Pathways of Addiction Opportunities in Drug Abuse Research (1996) / Chapter Skim
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4. Epidemiology
4. Epidemiology
Pages 94-116
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was established in 1974, epidemiology became one of its earliest priorities, and one of the first publications in NIDA's Research Monograph Series was Epidemiology of Drug Abuse: Current Issues (NIDA, 1976)
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This chapter describes the variety of data systems currently in place that address different aspects of the drug use problem in the United States and discusses accomplishments and future directions in epidemiological research. DEFINITIONS One way in which the epidemiology of drug abuse differs from more traditional epidemiological studies of infectious diseases is that drug abuse is not universally accepted as a medical condition.
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. Other major accomplishments of epidemiological research include the development of valid measures and survey methodologies and the collection and analysis of data on co-occurring psychiatric disorders, natural history, and etiology of drug abuse.
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Grant in 1990–1992 Foundation Estimates of Consequences of Use Drug Abuse Warning Hospital emergency SAMHSA Began in 1973; Network room visits; deaths data reported semiannually NOTE: DC* MADS = Washington, D.C., Metropolitan Area Study; DOD = Department of Defense; NIDA = National Institute on Drug Abuse; NIJ = National Institute of Justice; NIMH = National Institute of Mental Health; SAMHSA = Substance Abuse and Mental Health Services Administration.
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98 PATHWAYS OF ADDICTION TABLE 4.2 Percentages Reporting Past Month Use of Any Illicit Drug by Age Group and Demographic Characteristics, 1994-Ba Age Group (years) Demographic Characteristic 12–17 18–25 26–34 ≥35 Total Total 8.2 13.3 8.5 3.2 6.0 Race/Ethnicity White 8.5 14.6 9.0 3.1 6.0 Black 8.3 12.8 10.2 4.4 7.3 Hispanic 8.1 9.1 5.7 2.9 5.4 Other 2.7 b 3.2 b 3.1 Sex Male 8.5 17.1 11.6 4.3 7.9 Female 7.8 9.6 5.6 2.2 4.3 Population densityc 7.6 14.0 9.1 3.0 6.1 Large metro 10.4 13.5 8.3 3.9 6.6 Small metro Nonmetro 5.7 11.8 7.5 2.4 4.8 Region Northeast 6.8 10.8 7.8 2.7 5.1 North Central 9.2 13.8 8.7 2.8 5.8 South 7.7 14.2 8.5 3.5 6.3 West 8.8 13.6 9.0 3.5 6.6 Adult educationd |
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As shown in Figure 4.1 for four age groups, the percentage of those who used any illicit drug in the previous month declined steadily from 1979 to 1991 in all age groups except the over-35 group, which consistently reported very low rates of illicit drug use in the past 30 days. In 1979, approximately 14 percent of the total household population reported having used one or more illicit drugs in the past month, compared with 6 percent in 1994 (SAMHSA, 1995c)
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. annual surveys of nationally representative samples of eighth-, tenth-, and twelfth-grade students;5 in-school questionnaires are administered by professional interviewers to more than 45,000 students in approximately 420 public and private schools each year (Johnston et al., 1995)
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Those groups also showed dramatic decreases in marijuana use throughout the 1980s, although their rates have remained just about level or increased slightly in the early 1990s. National Comorbidity Survey NHSDA and MTF provide reasonably accurate epidemiological data on the use of alcohol, tobacco, and illicit drugs among the general population and the trends in those measures.
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MADS data on homeless and institutionalized populations were analyzed to determine the impact of those results on estimates of the number of injection drug users derived from studies such 6There have been other important and significant efforts to determine the epidemiology of drug abuse and dependence; the most notable is the Epidemiology Catchment Area studies (Eaton and Kessler, 1985) , but these were not nationally representative.
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The target audiences for these data are state and local policymakers, court administrators, law enforcement officials, and drug treatment program staff. DUF data are collected for two weeks each quarter by trained individuals who interview booked arrestees and obtain voluntary, anonymous urine specimens (NIJ, 1994)
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.9 In 21 of the 23 data collection sites, more than half of male and female booked adult arrestees tested positive for a drug at the time of arrest. Department of Defense Survey of Health Related Behaviors Among Military Personnel The Survey of Health Related Behaviors Among Military Personnel was conducted in 1980, 1982, 1985, 1988, 1992, and 1995.
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CEWG is not itself a data collection system; it synthesizes epidemiological and ethnographic research information from a variety of sources (including public health agencies, medical and treatment facilities, criminal justice and correctional offices, and law enforcement agencies) and provides current descriptive and analytic information on the nature and scope of drug abuse, emerging trends, consequences of illicit drug use and abuse, and characteristics of vulnerable populations.
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. One mechanism for assembling and analyzing this data is the Drug Abuse Warning Network (DAWN)
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, which compiles data on illicit drugs purchased, seized, or acquired in DEA investigations and includes information on drug purity, street price, and location of confiscation. RESEARCH OPPORTUNITIES Refinement of Data Systems As discussed above, the current epidemiological data collection surveys have made significant contributions to drug abuse research.
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provides the first nationally representative estimates on the co-occurrence of drug abuse and psychiatric disorders. The principal finding is that there is a significant overlap in diagnoses.
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, prevention programs and strategies may be developed that target those variables. Causal Relationships and Societal Norms Epidemiological research has provided an important source of information regarding the etiology of drug use and the social attitudes and norms pertaining to use.
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Epidemiological data can also be used to address more fundamental issues having to do with "norms" related to illicit drug use.13 Epidemiological research can be very useful in assessing what the norms are for particular drug-related behaviors and how those norms vary by person, place, and time. Most researchers in the field would emphasize the role of social factors, including broad social-cultural norms, in influencing initiation and experimental use of alcohol, tobacco, or illicit drugs, while intraindividual factors (biological and psychological)
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drug abusers, many of whom are multiple drug abusers, with cultures such as China, where it is easier to find individuals who are heavy users of only one illicit drug)
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. Other examples include questioning arrestees or pregnant women about recent drug use.
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Additional epidemiological research should focus on collecting and analyzing data on the nature and extent of drug abuse and dependence, drug use patterns, co-occurring drug abuse and psychiatric disorders, and refinement of measurement and analytical tools. Continued and refined epidemiological research will provide the data and analyses necessary for the development of treatment and prevention programs and will inform decisions on future allocation of resources to best address the alcohol, tobacco, and illicit drug abuse problem.
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1988. Learning and unlearning drug abuse in the real world: Clinical treatment and public policy.
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1995b. Prelimi nary Estimates from the Drug Abuse Warning Network: 1994 Preliminary Estimates of Drug Related Emergency Department Episodes.
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1994. Designing and analyzing studies of onset, cessation, and relapse: Using survival analysis in drug abuse prevention research.
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