in situations that have the potential to be dangerous or even violent each time they go to get the drug. Just like Logan et al. (2001) article brought up, most of the inmates felt that their violence started in outside circles, meaning that they were more likely to be violent with people they were dealing drugs to than their families in the beginning. Impaired cognition is hard to deny, but some of the ideas of what is acceptable and unacceptable behavior while on the drug are socially constructed. Non-substance Causes of Violence Violence can be a learned behavior. Either methamphetamine use can contribute to violent behavior or learned violent behavior can lead to violent behavior. So if a person is violent to begin with or are socialized to be violent they will most likely continue to have violent actions, but if methamphetamine is added into the picture it may be viewed that the drug use is causing it when in actuality it is just happening parallel to 16 the action. It is not necessarily that drug use leads to violence; so much as they are different ideas leading to a similar outcome. An example of this would be if a person was raised in an abusive household, they would learn that this interaction was appropriate in certain circumstances. Add twenty years of continued learning to this and the person may continue the cycle of violence in their own daily life. Now, if that person were violent in their thirties while using methamphetamine, it would be difficult to distinguish the precursor, the drug use or the violent history. So the violent behavior exhibited may come from the past or from methamphetamine use, but there is no direct tie between the two creating a spurious relationship. Many of the existing studies on drug use and violence have a tendency to lump all drugs together and reject the idea of looking at them separately. One study found that when looking at all drug use and alcohol use with violent patterns, there was no real difference between drug use and violence, and alcohol use and violence (Wilson, McFarlane, Malecha, Watson, Lemmey, Schultz, Gist, & Fredland, 2000). The rates of abuse with drug using or alcoholic partners were the same, in essence. This shows us that since there are no major differences between drugs and alcohol that it must be a learned behavior and not necessarily a reaction to the drug. Because of the different chemical reactions of the drugs, it would be of use to separate the drugs for further research. The other idea is that since these patterns of violence are learned, it could be happening at a parallel with drug use. The person who is abusing could be using drugs and abusing, but that does not mean that they are correlated. Logan et al. (2001), delves into the issue of violent behavior dictated by inmates. It shows us that their violent 17 patterns did not necessarily start with those close to them, but instead moved into their intimate circle later on. It just so happened, that around the time they were using the drug methamphetamine they were also involved in violent or aggressive behavior. It is not that there is a direct tie between past experiences of perpetrating violence to others and their usage of the drug methamphetamine; it’s just that the timing coincided with each other. Another study suggests that drug use actually has no correlation to violent arrests or domestic violence arrests (Rogers & Evans, 2003). Their findings suggest rather that a person’s previous arrest history is a better explanation to methamphetamine use, but that there is no correlation between methamphetamine use and violent offenses, Showing that there are other things going on at the time that could explain violent offenses or charges. Conclusion Articles from a wide variety of journals and other resources were used to examine whether it is that methamphetamine use and past experiences are correlated when looking at patterns of violent behavior; or your past experiences dictate your meaning of what it is to be under the influence of methamphetamine which could possibly mean violent behavior; or even that it is just the chemical changes in your body that create a condition for violent behavior to be present. The findings from research on alcohol use is very similar in this aspect as there is no direct information that dictates a physical change would take place to create the violent behavior. It is hard to say that violence is just a side effect of methamphetamine use, as there may have to have been past experiences to back up those interactions. While there are definite physiological changes that do happen within the body during 18 methamphetamine use which could alter one’s behavior, there have to be other things behind it. Studies on alcohol use bring up that there is a change resulting from the physiological effects of alcohol, namely being a loss of social filter, but that much of the behavioral aspects are learned from previous interactions. Many articles point out the fact that when interviewed, methamphetamine users felt their violent behavior was not under their control; rather, it was all due to the drugs they were using and the physiological change and/or change in character that created the behavior. If this were the case, however, it has the distinct feel of a purely essentialist argument, which denies the effect of the social environment on human behavior (DeLamater, Hyde & Shibley, 1998). But again, to say that it is fully a choice is a tough matter. There are physiological effects on your body’s nervous system while on the illicit substance methamphetamine or alcohol, which cannot be denied. We could say that it is how we interpret those neuron firings that affects our behavior, and if what you understand them to be is violent impulses then that is what you will get. Again, this is a difficult situation because it goes back to the idea that we have to initiate a thought on what it means to us, which just goes back to symbolic interactionism and creation of understanding of the body. Previous research relied on self reports of drug users, so to better understand this, I would like to see more studies like the Swedish health study where there was direct documentation of what people were hospitalized for (Grann & Fazel, 2004). It involved drug testing and still tied in what the person was brought in, and treated for, in the 19 hospital. This helps to further solidify the claims made by the people and others about violent interactions. The demographics of methamphetamine users are in flux, according to sheriff’s departments polled from across the United States. “Methamphetamine had been depicted as a blue collar, lower middle class drug. Most of the users were employed white males between 18 and 34 years of age” but use is growing among women, teens and minorities (www.naco.org, 2007; Sommers & Baskin, 2006). There is evidence from this study that point to the idea that the abuse of Methamphetamine is increasing in Native Americans and Hispanics as 36 percent of Sheriffs polled saw an increase in arrest rates for these groups. Use by women and teens are also on the rise as their rates had risen 98 percent in the cities of >250,000 residents, according to sheriffs polled. Methamphetamine seems to be spreading to the larger cities at a faster rate than previously thought as the cities of less that 25,000 had risen 62 percent while the larger regions had risen to 98 percent according to the sheriffs polled (www.naco.org, 2007). Demographic characteristics that predict violence are varied. Connelly, Hazen, Coben, Kelleher, Barth and Landsverk (2006) bring up that violence is more prevalent in more economically disadvantaged regions of society which are disproportionately made up of ethnic minorities especially African American, Latino, and Native American populations. The study found that women were more likely to be physically abused by their intimate partners if they were African American and married to their partner than those women who were non-Hispanic white and separated, divorced, or widowed. This brings up the idea of intimate partner violence being a prevalent issue to only those who 20 are currently in a relationship. Unfortunately this study didn’t do previous relationship research on intimate partner violence. Other previous research does tie depression, education, substance use, being married to or living with a partner, race, younger age, heavy drinking, and number of children to violent behavior in numerous ways( Connelly, Hazen, Coben, Kelleher, Barth & Landsverk, 2006; Skara, Pohkhrel, Weiner, Sun, Dent & Sussman, 2008; Libpsky, Caetano, Field & Bazargan,2005). Violence seems to have multiple demographics, but the one that seems to stand out between each of the articles is living with a partner or spouse. This stands out because it does make the likelihood of intimate partner violence higher due to proximity of both individuals (if you live with the other person, you see them more often, therefore have more opportunity for intimate partner violence than if you lived separately). Researchers are split when it comes to sources of violence. Some feel it is due to drug use and the lifestyle that often times goes hand in hand with it (Grann & Fazel, 2004). Others feel that it is all circumstantial and that violence can precede any drug use or violent behaviors that come after that point (Parker & Auerhahn, 1998). Still others feel it is due to physiological changes to the body while under the influence of drugs that causes violent behavior (Logan, Walker & Leukefeld, 2001). Due to this split it is important to research methamphetamine use and violent behavior. Hypothesis 1 Those arrested in the Sacramento region under the influence of MA will have more violent charges than those testing positive for other illicit and/or licit substances. 21 Hypothesis 2 Those testing positive for MA will mirror charges (violent vs. non-violent) with those testing positive for Alcohol. 22 Chapter 3 ANALYSIS OF THE DATA Methodology This study looks at the number and demographics of those testing positive for licit/illicit substances, alcohol, and no substances and compares them with their arrest charge (violent or non-violent charges). To do this, the Arrestee Drug Abuse Monitoring data was used which has advantages when looking at arrest records. It allows the researcher access into a different study group than those who would normally answer questions about their actions. Much research often relies on self-report data, which can be flawed. But the Arrestee Drug Abuse Monitoring data is helpful in one main way; it gives the actual arrest charge that the person was brought into the jail for. This gives us a better glimpse into the actual behaviors that are happening. This data also has a specimen sample that allows the researcher to then compare it with numerous other demographics that are recorded by their team (including their charge). The Arrestee Drug Abuse Monitoring data for Sacramento for 2000-2003 was used for this study to look at the relationship between drug use, specifically methamphetamine and violent crime charges at arrest. The data from illicit/licit substances tested positive in the specimen will be compared with specimens claiming alcohol use to see if there is a difference in the arrest charges when looking for violent or non-violent offenses. These findings will then be compared with those specimens testing negative for all substances to control for error. 23 The Arrestee Drug Abuse Monitoring data for Sacramento for 2000-2003 is used in this study because it includes interviews; self reported data and urine specimen testing for illicit and/or licit substances for recently arrested adult males. This is unique as it provides a concrete measure of the current illicit and/or licit substances (including alcohol) in their bloodstream at the point of interviewing as well as the arrest charges. Data Funded by the National Institute of Justice, the Arrestee Drug Abuse Monitoring (ADAM) program was originally developed to collect information from arrestees to monitor drug trends. It gave local governments information on illicit substance usage in the region along with treatment needs and illicit substance markets. The ADAM program was implemented in 2000 after being changed over from the Drug Use Forecasting (DUF) program which was used from 1987-1997 by the National Institute of Justice. ADAM made it possible to expand the number of sites used for the study, thus making it more generalizable to the population. In the change over to the new program many of the old questions were kept in an effort to make it possible to observe changes over time. The male adult survey includes eight categories: 1) demographic data on each arrestee, 2) ADAM face sheet, 3) data on each of the cases, 4) calendar of admissions to different substance abuse and mental health programs, 5) data on use, abuse and addiction to substances, 6) drug data on the 5 most commonly used illicit substances, 7) urine test results, and 8) weights for male (National Institute of Justice, 2003). 24 For this study, the Arrestee Drug Abuse Monitoring (ADAM) program’s Sacramento dataset from 2003 will be used for statistical analysis. The Sacramento dataset was chosen because the Sacramento region is a hotspot for MA use (Yacoubian & Peters 2004). Sampling A probability sampling plan was used to collect data from the sites so that the sample would be generalizable to the general population of arrestees and not just the specific sample included in the study itself. Surveys were done within 48 hours of arrest and at several intervals during the day and week to ensure that there was equal representation. This way the sample could avoid being biased by missing arrests that could happen at specified times (morning, afternoon, weekdays etc). ADAM interviewers were sent out to numerous sites and conducted interviews based on the size of each county and booking facility in order to keep the sample within the proportionate size. A stratified cluster sample design was used by clustering facilities by size into a small number of strata. This way estimates were still available for jails not directly used in the sample. And finally, in the case of feeder jails, or jails where people were transferred to for more serious crimes, interviewers went out to make sure they interviewed those who were not transferred there but were initially booked there. Two types of samples were used, stock and flow. Stock includes those arrested before the interviewers arrived but were still within their 48 hours, this presented problems as some of the men from this portion could have already been released which creates a possible bias. Flow includes those who were booked while the interviewer was 25 at the facility and cases were selected straight from the availability from booking. Both stock and flow cases were chosen from the chronological booking log, which is kept at all law enforcement facilities, by taking cases at an interval that was previously determined by the target number of stock cases for that day (National Institute of Justice, 2003). All data was based on all arrestees booked in the Sacramento region (county). Data was collected on a double sided face sheet from voluntary, confidential interviews within 48 hours of arrest. Urine testing was also administered within that time limit to detect many of the more prominent illicit substances. Variables Many questions are asked within the survey itself to measure drug and alcohol dependence and abuse as well as arrest charges and demographic information for each of the arrestees. The questions used in this study to measure the type of charges people were arrested for and whether there are differences in drug use between those arrested for violent and nonviolent crimes based on their urinalysis results. The urinalysis results to be used are Alcohol, Marijuana, Cocaine, Opiates, Amphetamine, Methamphetamine, and the number of drugs tested positive for. The following demographics variables are included in this study: Racial Background, Age, Educational level, current Work Status, and Marital Status. Dependent: Arrest charges were used to create a dependent variable depending on whether the charge was a violent or non-violent charge. See Appendix for full list. Independent: 26 Each respondent gave a urine sample that was then tested for each of the illicit/licit substances: Cocaine/Crack, Heroin/Opiates, Methamphetamine/Amphetamine, and Marijuana. Respondents were then asked if they had five or more drinks in the same day in the past year which they could answer: Yes, No, or Don’t Know. Each of the variables was coded into binomial variables with Yes equaling 1 and No equaling 0. Don’t Know was set to missing. Control: Respondents were asked to give their racial background, which had the following responses: White, Black or African American, Hispanic/Latino, American Indian or Alaska Native, Native Hawaiian or other Pacific Islander, Asian, Don’t Know/Missing/Refussal. The age of each respondent was taken in the numeric values of 0 to 100, depending on their birth date. Respondents were asked their highest level of educational attainment which they could answer: High School or GED, Vocational or Trade School, Some College or Two Year Associate Degree, Four Year Degree or Higher, No Degree, and Don’t Know/Missing/Refussal. Education was recoded as (Less than High School = 1, High School Education or higher = 0, with Don’t Know/Missing/Refussal set as missing). Respondents were then asked their work status which had the following responses: Work Full-Time, Working Part-Time, Currently on Active military Status, Have a Job but out due to Illness/Leave/Furlough/Strike, Seasonal Work –Currently not Working, Unemployed or Laid off and looking for work, Unemployed and not looking 27 for work, Full-Time Homemaker, In School only, Retired, Disabled for Work, and Don’t Know/Missing/Refussal. Work Status was coded as (Working = 0, Not Working = 1, with Don’t Know/Missing/Refussal set as missing). Marital status was asked by interviewers and the responses were: Single/Never Married, Divorced, Legally Separated, Widowed, Married/Including Common Law Marriage and Don’t Know/Missing/Refussal. Marital Status was coded as (Married = 1, Not Married = 0, with Don’t Know/Missing/Refussal set as missing). Respondents were asked whether or not they had a prior arrest history. The possible responses were: No, Yes, and Don’t Know/Missing/Refussal. Prior Arrest History was recoded as (Yes = 1, No = 0, with Don’t Know/Missing/Refussal set as missing). Correlates of Recent Methamphetamine Use Two descriptives tables (single drug positive and poly-substance positive) will be created by comparing all drug negative results with methamphetamine positive results with the following variables: Racial Background, Age, Work Status, Marital Status, Educational Level, Primary charge (non-violent offense, and personal/violent offense), Previous Arrest, and Drug-positive rates (marijuana, cocaine, opiates). Logistic Regression Analyses Logistic regression analyses will be performed to test the hypotheses. They first hypothesis, that those arrested in the Sacramento region under the influence of Methamphetamine will have more violent charges than those testing positive for other illicit and/or licit substances, will be tested by performing a logistic regression by looking 28 at the dependent variable (violent or non-violent arrest charge) in relation to the independent variable (recent Methamphetamine use, or Methamphetamine positive urinalysis/All Drug positive results) and the control variables (Racial Background, Martial Status, Age, Work Status, and Educational Level). The second hypothesis, those testing positive for methamphetamine will mirror charges (violent or non-violent) with those testing positive for alcohol, will be tested by performing a logistic regression by looking at the dependent variable (violent or non-violent arrest charge) in relation to the independent variable (recent Methamphetamine use, or Methamphetamine positive urinalysis/Alcohol positive results) and the control variables (Racial Background, Martial Status, Age, Work Status, and Educational Level). Limitations One of the major limitations of this study is that it is only based on male subjects, due to the small size of the female sample. This does focus the study to male violence, but hopefully future research and surveys will better cover the female portion of the population so that it can be better studied. The other major limitation is that the data is only from a population of those recently arrested, which means that it is not generalizable to the general population outside of those being arrested. 29 Chapter 4 FINDINGS AND INTERPRETATION The primary aim of this study is to find if there is a relationship between arrest for violent crimes and testing positive for methamphetamine. The two hypotheses being tested are, first, that individuals arrested in the Sacramento region under the influence of methamphetamine would have more violent charges when compared with those testing positive for other illicit and/or licit substances. The second was that those testing positive for methamphetamine would have similar charges to those who used alcohol in the last twelve months. Table 1 indicates that most of those arrested with drugs or alcohol in their system had a high school degree or further education. Methamphetamine users in this study were more likely to be white, working, unmarried males with at least a high school degree, a previous arrest, and a non-violent charge. Marijuana users were more likely to be African American, working, unmarried males with at least a high school degree, a previous arrest, and a non-violent charge. Cocaine users were more likely to be African American, non-working, unmarried males with at least a high school degree, a previous arrest, and a non-violent charge. Opiate users were more likely to be white, non-working, unmarried males with at least a high school degree, a previous arrest, and a non-violent charge. And alcohol users were more likely to be white, non-working, married males with at least a high school degree, a previous arrest, and a non-violent charge. 30 Table 1. Descriptive Statistics by Single Substance Positive Urinalysis Results N=652 Racial Background Methamphetamine Marijuana Cocaine Opiate Alcohol White Black Hispanic American Indian Asian Other 60.8% 8.8% 20.7% 1.6% 34.6% 48.6% 14.2% .4% 15.2% 76.6% 4.9% .5% 66.7% 20.8% 8.3% 0 44.5% 36.3% 16.6% 0 7.5% 0 1.6% 0 2.2% .5% 0 4.2% 1.3% 0 Work Status Working Not Working 58.1% 41.9% 56.9% 43.1% 43% 57% 45.8% 54.2% 42.2% 57.7% Marital Status Married Not Married 23.8% 76.2% 20.6% 79.4% 27.4% 72.6% 20.8% 79.2% 78.4% 21.5% Education Level 26.6% 28.7% 21.1% 29.2% 25.2% 73.4% 71.3% 78.9% 70.8% 74.7% Previous Arrest Less than High School High School or Higher No Yes 8.8% 91.3% 20% 80% 5.9% 94.1% 25% 75% 12.2% 87.7% Violent Charge No Yes 83.5% 77.2% 85.5% 83.3% 80.9% 16.5% 22.8% 14.5% 16.7% 19% 31 Table 2 indicates that the majority of drug and alcohol users arrested were white, currently employed, and charged with a non-violent offense. Methamphetamine users in this study were more likely to be white, working, unmarried males with at least a high school degree, a previous arrest, and a non-violent charge. Marijuana users were more likely to be white, working, unmarried males with at least a high school degree, a previous arrest, and a non-violent charge. Cocaine users were more likely to be African American, non-working, unmarried males with at least a high school degree, a previous arrest history, and a non-violent charge. Opiate users were more likely to be white, nonworking, unmarried males with at least a high school education, a previous arrest, and a non-violent charge. Alcohol users were more likely to be white, working, unmarried males with at least a high school degree, a previous arrest, and a non-violent charge. And no-substance users were more likely to be white, working, unmarried males with at least a high school education, a previous arrest, and a non-violent charge. 32 Table 2. Descriptive Statistics by Poly Substance Positive Urinalysis Results N= 2417 Racial Background MA Marijuana Cocaine Opiate Alcohol No-Substance White Black Hispanic American Indian Asian Other 59% 11.9% 22.4% 1.4% 40.5% 39.8% 16.6% .7% 19% 69.5% 9.3% .6% 48.4% 32.2% 14.8% 1.3% 45.6% 31.3% 19.6% 0 43.7% 26.8% 22.7% 0 4.2% .4% 1.5% .3% 1.4% .2% 1.9% .6% 1.8% 0 4.3% 0 Work Status Working Not Working 53.5% 46.5% 53% 47% 41.4% 58.6% 44.2% 55.8% 55.7% 44.2% 61.7% 38.2% Marital Status Married Not Married 22.3% 77.7% 20.2% 79.8% 23.6% 76.4% 21.2% 78.8% 22% 77.9% 27.3% 72.6% Education Level 29.8% 29.2% 23.2% 27.6% 25.7% 26.3% 70.2% 70.8% 76.8% 72.4% 74.2% 73.6% Previous Arrest Less than High School High School or Higher No Yes 8.2% 91.8% 14.5% 85.5% 6.8% 93.2% 12.8% 87.2% 11.9% 88% 20.7% 79.2% Violent Charge No Yes 87% 13% 82.4% 17.6% 82.6% 17.4% 82.7% 17.3% 81% 18.9% 73% 26.9% 33 Results Hypothesis 1: Those arrested in the Sacramento region under the influence of methamphetamine will have more violent charges than those testing positive for other illicit and/or licit substances. Unfortunately, the results for the logistic regression did not support the hypothesis that methamphetamine users would have more violent charges than other drug and alcohol users. This regression did, however, show that one of the control variables was statistically significant in correlation to the respondents arrest charge (whether violent or non-violent). The independent variable, methamphetamine positive urinalysis, was found to have a non-significant correlation with a value of .056. In this logistic regression for single substance users it appears that the only variable that is significant is marital status (Table 3). Those that were married at the time of their arrest showed a high significance level of .001. Married respondents were .001 units more likely to have a violent arrest charge than those that were unmarried at the time of their arrest. Many of the control variables were found to be not significant. These variables are: Race, Work Status, Educational Achievement, Arrest History, Marijuana Positive, Cocaine Positive, and Opiate positive. Though this model didn’t support the hypothesis, it did explain part of the variation found in the respondents arrest charge (whether violent or non-violent). The statistically significant R Square (.036) for this table explains 3.6% of the variation within the violent arrest variable by taking into consideration methamphetamine positive urinalysis results, race, work status, educational achievement, arrest history, marital 34 status, marijuana positive urinalysis results, cocaine positive urinalysis results, and opiate positive results. This does mean, though, that 96.4% of the variation was unexplained by this regression. 35 Table 3. Logistic Regression Predicting Type of Charge for Single Substance Users ADAM 2000-2003 Variable Methamphetamine Test (Negative Omitted) Positive Race Hispanic Dependent Variable: Violent Charge .056 (.568) -.157 (.387) Black -.180 (.318) Native American -.234 (.310) Asian -.252 (.190) White -.197 (.270) Work Status (Working Omitted) Not Working Educational Achievement (High School and above Omitted) Less than High School Education Arrest History (No Previous Arrest Omitted) Previous Arrest Marital Status (Not Married Omitted) Married -.021 (.503) .008 (.816) -.095 (.055) .120 (.001)*** 36 Marijuana Test (Negative Omitted) Positive Cocaine Test (Negative Omitted) Positive Opiate Test (Negative Omitted) Positive .110 (.271) .054 (.617) .089 (.544) Intercept 1.891 (.059) R-Square .036* F 1.806 Number of Cases 652 *p<.05, **p<.01, ***p<.001 Note: Number in Parenthesis is the Standard Error 37 Results Hypothesis 1: Those arrested in the Sacramento region under the influence of methamphetamine will have more violent charges than those testing positive for other illicit and/or licit substances. This logistic regression uses a poly-substance model (can be testing positive for any combination of drugs, not just single substance) to compare methamphetamine positive respondents with all other drug positive respondents. The data did not support they hypothesis that respondents testing positive for methamphetamine will have more violent charges than respondents testing positive for other drugs or substances. In performing this logistic regression, several variables were found to be significant in correlation to violent arrests in Sacramento. Respondents testing positive for methamphetamine was found to be statistically significant. Respondents with methamphetamine in their system were less likely to be arrested with a violent charge by (-.082) units, showing a negative correlation between methamphetamine use and violent arrest (Table 4). The marital status of the respondent was found to be statistically significant. Those that were married at the time of their arrest were (.100) units more likely to have an arrest with a violent charge. Previous arrest was also found to be statistically significant in this regression. Those with a previous arrest were less likely to be arrested with a violent charge by (.095) units, showing a negative correlation between previous arrest and current violent arrest. 38 Along with race, several other control variables were not found to be statistically significant. These variables are: work status, educational achievement, marijuana positive urinalysis result, cocaine positive urinalysis result, and opiate positive urinalysis result. Though this model did not support the hypothesis, it did help to explain 4.1% of the variation found in violent charges for Sacramento by taking in to consideration methamphetamine positive urinalysis results, race, work status, educational achievement, arrest history, marital status, marijuana positive urinalysis results, cocaine positive urinalysis results, and opiate positive urinalysis results. Unfortunately, this also means that 95.9% of the variation was not explained by this logistic regression. 39 Table 4. Logistic Regression Predicting Type of Charge for Poly-Substance Users ADAM 2000-2003 Variable Methamphetamine Test (Negative Omitted) Positive Race Hispanic Dependent Variable: Violent Charge -.082 (.000)*** .061 (.554) Black .034 (.743) Native American -.008 (.953) Asian -.025 (.827) White .021 (.834) Work Status (Working Omitted) Not Working Educational Achievement (High School and above Omitted) Less than High School Education Arrest History (No Previous Arrest Omitted) Previous Arrest Marital Status (Not Married Omitted) Married -.026 (.187) .016 (.454) -.095 (.002)** .100 (.000)*** 40 Marijuana Test (Negative Omitted) Positive Cocaine Test (Negative Omitted) Positive Opiate Test (Negative Omitted) Positive -.030 (.131) .000 (.994) .001 (.986) Intercept 2.605 (.009)** R-Square .041 F 4.951 Number of Cases 2417 *p<.05, **p<.01, ***p<.001 Note: Number in Parenthesis is the Standard Error 41 Results Hypothesis 2: Those testing positive for methamphetamine will mirror charges with those testing positive for alcohol. This logistic regression did not support the hypothesis that those with a positive urinalysis for methamphetamine would mirror the charges for those with alcohol positive results as neither tested statistically significant, with methamphetamine at (-.036) and alcohol at (-.004) (Table 5). Two of the control variables were found to be statistically significant in this analysis though. The respondent’s marital status was found to be statistically related to their arrest charge. Married respondents were found to be .115 units more likely to be arrested with a violent charge than those that were unmarried at the time of their arrest. The respondent’s arrest history was also found to be statistically related to their current arrest charge. Respondents with a previous arrest were found to be -.100 units more likely to be currently arrested for a violent charge than those without a previous arrest. This means that previous arrest was actually negatively correlated with a violent charge for their current arrest. In addition to methamphetamine positive urinalysis results, many of the control variables were found to be non-significant. These variables are: race, work status, educational achievement, and alcohol in the last year. Though this model did not support the hypothesis that methamphetamine positive respondent’s charges would mirror alcohol positive respondent’s charges, it did help explain some of the variation for violent arrests in Sacramento. The statistically 42 significant R Square does explain 3.3% of the variation within this logistic regression with a value of (.033) when taking in to consideration methamphetamine positive urinalysis results, alcohol positive results, race, work status, educational achievement, arrest history, and marital status. This does leave 96.7% of the variation unexplained. 43 Table 5. Logistic Regression Predicting Type of Charges for Single Substance Users in Comparison to Alcohol Users ADAM 2000-2003 Variable Methamphetamine Test (Negative Omitted) Positive Alcohol in the Last 12 Months (Negative Omitted) Positive Race Hispanic Dependent Variable: Violent Charge -.036 (.321) -.004 (.907) -.122 (.497) Black -.150 (.399) Native American -.205 (.373) Asian -.223 (.243) White -.166 (.348) Work Status (Working Omitted) Not Working Educational Achievement (High School and above Omitted) Less than High School Education Arrest History (No Previous Arrest -.025 (.426) .012 (.734) 44 Omitted) Previous Arrest Marital Status (Not Married Omitted) Married -.100 (.042)* .115 (.002)** Intercept 2.462 (.014)* R-Square .033 F 1.948 Number of Cases 652 *p<.05, **p<.01, ***p<.001 Note: Number in Parenthesis is the Standard Error 45 Results Hypothesis 2: Those testing positive for methamphetamine will mirror charges with those testing positive for alcohol. This logistic regression uses a poly-substance model (can be testing positive for any combination of drugs, not just single substance) to compare methamphetamine positive respondents with alcohol positive respondents. Unfortunately, the data from this regression does not support the hypothesis that respondents testing positive for methamphetamine will mirror charges for those testing positive for alcohol. Respondents testing positive for methamphetamine was found to be statistically significant in this regression. Methamphetamine positive respondents were found to be less likely to be arrested with a violent charge by (.803) units (Table 6). This shows a negative correlation between methamphetamine positive respondents and violent charges. Married respondents were found to be statistically significant. Those that were married at the time of their arrest were (.104) units more likely to be charged with a violent crime than those who were unmarried. And previous arrest was also found to be statistically significant. Respondents with a previous arrest were less likely to be arrested with a violent charge by (.095) units. This shows a negative correlation between violent charge and previous arrest. In addition to the variable representing race, many of the other control variables were also found not to be significant in this regression. These variables are: work status, educational achievement, and alcohol use in the last year. 46 Although this logistic regression did not support the hypothesis, it does help to explain some of the variation in violent charges in Sacramento. This regression did explain 3.9% of the variation when taking methamphetamine positive urinalysis results, race, work status, educational achievement, arrest history, marital status, and alcohol use in the last year. This does, however, leave 96.1% unexplained by this model and the variables within it. 47 Table 6. Logistic Regression Predicting Type of Charge for Poly-Substance Users in Comparison to Alcohol Users ADAM 2000-2003 Variable Methamphetamine Test (Negative Omitted) Positive Race Hispanic Dependent Variable: Violent Charge -.083 (.000)*** .056 (.586) Black .029 (.780) Native American -.008 (.952) Asian -.017 (.878) White .020 (.845) Work Status (Working Omitted) Not Working Educational Achievement (High School and above Omitted) Less than High School Education Arrest History (No Previous Arrest Omitted) Previous Arrest Marital Status (Not Married Omitted) Married -.027 (.162) .016 (.474) -.095 (.002)** .104 48 (.000)*** Alcohol in the Last 12 Months (Negative Omitted) Positive .006 (.775) Intercept 2.475 (.013)** R-Square .039 F 5.640 Number of Cases 2417 49 After testing each of the hypotheses, it seems to show us three major themes within the data. First and foremost to this study is that methamphetamine is negatively correlated to violent arrests in the Sacramento region. This shows that those under the influence of methamphetamine are less likely to be arrested with a violent charge. Second, previous arrest history is negatively correlated to current violent arrest in the Sacramento region. Therefore, a person arrested with a previous arrest history is less likely to have been arrested with a violent charge in this sample. And third, that marital status was the only positively correlated variable in this study to having a current violent arrest in the Sacramento region. In this sample, those arrested that were currently married are more likely than their unmarried counterparts to have been arrested with a violent charge. The first hypothesis, that those testing positive for methamphetamine would have more violent charges than those testing positive for other licit and/or illicit substances, is not supported by the data. The only two significant variables were marital status and arrest history in the single substance regression with values of (.120 and -.095 respectively). And in the poly-substance regression, arrest history was significant with a value of (-.095), marital status was significant with a value of (.100) and methamphetamine positive urinalysis was significant with a value of (-.082). So through both of the logistic regressions we see a negative relationship between arrest history and violent charge, a positive relationship between marital status and violent charge, and in the poly-substance regression there is a negative correlation between methamphetamine positive respondents and violent charges. 50 The second hypothesis, that methamphetamine positive respondents would mirror charges to alcohol positive respondents was also not supported by the data. In the single substance regression, only previous arrest and marital status were significant with values of (-.100 and .115) respectively. The poly-substance regression arrest history was significant with a value of (-.095), marital status was significant with a value of (.104), and methamphetamine was significant with a value of (-.083). This shows that between the two logistic regressions, there is a relationship between being married and having a violent charge and a negative relationship with having a previous arrest or having methamphetamine in your system. This all leads us down an interesting path for further research. First and foremost we need to start with methamphetamine. As previously hypothesized in this research, the idea would be that due to numerous different aspects of the use of methamphetamine (from the physiological changes to the actions it takes to get the drug) that it would be more likely that the arrestee would have been brought in on a violent charge. But in this research data it actually shows the opposite to be true, and with fairly high significance levels. So even when compared with alcohol users, drug free arrestees, and with other users (both single substance and poly substance) we see that there is a negative correlation between methamphetamine positive arrestees and violent charges. As for previous arrest record, this could go back to the idea that a violent offense could be a ‘crime of passion’ so to speak, and that they aren’t necessarily tied to a repeat offender (Logan, Walker & Leukefeld, 2001). So, instead of someone who is continually brought in on a violent offense, these are rather one time offenders or those who have no 51 history whatsoever. This, when evaluating and exploring it from a sociological model is interesting as one would think that there would at least be some sort of history. And more yet, what is to happen to this person now that they are brought in? Does this mean that they will be more likely to be arrested for other offenses in the future now that they have an arrest history or could it be a one shot deal where this will be there only arrest? One of the limitations to this study was the availability of data as well as the size of the study sample. This makes it difficult to generalize, but it does give us a better picture of what is happening in the Sacramento region. The lack of a female sample (sizable enough to run data with), also makes this study more pertinent to male arrestees and charges. 52 Chapter 5 DISCUSSION Discussion of Findings Although the literature focused on methamphetamine usage and a tie to violent behavior, this study found the opposite to be true. In this study we saw that methamphetamine usage was actually negatively correlated to a violent arrest, as was found in Rogers and Evans 2003 study. So those who tested positive for methamphetamine (both as a single substance or combined with a poly-substance) were less likely to be arrested with a violent charge as their primary charge. Much of the literature was based around the idea of physiological changes that happen within the body and would put the person into a ‘fight or flight’ mode, thus making them more susceptible to decisions that they may not have made without the physiological changes (Simon, Richardson, Dacey, Glynn, Domier, Rawson & Ling, 2002). Because of the rapid release of hormones and other chemicals, the body is put into a state of tense waiting characterized by rapid heartbeat and circulation which could be felt and interpreted by the individual as a more high stress situation than it could be in reality (Cartier, Farabee & Prendergast, 2006). One of the other ideas brought up in the literature is that it can create a psychological change, or understanding, as to what it is like to be under the influence of methamphetamine and this could alter a persons judgment and make them more prone to violent behavior due to their understanding (Cartier, Farabee & Prendergast, 2006). The 53 data, yet again, goes against this in that it is a negative correlation between methamphetamine positive arrestees and violent arrest charges. Another theory from the literature was that if someone was violent to begin with they would be more prone to violence while under the influence of methamphetamine they would still be violent, but that it may exacerbate it (Lipsky, Caetano, Field & Bazargan, 2005; Skara, Pokhrel, Weiner, Sun, Dent & Sussman, 2008; Cohen, Dickow, Horner, Zweben, Balabis, Vandersloot, & Reiber, 2003; Sommers & Baskin, 2006; Baskin-Sommers & Sommers, 2006; Wright & Klee, 2001). There was no real way to test for this variable other than looking at the previous arrest variable to see if they had been charged previously, although there was no way to tell if it was a violent or nonviolent offense. But, in this study marital status was a significant variable. So it is possible to use that as a link, albeit a loose link, between previous history of violence and current violent charge. Most of the studies on intimate partner violence pointed to the idea that a person would continue to be violent or abuse independent of the relationship that they were in at the time (James, Johnson & Raghavan, 2004). Therefore, we may be able to extrapolate this into this study by looking at it from the idea that this may not have been their first violent offense, but it may have been the first time that they were arrested and charged with a violent offense. Not only that, but we need to look at the way that the variable was coded for this study. Many of the violent offenses could be seen as intimate partner violence. So it is possible, that due to the coding it focused in more on intimate partner violence than it did on drug related violence (as drug dealing etc variables were not 54 counted as violent). Since most of the studies on violence and drug use are self-report, it leaves a large gap in the research. Self-report literature often can be flawed due to the honesty of the sample, or respondent, and other factors (some are often afraid to be honest about some of the questions in that they may go or return to jail if they are honest). When each of the hypotheses was looked at for this study, all of the hypotheses were proven to be incorrect. Although the literature review would point to them being correct, after the statistical analysis of the regressions used for this study, it actually points to the opposite being true. That methamphetamine use has a negative correlation to violent behavior (in this case a violent arrest in the Sacramento region). But there was a very strong correlation between marital status and violent arrest. This leaves a large space for future research on the topic. This study may not have been able to prove the given two hypotheses. First, that those testing positive for methamphetamine will have more violent arrest charges than those testing positive for other substances. And second, that methamphetamine users charges will mirror charges for those testing positive for alcohol. Though these two hypotheses were not proven, it does give good research and information on the study of violence and methamphetamine use. Evaluation and Critique of Study This study was set up to see if there was a correlation between methamphetamine usage and violent behavior. As most of the previous research pointed to the idea that methamphetamine usage may have a large correlation to violent behavior in men, as well 55 as women (although this study was unable to evaluate the truthfulness of the women statement due to sample size). As with all studies, there were limitations to this study as well. The first and foremost is the generalizability to the outside population. This study was based on the ADAM dataset from the combined years of 2000 to 2003, which is still a small sample size when trying to look at it from a national perspective. This does paint an interesting picture for the local region of Sacramento, but still leaves some room for further research in other regions that could be highly affected by the methamphetamine usage in their areas. One of the other limitations was that it was based entirely on a male sample for the study, as women were not sampled for the dataset in numbers large enough to make it statistically significant for the region (or this study). One of the major critiques of this study was the inability to test the third hypothesis with the single substance variable due to coding. It was in the coding itself that the no-drug in system variable would disappear due to the way that it was set up to look at the single drug variable. This could have given the study and interesting glimpse into how methamphetamine users differed from no-substance in a single substance regression. Impact on Future Research As shown above, one of the major areas for future research is in the intimate partner violence variable. This became a foremost idea within the study as the marital status of a person was positively correlated with a violent arrest charge. This could become an interesting focal point for many studies as (James, Johnson & Raghavan, 2004) showed that a person abused in the past was much more likely to abuse another 56 individual in the future. This can add on to a vast array of information and data on the subject of intimate partner violence and can also add a facet into the research of drug use and violence. In this region, it may not have been statistically significant for other drugs users to be charged with violent offenses. But this showed a very different variation what was statistically significant not only for this study, but for subsequent studies as well. Because if there is a negative correlation between methamphetamine use and violent charges then there is a whole other realm that we need to study in drug use. This goes against most of the literature that is currently available. Sociologically, this becomes of interest due to the lack of information on the topic of drug use and violence. Because if it is not studied, then how can we know or understand the topic to its fullest content? It is possible that it could even be a regional difference in behavior, or just a variation. And that other regions would test differently than the Sacramento region did in this study, but that is an area for further research. It would be of interest to see how some of the larger cities and regions would test when run with the same analysis to see if there was a difference depending on region, and possible understanding of what it is to be under the influence of methamphetamine. Conclusion While this study’s regressions and analysis showed unexpected findings, it does set up the area for further research. After looking over the literature for this study and examining the role that intimate partner violence may play in the arrest charges we see that methamphetamine use actually is less likely to be found in a violent charge than a person being married. So after finding that marital status was the only significant 57 variable in the analysis, this study was left with many questions and critiques for further study in the area of intimate partner violence and violent arrest charges. These findings point to ideas for future research that could better help not only health officials but all communities that are affected by violent behavior, whether it be due to drug use or to other variables. 58 APPENDIX Dependent Variable *Charges 1.01 AGGRAVATED ASSAULT 1.02 BLACKMAIL/EXTORTION/THREAT 1.03 KIDNAPPING 1.04 MANSLAUGHTER - NEGLIGENTE 1.05 MURDER/HOMICIDE 1.06 ROBBERY 1.07 SEXUAL ASSAULT/RAPE 1.08 WEAPONS 1.09 DOMESTIC VIOLENCE 1.10 CHILD ABUSE 1.11 SPOUSE/PARTNER ABUSE 1.12 OFFENSE AGAINST FAMILY/CHILD 1.13 VIOLATION PROTECT ORDER 1.14 OTHER ASSAULT 1.15 OTHER CRIME AGAINST PERSONS 2.01 DWI/DUI 2.02 DRUG POSSESSION 2.03 DRUG SALE 2.04 LIQUOR 2.05 POSSESSION OF ALCOHOL 2.06 UNDER INFLUENCE OF SUBSTANCE 2.07 OTHER DRUG OFFENSE 2.08 CLANDESTINE DRUG LABORATORY 3.01 ARSON 3.02 BRIBERY 3.03 BURGLARY 3.04 BURGLARY TOOLS 3.05 DAMAGE/DESTROY PROPERTY 3.06 FORGERY 3.07 FRAUD 3.08 LARCENY/THEFT 3.09 STOLEN PROPERTY 3.10 STOLEN VEHICLE 3.11 TRESPASSING 4.01 CURFEW (JUVENILE) 4.02 FAILED PLACEMENT (JUVENILE) 4.03 RUNAWAY (JUVENILE) 4.04 TRUANCY (JUVENILE) 59 4.05 VIOLATION OF HOME SUPERVISION (JUVENILE) 4.06 CONTROLLED SUBSTANCE VIOLATION (JUVENILE) 4.07 INCORRIGIBLE/UNRULY (JUVENILE) 5.01 PROSTITUTION 5.02 EMBEZZLEMENT 5.03 FARE BEATING 5.04 FLIGHT/ESCAPE 5.05 GAMBLING 5.06 OBSCENITY 5.07 OBSTRUCTION OF JUSTICE 5.08 OTHER 5.09 PUBLIC PEACE/DISTURBANCE 5.10 PICKPOCKET 5.11 SEX OFFENSE 5.12 PROBATION/PAROLE VIOLATION 5.13 TECH. VIOLATION 5.14 TRAFFIC-RELATED 5.15 CONT. DELINQUENCY OF A MINOR 5.16 UNSPECIFIED WARRANT 5.17 SALES NO LICENSE 7.01 PC_AGG. ASSAULT 7.02 PC_BLACKMAIL/EXT. 7.03 PC_KIDNAPPING 7.04 PC_NEG. MANSLAUGHTER 7.05 PC_MURDER/HOMICIDE 7.06 PC_ROBBERY 7.07 PC_SEXUAL ASSAULT 7.08 PC_WEAPONS 7.09 PC_DOM. VIOLENCE 7.10 PC_CHILD ABUSE 7.11 PC_SPOUSE/PARTNER ABUSE 7.12 PC_OFFENSE AGAINST FAMILY AND CHILDREN 7.13 PC_PROTECTION ORDER VIOLATION 7.14 PC_OTHER ASSAULT 7.15 PC_OTHER CRIMES AGAINST PERSONS 7.16 PC_DWI/DUI 7.17 PC_DRUG POSSESSION 7.18 PC_DRUG SALE 7.19 PC_LIQUOR 7.20 PC_POSSESS ALCOHOL 7.21 PC_UNDER INFLUENCE OF CONT. SUBSTANCE 7.22 PC_OTHER DRUG OFF. 7.23 PC_ARSON 60 7.24 PC_BRIBERY 7.25 PC_BURGLARY 7.26 PC_BURGLARY TOOLS 7.27 PC_DAMAGE PROPERTY 7.28 PC_FORGERY 7.29 PC_FRAUD 7.30 PC_LARCENY/THEFT 7.31 PC_STOLEN PROPERTY 7.32 PC_STOLEN VEHICLE 7.33 PC_TRESPASSING 7.34 PC_PROSTITUTION 7.35 PC_EMBEZZLEMENT 7.36 PC_FARE BEATING 7.37 PC_FLIGHT/ESCAPE 7.38 PC_GAMBLING 7.39 PC_OBSCENITY 7.40 PC_OBSTRUCTION OF JUSTICE 7.41 PC_OTHER 7.42 PC_PUBLIC PEACE/DESTURBANCE 7.43 PC_PICKPOCKET/JOSTLING 7.44 PC_SEX OFFENSE 7.45 PC_PROBATION/PAROLE VIOLATION 7.46 PC_TECH. VIOLATION 7.47 PC_TRAFFIC-RELATED 7.48 PC_UNSPECIFIED WARRANT 7.49 PC_IMMIGRATION 7.50 PC_INCITING A RIOT 8.01 FEDERAL VIOLATION 8.02 ILLEGAL ENTRY INTO US 7777.00 M NOT APPLICABLE 9999.00 M MISSING 61 BIBLIOGRAPHY Amatetti, S. Young, N. 2004. Women, Children and Methamphetamine. Available online: http://www.ncsacw.samhsa.gov/ Anglin MD, Burke C, Perrochet B, Stamper E, Dawud-Noursi S, (2000). History of the Methamphetamine Problem, Journal of Psychoactive Drugs, 32(2): 137-41. Anonymous. 1999. NIJ study questions link between methamphetamine use, violence. May, 17, 1999. Available online: www.ojp.usdoj.gov/jic Anonymous. 2008. History of Methamphetamine. http://www.montgomerycountytn.org/County/sheriff/meth/hismeth.aspx Armstrong, Gaylene S. and Marie L. Griffin. 2007. "The Effect of Local Life Circumstances on Victimization of Drug-Involved Women." 24(1):80-105. Baskin-Sommers, A. Sommers, I. 2006. Methamphetamine use and violence among young adults. Journal of Criminal Justice. 34: 661-674. Basking, A. Sommers, I. 2006. Methamphetamine Use and Violence. Journal of Drug Issues. 0022-0426/06/01 77-96 Brecht, Mary-Lynn. Greenwell, Lisa. Anglin, M. Douglas. (2006) Substance use pathways to methamphetamine use among treated users. [Online]. Available: http://www.sciencedirect.com.proxy.lib.csus.edu/science?_ob=ArticleURL&_udi=B6VC 9-4JW15NF3&_user=521814&_coverDate=01%2F31%2F2007&_rdoc=1&_fmt=&_orig=search&_s ort=d&view=c&_acct=C000059575&_version=1&_urlVersion=0&_userid=521814&md 5=217571339ea6ac6264365bd8d15ce8d7 Borwn, J. Hohman, M. 2006. The Impact of Methamphetamine Use on Parenting. Available online at http://www.haworthpress.com/web/JSWPA Charon, Joel M. 2007. Symbolic Interactionism: An Introduction, An Interpretation, An Integration, 9th edition. Upper Saddle River, NJ: Pearson. Cho, A. Melega, W. 2002. Patterns of Methamphetamine Abuse and Their Consequences. Journal of Addictive Diseases. 21(1). 62 Cohen, J. Dickow, A. Horner, K. Zweben, J. Balabis, J. Vandersloot, D. Reiber, C. 2003. Abuse and Violence History of Men and Women in Treatement of Methamphetamine Dependence. The American Journal on Addictions. 12:377-385. DeLamater, John D. and Janet Shibley Hyde. 1998. “Essentialism Vs. Social Constructionism in the Study of Human Sexuality.” Journal of Sex Research 35:10-18. Dubeski, Norman. 2001. Durkheim's Altruism As The Source Of His Social Holism: A Discussion Of The Viability Of A Social Basis For Moral Principles. Electronic Journal of Sociology. 1198 3655. El-Bassel, N. Gilbert, L. Wu, E. Hyun, G. Hill, J. 2005. HIV and intimate partner violence among methadone maintained women in New York City. Social Science and Medicine. 61: 171-183. Grann, M. Fazel, S. 2004. Substance misuse and violent crime: Swedish population study. BMJ. 328: 1233-1234. Grella, C.E.; Hser, Y.; Huang, Y. 2006. “Mothers in Substance Abuse Treatment: Differences in Characteristics Based on Involvement with Child Welfare Services”. Child Abuse and Neglect. 30: 55-73. Hequembourg, Amy, Richard Mancuso and Brenda Miller. 2006. "A Comparative Study Examining Associations between Women's Drug-Related Lifestyle Factors and Victimization within the Family." Violence and Victims 21(2):231-246. Jerome Cartier, David Farabee and Michael L. Prendergast. 2006. “Methamphetamine Use, Self-Reported Violent Crime, and Recidivism Among Offenders in California Who Abuse Substances.” Journal of Interpersonal Violence. 21: 435 Moran, P. Vuchinich, S. Hall, N. 2004. Associations between types of maltreatment and substance use during adolescence. Child Abuse and Neglect. 28: 565-574. National Institute of Justice. 2003. “Arrestee Drug Abuse Monitoring (ADAM) Program in the United States.” http://www.icpsr.umich.edu/cocoon/ICPSR/STUDY/04020.xml#methodology Parker, R. N., & Auerhahn, K. (1998). Alcohol, drugs, and violence. Annual Review of Sociology, 24, 291-311. 63 Rawson, R. Anglin, M. Ling, W. 2002. Will the Methamphetamine Problem Go Away? Journal of Addictive Diseases. 21(1). Rawson, R. Huber, A. Brethen, P. Obert, J. Gulati, V. Shoptaw, S. Ling, W. 2002. Status of Methamphetamine Users 2-5 Years After Outpatient Treatment. Journal of Addictive Diseases. 21(1) Rodriguez, Nancy; Katz, Charles; Webb, Vincent J.; Schaefer, David R. (2005). Examining the Impact of Individual, Community, and Market Factors on methamphetamine Use: A Tale of Two Cities. Journal of Drug Issues 0022-0426/05/04 66-694. Rogers PhD, John D., Evans M.A., Michelle, (2003). Methamphetamine Use in Santa Clara County, California. Available Online at: http://pri.sfsu.edu/reports/Methamphetamine_Use_in_Santa_Clara_County.pdf Shoptaw, S. Reback, C. Freese, T. 2002. Patient Characteristics, HIV Serostatus, and Risk Behaviors Among Gay and Bisexual Males Seeking Treatment for Methamphetamine Abuse and Dependence in Los Angeles. Journal of Addictive Diseases. 21(1) Sim, T. Simon, S. Domier, C. Richardson, K. Rawson, R. Ling, W. 2002. Cognitive Deficits Among Methamphetamine Users with Attention Deficit Hyperactivity Disorder Sympotmatology. Journal of Addictive Diseases. 21: 1. Simon, S. Richardson, K. Dacey, J. Glynn, S. Domier, C. Rawson, R. Ling, W. 2002. A Comparison of Patterns of Methamphetamine and Cocaine Use. Journal of Addictive Diseases, 21: 1 Simon, S. Domier, C. Sim, T. Richardosn, K. Rawson, R. Ling, W. 2002. Cognitive Performance of Current Methamphetamine and Cocaine Abusers. Journal of Addictive Diseases, 21: 1 Susan E. James, Janice Johnson and Chitra Raghavan. 2004. “’I Couldn’t Go Anywhere‘: Contextualizing Violence and Drug Abuse: A Social Network Study.” Violence Against Women 10: 991 TK Logan, Robert Walker and Carl G. Leukefeld. 2001. “Intimate Partner and Nonintimate Violence History Among Drug-Using, Incarcerated Men.” Interview Journal of Offenders and Their Complete Criminal 45; 228 United States Department of Justice, (2002) COPS Fact Sheet: COPS Methamphetamine Funding, U.S. Department of Justice, Washington, D.C.. 64 von Mayrhauser, C., Brecht, M., & Anglin, M. D. (2002). Use ecology and drug use motivation of methamphetamine users admitted to substance abuse treatment facilities in Los Angeles: An emerging profile. Journal of Addictive Diseases, 21(1), 45-60. Wilson, P., McFarlane, J., Malecha, A.,Watson, K., Lemmey, D., Schultz, P., Gist, J., & Fredland, N. (2000). Severity of violence against women by intimate partners and associated use of alcohol and/or illicit drugs by the perpetrator. Journal of Interpersonal Violence, 15(9), 996-1008. Wright, S.,&Klee, H. (2001).Violent crime, aggression and amphetamine: What are the implications for drug treatment services? Drugs: Education, Prevention, and Policy, 8(1), 73-89. Yacoubian Jr., George S.; Peters, Ronald J. (2004). Exploring the Prevalence and Correlates of Methamphetamine Use: Findings From Sacramento’s ADAM Program. Journal of Drug Education, 34(3) 281-294.