oversight

Rural Drug Abuse: Prevalence, Relation to Crime, and Programs

Published by the Government Accountability Office on 1990-09-14.

Below is a raw (and likely hideous) rendition of the original report. (PDF)

                      Report to Congressional Requesters




S~q)t.t~rIltwr 1990
                      RURAL DRUG
                      ABUSE
                      Prevalence, Relation to
                      Crime, and Programs




                                                        3
                                                II0I III
                                                  142336




GAO/I’EMD-90-24
_._-_._   ----.-_-..   .--.---   __.   ------------   --   ,-
             United States
GAO          General Accounting Office
             Washington, D.C. 20548

             Program Evaluation    and
             Methodology  Division

             B-240864

             September 14,199O

             The Honorable David Pryor
             The Honorable Max Baucus
             The Honorable Thomas Harkin
             The Honorable Dale Bumpers
             The Honorable Kent Conrad
             United States Senate

             On March 19 and June 8,1990, you asked us to examine the nature and
             extent of the drug crisis in rural parts of America. The request asked
             that we focus on the prevalence of substance abuse, its relationship with
             crime, and the effectiveness of program efforts to prevent or treat rural
             substance abuse. We were also asked to determine what data exist on
             these issues and, to the extent data are available, to collect, examine,
             and interpret them. Our main finding is that total substance abuse rates
             are about the same in rural and nonrural places.


             For some time now, the public has seen substance abuse as one of the
Background   most important problems facing the nation. In particular, the public is
             concerned that illegal drugs are responsible for violent crime and that
             the crime rate is rising. There appears to be broad support for govern-
             ment programs to combat substance abuse through education, treat-
             ment, and law enforcement (Shinn, 1990).

             Public, scholarly, and policymaker attention has tended to focus on
             “high intensity” drug zones in large cities such as New York, Wash-
             ington, D.C., Los Angeles, Miami, and Houston and along the U.S.-Mexico
             border. In contrast, much less attention has been paid to less-densely
             populated rural areas farther removed from the coasts or the country’s
             southern border. For example, the only national survey report explicitly
             focusing on substance abuse in rural areas is over a decade old. That
             report concluded that for most illegal drugs, about two thirds as many
             rural as nonrural inhabitants would try drugs during their lifetimes. The
             report also noted that “The pattern of increases in rural drug abuse sug-
             gests that rural/nonrural prevalence differences are declining and will
             disappear entirely if current trends persist.” (U.S. Department of Health
             and Human Services, 1981, p. 1) To our knowledge, no systematic
             assessment of these trends has been undertaken since then. Nor has
             much attention been given to describing the relationship between sub-
             stance abuse and crime in rural areas or to reporting whether the effec-
             tiveness of prevention and treatment programs differs in these areas.


             Page 1                                       GAO/PEMD-90-24   Rural Drug Abuse
                                                                                      ir-
           B-240864




           We addressed three main questions:
Analysis
           1. What information exists on the extent of substance abuse in rural
           places?

           2. What is known about the relationship between substance abuse and
           crime in rural places?

           3. What data are available concerning the effectiveness of prevention
           and treatment programs in reducing rural substance abuse?

           We defined substance abuse as involvement with illegal drugs, illegal
           use of drugs (such as alcohol or prescription medicine), or drug use
            linked to other criminal activity or needing treatment. For example, an
           individual involved with illegal drugs (such as cocaine, heroin, or mari-
           juana) in any way is considered a substance abuser. But illegal use of
            legal drugs such as alcohol and prescription medicine also qualifies as
            substance abuse (as when a person drives while under the influence of
            alcohol, drinks while under age, or obtains prescription drugs under
            false pretenses). Substance abuse can also occur if a person commits
            such acts as domestic violence while under the influence or requires
            medical care for alcohol dependency or overdosing on inhalants. Note
           that alcohol is considered substance abuse in this report only when it is
           used illegally or when it causes problems for the user; data on legal,
            nonproblematic alcohol use by adults are not included in this report.


           Our review of survey, arrest, and treatment data produced several find-
Findings   ings concerning the nature and extent of substance abuse in rural places.
           The survey data for high school seniors is presented in table 1; arrest
           and treatment data are summarized in figure 1. (Additional data on the
           extent and nature of substance abuse are in appendix II.)




           Page 2                                        GAO/PEMD-99-24   Rural Drug Abuse




                                 :., ‘I
                                    R-240854




Table 1: Hlghllghtr of Selected
Subrtence Use Prevalence for High                                                               Population density
School Seniora, Class of 1988       Freauencv of we                          Non-SMSA’          Medium SMSA’               Large SMSA’
                                    Within lifetime
                                      Alcohol                                         91.3%                   92.3%                   92.2%
                                      Marijuana                                       41.9                    49.7                    47.8
                                      Cocaine                                          8.6                    12.8                    14.3
                                      Inhalants                                       17.8                    16.1                    16.8
                                      Stimulants                                      20.3                    21.3                    16.7
                                      Sedatives                                        7.5                     8.0                     7.9
                                      Tranquilizers                                    9.3                     9.4                     9.4
                                      Hallucinoaens                                    5.8                     9.8                    10.2
                                      Heroin                                           1.2                     1.2                     1.0
                                      Other oniates                                    7.9                     9.3                     8.1
                                    Within past year
                                      Alcohol                                         83.9                    85.7                    86.1
                                      Marijuana                                       29.0                    34.7                    34.3
                                      Cocaine                                          5.3                     8.5                     9.3
                                      Inhalants                                        7.5                     6.0                     6.5
                                      Stimulants                                      11.3                    11.9                     8.8
                                      Sedatives                                        3.5                     3.8                     3.6
                                      Tranquilizers                                    4.5                     5.0                     4.7
                                      Hallucinogens                                    3.5                     6.0                     6.5
                                      Heroin                                           0.5                     0.5                     0.4
                                      Other opiates                                    4.4                     5.2                     4.0
                                    Within past 30 days
                                      Alcohol                                         63.8                    64.1                    63.8
                                      Marijuana                                       14.3                    19.3                    19.4
                                      Cocaine                                          2.1                     3.8                     4.2
                                      Inhalants                                        3.4                     2.4                     2.0
                                      Stimulants                                       4.8                     5.1                     3.5
                                      Sedatives                                        1.5                     1.6                     1.0
                                      Tranauilizers                                    1.4                     1.7                     1.3
                                      Hallucinogens                                    1.4                     2.6                     2.2
                                      Heroin                                           0.2                     0.2                     0.1
                                      Other opiates                                    1.6                     1.8                     1.2
                                    Daily within past 30 days
                                      Alcohol                                          4.5                     4.5                     3.5
                                      Mariiuana                                        1.4                     3.4                     2.6
                                    %MSA: Standard metropolitan statistical area.
                                    Source: L. D. Johnston, P. M. O’Malley, and J. G. Bachman, Drug Use, Drinking, and Smoking: National
                                    Survey Results from High School, College, and Young Adult?opulations,    19751988 (Ann Arbor: Univer-
                                    flslty 0                                                                            Human Services,
                                    Public Health Service, Alcohol, Drug Abuse, and Mental Health Administration, National Institute on
                                    Drug Abuse, 1989) pp. 42,44,46, and 48.




                                    Page 3                                                         GAO/PRMD-3044       Rural Drug Abuse
                                           B-240854




Flgure 1: Subrtance Abu8e Treatments
and Arwts, 1988
                                           Rat0 par 1000 lnhabitantm
                                           18




                                            8




                                           Source: Treatment admissions data in W. Butynski, D. Canova, and S. Jenson, State Resources and
                                           Services Related to Alcohol and Drug Abuse Problems, Fiscal Year 1988: An Analysis of State Alcofiol
                                           and Drug Abuse Profile Data, a report for the National lnstrtute on Alcohol Abuse and Alcoholrsm and
                                           Ihe National Institute on Drug Abuse (Washington, D.C.: National Association of State Alcohol and Drug
                                           Abuse Directors, 1989) pp. 22 and 36; arrest data in U.S. Department of Justice, Crime in the United
                                           States, 1988 (Washington, DC.: Federal Bureau of Investigation, 1989a); and U.S.Department of Jus-
                                           tice, unpublished data, Federal Bureau of Investigation, 199Of.


                                           These data show the following:

                                       l Total substance abuse (alcohol abuse plus other drug abuse) rates in
                                         rural states are about as high as in nonrural states.
                                       . Of all substances, alcohol is by far the most widely abused.
                                       . What discriminates between rural and nonrural areas is that prevalence
                                         rates for some drugs (such as cocaine) appear to be lower in rural areas,
                                         while prevalence rates for other drugs (such as inhalants) may be
                                         higher.


                                           Page 4                                                          GAO/PEMIM@24        Rural Dnqg Abuse
                                              5240854




                                              The data from the high school senior survey (table 1) can be generalized
                                              to the 48 contiguous states. The arrest and treatment totals (figure l),
                                              while not from a nationally representative sample, include the reports of
                                              48 and 47 states, respectively.

                                              Most research shows that the link between drugs and crime is strong.
                                              Heavy substance abusers are often criminals, and criminals are often
                                              substance abusers. The data collected by law enforcement agencies and
                                              prisons do not necessarily provide an accurate measure of the extent of
                                              drug-related crime, however. Arrest rates for substance abuse violations
                                              (figure 1) and the substance abuse rates of those in state prisons (table
                                              2) are nonetheless the best measures available concerning drugs and
                                              crime in rural areas. (Additional data are in appendix III.)

Table 2: Substance Abuse Among
Inmates Recently Admitted to Four State                                                                                Both alcohol      Total
Correctlons Syrtems                                                                          AFb\ta; Othe;bqlwi           and drug substance
                                              State                                                                          abuse     abuse
                                              Arkansas                                             24%            20%            27%       71%
                                              Iowa                                                 21             10             44        75
                                              Montana                                              17             13             61        91
                                              North Dakota                                         28                a           54        73
                                              aNot available.
                                              Source: Unpublished   1990 data provided by Arkansas, Iowa, Montana, and North Dakota


                                              Despite the shortcomings of these data, our review allows us to draw
                                              three main conclusions:

                                          l Rural areas have arrest rates for substance abuse violations that are as
                                            high as those in nonrural areas.
                                          . Most prison inmates in rural states have abused alcohol, other drugs, or
                                            both.
                                          l The prevalence of substance abuse among inmates completely over-
                                            whelms available treatment services.

                                              A wide variety of programs seek to reduce substance abuse through pre-
                                              vention or treatment. We focused on three major federal programs that
                                              provide funds to the states for these purposes. (See appendix IV.) The
                                              Federal Drug Control and System Improvement Grant program, adminis-
                                              tered by the Bureau of Justice Assistance within the Department of Jus-
                                              tice, distributes funds to state and local governments to apprehend,
                                              prosecute, adjudicate, incarcerate, and treat substance abuse offenders.
                                              The Alcohol, Drug Abuse, and Mental Health Administration (ADAMHA)



                                              Page 5                                                        GAO/PEMD-@O-24      Rural Drug Abase
    E240854




    within the U.S. Department of Health and Human Services provides
    states with funding for the development of prevention, treatment, and
    rehabilitative programs and activities to deal with alcohol and drug
    abuse. The Drug-Free Schools and Communities State and Local Grant
    Program, administered by the U.S. Department of Education, funds
    school and community efforts to reduce the incidence and prevalence of
    substance abuse.

    Our review of the literature on program effectiveness indicates that
    only a few thorough evaluations have found particular programs to be
    effective, but almost no studies have focused on programs in the rural
    United States. Furthermore, we are unaware of any evaluations that
    compare the effectiveness of law enforcement, education, and treatment
    programs. Our findings on program effectiveness are therefore quite
    limited.

l   Little information exists on the effectiveness of law enforcement in
    reducing drug abuse in either rural or nonrural areas. The rural states
    we visited do have plans to improve their ability to evaluate law
    enforcement programs, however.
l   The evidence suggests that educational programs can modestly reduce
    drug abuse, although we found only a few evaluations of prevention
    program effectiveness in rural states.
l   Some treatment programs appear to reduce drug abuse. However,
    studies of treatment effectiveness have rarely focused on rural areas.
    Currently, at least a few rural states have begun evaluating their own
    treatment programs.
l   Over 80 percent of treatment admissions in rural states are for alcohol
    abuse. However, all states are required to devote at least 36 percent of
    their ADAMHAblock grant funding to treatment programs for drugs other
    than alcohol. This implies that these funding allocation mandates may
    not meet rural needs.

    We were nonetheless able to identify features of rural places that should
    be taken into account if law enforcement, treatment, and education pro-
    grams are to be made more effective. Although we cannot draw defini-
    tive conclusions about program effectiveness, we are able to note that
    certain barriers must be overcome if rural areas are to be successful in
    reducing substance abuse. Rural programs can have greater per-client
    costs because of their “diseconomies of scale.” These areas may find it
    difficult to attract and hold trained and experienced staff. Clients must
    travel farther to reach programs and program staff must travel farther



    Page 6                                       GAO/PEMD-90-24   Rural Drug Abuse
B240854




to reach clients. The programs may lack acceptance by the community,
community agencies, and the local school system.

The defining characteristic of rural areas is their low population den-
sity. This makes it difficult to have high program intensity: a rural com-
munity is unlikely to be able to afford drug program specialists. Rural
police must handle the full range of law enforcement problems, rural
teachers must perform a wide variety of educational services, and rural
health care workers must provide a broad array of health services. Indi-
viduals in these jobs, no matter how dedicated, can hardly be expected
to develop expertise in, or devote much time to, drug issues.

We believe that one way for rural places to compensate for the shortage
of expertise is to pool resources and coordinate efforts, In this way,
rural areas may be able to address collectively problems that would be
too complex for any one community to resolve on its own.

At your request, we did not ask federal agencies to comment formally on
this report. As agreed with your offices, unless you publicly announce
the contents of this report earlier, we plan no further distribution of it
until 30 days from its date. We will then send copies to interested con-
gressional committees and federal agencies, and we will make copies
available to others upon request. Except as noted, our work was con-
ducted in accordance with generally accepted government auditing
standards.

If you have any questions or would like additional information, please
call me at (202) 275-1864. Major contributors to this report are listed in
appendix VIII.




Eleanor Chelimsky
Assistant Comptroller General




Page 7                                        GAO/PEMD-90-24   Rural Drug Abuse
Contents


Letter
Appendix I                                                                  12
Objectives, Scope,and Objectives
                      Scope and Methodology
                                                                            12
                                                                            12
Methodology
Appendix II                                                                 15
The Extent of              Evidence
                           Main Findings
                                                                            15
                                                                            24
SubstanceAbuse in
Rural Places
Appendix III                                                                26
SubstanceAbuse and         Evidence
                             . . .                                          26
                                                                            35
Crime in Rural Places      MainFindings
Appendix IV                                                                 36
Programs to Prevent        Evidence
                           Main Findings
                                                                            36
                                                                            47
or ReduceSubstance
Abuse
Appendix V                                                                  49
Rural States
Appendix VI
Supporting Tables
Appendix VII                                                                62
Request Letters
Appendix VIII                                                               65
Major Contributors to
This Report


                           Page 8             GAO/PEMD-90-24   Rural Drug Abuse
Bibliography                                                                               66

Tables         Table 1: Highlights of Selected Substance Use Prevalence                     3
                    for High School Seniors, Class of 1988
               Table 2: Substance Abuse Among Inmates Recently                              5
                    Admitted to Four State Corrections Systems
               Table II. 1: Lifetime Prevalence of 18 Types of Substances                  17
                    for High School Seniors, Class of 1988
               Table 11.2:Annual Prevalence of 18 Types of Substances                      18
                    for High School Seniors, Class of 1988
               Table 11.3:Thirty-Day Prevalence of 18 Types of                             19
                   Substances for High School Seniors, Class of 1988
               Table 11.4:Thirty-Day Prevalence of Daily Use of Three                      20
                    Substances for High School Seniors, Class of 1988
               Table 11.6:Alcohol and Other Drug Treatment Admissions                      23
                    and Arrests by Rural and Nonrural States and
                    Counties, 1988
               Table 111.1:Drug Abuse Violation Arrests, 1988                              29
               Table 111.2:Ratio of Drug Abuse Arrests to Arrests for                      31
                    Property or Violent Crimes, 1988
               Table 111.3:Substance Abuse Among Inmates Recently                          33
                   Admitted to Four State Corrections Systems
               Table IV. 1: Admission and Discharge Information for                        41
                   Clients Receiving Primary Substance Abuse
                   Treatment in Iowa, 1988
               Table IV.2: Follow-Up Information on Substance Abuse                        41
                   Clients at Admission and 6 Months After Discharge in
                   Iowa, 1988
               Table IV.3: Discharge and Follow-Up Information for                         42
                   Primary Chemical Dependency Clients in Montana,
                    1988
               Table VI. 1: Annual Prevalence of Use of 14 Types of                        50
                   Drugs Among Respondents of Modal Age 19-30, I988
               Table VI.2: Thirty-Day Prevalence of Use of 14 Types of                     51
                   Drugs Among Respondents of Modal Age 19-30,1988
               Table VI.3: Thirty-Day Prevalence of Use of Two                             52
                   Substances Among Respondents of Modal Age 19-30,
                    1988
               Table VI.4: Lifetime Drug Use Prevalence Among High                         52
                   School Seniors in Iowa, Montana, North Dakota, and
                   the United States, 1988



               Page 9                                       GAO/PEMD-90-24   Rural Drug Abuse
          Contents




          Table VI.5: Thirty-Day Drug Use Prevalence Among High               53
              School Seniors in Iowa, Montana, North Dakota, and
              the United States, 1988
          Table VI.6: Alcohol and Other Drug Abuse Violation                  64
              Arrests by State, 1988
          Table VI.7: Treatment Admission Rates to State Alcohol              66
              and Drug Abuse Clinics
          Table VI.8: Drug Treatment Admissions by Primary Drug               68
              (Other Than Alcohol) In Rural and Nonrural States,
               1988
          Table VI.9: Drug Abuse Violation Arrests by Type of Drug            69
              and Type of Offense, 1988
          Table VI. 10: Substance Abuse Among Inmates Admitted                61
              to the Montana State Prison December 1989 to June
               1990

Figures   Figure 1: Substance Abuse Treatments       and Arrests, 1988         4
          Figure III. 1: Substance Abuse Violation   Arrests by Type          26
               of State, 1988
          Figure 111.2:Substance Abuse Violation     Arrests by Type          27
               of County, 1988
          Figure 111.3:Substance Abuse Violation     Arrests by Size of       28
               City, 1988

          Abbreviations

          ADAMHA      Alcohol, Drug Abuse, and Mental Health Administration
          BJA         Bureau of Justice Assistance
          DEA         Drug Enforcement Administration
          DUF         Drug Use Forecasting
          FBI         Federal Bureau of Investigation
          GAO         U.S. General Accounting Office
          NDATUS      National Drug and Alcoholism Treatment Unit Survey
          NIBRS       National Incident-Based Reporting System
          NIDA        National Institute on Drug Abuse
          SADAP       State Alcohol and Drug Abuse Profile
          SISCF       Survey of Inmates in State Correctional Facilities
          SMSA        Standard metropolitan statistical area
          STRIDE      System to Retrieve Information from Drug Evidence
          TOPS        Treatment Outcome Prospective Study
          T.O.W.      The Other Way
          UCR         Uniform Crime Reports


          Page10
Y




    Page 11   GAO/PFMMJM4   Rural Dw   Abuse
i,
     Appendix I

     Objectives,Scope,and Methodology


                   The federal government has made the effort to curb drug abuse a high
     Objectives    priority. To allocate resources effectively and fairly in combating drug
                   abuse, the Congress needs accurate information concerning the nature
                   and extent of drug use, drug-related crime, and program efforts to pre-
                   vent or treat drug use. Our purpose in this report was to determine what
                   data on these issues exist and, to the extent these data were available, to
                   collect, examine, and interpret them. We addressed three main
                   questions:

                   1. What information exists on the extent of substance abuse in rural
                   places?

                   2. What is known about the relationship between substance abuse and
                   crime in rural places?

                   3. What data are available concerning the effectiveness of prevention
                   and treatment programs in reducing rural substance abuse?


                   To answer these questions, we examined data from rural states and
     Scopeand      rural areas for two reasons. First, the requesters have introduced legis-
     Methodology   lation using both concepts. Second, some data are available at the state
                   level; some data are reported in rural and other categories. For the pur-
                   poses of this study, a rural state is defined as 1 of 18 states with a popu-
                   lation density of 50 persons or fewer per square mile. (These 18 states
                   are listed in appendix V.) The definition of a rural area differs by data
                   source. Rather than discard information that did not fit some single defi-
                   nition of rural area, we used whatever data were available to help sup-
                   port inferences drawn from the state-level sources or to illustrate
                   exceptions to them.

                   We defined substance abuse as involvement with illegal drugs, illegal
                   use of drugs (such as alcohol or prescription medicine), or drug use
                   linked to other criminal activity or needing treatment. For example, an
                   individual involved in any way with illegal drugs (such as cocaine,
                   heroin, or marijuana) is considered a substance abuser. But illegal use of
                   legal drugs such as alcohol and prescription medicine also qualifies as
                   substance abuse when a person drives while under the influence of
                   alcohol, drinks while under age, or obtains prescription drugs under
                   false pretenses. Substance abuse can also occur if a person commits such




                   Page 12                                        GAO/PEMD-90-24   Rural Drug Abuse
Appemdix 1
Objectives, Scope, and Methodology




acts as domestic violence while under the influence or requires medical
care for alcohol dependency or overdosing on inhalants.’

Note that alcohol is included in substance abuse only when it is used
illegally or when it causes problems for the user; data on legal, non-
problematic alcohol use by adults are not included in this report.
Because alcohol is by far the most widely abused substance in the
United States, we often present alcohol-related data as a distinct cate-
gory while aggregating all other drug abuse into a single category. This
does not imply that alcohol abuse is different in kind from other drug
abuse. The term “total substance abuse” means the combination of
alcohol abuse and other drug abuse.

“Prevalence rate” is a key term for understanding substance abuse. The
prevalence rate is the number of individuals in a population who have
used a substance during a specified time divided by the number of indi-
viduals in the population at that specified time (Lilienfeld and
Lilienfeld, 1980, p. 139). For example, the “lifetime” prevalence rate
indicates the percentage of a population that uses the substance at any
time during their lives; “annual” prevalence means the percentage of a
population that has used the substance within the past year; “30-day”
prevalence signifies the percentage having used the substance at least
once during the most recent month; and “30-day daily use” prevalence
measures the proportion of the population having taken the substance
each day during the past month.

Substance abuse and crime are associated in three ways in this report.
Substance abuse and crime are related if (1) possession or use of the
drugs (such as cocaine) or engaging in certain activities in drug-induced
conditions (such as public drunkenness) is a criminal offense by defini-
tion, (2) the crime is committed while the perpetrator is under the influ-
ence of a substance, or (3) the criminal has substance abuse problems,
even if these problems have not been linked with a particular crime.

We used a variety of sources to answer each of the three evaluation
questions. We collected and evaluated data from

1. national and state surveys, federal and state government studies, leg-
islation, regulations, and other reports;



‘Tobacco is included in this report only when it is used by minors.



Page 13                                                         GAO/PRMD-90-34   Rural Drug Abuse
                                                                            ,
Appendix I
Objectives, Scope, and Methodology




2. interviews with federal and state officials, including the alcohol and
drug abuse directors or their representatives from rural states respon-
sible for substance abuse issues;

3. interviews with agency personnel in sheriffs’ offices, treatment cen-
ters, and school districts in Arkansas, Iowa, and Montana; and

4. interviews with other experts on substance abuse issues.

We reviewed relevant information from as far back as 1977, although
the data we present were the most recent available at the time this
study was conducted. Specific dates for the data sources used in the
report, as well as their particular characteristics, are noted in the text.
In general we used numerical data to calculate summary statistics (such
as averages, rates, or percentages) for rural as well as nonrural states or
areas. Where possible and appropriate, we conducted statistical tests to
compare rural and nonrural places.




Page 14                                       GAO/PEMD-90-24   Rural Drug Abuse
Appendix II

The Extent of SubstanceAbuse in Rural Places


                          Question 1: What information exists on the extent of substance abuse in
                          rural places? Measuring the extent of illegal or stigmatizing activities is
                          never easy. Therefore, accurately assessing how widespread substance
                          problems are creates numerous challenges. In this section, we review the
                          evidence from a number of sources. Because all the sources are imper-
                          fect, no one of them should be regarded as definitive. Together, how-
                          ever, they allow us to draw several conclusions about substance abuse
                          in rural America. Our main sources were as follows:

                      .   1988 Household Survey (US. Department of Health and Human Ser-
                          vices, 1989),
                      .   1988 High School Survey (Johnston, O’Malley, and Bachman, 1989),
                      .   Drug Abuse in Rural America
                                                    - (U.S. Department of Health and Human
                          Services, 1981),
                      .   State Alcohol and Drug Abuse Profile (Butynski, Canova, and Jenson,
                          1989),
                      .   Uniform  Crime Reports (U.S. Department of Justice, 1989a).
                          -


Evidence

National Prevalence       Two national surveys attempt to determine the extent of alcohol and
Surveys                   other drug use in the United States. The Household Survey, conducted
                          nine times between 1971 and 1988, is designed to measure substance use
                          in the general population, while the annual High School Survey attempts
                          to gauge alcohol and other drug use prevalence among youths.’

                          Only in 1979 did the household survey issue a separate report on drug
                          use in rural areas (U.S. Department of Health and Human Services,
                          1981).” As noted earlier, a main finding of Drug Abuse in Rural America
                          was that lifetime prevalence rates among rural inhabitants were
                          approximately two thirds the corresponding nonrural prevalence rates.
                          This was true for most classes of illegal drugs except heroin (for which




                          ‘For brief summaries of these and other federal surveys and data sources on drugs, see Collins and
                          Zawitz, 1990.
                          2This study defined “rural” as areas that are outside standard metropolitan statistical areas and have
                          populations of fewer than 26,000 persons.



                          Page 15                                                        GAO/PEMD-90-24      Rural Drug Abuse
Appendix II
The Extent of Subetance    Abuse In
RuralPlaces




rural rates were much lower),3 The pattern of increases in rural drug
abuse suggested that rural and nonrural prevalence differences were
declining and would disappear entirely if existing trends persisted, how-
ever (US. Department of Health and Human Services, 1981, p. 1).

At the time of our study, we were not able to determine rural substance
prevalence rates from the data published in the 1988 Household Survey.
This survey could be used to estimate these rates, however, as its
records contain census tract information.4 At least two factors nonethe-
less limit the accuracy of such estimations.6 Most importantly, the
survey omits several groups that do not live in households but are
known to have high rates of substance abuse: those living in correctional
institutions, in health and mental institutions, in drug-treatment centers,
or on military bases. Second, the survey’s questionnaires were answered
in the presence of family members and survey officials. Such survey
methods may underestimate substance use, particularly as the stigma of
using alcohol and other drugs increases (US. Congress, 1990a, p. vii).
This may be a special problem if rural communities are less tolerant of
drug use than larger cities6

The 1988 High School Survey does compare alcohol and other drug use
prevalence among a sample of high school seniors and young adults
from rural (that is, “nonmetropolitan”) areas, medium-sized metropol-
itan areas, and the 16 largest metropolitan areas in the country. In 1988,
approximately 17,000 students from 132 schools around the country
participated in the survey by filling out questionnaires in classrooms
during school hours. The High School Survey suffers from the same two
limitations as the Household Survey. The High School Survey does not
include individuals known to have relatively high rates of substance
abuse-school dropouts-and       it relies on the honesty of self reports


“For example, across all age groups, the prevalence of lifetime experience with marijuana was 23
percent in rural areas and 33 percent in nonrural areas; cocaine, 6 percent and 10 percent; halluci-
nogens, 6 percent and 9 percent. Lifetime heroin prevalence in rural areas is not given for all age
groups; among young adults, lifetime prevalence is 2 percent. Nonrural lifetime heroin prevalence
was not given. (See U.S. Department of Health and Human Service, 1981, pp. 1 and 6.)
4The report entitled National Household Survey on Drug Abuse: Highlights 1988 (released in late
July, 1990) does contain some data on substance abuse in nor-metropolitan areas (U.S. Department of
Health and Human Services, 199Oc).

“The National Institute on Drug Abuse (NIDA) recognizes these factors as limitations. (See U.S.
Department of Health and Human Services, 1989, pp. Q-10.)

“To our knowledge, only one rural state-Utah-has     conducted its own household survey (National
Association of State Alcohol and Drug Abuse Directors, 1990a).



Page 16                                                         GAO/PEMD-90-24      Rural Drug Abuse
                                       Appendix II
                                       The Extent of Snbat4um           Abuse in
                                       RlualPlaci!a




                                       (Johnston, O’Malley, and Bachman 1989, pp. 23 and 334). Consequently,
                                       prevalence rates may be underestimated.

                                       The 1988 High School Survey reports prevalence in lifetime, annual, 30-
                                       day, and 30-day daily-use prevalence rates, Prevalence rates for high
                                       school seniors for 18 substances in the three types of areas are
                                       presented in tables II.1 to 11.4.

Table 11.1:Lifetime Prevalence of 18
Types of Substances for High School                                                                     Population density
Seniors, Class of 1988                 Substance-.                                    Non-SMSA          Medium SMSA                Large SMSA
                                       _---
                                       Alcohol                                                91.3%                   92.3%             -     92.2%
                                       __----
                                       Ciaarettes                                             68.7                    66.9                    63.3
                                       .__I______- -
                                       Marijuana                                              41.9                    49.7      -_____        47.8
                                       Cocainea                                                8.6                    12.8                    14.3
                                            “Crack”                                            3.2                     5.1                     5.8
                                            Other                                              9.0                    13.1                    13.7
                                       Stimulants
                                        .._----.--__                                          20.3                    21.3                    16.7
                                       lnhalantsb
                                       --______-_.                                            17.8                    16.1                    16.8
                                       -- Amyl/butyl nitrites                                  2.9                     3.2                     3.5
                                       Sedatives=                                              7.5                     8.0                     7.9
                                            Barbiturates
                                                     ..._____--                                6.6                     7.0                     6.3
                                            Methaqualone                                       2.9                     3.3                     3.6
                                       TranquilizersF                                          9.3                     9.4.____    __--____    9.4
                                       Hallucinogensb
                                       __--_____            -. --____                          5.8  -                  9.8                    10.2
                                            LSD                                                5.2                     8.8                     8.2
                                            PCP         __.-.                                  1.2                     2.6          --___      5.3
                                       Heroin                                                  1.2                     1.2                     1.0
                                       Other opiates                                           7.9                     9.3                     8.1
                                       WI surveys contained questions about cocaine use; questions about “crack” and “other cocaine” were
                                       listed on 40 and 20 percent of the surveys, respectively. (See Johnston, O’Malley, and Bachman, 1989,
                                       p. 31.)

                                       bUnadjusted for known underreporting        of certain drugs, (See Johnston, O’Malley, and Bachman, 1989,
                                       p. 31.)

                                       ‘Prescription drugs are included only if they are taken for nonmedicinal purposes
                                       Source: L. D. Johnston, P. M. O’Malley, and J. G. Bachman, Drug Use, Drinking, and Smoking: National
                                       Survey Results from High School, College, and Young Adults Populations, 1975-1988 (Ann Arbor: Univer-
                                       sity of Michigan. Institute for Social Research, for the US. Department of Health and Human Services,
                                       Public Health Service, Alcohol, Drug Abuse, and Mental Health Administration, National Institute on
                                       Drug Abuse, 1989). table 6, p. 42.




                                       Page 17                                                             GAO/PEMD-99-24      Rural Drug Abuse
                                                                                                                                                    .
                                           Appendix ll
                                           The JZxtent of Substance        Abuse in
                                           IhIdPLaces




Table 11.2:Annual Prevalence of 18 Type8
of Substances for High School Seniors,                                                                        Population density
Class of 1988                              Substance                                       Non-SMSA           Medium SMSA               Laroe SMSA
                                           Alcohol                                                 83.9%                   85.7%                  86.1%
                                           Ciaarettes                                                  a                       a                      a
                                           Marijuana                                               29.0                    34.7                   34.3
                                           Cocaineb                                                 5.3                     8.5                    9.3
                                              “Crack”                                               2.0                     3.3                    3.9
                                              Other                                                 4.5                     7.8                    9.8
                                           Stimulants                                              11.3                    11.9                    8.8
                                           lnhalantsC                                               7.5                     6.0                    6.5
                                              AmvVbutvl        nitrites                             2.1                     1.4                     1.9
                                           Sedativesd                                               3.5                     3.8                     3.6
                                              Barbiturates                                          3.2                     3.4                     2.8
                                              Methaqualone                                          1.2                     1.2                     1.5
                                           Tranauilizersd                                           4.5                     5.0                     4.7
                                           HallucinogensC                                           3.5                     6.0                     6.5
                                              LSD                                                   3.1                     5.6                     5.2
                                              PCP                                                   0.5                     0.6                     2.8
                                           Heroin                                                   0.5                     0.5                     0.4
                                           Other opiates                                            4.4                     5.2                     4.0
                                           ‘Not available.
                                           bAll surveys contained questions about cocaine use; questions about “crack” and “other cocaine” were
                                           listed on 40 and 20 percent of the surveys, respectively. (See Johnston, O’Malley, and Bachman, 1989,
                                           p. 31.)

                                           ‘Unadjusted       for known underreporting   of certain drugs. (See Johnston, O’Malley, and Bachman, 1989,
                                           p. 31.)

                                           dPrescription drugs are included only if they are taken for nonmedicinal purposes.
                                           Source: L. D. Johnston, P. M O’Malley, and J. G. Bachman, Drug Use, Drinking, and Smoking: National
                                           Survey Results from High School, College, and Young Adults Populations, 19751988 (Ann Arbor: Univer-
                                           srty of Michigan, Institute for Social Research, for the U.S. Department of Health andHuman Services,
                                           Public Health Service, Alcohol, Drug Abuse, and Mental Health Administration, National Institute on
                                           Drug Abuse, 1989) table 7, p. 44.




                                           Page 18                                                              GAO/PEMD-SO-ZQ      Rural Drug Abuse
                                         Appendix II
                                         The Extent of Substnnce    Abuse in
                                         Rural Places




Table 11.3:Thirty-Day Prevalence of 18
Types of Substances for High School                                                                    Population density
Seniors, Clans of 1988                   Substance                                 Non-SMSA            Medium SMSA                Larae SMSA
                                         Alcohol                                            63.8%                   64.1%                   63.8%
                                         Cigarettes                                         31.4                    28.3                    26.9
                                         Marijuana                                          14.3                    19.3                    19.4
                                         Cocainea                                            2.1                     3.8                     4.2
                                            “Crack”                                          1.1                     1.7              --     1.9
                                            Other                                            2.2                     3.5                     3.4
                                         Stimulants                                          4.8                     5.1                     3.5
                                         lnhalantsb                                          3.4                     2.4                     2.0
                                            Amyl/butyl nitrites                              0.9                     0.5                     0.7
                                         Sedatives=                                          1.5                     1.6                     1.0
                                            Barbiturates                                     1.3                     1.4                     0.9
                                            Methaqualone                                     0.7                     0.5                     0.2
                                         iranquilizersC                                      1.4                     1.7                     1.3
                                         Hallucinogensb                                      1.4                     2.6                     2.2
                                            LSD                                              1.2                     2.3                     1.6
                                            PCP                                              0.1                     0.3                     0.5
                                         Heroin                                              0.2                     0.2                     0.i
                                         Other ooiates                                       1.6                     1.8                     1.2
                                         ‘All surveys contained questions about cocaine use; questions about “crack” and “other cocaine” were
                                         listed on 40 and 20 percent of the surveys, respectively. (See Johnston, O’Malley, and Bachman, 1989,
                                         p. 31.)
                                         bUnadjusted for known underreporting   of certain drugs. (See Johnston, O’Malley, and Bachman, 1989,
                                         p. 31.)

                                         CPrescription drugs are included only if they are taken for nonmedicinal purposes
                                         Source: L. D. Johnston, P. M. O’Malley, and J. G. Bachman, Drug Use, Drinking, and Smoking: National
                                         Survey Results from High School, College, and Young Adultsbr-
                                         srty of Michrgan, Institute for Social Research, for the U.S. Department of Health and Human Services,
                                         Public Health Service, Alcohol, Drug Abuse, and Mental Health Administration, National Institute on
                                         Drug Abuse, 1989) table 8, p. 46.




                                         Page 19                                                         GAO/PEMlMNL24        Rural Drug Abuse
                                               hmndir If
                                               The Extant    of Subptanee Abuse iu
                                               Ruralplacee




Table 11.4:Thhty-Day Prevalence of Daily
Use of Three Substances for High School                                                                     Population density
Seniors, Class of 1988’                        Substance                                 Non-SMSA           Medium SMSA                 Large SMSA
                                               Alcohol                                             4.5%                    4.5%                     3.5%
                                               Mariiuana                                           1.4                     3.4                      2.6
                                               Ciaarettes
                                                  One or more                                     18.8                    17.7                    18.0
                                                  Half-pack or more                               10.7                    10.4                     10.8
                                               Number of students surveved                      4.200                    7.000                   4,400
                                               aThirty-day daily use prevalence rates were unavailable for other drugs.
                                               Source: L. D. Johnston, P. M. O’Malley, and J. G. Bachman, Drug Use, Drinking, and Smoking: National
                                               Survey Results from High School, College, and Young Adults Populations, 19751988 (Ann Arbor:Univer
                                               stty of Michigan, Institute for Social Research, for the U.S. Department of Health and Human Services,
                                               Public Health Service, Alcohol, Drug Abuse, and Mental Health Administration, National Institute on
                                               Drug Abuse, 1989) table 9, p. 48.


                                               These tables show the following:

                                           . Alcohol is by far the most widely and commonly used substance. Over
                                             90 percent of seniors in rural areas have used alcohol some time during
                                             their lives; over 80 percent have used it in the past year, over 60 percent
                                             in the past month. About 5 percent of rural seniors drink daily. No large
                                             differences separate rural, metropolitan, and large metropolitan areas.7
                                           . Marijuana is well behind alcohol and cigarettes in extent and frequency
                                             of use. More than 40 percent of rural seniors have tried marijuana,
                                             almost 30 percent using it the previous year and over 14 percent the
                                             past month. One in a hundred rural seniors smokes marijuana daily.
                                           . One of 11 rural seniors reports having tried cocaine, and 2 in 100 had
                                             used cocaine within 1 month of the survey.
                                           l Students in rural areas have lifetime, annual, and 30-day prevalence
                                             rates for stimulants, inhalants, sedatives, and tranquilizers that are
                                             comparable to those of seniors in nonrural areas.
                                           . PCP and heroin are rarely reported to be used in either rural or nonrural
                                             areas.

                                               The authors of the 1988 High School Survey concluded that “In general,
                                               the differences in the use of most illicit drugs across these different sizes
                                               of community are small at the present time, reflecting how widely illicit
                                               drug use has diffused through the population.” (Johnston, O’Malley, and
                                               Bachman, 1989, p. 47) Overall use of drugs other than alcohol was
                                               lowest in nonmetropolitan areas (34 percent annual prevalence) and

                                               7The authors of the 1988 High School Survey do not report whether differences between rural, met-
                                               ropolitan, and large metropolitan areas are stat&tically significant, nor were we able to conduct sta-
                                               tistical tests using their published data.




                                               Page 20                                                         GAO/PFMIBO-24        Rural Drug Abuse
                         Appendix IT
                         The Extent of Substance    Abuae in
                         Rural Place6




                         about equal in the medium-sized and largest metropolitan areas (39 per-
                         cent and 41 percent, respectively). Annual prevalence rates of illicit
                         drugs other than alcohol and marijuana show roughly the same ranking:
                         18 percent of seniors in the nonmetropolitan sample used illicit drugs in
                         the past year, compared with 23 and 21 percent in medium and large
                         metropolitan areas.

                         Data on drug use prevalence among young adults who previously partic-
                         ipated in the school survey and live in nonmetropolitan areas are also
                         contained in the High School Survey. Like the survey of high school
                         seniors, the young adult survey found that for most illicit drugs, there is
                         no association between community size and prevalence of use, which
                         “may be a counter-intuitive finding for many.” (Johnston, O’Malley, and
                         Bachman, 1989, p. 180) Cocaine and marijuana use did have a slight
                         positive relationship with community size. In general, the results of the
                         young adult sample mirrored those of the high school seniors. (Tables
                         VI. 1 to VI.3 in appendix VI contain prevalence rates for each type of
                         substance for the young adult survey.8)

                         Several of the rural states have conducted their own student alcohol and
                         other drug use surveys.0 The surveys generally support the results of
                         the High School Survey. The principal results of the school surveys in
                         Iowa, Montana, and North Dakota are presented in tables VI.4 and VI.6
                         in appendix VI.l” Although Arkansas has not conducted a high school
                         survey, schools from two locations within the state were included in the
                         1988 High School Survey.


F‘revalence Data From    Two other data sources provide evidence concerning the extent of
Treatment and Criminal   health and legal problems caused by substance abuse. The State Alcohol
                         and Drug Abuse Profile (SADAP)survey, conducted annually by the
Justice Sources          National Association of State Alcohol and Drug Abuse Directors since
                         1982, contains data on the number of patientsadmitted into state-
                         funded alcohol and drug abuse clinics each year. The Federal Bureau of
                         Investigation (FBI) Uniform Crime Reports (UCR) program collects data
                         from state and local law enforcement agencies on the number of arrests

                         “We did not include data on the legal, nonproblematic use of alcohol by adults in these tables.
                         OWeidentified the following rural states as conducting their own student surveys: Alaska, Arizona,
                         Colorado, Iowa, Kansas, Maine, North Dakota, South Dakota, Utah, and Wyoming.

                         “‘These surveys have much more detailed information concerning drug use, attitudes, and knowledge
                         of the students in these states. (See Iowa, 1989b, pp. 6,16, 19, and 24; Montana, 1990a, pp. 13-16;
                         North Dakota, 1986.)



                         Page 21                                                         GAO/PEMD-DO-24      Rural Drug Abuse
Appendix II
Tbe Extent of Subdance    Abuse in
Rural Places




made for alcohol and drug abuse violations and also for the type of
drugs involved. State alcohol and drug abuse treatment rates can be cal-
culated from the SALMJdata; UCR data allow state alcohol and other drug
abuse arrest rates to be determined.

Neither data set is flawless. As we noted in an earlier study, problems
exist with the “quality, completeness, and consistency” of the state
criminal history systems used to gather data for UCR (US. General
Accounting Office, 1990, p. 18). Particular difficulties arise in the use of
arrest data to examine trends because of changes in reporting over time
and differences across police departments in definitions and priorities.
~ADAP’Sadmissions data are also limited: for example, WDA.Pdoes not
contain data from privately funded drug treatment programsL1 Further-
more, inferences made from treatment and arrest data suffer similar
weaknesses. Admissions data measure only the number of individuals
beginning treatment and neither the number of those needing or com-
pleting it. Arrest data count only those caught committing substance
abuse violations as their most serious offense, not the number of viola-
tions occurring.12 Both data sets thus reflect the resources and activities
of the public health and law enforcement agencies within the states as
well as the behavior of the states’ populations. Finally, these data are
not fully independent indicators of substance abuse problems; large per-
centages of those receiving treatment are referred to clinics by the crim-
inal justice system.13

Nonetheless, treatment and arrest data present relevant indicators of
drug problems because they reflect substance abuse severe enough to
bring individuals into contact with health clinics and law enforcement
agencies. That is, neither source measures much “casual” use, and there-
fore the data constitute useful estimates of core substance abuse
problems in the states but do not allow conclusions to be drawn on the
extent of that abuse. Information from both sources is summarized in
table 11.6.State-by-state data are found in tables VI.6 and VI.7 in
appendix VI.

’ ‘Another survey, the National Drug and Alcoholism Treatment Unit Survey (NDATUS), does obtain
data from privately funded programs to combine with SADAP information. Because NDATUS is a
voluntary reporting program for treatment and prevention programs, however, ita relationship to the
universe of drug and alcohol abuse programs is not known. Many private substance abuse treatment
programs do not report their data to NDATUS. (See Collins and Zawitz, 1990, p. 10.)

“For example, if a person arrested for bank robbery is found to possesscrack, only the arrest for
robbery is reported.

t3For example, over 20 percent of alcohol and 30 percent of drug treatment admissions in Arkansas
during 198’7and 1988 were referred by the criminal justice system (Arkansas, 1989, p. SO).



Page 22                                                       GAO/PEMD-90-24      Rural Drug Abuse
                                              Appendix II
                                              The Extent of Substance        Abuse in
                                              Rural Places




Table 11.5:Alcohol and Other Drug
Treatment Admissions and Arrests by                                                                     Alcoholb        Other drug@=                    Total
Rural and Nonrural States and Counties,       Treatment admissionsd
1988”
                                                 Rural states                                                  7.7                   1.7                  9.4
                                                 Nonrural   states                                             4.7                   2.2                  6.9
                                              Arrest$

                                              -.- Rural states’                                               14.3                   2.8           --
                                                                                                                                                        17.0
                                                 Nonrural   states                                            12.3                   4.8                17.1
                                                 Rural countieso                                              12.6                   2.4                15.0
                                                 Nonrural   counties                                          11.3                   3.0                14.2
                                              ‘Rate per 1,000 inhabitants.
                                              bArrests for alcohol include driving while under the influence, liquor law violations, and drunkenness

                                              ‘Treatment data for other drugs include abuse of legal substances (such as over-the-counter      products
                                              and tranquilizers); all arrests involve illegal use.
                                              dTreatment admissions include only programs that received some funds administered by the state
                                              alcohol and drug agency during the state’s fiscal year 1988. Rural states that did not submit data
                                              included New Mexico and Wyoming; Washington was the only nonrural state that did not report these
                                              data.
                                              eArrest data based on agencies submitting 12 months complete data. Kentucky and Florida did not
                                              submit data.

                                              ‘Includes the 18 states with population densities of 50 persons or fewer per square mile
                                              eRural counties are outside SMSAs. Counties in SMSAs are designated suburban counties
                                              Source: Treatment data in W. Butvnski, D. Canova, and S. Jenson, State Resources and Services
                                              Related to Alcohol and Drug Abuse Problems, Fiscal Year 1988: An Analysis of State Alcohol and Drug
                                              Abuse Profile Data. a reoort for the National Institute on Alcohol Abuse and Alcoholism and the National
                                              tnstrtute on Drug Abuse (Washington, DC: National Association of State Alcohol and Drug Abuse Direc-
                                              tors, 1989) pp. 22 and 36; arrest data in US Department of Justice, Crime in the United States, 1988
                                              (Washington, D.C.: Federal Bureau of Investigation, 1989a); and U.S. Department of Justice, unpub-
                                              lished data, Federal Bureau of Investigation, 1990f.


                                              This table shows that rural states and counties have

                                          l   higher rates of treatment admissions and arrests involving alcohol,
                                          l   lower rates of treatment admissions and arrests for drugs other than
                                              alcohol, and
                                          l   total rates of treatment admissions and arrests for substance abuse
                                              (alcohol and other drug abuse) that are about as high as those in
                                              nonrural states.

                                              Note that alcohol abuse accounts for the vast majority of treatment
                                              admissions and arrests in both rural and nonrural states.

                                              Data are available through SADAP from most states on the primary drug
                                              other than alcohol abused by those admitted to drug treatment pro-
                                              grams (Admission rates for each drug are reported in appendix VI, table


                                              Page 23                                                            GAO/PEMD-99-24       Rural Drug Abuse
                    Appendix II
                    The Extent of Substauw   Abuse In
                    Rural Places




                    VI.&) The differences between rural and nonrural states are generally
                    consistent with the prevalence rate evidence presented above. For
                    example, rural states appear to have lower rates of admissions for
                    cocaine and heroin abuse but higher rates for stimulants and inhalants.


                    Our review of survey, treatment, and arrest data has produced several
Main Findings       consistent findings:

                9 Alcohol is by far the most widely abused drug in rural areas.
                l Prevalence rates for some drugs (such as cocaine) appear to be lower in
                  rural than nonrural areas. Prevalence rates for other drugs (such as
                  inhalants) may be higher in rural areas than elsewhere.
                . Total substance abuse (alcohol abuse plus other drug abuse) rates in
                  rural states are about as high as in nonrural states.




                    Page 24                                      GAO/PEMD-90-24   Rural Drug Abuse
Appendix III

SubstanceAbuse and Crime in Rural Places


                          Question 2: What is known about the relationship between substance
                          abuse and crime in rural places? Most research shows that the link
                          between drugs and crime is strong. Heavy substance abusers are often
                          criminals, and criminals are often substance abusers.1 It is nonetheless
                          difficult to blame specific crimes on drug use or to say that drugs caused
                          particular crimes. Unless the criminal is arrested and tested for drugs at
                          the scene of the crime, self-reports are usually used to find out whether
                          the culprit was under the influence of drugs at the time; self-reports
                          may understate the link between drugs and crime. And because sub-
                          stance abusers are usually tangled in a web of deviant behavior, crimi-
                          nality may be just another symptom of the abuser’s problems (Wish and
                          Johnson, 1986, p. 63). Consequently, much of the information on sub-
                          stance abuse and crime involves drug law violations or the alcohol and
                          drug use of individuals who have come in contact with the criminal jus-
                          tice system. In this section we examine the evidence concerning these
                          issues.



Evidence

SubstanceAbuse Arrests,   One measure of criminal activity involving substance abuse is the
                          number of arrests for alcohol or other drug abuse violations. The Fed-
1988                      eral Bureau of Investigation, through its Uniform Crime Reporting pro-
                          gram, collects data on four types of substance abuse arrests: three kinds
                          of alcohol abuse violations (driving under the influence, liquor law vio-
                          lations, and drunkenness) and other drug violations. We calculated
                          arrest rates for substance abuse violations for rural and nonrural areas
                          and states; these rates are depicted in figures III. 1 through III.3.2 (State-
                          by-state data are presented in appendix VI, table VI.6.)




                          ‘Although drug users are by definition criminals because possession of drugs is illegal (except for
                          alcohol users), the evidence shows that substance abuse is common among those apprehended for
                          committing other crimes. (See Wish and Johnson, 1986; Speckart and Anglin, 1985.)

                          ‘The FBI published UCR data for 1989 in early August 1990.



                          Page 25                                                         GAO/PEMD-90-24      Rural Drug Abuse
                                         Appendix III
                                         Substance Abuse     and Crime in Rural Places




Figure 111.1:Substance Abuse Violation
Arrests by Type of State, 1988
                                         Arm&s per 1000 Inhabltants
                                         18




                                                       Other drugs
                                                       Alcohol


                                         Source: Arrest data in U.S. Department of Justice, unpublished data, Federal Bureau of Investigation,
                                         1990f.




                                         Page 26                                                          GAO/PEMD-90-24       Rural Drug Abuse
                                         Appendix   IIf
                                         SubName     Abuse aud Crime in Rural Placea




Figure 111.2:Substance Abure Violation
Arrest8 by Type of County, 1988          18   AmatepwlOOOInhabltmtm




                                              I-J      Other drugs
                                                       AlCOhOl

                                         Source: Arrest data in U.S. Department of Justice, Crime in the United States, 1988 (Washington, DC.:
                                         Federal Bureau of Investigation, 1989a).




                                         Page 27                                                         OAO/PEMD-90.24      Rural Drug Abuse
                                                                                                                                           ,
                                         Appendix III
                                         Substance Abuse and Crime in Rural Places




Figure 111.3:Substance Abuae Violation
Armts by Size of City, 1988              Anwa   par 1000 Inhabitants
                                         22




                                                       Other drugs
                                                       Alcohol


                                         Source: Arrest data in US. Department of Justice, Crime in the United States, 1988 (Washington, DC:
                                         Federal Bureau of Investigation, 1989a).


                                         These figures show that rural states, rural counties, and smaller towns
                                         have lower arrest rates involving illegal drugs but higher arrest rates
                                         involving a drug (alcohol) being used illegally than do nonrural states,
                                         suburban counties, and larger cities. Total arrest rates for substance
                                         abuse violations are as high in rural states, rural counties, and smaller
                                         towns as they are in nonrural states, suburban counties, and larger
                                         cities.

                                         The FBI’S UCR program also collects arrest data by the type of drug and
                                         type of offense (sales or manufacturing as contrasted with possession).
                                         Cocaine, opium, and their derivatives made up a significantly smaller
                                         percentage of arrests for drug abuse violations in rural states than in
                                         nonrural states in 1988. (See table 111.1.)Most drug abuse arrests in
                                         rural states involved marijuana, and rural states had significantly larger
                                         percentages of their drug abuse arrests for marijuana or synthetic nar-
                                         cotics than did nonrural states. Overall about three quarters of drug


                                         Page 28                                                        GAO/PEMD-90-24      Rural Drug Abuse
                                           Appendix III
                                           Subetance Abuse and Crime in Rural Places




                                           abuse violation arrests are for possession, with the remaining quarter
                                           for sales or manufacturing; rural and nonrural states had similar shares
                                           of drug abuse arrests for possession. (State-by-state data for drug
                                           arrests by type of drug and type of offense are included in appendix VI,
                                           table VI.9,)


Table 111.1:Drug Abure Violation Arrests, 198W
                                                   Type of drug
                          Cocaine and                       Synthetic              Other                              Type of offense
Area                           opiates    Marijuana        narcoticsb              drugs   Total                Sales    Possession    Total
Rural
    __.states
___-.  ..-.-.-. _-_--                20%c         63%c               6%c               10% 1OO%d                   25%             75% 1OO%d
Nonrural     states                  39           49                 3                  9   100                    27              73   100
United     States                    32           54                 4                 10   100                    26              74   100
                                           aData based on agencies submitting 12 months of complete data. Kentucky and Florida did not submit
                                           data.

                                           bSynthetic narcotics include manufactured   narcotics, such as Demerol and Methadone, that can cause
                                           “true” drug addiction.
                                           CDifference of means tests between rural and nonrural states significant at the go-percent level.

                                           dRows may not add to 100 percent because of rounding.
                                           Source: Arrest data in U.S. Department of Justice, unpublished data, 1990f


                                           Arrest rates, of course, do not directly measure criminal activity. First,
                                           not all criminals are arrested. Second, arrest rates may vary among
                                           areas having different population densities because of law enforcement
                                           priorities, resources, and intensity, even if crime rates are the same in
                                           each area. Lower arrest rates may mean either that fewer crimes were
                                           committed or that fewer resources were devoted to apprehending
                                           criminals. In the same way, higher arrest rates may mean that more
                                           arrests are being made while the true amount of crime has not varied.3

                                           The data indicate that arrest rates for substance abuse violations are
                                           similar for rural and nonrural areas. But what about the substance
                                           abuse rates for those arrested for crimes other than drug violations? The
                                           Drug Use Forecasting (DUF) program is the largest study that does use
                                           urinalysis to detect illicit drug-taking by those arrested for serious
                                           crimes. (U.S. Department of Justice, 199Oc). In 1988, DUF collected data


                                           “Because arrest rates can also vary from year to year because of differences in reporting, legal
                                           changes (for example, if the legal drinking age is altered), data collection changes (if the number of
                                           reporting agencies shifts), and changes in law enforcement priorities or resources in addition to (or
                                           instead of) real changes in crime rates, we do not report arrest rate trends for alcohol and other drug
                                           abuse violations.



                                           Page 29                                                           GAO/PEMD-99-24      Rural Drug Abuse
fhhuum      Abuse and Crime ln Rural Places




from over 10,000 males in 20 cities and females in 14 cities. The per-
centage of males testing positive for any drug at the time of arrest
ranged from 64 percent to 83 percent; the range for females was from 44
percent to 81 percent. Because DUF data are not collected from any
nationally or otherwise representative sample, they are not appropriate
for making generalizations to all arrested in the nation or even to all
arrested in the cities that DUF surveys (Adams, 1990). Unfortunately,
DUF does not collect information from rural areas.

Some rural states do ask convicted felons entering state prisons whether
they were under the influence of alcohol or other drugs at the time they
committed the crime for which they were convicted. Of the felons
entering Arkansas prisons in 1989 and completing a questionnaire, 67
percent indicated that they were under the influence of alcohol or other
drugs when they committed the crime.4 Over half the individuals
entering Montana’s correction system between December 1989 and June
1990 reported that they used alcohol or other drugs during their
offenses (Montana, 1990b).fi

One special worry about illegal drugs is that abusers are likely to
commit other violent and property crimes. We examined the relationship
between violent and property crimes and illegal drugs by comparing
arrest rates for each category. This comparison showed that the ratio of
drug arrests to arrests for violent crime or property crimes is similar
over areas of different population sizes6 (See table 111.2.)




41n 1080,3,667 persons were admitted into the Arkansas corrections system. Approximately one
third (1,180) of the inmates did not fill out the questionnaires concerning substance use; the other
2,468 prlsoners did (Arkansas, 1990).
‘Of studies funded by rural states, that of Kansas is the most thorough study that we found of sub
stance abuse among the incoming corrections population (Scheurich and Hou, 1000).

‘Violent crimes include murder, forcible rape, robbery, and aggravated assault; property crimes
include burglary, larceny-theft, motor vehicle theft, and arson. The main exception to the stable pat-
tern involves drug abuse and property crime arrests in the largest cities, where a greater proportion
of arresta for property are reported.



Page 80                                                         GAO/PEMBBO-24        Rural Drug Abuse
                                             Appendix III
                                             Substnuce Abuse and Crime in Rural Places




table 111.2:Ratio of Drug Abuse Arrests
to Arrests for Property or Violent Crimes,                                               Drugs/property                    Drugs/violent crimes
1888                                         _____ ______-               ---.-----.__-                                                    .-
                                             Rural counties
                                             --       ____-               --_-___                     0.66                                      1.97
                                             Suburban counties                                        0.56                                      1.85
                                             Towns and cities ___~._.____
                                             ---
                                                 Less than
                                             _...-____ ---_--10,000 ----~-.-~_-____                   0.33                                      1.81
                                                 1
                                             ---~.o,ooo-24,999                                        0.30                         -I__-        1.94
                                                 25,000.49,999
                                                            -__._ ~-__ -~. .~                         0.35                                      1.80
                                                 50,000-99,999
                                             -.--..-__---.-                   ~--__                   0.37                               -      1.65
                                                 100,000-249,999                                      0.47                            ----.-    1.80
                                                 More than 250.000                                    0.75                                      1.88
                                             Source: US Department of JustIce, Crime in the United States, 1988 (Washington, DC.: Federal Bureau
                                             of Investigation, 1989a).


                                             In all but the largest cities, for every drug abuse violation arrest there
                                             were about three property crime arrests. In all areas, there were nearly
                                             two drug arrests for every arrest for violent crime. At least by this mea-
                                             sure, drug abuse is not associated with greater levels of violent crimes,
                                             and it is only modestly associated with property crime in the more
                                             heavily populated areas compared to the more rural ones.

Drugs Seizedby Law
Enforcement
                                             Neither the FBI’S UCR program nor any other government program that
                                             we could identify has collected statistics on the amount or type of drugs
                                             seized by federal, state, and local law enforcement agencies across the
                                             countryq7 The Drug Enforcement Administration (DEA), through the
                                             System to Retrieve Information from Drug Evidence (STRIDE), can pro-
                                             vide detailed material about federal drug confiscations over the years.
                                             STRIDE includes data on the type, amount, price, purity, and location of
                                             drugs seized or bought by DEA. Unfortunately, STRIDE does not include
                                             much information on the state and local activities that constitute most
                                             of the country’s drug control activities.*




                                             7The FBI’s National Incident-Based Reporting System (NIBRS), which will replace UCR over the next
                                             several years, will collect drug seizure data as well as a variety of other information concerning
                                             drugs. (See lJ.S. Department of Justice, 1988.)
                                             “DEA’s formal mandate to focus its enforcement activities in certain areas, such as high-volume
                                             heroin and cocaine dealers, also limits the scope of STRIDE (Collins and Zawitz, 1990, p. 12). See “A
                                             Drug Trafficking Report,” 1988, for a graphic display of DEA drug seizure data for the 1988 fiscal
                                             year.



                                             Page 31                                                         GAO/PEMD-90-24      Rural Drug Abuse
                         Appendix III
                         Substance Abuse and Crime in Rural Places




                         The Bureau of Justice Assistance within the US. Department of Justice
                         does collect state-by-state data on drug “removals.“0 These data do not
                         necessarily represent all drugs seized by law enforcement agencies in
                         the states, however. For example, in 1988, Arkansas’s report to the
                         bureau included only drug removals by the Arkansas State Police, Iowa
                         submitted data from 194 state and local law enforcement agencies, Mon-
                         tana included only drugs seized by multijurisdictional drug task forces
                         and other agencies, and North Dakota gathered data from 20 law
                         enforcement agencies. As a result, it is not possible to use drug removals
                         among the states as a valid measure of the severity of the drug problem.


The Corrections System   Large percentages of persons admitted to correctional institutions for
                         serious crimes have abused alcohol or other drugs, In the Survey of
                         Inmates in State Correctional Facilities (SISCF), a nationally representa-
                         tive study of almost 14,000 prison inmates conducted in 1986, almost 80
                         percent of the inmates reported drug use at some time in their lives.
                         Forty-three percent of the inmates reported that they were using illegal
                         drugs daily or nearly daily in the month before their current offense,
                         while 36 percent reported that they were under the influence of drugs
                         when they committed their current offense (Innes, 1989; see also U.S.
                         Department of Justice, 1990e, p. 2). Methodological research indicates
                         that the self-reports of drug users can be a reliable source of informa-
                         tion on past drug use (Rouse, Kozel, and Richards, 1985). However,
                         because respondents may seek to conceal or underreport their use of
                         illicit drugs, self-reports should be considered conservative estimates of
                         drug-related behavior unless other objective tests (such as urine exams)
                         are given (U.S. Congress, 1990b).l”

                         Despite its limitations, SISCF provides valuable information about the
                         extent of drug use among persons convicted of crimes. Although the
                         survey does not provide data that can be used to estimate drug preva-
                         lence for similar populations in rural areas, it does give baselines for
                         comparison, The rural states we visited do conduct their own assess-
                         ments of the substance abuse problems of individuals entering their
                         prisons. A summary of the assessment data we obtained from these
                         states is contained in table 111.3.Although the assessments vary widely
                         in form, scope, and method of administration, one finding is clear: In the

                         ““Removals” include drugs bought or seized by law enforcement agencies. These data are collected as
                         part of each state’s drug control strategy.
                         “‘Note, however, that the self reports of inmates ln Montana showed rates of alcohol and other drug
                         abuse comparable to those determined by other assessmentmethods. See appendix VI, table VI.10.



                         Page 32                                                       GAO/PEMIk99-24      Rural Drug Abuse
                                                 Appendix IU
                                                 Substance Abuee and Crime in Rural Places




-----.
                                                 rural states of Arkansas, Iowa, Montana, and North Dakota, vast mqjori-
                                                 ties (71 percent and above) of prison inmates have alcohol or other drug
                                                 abuse problems.


Table 111.3:Substance Abuse Among Inmates Recently Admitted to Four State Corrections Systems
                                    Alcohol   Other drug Alcohol and other       Total substance
State                                abuse         abuse         drug abuse                abuse                             No abuse                Total
Arkansas,’
   Number                  - ..--               584               492                      678                   1,754               714            2,466
   Percent                                       24%               20%                      27%                      71%              29%              100%
Iowa”
                                                --.-
   Number                                      1,044              521                   2,175                    3,740             1,222            4,962
   Percent                                        21%              10%                     44%                      75%               25%              100%
Montana’,
   Number                                         58               45                      212                     315                31              346
   Percent                          .__..--~      17%--            13%                      61%                      91%                9%             100%
North Dakota’”
   Number
                          ~~-. _~--I_---        106                     e                  298                     404               151              565
   Percent                                       28%                    e                   54%                     73%               27%              100%
                                                 aln 1989, 3,657 persons were admitted into the Arkansas corrections system. Approximately one third
                                                 (1,189) of the inmates did not fill out the reports concerning substance use; these individuals have been
                                                 omitted from the table.
                                                 blowa data for calendar year 1988.

                                                 CMontana uses several different methods to assess the substance abuse problems of persons in the
                                                 state prisons. (See table VI.10 in appendix VI for a presentation of these different assessments.) Mon-
                                                 tana data are from December 1989 to June 1990.
                                                 dNorth Dakota does not record a separate category for other drug abuse and the categories of alcohol
                                                 abuse and alcohol and other drug abuse overlap. Total substance abuse thus is not the sum of the first
                                                 three columns. North Dakota data from June 1989 to June 1990.
                                                 eNot available.
                                                 Source: Arkansas, unpublished data, Department of Corrections, Pine Bluff, July 2, 1990b; Iowa, Iowa
                                                 Strategy for Drug Control and System Improvement, 1990, (Des Moines: Department of Public Hex,
                                                 Governor’s Allrance on Substance Abuse, January 1990) table 8, p. 16; Montana, unpublished data,
                                                 Chemical Dependency Program, Montana State Prison, Deer Lodge, July 1990; North Dakota, unpub-
                                                 lished data, Department of Corrections, North Dakota State Prison, Bismarck, July 1990.


                                                 While many inmates are diagnosed, or report themselves, as having
                                                 either alcohol or other drug problems, note that the largest segment of
                                                 substance abusers typically have alcohol and other drug abuse
                                                 problems. This suggests that it is a mistake to focus attention on the
                                                 effect of any one drug on criminal activity.*l If the criminal’s “drug of

                                                 “The National Drug Strategy concurs: “But while we must be vigilant about the emergence of new
                                                 drugs such as ‘ice,’ the solution lies not so much in targeting particular substances as in focusing on
                                                 drug use, no matter what the drug. . . ,” (White House, 1990, p. 19)



                                                 Page 33                                                          GAO/PEMD-O-24        Rural Drug Abuse
                         Appendix   ID
                         Subhmce     Abuse and Crime ln Rural Places




                         choice” is not readily available, it is likely that most drug-abusing
                         criminals will use some other cheap or convenient substitute.


Data Quality and Needs   Several data gaps regarding substance abuse violations exist in the FBI'S
                         current UCR program.12 First, UCR uses a “hierarchy rule” in reporting
                         arrests: if a person is arrested for committing multiple crimes, only the
                         most serious crime is included in the report (U.S. Department of Justice,
                         1988). Unless a substance abuse violation is the most serious crime for
                         which a person is arrested, the substance abuse violation does not show
                         up in the UCR data.

                         Second, UCR does not collect data from the states on the amount of drugs
                         seized during arrests. Third, UCR does not collect data concerning
                         whether the arrested person was under the influence of alcohol or other
                         drugs during the arrestI The FBI reports that it expects to fill these gaps
                         with its National Incident-Based Reporting System (U.S. Department of
                         Justice, 1988, pp. 13 and 19). At least 25 states will participate volunta-
                         rily in NIBRS by 1991. However, voluntary participation in crime data
                         systems has not, in the past, tended to produce complete, consistent, or
                         comparable data.

                         Assessments of the drug abuse problems of inmates vary widely in
                         form, scope, and method of administration. We did not evaluate the
                         quality of these assessments. It is apparent from the tables concerning
                         Montana (table VI.10, appendix VI), moreover, that different assessment
                         methods can provide different results even when administered to the
                         same populations. Although there may be some advantages to having all
                         states adopt a uniform assessment process, state officials did not report,
                         nor do we believe, that state corrections systems were hindered in their
                         work by their inability to correctly classify the substance abuse
                         problems of their inmates.

                         Whether the substance abuse problems of each inmate are correctly and
                         consistently classified is of little importance when the number of
                         inmates identified as substance abusers vastly exceeds the number that
                         are treated for substance abuse problems while incarcerated (U.S.
                         Department of Justice, 1990e, p. 2). Arkansas is currently able to pro-
                         vide substance abuse counseling only to about 240 inmates at a time,

                         ‘“For other problems with criminal statistics, see U.S. General Accounting Office, 1990.

                         ‘“Unless the arrest was for driving while under the influence or drunkenness.



                         Page 34                                                        GAO/PEMD-W-24       Rural Drug Abuse
                    Appendix III
                    Substance Abuse and Crime in Rural Places




                    although approximately 70 percent (3,800) of the 6,400 prison popula-
                    tion needs such counseling (Arkansas, 1989, p. 11). Iowa has determined
                    that treatment resources for adult offenders, particularly “beds” allo-
                    cated especially for treatment, are among its greatest needs (Iowa, 1990,
                    p. 39). Montana placed prison treatment programs as the second highest
                    priority in its drug strategy (Montana, n.d., p. 2). North Dakota also
                    notes that its resource scarcity “results in severe restrictions imposed
                    upon the number of inmates that can be included in treatment” (North
                    Dakota, 1989, p. 38).


                    Despite the shortcomings of the available data on the relationship
Main Findings       between drugs and crime in the rural United States, our review of these
                    data allow us to draw three main conclusions:

                . Rural areas have arrest rates for substance abuse violations that are as
                  high as those in nonrural areas.
                9 Most prison inmates in rural states have abused alcohol, other drugs, or
                  both.
                l The prevalence of substance abuse among inmates completely over-
                  whelms available treatment services.




                    Page 36                                      GAO/PEMD-3024   Rural Drug Abuse
Appendix IV                                                                                                   ,

Programsto Prevent or Reduce
SubstanceAbuse

              Question 3: What data are available concerning the effectiveness of pre-
              vention and treatment programs in reducing rural substance abuse?
              Measuring the effectiveness of law enforcement, treatment, and educa-
              tion programs in preventing or reducing substance abuse has been even
              more difficult than measuring the extent of substance abuse and drug-
              related crime. Good program evaluations are not easy to do, and their
              conclusions are often limited to particular situations. Factors that are
              easy to measure (funding, staff, enrollment, arrests) tell us little about
              the effectiveness of a program, while the important effects (reductions
              in the prevalence and problems of substance abuse) are harder to assess,
              link to specific program features, and generalize to other situations. In
              this section, we review the extent to which law enforcement, treatment,
              and education programs have been evaluated in the rural states.


              A variety of current or planned federal, state, and local programs in
Evidence      education, law enforcement, and treatment attempt to reduce substance
              abuse. While it is not easy to summarize these programs because of their
              number and diversity, the programs described below are three main fed-
              eral programs that provide funds to states for their substance abuse
              efforts.1 Each of these programs calls for the states to submit program
              reports. The law enforcement and treatment reports we reviewed give
              descriptions of current and proposed projects as well as performance or
              progress on existing initiatives; the education reports had not been pub-
              lished when our study was conducted. Examples of state substance
              abuse reports are

              Arkansas Drug Control Strategy (Arkansas, 1990a),
              Iowa Drug Control Strategy (Iowa, 1990),
              Montana Drug Control Strategy (Montana, n.d.a),
              North Dakota Drug Control Strategy (North Dakota, 1989),
              Arkansas Comprehensive Drug Plan (Arkansas, 1989),
              Iowa Comprehensive Drug Plan (Iowa, n.d.a),
              Montana Comprehensive Drug Plan (Montana, n.d.b),
              North Dakota Comprehensive Drug Plan (North Dakota, n.d.).




              ’ In an example of program diversity, Iowa had 61 state government programs related to substance
              abuse in fiscal year 1990. (See U.S. Congress, 1990a, pp. 9-17; Iowa, 1989b, pp. 1-16.) The law
              enforcement, treatment, and education programs described below were all included in the Anti-Drug
              Abuse Act of 1988 (Public Law 100-690).



              Page 36                                                      GAO/PEMD-99-24     Rural Drug Abuse
                  Appendix    IV
                  Prugrants   to Prevent   or Reduce
                  Submuwe      Abuse




Law Enforcement   The Federal Drug Control and System Improvement Grant program,
                  administered by the Department of Justice’s Bureau of Justice Assis-
                  tance (&IA) distributes funds to state and local governments to appre-
                  hend, prosecute, adjudicate, incarcerate, and treat substance abuse
                  offenders.2 These BJA grants can be used to provide personnel, equip-
                  ment, training, technical assistance, and information systems. Twenty-
                  one programs, ranging from multijurisdictional task force programs to
                  projects designed to improve the effectiveness of the court process, are
                  approved for fundinga Evaluation is one of the 21 authorized programs4
                  In addition, each program funded through a BJA grant must contain an
                  evaluation component unless given a waiver by the director of BJA.

                  Arkansas, Iowa, Montana, and North Dakota all contain evaluation pro-
                  grams as part of their drug control strategies, while Iowa and Montana
                  have received program grants specifically for evaluation (Arkansas,
                  1990a, pp. 26-27; Iowa, 1990, pp. 69-71; Montana, n.d.a, p. 8; North
                  Dakota, 1989, pp. 73-74)” Funding for these evaluations was not avail-
                  able until fiscal year 1990; it is too early to report results.

                  Arkansas’s 1990 drug control strategy directs that “Each program
                  funded by the state shall contain an evaluation component” so that the
                  administrators and policymakers can “assess the extent to which the
                  activities funded have achieved the program’s goals.” To accomplish its
                  program evaluation goals, Arkansas’s drug control strategy calls for it
                  to solicit grants to provide evaluation services (Arkansas, 1990a, pp. 26-
                  27).

                  Iowa’s 1990 drug control strategy describes several on-going or pro-
                  posed evaluations funded by the BJA block grant. These evaluations con-
                  cern state data collection efforts, substance abuse services for

                  2The BJA grants are authorized by the Anti-Drug Abuse Act of 1988. The Drug Enforcement Admin-
                  istration also attempts to reduce substance abuse through better law enforcement in the states. DEA
                  agents and support personnel operate within the states in cooperation with state and local law
                  enforcement authorities, and DEA provides funding for federal, state, and local task forces (White
                  House, 1989, p. 120).
                  “These programs are listed in Public Law 100-690, 102 Stat. 4301, and 102 Stat. 43294431.

                  4Approved programs include “Drug control evaluation programs which state and local units of gov-
                  ernment may utilize to evaluate programs and projects directed at state drug control activities”
                  (Public Law lOO-690,102 Stat. 4331). BJA has sponsored research and training conferences and
                  issued publications focusing on evaluation research. See, for example, U.S. Department of Justice,
                  1989,1990a, 1990b.

                  “For the 1990 fiscal year, $60,000 and $76,000 in program evaluation grants were approved for Iowa
                  and Montana, respectively (U.S. Department of Justice, 199Oa).



                  Page 37                                                       GAO/PEMD-90-24     Rural Drug Abuse



                                                                                     _         _
Appendix IV
Pmgrtune to Prevent    or Reduce
Substance Abuse




institutionalized juveniles, and the Substance Abuse Free Environment
community program, among others (Iowa, 1990, pp. 69-70). The results
of these evaluations were not yet available in July 1990.

Montana’s 1990 drug control strategy determined that “program evalua-
tion should be given a priority.” (Montana, n.d.a, p. 8) The drug strategy
task force that prepared the strategy has pledged to work with the Mon-
tana Board of Crime Control “to develop a viable evaluation program.”
Limited progress had been made toward this goal by July 1990,
however.

North Dakota’s drug control strategy provides a list of programs to be
evaluated and notes that funded programs will be required to complete
g-month activity reports and annual project reports (North Dakota,
1989, p. 73).

That these states’ drug control strategies recognize the need to evaluate
is commendable, and their current lack of evaluation results is under-
standable. Further, the absence of law enforcement effectiveness studies
is not unique to rural states. Although it is generally accepted by policy-
makers that law enforcement programs are both necessary and useful,
still, the truth is that “little information exists on the types of enforce-
ment strategies used . . . or the effectiveness of law enforcement” in
reducing substance abuse (Collins and Zawitz, 1990, p, 12).” We are not
aware of any evaluations, whether conducted nationally or by the
states, that demonstrate the efficacy of a law enforcement program in
reducing the supply of, or demand for, illegal drugs.

This does not imply, of course, that law enforcement programs are inef-
fective. The problem is to measure the effect. The most common mea-
sures-number of arrests, amount of drugs seized, drug prices-have
one failing in common: they can grow because law enforcement is
becoming more effective or because there is a greater incentive to report
or because the problem is getting worse, among other reasons. It is
therefore difficult even to be sure of what the facts are, much less to
assign causality.

In the absence of program evaluations that would allow them to better
target their resources, law enforcement officials in Arkansas, Iowa, and
Montana concur that rural law enforcement agencies need to pool

“Regarding policymaker views on the necessity and usefulness of law enforcement efforts, and
efforts to improve these efforts, see White House, 1990, pp. 13-27; U.S. Congress, 199Oc,pp. 33-64.



Page 38                                                        GAO/PEMD-SO-24      Rural Drug Abuse
Appendix IV
Programs to Prevent   or Reduce
Substance Abuse




resources and coordinate efforts if they are to become more effective.
The need for pooling resources and coordinating efforts is clearly dis-
played in these states’ drug control strategies. As the Arkansas drug
control strategy explains it,

“a great number of Arkansas counties are protected primarily through services pro-
vided by very small law enforcement agencies. Many rural areas within the state are
unable to provide 24-hour protection, much less special drug control units. In order
to compensate for this lack of manpower, multi-agency, multi-jurisdictional  task
forces need to be considered. These task forces could combine the manpower and
equipment of several agencies in an effort to enhance law enforcement services.”
(Arkansas, 1990a, p. 6)

Greater cooperation among law enforcement units (through some form
of “task force”) is consequently given as one of the highest priorities in
Arkansas as well as in the other rural states we visited. Arkansas, for
example, gives “better cooperation among law enforcement agencies” its
highest priority rating, noting that the “formation of multi-jurisdictional
enforcement groups and multi-disciplinary groups has been identified as
the most effective way to achieve such cooperation. The advantages of
such units are well-known in drug law enforcement.” (Arkansas, lQQOa,
p. 13) The drug control strategies for Iowa, Montana, and North Dakota
also make law enforcement cooperation and coordination through task
forces similarly high priorities (Iowa, 1990, p. 39; Montana, n.d.a, p. 5;
North Dakota, 1989, p. 47).

One example of the need for pooling resources involves undercover
activity. A common theme among the law enforcement personnel we
interviewed was that undercover activity plays an integral role in
fighting illegal drug abuse. In this view, unless undercover (that is,
secret, nonuniformed) agents are active within the drug-abusing commu-
nity, law enforcement agencies will be unable to gather the information
needed to arrest and convict drug abusers. While we found no evidence
indicating that rural areas were any different from metropolitan areas
regarding the need for undercover activity, it may be more difficult to
get undercover work done in rural areas, for two reasons. First, under-
cover work is difficult to do in rural areas, because “everyone knows
everyone”; consequently, infiltrating the drug-using community can be
done only slowly. Second, it is not easy to find people to do undercover
work in rural areas. Having law enforcement agencies pool their under-
cover agents is one way to increase rural access to them.




Page 39                                             GAO/PEMD-90-24   Rural Drug Abuse
            Appendix IV
            Programs to Prevent   or Reduce
            Substance Abuse




Treatment   The Alcohol, Drug Abuse, and Mental Health Administration adminis-
            ters the ADAMHA block grant program. This program provides the states
            with funding for planning, establishing, maintaining, coordinating, and
            evaluating projects for the development of more effective prevention,
            treatment, and rehabilitative programs and activities to deal with
            alcohol and drug abuse. The ADAMHAblock grant requires the states to
            spend at least 36 percent of the funds on alcohol services, 35 percent on
            other drug services, and 20 percent on prevention.7 Other funding man-
            dates also exist.” Arkansas, Iowa, and Montana each contain evaluation
            components as part of their comprehensive drug plans.

            The Arkansas comprehensive drug plan indicates that “The State has
            established criteria [including ‘independent peer review’] to evaluate the
            effective performance” of programs funded by the ADAMHA block grant
            (Arkansas, 1989, p. 10). We were unable to find any effectiveness evalu-
            ations that had yet been performed on the basis of these criteria.

            Iowa has recently completed an evaluation concerning the use and out-
            comes of its treatment programs (Krieg, 1989). This study is a useful
            first step in assessing the effect of treatment programs on substance
            abuse as well as other posttreatment outcomes (employment, income,
            criminal behavior). As the author admits, because the “data related to
            frequency of substance use at admission, discharge, and follow-up is
            unreliable . . . no correlations or conclusions can be made” yet about
            program effectiveness (Krieg, 1989, pp. Q-10).

            The data from Iowa do suggest that while treatment is no “magic bullet”
            to the problems of substance abuse, certain gains may be possible. (See
            table IV.1.) Regarding the difficulty of treatment, note that almost one
            third (7,267 of 24,281) of those admitted to treatment programs had
            been admitted before. Of those who were discharged from the program a
            second time, over 40 percent had completed primary treatment the first
            time. Admittance to treatment, or even successful completion of a treat-
            ment program, is clearly no guarantee that substance abuse problems
            will go away.



            ‘Alcohol and other drug-related prevention services may also be counted as alcohol and other drug
            services.

            ‘Statutory set-asides have been established for special populations (for example, for programs
            designed for women) and designated programs (such as intravenous drug abuse treatment) (Public
            Law 100-690, 102 Stat. 4200).



            Page 40                                                       GAO/PEMD-90-24     Rural Drug Abuse
                                            Appendix IV
                                            Program9 to Prevent   or Reduce
                                            Substance Abum




Table IV.l: Admission and Dircharge
lnformatlon for Client8 Receiving Prlmaty                                                                          Number                  Percent
Subetance Abu8e Treatment In Iowa,          Total admissions to treatment programs                                   24,281                     100
1990
                                            Patients who are readmitted                                               7.267                      30
                                            Readmitted patients who were discharoed                                   4,501                     100
                                              Completed first treatment                                               1,872                      42
                                              Left first treatment before completion                                  1,288                      29
                                              Unfit for first oroaram                                                   860                      19
                                              Referred to another prooram                                               274                       6
                                              Other                                                                     207                       4
                                            Source: M. Krieg, “Analysis of Utilization and Outcome in Iowa Substance Abuse Treatment Programs,”
                                            in Annual Report of the State Drug Enforcement and Abuse Prevention Coordinator, 1989 (Des Moines:
                                            Iowa Uepartment of Public Health, Division of Substance Abuse, October 1989). pp. 6-7.


                                            The relatively small sample of discharged patients for whom follow-up
                                            data are available did have lower unemployment and arrest rates and
                                            higher rates of attendance in maintenance programs 6 months after
                                            treatment than they had experienced at the time of admission into the
                                            treatment program, however.0 (See table IV.2.)

Table IV.2: Follow-Up Information on
Substance Abuse Clients at Admiralon                                                                               Number                   Percent
and 6 Month8 After Dibcharge in Iowa,       Successful contacts                                                         331                     100
1988
                                            At admission
                                              In maintenance program9                                                    152                     46
                                                                                                                               b                      b
                                              Self-reported substance abuse
                                              Unemploved                                                                  99                     30
                                              Arrested within last 12 months                                             209                     63
                                            6 Months after discharge
                                              In maintenance proaramsa                                                   179                     54
                                                                                                                               b                      b
                                              Self-reported substance abuse
                                              Unemployed                                                                  50                     15
                                              Arrested within last 12 months                                              53                     16
                                            alncIudes support groups as well as Alcoholics Anonymous and Narcotics Anonymous.

                                            bUnreliable data.
                                            Source: M. Krieg, “Analysis of Utilization and Outcome in Iowa Substance Abuse Treatment Programs,”
                                            in Annual Report of the State Drug Enforcement and Abuse Prevention Coordinator, 1989 (Des Moines:
                                            Iowa Department of Public Health, Division of Substance Abuse, October 1989) pp. 6-7.


                                            “A second, smaller, preliminary study of the T.O.W. (“The Other Way”) program has also been con-
                                            ducted in Iowa. This study compared the recidivism rates of 74 inmates successfully completing the
                                            T.O.W. program with 74 inmates who refused to enter the program, dropped out of it, or did not
                                            participate in it. The T.O.W. graduates had a 13-percent recidivism rate; the nonparticipants have
                                            had a Bl-percent recidivism rate. Because it was only a preliminary study, no cause-andeffect conclu-
                                            sions are made (Iowa, 1989c).



                                            Page 41                                                       GAO/PEMD-SO-24           Rural Drug Abuse
                                      Appendlr IV
                                      Progranw to Prevent            or Reduce
                                      Substance Abuse




                                      The Montana comprehensive drug plan calls for annual on-site evalua-
                                      tions of treatment programs in order for them to receive state certifica-
                                      tion (Montana, n.d., pp. 15-16). One purpose of these evaluations is to
                                      collect treatment data to demonstrate program effectiveness. One mea-
                                      sure of treatment effectiveness used in these evaluations is the number
                                      of patients reporting total abstinence 6 months after they have been dis-
                                      charged from primary treatment. Discharge and follow-up data for
                                      state-approved treatment programs in Montana in 1988 are summarized
                                      in table IV.3. Almost 80 percent of those contacted 6 months after they
                                      successfully completed primary treatment claimed to abstain totally
                                      from substance abuse. Because these abstinence rates are much higher
                                      than what might be expected from other studies, Montana questions the
                                      validity of these dataal

Table IV.3 Discharge and Follow-Up                                                                          .
Information for Primary Chemical                                                                                Number             Percent
Dependency Clients in Montana, 1988   Individuals      discharaed       from treatment                           -~6;100                 100
                                         Completed        treatment                                                3,668                  60
                                         Left treatment        before    completion                               1,819                   30
                                         Referred      to another       program                                     388                    6
                                         Other                                                                      325                    4
                                      Follow-up     attempts                                                      2,154                  100
                                      Individuals      contacted                                                  1,542                   72
                                      Of those contacted
                                         Individuals     in maintenance           Droarams                          865                   56
                                         Individuals     reporting      total abstinence                          1,290                   78
                                      Source: Montana, Montana Comprehensive Chemical Dependency Plan (Helena: Department of Institu-
                                      tions, Treatment Service Division, Chemical Dependency Bureau, ndb), pp. 40f, 47f, 55f, 62f, and 68f.


                                      North Dakota’s comprehensive drug plan does not indicate that program
                                      evaluation is yet a program priority. Instead, research projects are
                                      directed to “verify the nature and scope of alcohol/drug use, and to
                                      determine the needs of the people of the state.” (North Dakota, n.d., p.
                                      3)

                                      The paucity of data from treatment program evaluations does not dis-
                                      tinguish the rural United States. Indeed, in a 1989 report of the National
                                      Association of State Alcohol and Drug Abuse Directors to the Office for


                                      “‘Montana’s Chemical Dependency Bureau states that it “is very concerned regarding the validity of
                                      [the] effectiveness data . , This data appears invalid as [the improvement rate] is far above the
                                      national average.” The bureau describes some weaknesses of the data and recommends improve-
                                      ments (Montana, 1989, p. 8).



                                      Page 42                                                        GAO/PEMD-9@24         Rural Drug Abuse
Appendix IV
Programs to Prevent    or Reduce
Substance Abuse




Treatment Improvement that described the priorities of the state sub-
stance abuse agencies for technical assistance in support of the ADAMHA
block grant, “evaluation of treatment” and “evaluation of prevention”
were two of the top three priorities. I1The office is currently developing,
in coordination with the states, a uniform reporting plan that may assist
the states in evaluating the effectiveness of their treatment programs
(U.S. Department of Health and Human Services, 1990b).

While several national sources such as NDATUS and SADAP provide data on
drug abuse treatment programs, the Treatment Outcome Prospective
Study (?DPS)is the primary national study providing information on pro-
gram effectiveness (Hubbard et al., 1989).*2 TDPSinterviewed over
10,000 individuals undergoing treatment in 37 publicly funded drug
abuse treatment programs in 10 cities during 1979, 1980, and 1981
about their drug and alcohol use and related problems, including their
involvement in crime and the criminal justice system. Treated individ-
uals were interviewed during and up to 6 years after treatment. The
clinics in the study provided three types of treatment programs: metha-
done maintenance, residence, and outpatient drug-free care.

?T)PS,the most comprehensive study of the effectiveness of drug abuse
treatment ever undertaken, had at least four main conclusions. First, all
three treatment programs reduced substance abuse among current
abusers. Second, the longer an individual received treatment, the less
substance abuse of all types of drugs the individual experienced. Third,
drug abusers tended to reduce their criminal involvement if they
received treatment. Fourth, substance abuse treatment within the crim-
inal justice system was not less effective even though it may be coerced:
“Criminal justice clients do as well or better than other clients in drug
abuse treatment.” (Hubbard et al., 1989, p. 133; see also U.S. Depart-
ment of Justice, 1990e) However, the authors noted “There is no ques-
tion that treatment works, but much more needs to be known about how
and why treatment works.“13

i ‘“Adolescent treatment” was the top priority. The office is required by law to provide technical
assistance to state agencies receiving ADAMHA funding (U.S. Department of Health and Human Ser-
vices, 1990a, p. 1).

12This study was sponsored by the National Institute on Drug Abuse (NIDA) with support from the
National Institute of Justice. NIDA also publishes a series of research monographs on specific treat-
ment issues. See for example, Rahdert and Grabowsld, 1988; Ashery, 1986; Tims and Ludford, 1984.
For a summary of treatment research, see National Association of State Alcohol and Drug Abuse
Directors, 199Oa.

13Quotefrom National Association of State Alcohol and Drug Abuse Directors, 1990, p. 14, attributed
to the authors of the ‘RX’S study.



Page 43                                                        GAO/PEMD-90-24      Rural Drug Abuse
Appendix IV
Programs to Prevent   or Reduce
Substance Abuse




In contrast to the relative scarcity of evaluations of drug treatment pro-
grams, a large number of studies have examined the effectiveness of
alcohol treatment programs. I4A recent review of the literature cau-
tioned that “As with any large and diverse body of information, the
data admit differing interpretations,” and that “There is no single treat-
ment that is effective for all persons with alcohol problems.” (Institute
of Medicine, 1990, p. 147) Nevertheless, it tentatively concluded that
“treating people with alcohol problems is an endeavor that can produce
very positive results.” (Institute of Medicine, 1990, p. 148)

Although little information exists on the effectiveness of drug programs
in the rural United States, three reports have identified the main
problems common to rural programs that might limit their effectiveness:
Edwards and Egbert-Edwards, 1988; U.S. Department of Health, Educa-
tion, and Welfare, 1977,1978. It is true that many of the problems these
reports list may not be unique to rural areas; however, several of the
common elements of the reports bear repeating. Despite the fact that
these reports were written a decade apart, the problems appear to have
changed little during that time:

1. Funding: rural programs have greater per-client costs because of their
“diseconomies of scale”;

2. Lack of acceptance by community, community agencies, and the local
school system;

3. Lack of trained and experienced staff;

4. Transportation: clients must travel further to reach programs and
program staff must travel farther to reach clients.

We do not have reason to believe that residential care programs would
be any less effective, or were any more difficult to implement, in rural
states. The same cannot be said for outpatient care and “aftercare.‘+j
Residential care is comparatively easy to administer, even in rural

14”0ne estimate is that more than 600 treatment outcome studies have been completed, about half of
which have been completed in the 1980s; among these there have been approximately 200 compara-
tive clinical trials, about two-thirds of which have employed random assignment.” (Institute of
Medicine, 1990, p. 147)
‘““The fundamental goal of aftercare in drug abuse treatment is to prevent treated patients from
returning to drug abuse . . . [Alftercare has come to encompass efforts to ensure that the former
client can successfully maintain a life free from drug dependence in the larger community following
treatment.” (Hawkins and Catalano, 1986, p. 917)



Page 44                                                        GAO/PEMD-90-24     Rural Drug Abuse
            Appendix N
            Frograme to Prevent   or Reduce
            Substance Abuse




            states, because the substance abuser must usually come to the treatment
            clinic for an extended stay. Outpatient care and aftercare, in contrast,
            are more difficult because the treatment must come closer to the abuser.
            Aftercare is thus almost by definition harder to provide in less densely
            populated areas. It is much easier to bring substance abusers 100 miles
            one time to attend a 28-day treatment program, for example, than it is to
            bring them 100 miles 28 times to attend an evening program. Providing
            outpatient and aftercare that is easily accessible to all rural America is a
            challenge. Pooling resources (through multicounty programs, for
            example) and coordinating efforts (through other health programs) may
            be ways to meet this challenge.

            Monitoring the substance abuse behavior of those who have completed
            primary care programs is imperative for evaluating program effective-
            ness. In many cases, especially when substance abusers are voluntarily
            admitted to primary care programs, it may not be possible for the gov-
            ernment to monitor subsequent drug use. But many substance abusers
            are placed in treatment as part of their criminal sentence. To the extent
            that society has a special interest in reducing substance abuse among
            criminals, routine monitoring could be made a condition of probation or
            parole. This information could be used to evaluate treatment effective-
            ness as well as identify ongoing substance abuse problems.

            As we noted above, all states are required to devote at least 35 percent
            of their ADAMHA block grant funding to alcohol and 35 percent to other
            drug treatment programs. Yet the data we presented in tables II.5 and
            VI.7 show that over 80 percent of treatment admissions in rural states
            are for alcohol abuse. This implies that these funding allocation man-
            dates may not meet rural needs.


Education   The main source of federal funding for substance abuse education has
            been the State and Local Grant Program authorized under the Drug-Free
            Schools and Communities Act and its amendments and administered by
            the U.S. Department of Education. Drug-Free School funding is to be
            used to help schools and communities reduce the incidence and preva-
            lence of substance abuse. The program includes the development and
            expansion of prevention and intervention programs for students in
            grades K-12, comprehensive school programs for parents of students,
            and community and school collaborations. Each state is to submit a bien-
            nial report to the secretary of Education describing the extent of sub-
            stance abuse problems in the state’s schools, the types of drug-free
            school programs offered, and an “evaluation of the effectiveness of


            Page 46                                        GAO/PEMD-90-24   Rural Drug Abuse
Appendix   N
Rograme    to Prevent   or Reduce
Sub&awe     Abuse.




State and local drug and alcohol abuse education and prevention pro-
grams.” (Public Law 101-226; 103 Stat. 1933) The states have not yet
been required to submit this report.16

It is difficult to measure whether drug prevention programs are suc-
cessfu1.17A few evaluations of the effectiveness of their prevention
efforts have been conducted in rural areas (Scheurich, n.d.; Utah, 1988;
Sarvela and McClendon, 1987). We do not believe the scarcity of rural
program evaluations is a big problem, however. Indeed, we question
whether rural schools should be required to do such evaluations,
although they may be encouraged to do so alone, in collaboration with
other schools, or as a part of a state evaluation program. It may be a
better use of federal resources for a few carefully designed studies to be
done that include rural schools in the sample to confirm the general
effectiveness of prevention programs.

Substance abuse prevention programs, especially those emphasizing
“social-influence” and “community-based” approaches, may be effective
in preventing or reducing substance abuse.18Community-based methods
are those “that mobilize all elements of a community in a coordinated
plan of attack” against drug use.le Social-influence programs attempt “to
curb adolescent drug use by motivating young people to resist drugs and




“We were able to collect some preliminary information on the Drug-Free Schools and Communities
programs in Iowa. For example, 427 of the 431 school districts in Iowa have received program
funding, with 220 of 600 high schools using “peer helping” programs, 200 of 600 high schools using
“student assistance” programs, 300 districts using “Quest” programs, and 80 districts having “sup
port groups” (Iowa, n.d.b).

17Toshow that a prevention program is successful, the evaluator must demonstrate that something
did not happen (that is, that drugs were not taken) because of the program. Thii is especially difficult
when attempting to measure long-term success.We are currently conducting two forthcoming studies
concerning the effectiveness of substance abuse education.

lsFor descriptions of both types of programs, see U.S. Department of Health and Human Services,
1988.
loThe National Drug Control Strategy asserts that community-based approaches are “the most effec-
tive strategies for preventing drug use and keeping drugs out of schools and neighborhoods.” (White
House, 1990, p. 41) Several research papers evaluating community-based efforts to prevent drug use
were presented at a recent conference sponsored by RJA and National Institute of Justice; see the
papers presented on the ‘Community Responsesto Drug Abuse” panel (U.S. Department of Justice,
1990b). The report “Inventory of and Criteria for Funding Montana’s Youth-Oriented, Drug Rreven-
tion Programs” describes the elements “that would most likely be present within a successful pro-
gram.” These elements emphasize community-wide involvement (Gold, Gold, and Carplno, n.d.).



Page 46                                                          GAO/PEMD-90-24      Rural Drug Abuse
                    Appendix N
                    Programe to Prevent    or Reduce
                    Substance Abuse




                    helping them acquire the skills to do so.“20(Ellickson and Bell, 1990a,
                    1990b)

                    Our review of the data suggests that substance abuse problems are not
                    very different in the country than they are in the city. Although the
                    substances may be different, the problems are the same. To the extent
                    that the causes for and prevalence of substance abuse are similar in
                    rural and nonrural areas, substance abuse programs proven to be effec-
                    tive should work equally well in rural areas.


                    Only a few thorough evaluations have indicated that particular pro-
Main Findings       grams are effective, but almost no studies have focused on programs in
                    rural America. Furthermore, we are unaware of any evaluations that
                    compare the effectiveness of law enforcement, education, and treatment
                    programs. Our findings on program effectiveness are thus quite limited.

                . Little information exists on the effectiveness of law enforcement in
                  reducing drug abuse either in rural or nonrural areas. Arkansas, Iowa,
                  and Montana do have plans to improve their ability to evaluate law
                  enforcement programs, however.
                l The evidence that exists suggests that educational programs can mod-
                  estly reduce drug abuse, although we found only a few evaluations of
                  prevention program effectiveness in rural states.
                . Some treatment programs appear to reduce drug abuse. However,
                  studies of treatment effectiveness have rarely focused on rural areas.
                  Currently, at least a few rural states have begun evaluating their own
                  treatment programs.
                l Over 80 percent of treatment admissions in rural states are for alcohol
                  abuse. However, all states are required to devote at least 35 percent of
                  their ADAMHA block grant funding to treatment programs for drugs other
                  than alcohol. This implies that these funding allocation mandates may
                  not meet rural needs.

                    We were nonetheless able to identify features of rural places that need
                    to be taken into account if law enforcement, treatment, and education
                    programs are to be made more effective. Although we cannot draw
                    definitive conclusions about program effer+;yreness, we do note that cer-
                    tain barriers need to be overcome if rur        ; are to be successful in

                    ““The evaluation of the social-influence program found in Ellickson and Bell (1990a, 1990b) did con-
                    tain a couple of rural schools in the sample, but the authors did not analyze the influence of “rural-
                    ness” on program outcomes. Telephone conversation with Robert M. Bell, April 23, 1990.



                    Page 47                                                         GAO/PEMD-90-24      Rural Drug Abuse
Appendix N
Pmgmum to Prevent   or Reduce
Snbntance Abuse




reducing substance abuse. Rural programs can have greater per-client
costs because of their “diseconomies of scale.” These areas may find it
difficult to attract and hold trained and experienced staff. Clients must
travel farther to reach programs and program staff must travel farther
to reach clients. The programs may lack acceptance by the community,
community agencies, and the local school system.

The defining characteristic of rural states is their low population den-
sity. This makes it difficult to have high program intensity: a rural com-
munity is unlikely to be able to afford drug program specialists. Rural
police must handle the full range of law enforcement problems, rural
teachers must perform a wide variety of educational services, and rural
health care workers must provide a broad array of health services. Indi-
viduals in these jobs, no matter how dedicat,ed, can hardly be expected
to develop expertise in, or devote much time to, drug issues.

We believe that one way to compensate for the shortage of expertise is
to pool resources and coordinate efforts. In this way, rural areas may be
able to address collectively problems that would be too complex for any
one community to resolve on its own.




Page 48                                       GAO/PRMJMO-24   Rural Drug Abuse
Appendix V

Rural States


               Alaska
               Arkansas
               Arizona
               Colorado
               Idaho
               Iowa
               Kansas
               Maine
               Montana
               Nebraska
               Nevada
               New Mexico
               North Dakota
               Oklahoma
               Oregon
               South Dakota
               Utah
               Wyoming’




               ‘Vermont has also been included in proposed legislation as a “special needs rural area,” but it does
               not have a population of 60 or fewer persons per square mile. Therefore data from Vermont are not
               included with data from other rural states in this report.



               Page 49                                                        GAO/PEMD-99-24      Rural Drug Abuse
Appendix VI

Supporting Tables


Table Vl.1: Annual Prevalence of Use of
14 Types of Drugs Among Respondents                                                                       Population density’
of Modal Age 19-30,1988                                                                                                                           Very
                                                                                          Farm or         Small     Medium         Lar e
                                          Drug                                            country          town         city          B
                                                                                                                                     Cty         laiK
                                          Anv illicit drua                                     27.0%        34.0%        38.7%       35.9%        39.1%
                                             Marijuana                                         22.3         29.5         34.5        31.1         34.1
                                             Nonmarijuana                                      15.4         20.2         23.5        20.8         23.7
                                          Cocaine                                               a.5         12.9         15.3        13.9         17.1
                                          Crackb                                                1.6          2.9          3.0         3.3          4.4
                                          lnhalantsC                                            1.1          I.8          1.7         i .a         1.4
                                          Hallucinogensd                                        2.1          3.9          4.0         3.2          4.0
                                          LSD                                                   1.8          3.3          2.9         2.3          2.5
                                          Heroin                                                0.1          0.2          0.3         0.2          0.2
                                          Other opiates                                         2.3          2.5          2.6         2.7          2.8
                                          Stimulants                                            6.5          7.3          a.5         6.2          5.5
                                          Barbiturates                                          1.7          2.0          2.3         1.6          1.5
                                          Methaqualone                                          0.4          0.5          0.6         0.5          0.6
                                          Tranquilizers                                         4.2          4.2          5.3         3.7          3.8
                                          Approximate number of
                                             respondents                                        990       2,300         i ,800      1,600        1,100

                                          aA small town is defined as having less than 50,000 inhabitants, a medium city as 50,000-100,000, a
                                          large city as 100,000~500,000, and a very large city as having over 500,000 inhabitants.

                                          ‘Forty percent of the questionnaires   contained questions about this drug.

                                          ‘Unadjusted for known underreporting     of certain drugs. Eighty percent of the questionnaires   contained
                                          questions about this drug.
                                          %nadjusted for known underreporting of certain drugs. PCP was asked about in 20 percent of the
                                          questionnaire forms; the prevalence estimate was omitted because of the small number of cases.
                                          Source: L. D. Johnston, P. M. O’Malley, and J. G. Bachman, Drug Use, Drinking, and Smoking: National
                                          Survey Results from High School, College, and Young Adult Populations, 1975-1988 (Ann Arbor: Univer-
                                          srty of Mtchigan, lnstttute for Social Research, for the U.S. Department of Health and Human Services,
                                          Public Health Service, Alcohol, Drug Abuse, and Mental Health Administration, National Institute on
                                          Drug Abuse, 1989), table 27, p, 181.




                                          Page 50                                                            GAO/PEMD-90-24       Rural Drug Abuse
                                         Appendix VI
                                         Supporting Tablea




Table V1.2:Thirty-Day Prevalence of Um
of 14 Vpsr of Drugs Among                                                                                Population density0
Respondents of Modal Age 19-30,1998                                                                                                               Very
                                                                                         Farm or         Small     Medium         Large          large
                                         Drug                                            country         town          city         city           city
                                         Any illicit drug                                     16.;%        19.5%        22.5%        19.2%        21.9%
                                            Mariiuana                                         13.7         17.0         19.8        16.8           18.7
                                            Nonmariiuana                                       7.4          9.6         10.6         8.6           10.2
                                         Cocaine                                               3.2          5.8          6.4         5.2            7.5
                                         Crackb                                                0.7          1.6          1.2          1.4--         1 .o
                                         InhalanW                                              0.6          0.7          0.4          0.5           0.5
                                         Hallucinonensd                                        0.5          1.2          1.1          0.8           0.9
                                         LSD          -                                        0.4          1 .o         0.7          0.6           0.8
                                         Heroin                                                0.0          0.1          0.2          0.0           0.1
                                         Other ooiates                                         0.6          0.6          0.8          0.7           0.6
                                         Stimulants                                            3.2          3.0          3.1          2.3           1.5
                                         Barbiturates                                          0.7          0.6          0.6          0.6           0.6
                                         Methaaualone                                          0.1          0.1          0.1          0.0           0.1
                                         Tranquilizers                                         1.8          1.4          1.8          1.2           0.9
                                         Approximate   number     of
                                           resDondents                                         990       2.300        1BOO         1.600         1.100
                                         ‘A small town is defined as having less than 50,000 inhabitants, a medium city as 50,000-100,000, a
                                         large city as lOO,OOO-500,000,and a very large city as having over 500,000 inhabitants.

                                         bForty percent of the questionnaires   contained questions about this drug

                                         ‘Unadjusted for known underreporting     of certain drugs. Eighty percent of the questionnaires    contained
                                         questions about this drug.

                                         dUnadjusted for known underreporting of certain drugs. PCP was asked about in 20 percent of the
                                         questionnaire forms; the prevalence estimate was omitted because of the small number of cases.
                                          Source: L. D. Johnston, P. M. O’Malley, and J. G. Bachman, Drug Use, Drinking, and Smokin : National
                                         Survey Results from High School, College, and Young Adult populations, 19/5-1988 (Anni
                                         fsltv 0                                                                              Human Services,
                                          Public Health Service, Alcohol, Drug Abuse, and Mental Health Administration, National Institute on
                                          Drug Abuse, 1969) table 28, pp. 184-86.




                                         Page 51                                                            GAO/PEMD-90-24       Rural Drug Abuse
                                           Appendix VI
                                           Supporting Tables




Table VI.& Thirty-Day Prevalence of Uao
of Two Substances Among Respondents                                                                     Population densltva
of Modal Age 19-30,1968                                                                                                                            Very
                                                                                          Farm or       Small          Medium           Large     lar e
                                           Drug                                           country        town              city           city      cBtY
                                           Mariiuana     dailv                                  3.1%            3.6%        3.3%           3.0%      3.2%
                                           Alcohol:     5+ drinks   in a row in past
                                             2 weeks                                           27.8         35.5           36.1           31.9      34.6
                                           aA small town is defined as having less than 50,000 inhabitants, a medium city as 50,000-100,000, a
                                           large city as lOO,OOO-500,000, and a very large city as having over 500,000 inhabitants.
                                           Source: L. D. Johnston, P. M. O’Malley, and J. G. Bachman, Drug Use, Drinking, and Smoking: National
                                           Survey Results from High School, College, and Young Adult?opulations,      19/5-1988 (Ann Arbor: Univer
                                           srty of Mrchtoan, lnstrtute for Soctal Research, for the US Department of Health and Human Services,
                                           Public HeaRK Service, Alcohol, Drug Abuse, and Mental Health Administration, National Institute on
                                           Drug Abuse, 1989) table 29, p. 187.

Table Vl.4: Lifetime Drug Use Prevalence
Among High School Seniors in Iowa,         Drug                                        Iowa    Montana            North Dakota            United States
Montana, North Dakota, and the United      Alcohol                                       95%           95%                        97%                92%
States, 19W
                                           CiQarettes                                    66            61                         68                 66
                                           Marijuana                                     40            36                         44                 47
                                           Other druas                                   19                 b                     19                 33
                                           aPrevalence data for individual drugs other than alcohol, cigarettes, and marijuana were not collected by
                                           the states.


                                           Source: Iowa, 1987-88 Iowa Study of Alcohol and Drug Attitudes and Behaviors Among Youth: Normative
                                           and Trend Data (Des Moines: Iowa Department of Education, Instruction and Curriculum Division, Sub-
                                           stance tducation Program, June 1989b), pp. 6, 16, 19, and 24; Montana, Montana Adolescent Health
                                           Status (Helena: Montana Coalition, the Montana Office of Public Instruction, and the Montana Depart-
                                           ment of Health and Environmental Sciences, March 1990a), pp, 13-16; North Dakota, The 1986 Alcohol
                                           and Drug Survey of North Dakota Junior and Senior High Students (Bismarck: Department of Human
                                           Servrces, Division of Alcoholism and Drug Abuse, November 1986), pp, 16,46, 71, and 100; L. D. John-
                                           ston, P. M. O’Malley, and J. G. Bachman, Drug Use, Drinking, and Smoking: National Survey Results
                                           from High School, College, and Young Adult Populations, 19/5-1988 (Ann Arbor: University of Michigan,
                                           tnstrtute for Social Hesearch, for the U.S. Department of Health and Human Services, Public Health
                                           Service, Alcohol, Drug Abuse, and Mental Health Administration, National Institute on Drug Abuse,
                                           1989) pp. 29-30.




                                           Page 62                                                              GAO/PEMD-90-24         Rural Drug Abuse
                                          Appendix M
                                          Supporthg Tables




Table Vl.5: Thirty-Day Drug Use
Prevalence Among Nigh School Seniors      Drua                                     Iowa       Montana          North Dakota  United States
in tows, Montana, North Dakota, and the        -
                                          Alcohol                                50-70%               71%                79%            64%
United States, 1988’                                                                                     b
                                          Cigarettes                                 23                                    19                   29
                                          Marijuana                                  17                  b                 17                   18
                                          Other druas                                 7                  b                  7                         b

                                          aPrevalence data for individual drugs other than alcohol, cigarettes, and marijuana were not collected by
                                          the states.

                                          bNot available.
                                          Source: Iowa, 1987-88 Iowa Study of Alcohol and Drug Attitudes and Behaviors Among Youth: Normative
                                          and Trend Data (Des Moines: Iowa Department of Education, Instruction and Curriculum Division, Sub-
                                          stance tducation Program, June 1989b), pp. 7, 16, 20, and 25; Montana, Montana Adolescent Health
                                          Status (Helena: Montana Coalition, the Montana Office of Public Instruction, and the Montana Depart-
                                          ment of Health and Environmental Sciences, March 1990a), pp. 13-16; North Dakota, The 1986 Alcohol
                                          and Drug Survey of North Dakota Junior and Senior High Students (Bismarck: Department of Human
                                          Servrces, Drvrsron of Alcoholism and Drug Abuse, November 1986) pp. 28, 55, 80, and 100; L. D. John-
                                          ston, P. M. O’Malley, and J. G. Bachman, Drug Use, Drinking, and Smoking: National Survey Results
                                          from High School, College, and Young Adult Populations, 1975-1988 (Ann Arbor: University of Michigan,
                                          instrtute for Social Research, for the U.S. Department of Health and Human Services, Public Health
                                          Service, Alcohol, Drug Abuse, and Mental Health Administration, National Institute on Drug Abuse,
                                          1989) pp. 3536, and 46.




                    Y




                                          Page 63                                                            GAO/PEMD-90-24     Rural Drug Abuse
                                                               Appendix VI
                                                               Supporting Tables




Table VI.& Alcohol and Other Drug Abuse Violation Arrests by State, 1988O
State                                                 Alcoholb       Rank                    Other drugs     Rank             Total         Rank
Rural
 ‘- New Mexico                                                                  20.28    2          4.44          8           24.72             3
     Oklahoma -.                                                                17.67    7          2.86         26           20.53             7
     Wyoming                                                                    18.53    5          1.74         41           20.27             9
     Nevada               ‘.-      ._- _ _...-..--.                             12.16   26          7.72          3           19.88            10
   .Utah                                                                        16.18   11          3.04         24           19.21            11
     Arkansas
      _.                   1_.    -_--- ..--______                              1654    IO          2.34         33           18.88            12
     Arizona                                                                    13.82   18          3.93         15           17.75            16
     Colorado                                                                   14.06   16          2.77         27           16.83            18
     Oregon                                                                     12.17   25          3.86         16           16.02            23
     South Dakota                                                               15.29   14          0.59         49           15.88            24
    ‘Nebraska                                                                   13.74   20          1.97         39           15.71            26
     Idaho                                                                      13.75   19          1.87         40           15.63            27
     Alaska                                                                 -   13.51   23          1.98         38           15.49            28
     iowa           -.                                                          13.53   22          0.88         47           14.41            30
     Kansas                                                                     10.31   30          2.00         37           12.32            36
     North’Dakota._...            . . _--._                                     10.95   28          1 .Ol        46           11.95            38
     Maine                                                                       9.93   32          1.54         43           11.48            42
     Montana                                                                     9.84   33          1.05         45           10.89            45
Nonrural
      .                -.
     California -’                                                              19.03    4          7.70          4           26.73             1
     Tennessee.                                                 --___           21.44    1          3.45         22           24.89             2
                      ---.
     “irai;ja                                                                   19.30    3          2.72         29           22.02             4
     Mississippi                                        .~._.      ___-         17.72    6          3.71         19           21.43             5
   -Texas-            -- -.                                                     17.61    8          3.76         18           21.37             6
     North Carolina                              ..~~..
                                                     .I__. ________             16.56    9          3.78         17           20.34             a
     New  . - Hampshire
                 ~. .- .--_- ~~-..-.---~ ~.                   -.-___            15.72   12          2.42         31           18.14            13
     South      Carolina
        -.. ..- _.~..-_~-~... ~~ ~-..-.-~~...                                   13.71   21          4.12         12           17.83            14
     Alabama                                                                    15.42   13          2.36         32           17.77            15
     District
          ._... -of .-.-.-.
                       Columbia.- .-..-~-.._                         -----.      0.27   49         16.80          1           17.06            17
     Wisconsin                                                    ..-_          15.11   15          1.70         42           16.82            19
     Marvland
   “..-     ’    ..-_._ _ ~.....- .~ ~.-.-~-..-~
                                                                                 9.58   35          7.23          7           16.81            20
     Washington                                                                 12.68   24          3.62         20           16.30            21
._-_ Indiana
          .-. . .. . -. ~...._~.-.- ..__..... ~~____________                    13.98   17          2.22         35           16.20            22
     Georgia                                                                    11.50   27          4.33         11           15.82            25
     Connecticut                              _---                               7.20   44          7.24          5           14.44            29
     New Jersey                          --.~-                                   5.78   45          7.23          6           13.01             31
  _-Ohio
      .^_..-. _...-__.-~ .- ._ ---___.                                          10.27   31          2.69         30           12.96             32
     Michigan                                                                    9.79   34          3.12         23           12.91             33
                                                                                                                                      (continued)



                                                               Page 54                                      GAO/PEMD-ftO-24   Rural Drug Abuse
                                                       AppendixVl
                                                       Supportlug Tables




State                                                                Alcoholb           Rank         Other drugs            Rank               Total            Rank
   Missouri                                                               9.35              37                 3.03             25            12.38               34
            ..--   ~- -~'----.--
  j+awaii                                                                  8.86             38                 3.47             21            12.33               35
  ~~L&Yisian~                                                              8.05             41                 3.94             14            11.99               37
    .Minnesota                                            --              10.45             29                 1.49             44            11.94               39
    New York           .      ._                                           3.89             47                 8.04              2            11.93               40
    Massachusetts .           _ .- . ..~-. - -...                          7.30             42                 4.36             10            11.88               41
    lllin&s ..-                                                       -    7.23             43                 3.98             13            11.22               43
 “Pennsylvania                                            .-.---           8.28             39                 2.74             28            11.01               44
   ‘Vermont       -. .-                                --___               8.24             40                 2.05             36            10.29               46
    West Virginia _...   ._ __.-..~ . .._. .___________.                   9.57             36                 0.60             48            10.18               47
    Rhode Island                                                           3.75             48                 4.38              9              8.13              48
  .,.Delaware
           _         .       ._.~__._~___ ~____________ --__               5.21             46                 2.31             34              7.52              49
Weighted (population) - averages
                             _---- ..--.-..-.-____..                          ----                                                                                 -
    Rural states                                               ---        14.25                                2.76                           17.01
    Nonruralstates                                                        12.28                                4.80                           17.08                -.
    United States                                                         12.57                                4.50                           17.07
Unweighted (state) averages
    Rural states                   ._-.- ..-.--___                ___-    14.01C                               2.53c                          18.55
    Noniural states ..~~. ^ ~.--_..-..---                                 11.06                                4.21                           15.27               -
 --United States                                                          12.14                                3.60                           15.74
                                                       %ate per 1,000 inhabitants. Data based on agencies submitting 12 months of complete data. Kentucky
                                                       and Florida did not submit data.

                                                       bAlcohol violations include driving while under the influence, liquor law violations, and drunkenness.

                                                       CDifference of means tests between rural and nonrural states significant at the 90-percent level.
                                                       Source: U.S. Department of Justice, unpublished data, Federal Bureau of Investigation, 1990f.




                                                       Page 66                                                            GAO/PEMD-90-24       Rural Drug Abuse
                                                          km*          m
                                                          Supporting     Tables




Table Vl.7: Treatment Admission Rates to State Alcohol and Drug Abuse Clinic3
State                .~~~. ..-. .~_..                  Alcohol      Rank      Other drugs                                Rank              Total             Rank
Rural        .--
 .Alaska                          ___ _.-- ---                                17.30         1              3.06                8          20.38                 1
                                                                       ______-
  Colorado                                                                    15.56         2              1.24              35           18.79                 5
  Maine        .                   _..~ ...__._~__.._                         13.71
                                                                             .__II_-        4              2.31              16           18.02                 6
  Oregon                                      --_____-.                       11.79         7              2.39              14           14.17                 6
  Nebraska -. --                                  ~---                        12.31         5              1.40    -         30           13.71                 9
  Montana      “.                  .-    .._-.-.-..-                          11.04         8              2.67              11           13.71                IO
  Nevada          -~                                                              8.92     12         -    1.54              28            10.48               13
  South Dakota                                -.____-------.                      5.77     21              4.04             -- 4            9.81               16
  Utah                                                                            6.80     16              1.33              33             8.13               19
  Iowa                                                                    -2?--            17              1.66              27             8.12               20
  Idaho                    .~    .~~--~ ~___-__-.__-.-.._              -4.93
                                                                          -..-             25.             1.92              23             6.85               25
  Arizona                                                                         4.88     26              1.92              22             6.79               26
  Kansas      -.                                                                  4.24     29              1.33              32             5.57               33
  North Dakota                                                                    2.56     40              2.60              12             5.16               35
  Arkansas                         ~-                                             3.03     36              1.22              37             4.25               38
                                                                                                                                                    ----.-
  Oklahoma                                                                        2.21     42              0.67              47             2.89               44
Nonrural                                                                                                                                                  --..
  District of Columbia      _-    ~~~~~-.--..-- .___        ---..__. -__-.----
                                                                       -9x                    11           a.48                1          17.82                2
  Wisconsin                                                                    14.91           3            2.58              13          17.48                3
  Massachusetts             .-    ~~~~                                         127-            6            4.73               3          16.87                4
                                                               -.. ---
  Rhode Island                                  I_-     ..-___. --.            11.02           9            3.48               6          14.50                7
  New York                                                  _-___--              8.86         13            4.81               2          13.68    ----      11
  Minnesota                                                                    10.26          10            1.77              26          12.03               12
  Vrrginia                           ~..~ .~~~.                                  8.32
                                                                    __.._-----__-__           14           -2.14              19          10.46               14
  South Carolina                                                                 8.06 ____-- 15             1.86          --. 24           9.93               15
  Georgia                                    ..-- --_..-...~- ...--~..___ 6.40                18            3.28               7
                                                                                                                                    _--__  9.68               17
  Delaware                                                                       6.10         19.~~--       2.71              10           8.81               18
  Maryland                                                                       3.97         31            4.01        .___-- 5           7.98      -_---.  21
  Vermont                                     .~-.~-- ~-..                       5.40
                                                                            .-~~__-.          22            2.33              15 --.-___ 7.73                22
  Connectrcut                                                                    5.11         23
                                                                                            _____-_-.-__    2.08              21           7.18              23
  West Vrrgrnia                                                                  5.86         20            1.08              42__-.       6.94 __-._.. 24
                                                                                                                                         ___.
  lllrnois                                                                       4.37 ____-- 28            2.29               18-__---__   6.67              27
  Flonda                                                                         4.95         24           1.48               29           6.43              28
                                                                                                                            -__
  California                                                                     3.86
                                                                              ..-___.         33           2.30               17           6.15 __-... 29
  Michigan                                                                       4.02         30           2.09        -.- __...
                                                                                                                              20           6.11              30
  Missouri                                                                     .--4.60        27           1.39               31           5.98              31
  Pennsylvania         w                                                -.--___- 2.94     __. 38           2.72
                                                                                                             _-                9           5.65 ___---
                                                                                                                                                   --_..-    32
  New Jersey                                                                     3.41         35           1.85               25           5.25_____         34
                                                                  ~._-.
                                                                                                                                                (continued)



                                                          Page 56                                                      GAO/PEMD-90-24      Rural Drug Abuse
                                                  Appeudlx VI
                                                  Supporting Tables




State
~---.         ..-.._--...                                       Alcohol         Rank        Other druas           Rank             Total        Rank
   Kentucky
 ,~,_._,~...__.
             ..I_._. ._-..-_- _. .___I.-                              3.87          32                1 .;8          34            5.15              36
   New Hampshire                                                      3.78          34                0.72           46            4.50              37
   Mississiopi   .                                                    2.78          39                0.92           44            3.70              39
   North Carol&a                                                      3.00          37                0.65           48             3.65             40
   Indiana                                                            2.30          41                1.12           40             3.41             41
   Ohio                    .                                          1.86          44                1.22           36             3.09             42
   Louisiana                                                          1.92          43                1.15           39             3.07             43
   Hawaii                  ‘~                                         1.76          45                1.12           41             2.88             45
   Tennessee                                                          1.53          47                1.19           38             2.73             46
   Alabama                                                            1.63          46                1.08           43             2.71             47
   Texas                        .-                                    0.64-         48                0.74           45             1.37             48
Weighted       (population)          averages
   Rural states           ~-                                          7.72                            1.67                          9.39
  -Nonrural      states         -.                                    4.74                            2.19                          6.92
   Unfted     States
                          -          . ..______                       5.11                            2.12                          7.23
Unwefghted           (state)
                          I..    averages
                                      --~
   Rural states
                       .._~
                                                                      8.22b                           1.96                        10.lTb
   Nonrural_ states
                _...--_-. .~~-..                                      5.28                            2.21                         7.49
   Umted States                                                       6.26                            2.12                         8.35
                                                  Vtate per 1,000 inhabitants. Data based on agencies submitting data. New Mexico, Washington, and
                                                  Wyoming did not submit data.
                                                  bDifference of means tests between rural and nonrural states significant at the go-percent level
                                                  Source: W. Butynski, D. Canova, and S. Jenson, State Resources and Services Related to Alcohol and
                                                  Drug Abuse Problems, Fiscal Year 1988: An Analysis of State Alcohol and Drug Abuse Profile Data, a
                                                  report for the Nahonal lnstrtute on Alcohol Abuse and Alcoholism and the Nahonal lnshtute on Drug
                                                  Abuse (Washington, DC.: National Association of State Alcohol and Drug Abuse Directors, 1989) pp. 22
                                                  and 36.




                                                  Page 57                                                       GAO/PRMD-9044      Rural Dm    Abuse
                                          Appendix VI
                                          Supporting Tables




Table VW: Drug Treatment Admlssions
by Primary Drug (Other Than Alcohol) In                                                    Rural states                      Nonrural states
Rural and Nonrural States, 1988’          Drug                                             Rate    Percent                    Rate    Percent
                                          Mariiuana                                         0.54            33                 0.34            15
                                          Cocaine                                           0.40            24                 0.67            30
                                          Stimulants          -
                                             Amohetamines                                   0.17            IO                 0.07                3
                                          Inhalants                                         0.02              1                0.01                0
                                          Sedatives
                                             Barbiturates                                   0.02              1                0.01                0
                                             Other sedatives or hwnotics                    0.02              1                0.01                1
                                          Tranquilizers                                     0.02             2                0.02                 1
                                          PCP                                               0.01             0                0.04               2
                                          Other hallucinogens                               0.02             1                0.01              i
                                          Heroin                                            0.21            13                0.55             25
                                          Other oDiates                                     0.05             3                0.08               3
                                          All others                                        0.18            11                0.38             17
                                          Total                                             1.65          100b                2.20           100b
                                          %ate per 1,000 inhabitants: percent of drug admissions. Excludes states that did not report admissions
                                          by primary drug abused. Rural states excluded are Kansas, Maine, New Mexico, North Dakota, and
                                          Wyoming. Excluded nonrural states are Georgia, North Carolina, Virginia, and Washington. Some states
                                          do not collect data for each drug.
                                          bColumns may not add to 100 because of rounding.
                                          Source: W. Butynski, D. Canova, and S. Jenson, State Resources and Services Related to Alcohol and
                                          Drug Abuse Problems, Fiscal Year 1988: An Analysis of State Alcohol and Drug Abuse Profile Data, a
                                          kg
                                          report or t e ationa nstltute on Ice 0
                                          Abuse (Washington, DC.: National Association of State Alcohol and Drug Abuse Directors, 1969) p. 36.




                                          Page 58                                                         GAO/PEMD-9024       Rural Drug Abuse
                                                                          Appendix VI
                                                                          Suppurting Tables




Table Vl.9: Drug Abuse Violation Arrest8 by Type of Drug and Type of Offense, 1988O
                                                     Type of drug
                                                              Synthetic      Other                                              Type of offense
State                                       Marijuana         narcotics     drugs TotaP                                Sales       Possession     TotaP
 Rural
-___
       Oregon z.--. __._ -._-_--_
                                                                    36%             41%            2%   21%   100%          5%              95%     100%
----.- Colorado -                                                   32              52             2    13    100          19               81      100
-_-_    Arizona-.__--..--                                           29              51             3    17    100          17               83      100
~ Nevada         - ._-. -. .-- ..-.--.                              29              35            28     8    100          36               64      106
~.----.Utah                                                         27              59             3    11    100          24               76      100
-__“_-.Oklahoma                                                     26              57            10     7    100          28               72      100
       Alaska                                                       24              61             7     7    100          46               54      100
        Kansas____--                                                20              63             7    11    100          25               75      100
       New
--- ..-._.       Mexico ~_____                                      19              68             8     5    100          31               69      100
--     Nebraska                                                     18              72             1     8    100          17               83      100
       Wyoming ~--
_-.___-_.-..-.                                                      18              73             7     3    100          36               64      100
___--_ Iowa --__._-.       -.._----..____.-____                     17              72             6     4    100          24               76      100
--~-.. Maine                                                        14              81             1     4    100          16               84      100
---._--Idaho __-.----.-                                             14              79             6     1    100          21               79      100
       Arkansas .~                                                  14              78             5     4    100          27               73      100
--- South          Dakota ---.- ___-
           .-..--l--...--                                           13              77             6     4    100          26               74      100
       Montana
 ----..-----l._--_-~                                                 8              38             2    52    100          14               86      100
       North Dakota                                                  6              82             5     6    100          38               62      100
Nonrural
--_-“.“..- _..... ...“--               _.._ -.--_---..
       Pennsylvania
            ..-._______-                               -.- --_~     76        _--19                3     3    100          63               37      100
-_---...
       New York                                                     71            24               1     4    100          41               59      100
-_-District_________.. of-Columbia
                            ___-.. - . ----.                        71            12               3    13    100          48               52      100
       California                                                   70            13               0    17    100          22               78      100
__-.“_-Delaware
            ..--.--.- ..-~ . ____-..--                              60            39               0     2    100          24               76      100
       New
_-- - .----..z-. Jersev                                             60            36               1     3    100          27               73      100
       Connecticut
“___..._-- - .___.                ---.-.--____.-~________           54            26              15     6    100          28               72      100
       Maryland
._..^.____   L--   ._.. -_ ._I___I..-      --.-.
                                                                    54            35               5     7    100          29               71      100
        Massachusetts                                       I____   52
                                                                    __            41               3     4    100          22               78      100
       Rhode Island                                                 52            39          -    5     5    100          20               80      100
                                                                                                   0    26    100          40               60      100
                                                                                                   1     0    100           7               93      100
                                                                                                   4     3    100          17               83      100
                                                                                                   9     4    100          32               68      100
                                                                                                   4     5    100          26               74      100
                                                                                                  11     6    100          16               84      100
                                                                                                   0     4    100          36               64      100
                                                                                                                                            (continued)




                                                                          Page 59                                    GAO/PEMD-90-24    Rural Drug Abuse
                                                              Appendix VI
                                                              SupportIng Tablea




                                                                        Type   of drua
                                       Cocaine and                                 Synthetic          Other                                 lbe     of offenre
State                                       opiate8           Marijuana            narcotic8          drugs      TotaP             Sale8          Porwarion       TotaP
    Ohro       .-.._---. _.._
                            -__-____                    33              59                    2             6      100                 19                   81      100
    North Carolina  __- ~-. ----___                     32              58                    2             9      100                 20                   80      100
    Wisconsin                                           28              64                    2             6       100                33                   67      100
._.Hawaii          -_ ~- _~--_____                      26              69                    1             3       100                17                   83      100
    New Hampshire                                       23              75                    2             0       100                15                   85      100
    Mississippi                                   ____---22             71                    2             4       100                23                   77      100
    Michigan                                            21              23                    1            55       100                59                   41      100
    West Virginia
           .._. .._.~..- . ------____                   21              74                    3             2       100                39                   61      100
    Minnesota.- ._ _ .                                  21              58                    4            17       100                28                   72      100
    Alabama                      .__.----                19             65                    2            14       100                16                   84      100
    Indiana                                              16             71                    3            10       100                20                   80      100
    Tennessee _. _                                       16             74                    7             4       100                30                   70      100
    Vermont                                              12             86                    1             2       100                15                   85      100
    Missouri                                              8             41                    4            46       100                12                   88      100
Weighted (population)
 .._averages
     -
    Rural.                                              26              58                    5            11       100                21                   79      100
    Nonrural ~..~.            .-~                       55              31                    2            11       100                29                   71      100
._-_.._
  Total      _..                                        53              34                    3            11       100                28                   72      100
Unweighted (state)
     averages-...
._ -_.                    .-. ._-..
     Rural                                              20b             63b                   6b           10       100                25                   75      100
     Nonrural-.-. --.~~ -
 .._._.....                                 .--         39              49                    3             9       100                27                   73      100
   Total                                                32              54                    4            10       100                26                   74      100
                                                              aData based on agencies submitting 12 months of complete data. Kentucky and Florida did not submit
                                                              data.
                                                              bDifference of means tests between rural and nonrural states significant at the 90-percent level.

                                                              ‘ROWS may not add to 100 because of rounding.
                                                              Source: U.S. Department of Justice, unpublished data, Federal Bureau of Investigation,     1993




                                                              Page 60                                                           GAO/PEMD-BO-24
                                                                                                                                             Rural Drug Abue
                  .



                                         Appemlix M
                                         Supporting Tables




Table Vl.10: Substance Abuse Among Inmates Admitted to the Montana State Prison December 1989 to June 1990’
                                              Othe;bql;wi Alcohol and other     Total substitft
Assessment
~--           method                Ab”bz!                       drug abuse                         No abuse                                 Total
Committeeb
---                   ___                58            45                212                    315       31                                  346
Percent                                   17%               13%                      61%                     91%              9%              100%
MCMF                                      39                49                      172                     260              77               337
Percent                                   12%               15%                      51%                     77%             23%              100%
Questionnaired
------..-------                          206              130                            e                  282              54               336
Percent                                   61%               39%                                              84%             16%              100%
                                         ‘A separate Minnesota Multiphasic Personality Inventory was conducted to determine the severity of the
                                         substance abuse addiction. This assessment found that 49 percent (168 of 342) were clinically
                                         addicted, 11 percent (34 of 342) were subclinically addicted, and 40 percent (137 of 342) had a ten-
                                         dency toward addiction.

                                         bCommittee - Montana State Prison Initial Classification   Committee

                                         CMCMl = Milan Clinical Multi-Axial Inventory.

                                         dQuestionnaire = self-reports of inmates. Self-reports do not include a separate category for drug and
                                         alcohol abuse.
                                         eNot available.
                                         Source: Montana, unpublished data, Chemical Dependency        Program, Montana State Prison, 1990




                                         Page 01                                                           GAO/P-90-24        Rural Drug Abuse
Appendix VII

RequestLetters



                                                                                                ?lNANu
                                       %bbd @tates#enate
                                            WASHINGTON, D.C. 206 10
                                                                                       StWAL COMMITTIE ON ADIN
                                                                                       BllJC7 CDYMllWt ON RTlllCS




               Honorable   Charles Bowsher
               Comptroller   General
               United States General Accounting           Office
               441 G Street,    N.W.
               Washington,   D.C. 20548
               Dear Mr.    Bowsher:
                        The effects    of drug-related    crime have been ielt          throughout
               our country.         Our states are no exception:     Arkansas,        Iowa, and
               Montana have experienced          dramatic  increases  in illegal          drug
               activity     in recent years.
                     The sad fact is that the drug crisis              has spread to even
               small towns and rural    communities across            America.   The following
               examples underscore   our point:
                     --   In El Dorado, Arkansas,         a town of 25,000, arrests      for
                          sale and possession    of    illegal     drugs increased  97% in
                          the first  six months of        last year over the same period
                          in 1988.   The El Dorado        police   chief attributes  this
                          mostly to the introduction           of crack cocaine in the area.
                     --   "Ice" - an extremely     potent form of methamphetamine
                          which,    according  to authorities, may become the
                          deadliest     drug of the 1990s - is available  in Arkansas,
                          Montana, and Iowa.
                     --   In Iowa,    the number of people admitted   for cocaine
                          treatment     doubled in 1987, double again in 1988, and
                          continues     to escalate.
                     --   In August 1989, the average waiting             period   at an
                          Arkansas substance abuse treatment            facility    was more
                          than three weeks.
                     --   Law enforcement  officers       shut down a crack house in
                          Helena, Montana, a city        of approximately  24,000 people.
                     --   The economic    impact of substance         abuse in     Iowa is over
                          $700 million    a year.
                       Arkansas,   Montana, and Iowa have substantial          rural
               populations,      but are experiencing      problems similar      to those in
               large urban areas.        We believe    that other rural     states may be
               suffering     as a result   of increases     in drug-related      crime, but we
               are unaware of any systematic          examination    of the drug problem in
               rural    America.




                     Page 62                                               GAO/PEMD-90-24      Rural Drug Abuse
       Appendix VU
       Request Letter6




Honorable Charles          Bowsher
March 19, 1990
Page 2



        We request      that the United States General Accounting                      Office
examine what information            exists     on the nature and extent               of the
drug crisis      in rural      parts of America and synthesize                 available
information.         This could include          examining     several
methodological        issues,     such as how the extent           of the problem is
or can be measured, the adequacy of data, and how well the
effectiveness        of different      interdiction       or treatment         efforts      are
evaluated.       A particularly        important      question     will     be
ascertaining       the proper allocation            of treatment        resources.
This will     help us as we prepare and pursue legislation
addressing     the problems we face in rural                communities.          Staff
from your Program Evaluation              and Methodolgy        Division       have
successfully       performed these and similar              analyses       on several
other issues for us, and we look forward to working with them on
this issue.
        Results  of your work would be most useful        to us if received
no later     than September 15, 1990.      If you have any questions
about this request,       please do not hesitate    to contact    us or any
of our staff     members, John Monahan (Senator       Pryor,  224-5364),
Maureen Driscoll      (Senator Baucus, 224-2655),      Ed Long (Senator
Harkin,    224-224-3254),     or Elizabeth   Goss (Senator Bumpers, 224-
224-4843).




DP/ jtm




       Page63                                                      GAO/PEMD-BO-24RurslDrugAbuse
      Appendix VU
      Requel3t Letters




                         mfted States Senate
                              WASHINGTON, DC 206 10


                                June 8, 1990

Mr. Charles A. Boweher
Comptroller   General
United States General Accounting          Office
441 G Street,   N.W.
Washington,   DC 20548
Dear Mr.    Bowaherr
The effects   of drug-related  crime  have been felt      throughout     our
country.    North Dakota is no exception.       Law enforcement
officials   in my state have reported    increases    in violent     crime
and have expended a growing portion      of their   resources     combatting
the drug trade.
I've become aware that the General Accounting    Office  has been
asked to examine the available    information on the nature and
extent  of the drug crisis  in rural America (request   attached).
Because of the importance      of this     study,     I would    like   to join    the
sponsors in their request.
If you have any questions,      please     feel     free   to contact    me, or Liz
Magill, of my staff.




                              United     States     Senator
KC!wmem
Enclosure




      Page 64                                                 GAO/PEMD-90-24   Rural Drug Abuse
Appendix VIII

Major Contributors to This Report


                     Michael J. Wargo, Director
Program Evaluation   James Solomon, Assistant Director
and Methodology      John Oppenheim, Assignment Manager
                     Sushi1 Sharma, Senior Advisor
Division             Mark Rom, Project Manager




                Y




                     Page 65                              GAO/PEMD-90-24   Rural Drug Abuse
                                                                                       .

Bibliography


               “A Drug Trafficking Report.” Governing, October 1988, pp. 72-73.

               Adams, E. H. “Background Comments on Hard Core Cocaine Addicts:
               Measuring and Fighting the Epidemic.” National Institute on Drug
               Abuse, Division of Epidemiology and Prevention Research, Rockville,
               Maryland, 1990.

               Arkansas. Comprehensive Plan for Alcohol and Drug Abuse Prevention
               Activities, 1989-90. Little Rock: Department of Human Services, Divi-
               sion of Alcohol and Drug Abuse Prevention, November 1989.

               Arkansas. Statewide Strategy, Drug and Violent Crime Control, Anti-
               Drug Abuse Act of 1988, State and Local Assistance for Narcotics Con-
               trol Program. Little Rock: Alcohol and Drug Abuse Coordinating Council,
               January 1990a.

               Arkansas. Unpublished data. Department of Corrections, Pine Bluff,
               July 2, 1990b.

               Ashery, R. S., ed. Progress in the Development of Cost-Effective Treat-
               ment for Drug Abusers. NIDA Research Monograph 58. Washington, D.C.:
               U.S. Government Printing Office, 1985.

               Butynski, W., D. Canova, and S. Jenson. State Resources and Services
               Related to Alcohol and Drug Abuse Problems, Fiscal Year 1988: An
               Analysis of State Alcohol and Drug Abuse Profile Data. A report for the
               National Institute on Alcohol Abuse and Alcoholism and the National
               Institute on Drug Abuse. Washington, D.C.: National Association of State
               Alcohol and Drug Abuse Directors, 1989.

               Collins, J. J., and M. W. Zawitz. Federal Drug Data for National Policy.
               Washington, DC.: U.S. Department of Justice, Office of Justice Pro-
               grams, Bureau of Justice Statistics, April 1990.

               Edwards, E. D., and M. Egbert-Edwards. “Prevention of Substance
               Abuse in Rural Communities: A Report of the Rural Programs Section of
               the O.S.A.P. Conference.” Graduate School of Social Work, University of
               Utah, Salt Lake City, December 1988.

               Ellickson, P. L., and R. M. Bell. “Drug Prevention in Junior High: A
               Multi-Site Longitudinal Test.” Science, March 16, 1990a, pp. 1299-1305.




               Page 66                                       GAO/PEMD-W24   Rural Drug Abuse
Bibliography




Ellickson, P. L., and R. M. Bell. Prospects for Preventing Drug Use
Among Young Adolescents. Santa Monica: Rand Corporation, 1990b.

Gold, R. L., A. W. Gold, and P. Carpino. “Inventory of and Criteria for
Funding Montana’s Youth-Oriented, Drug Prevention Programs.” Pre-
pared for Montana Board of Crime Control by Social Research and
Applications, Missoula, nd.

Hawkins, J. D., and R. F. Catalano. “Aftercare in Drug Treatment.”        The
International Journal of the Addictions, 20 (1985), 917-45.

Hubbard, R. L., et al. Drug Abuse Treatment: A National Study of Effec-
tiveness. Chapel Hill: University of North Carolina Press, 1989.

Innes, C. A. “Drug Use and Crime: State Prison Inmate Survey, 1986.”
U.S. Department of Justice, Office of Justice Programs, Bureau of Jus-
tice Statistics, Washington, D.C., July 1988.

Institute of Medicine. Broadening the Base of Treatment for Alcohol
Problems. Washington, D.C.: Natyonal Academy Press, 1990.

Iowa. Annual Report of the State Drug Enforcement and Abuse Preven-
tion Coordinator, 1989. Des Moines: 1989a.

Iowa, Iowa Comprehensive Plan for Substance Abuse, 1989-90. Des
Moines: Department of Public Health, Division of Substance Abuse,
n.d.a.

Iowa. Iowa Strategy for Drug Control and System Improvement, 1990.
Des Moines: Department of Public Health, Governor’s Alliance on Sub-
stance Abuse, January 1990.

Iowa. 1987-88 Iowa Study of Alcohol and Drug Attitudes and Behaviors
Among Youth: Normative and Trend Data. Des Moines: Iowa Depart-
ment of Education, Instruction and Curriculum Division, Substance Edu-
cation Program, June 198913.

Iowa. “Overview of Drug-Free Schools and Communities.” Presentation
to DFSC application writing workshop, Des Moines, n.d.b.




Page 07                                       GAO/PEMD-90-24   Rural Drug Abuse
Bibliography




Iowa. “Recidivism - Alcohol and Drug Treatment Clarinda Correction
Facility/T.o.w. Program.” In Annual Report of the State Drug Enforce-
ment and Abuse Prevention Coordinator, 1989. Des Moines: Department
of Public Health, Division of Substance Abuse, 1989c.

Johnston, L. D., P. M. O’Malley, and J. G. Bachman. Drug Use, Drinking,
and Smoking: National Survey Results from High School, College, and
Young Adult Populations, 1975-1988. Ann Arbor: University of Mich-
igan, Institute for Social Research for the U.S. Department of Health and
Human Services, Alcohol, Drug Abuse, and Mental Health Administra-
tion, National Institute on Drug Abuse, 1989.

Krleg, M. “Analysis of Utilization and Outcome in Iowa Substance Abuse
Treatment Programs.” In Annual Report of the State Drug Enforcement
and Abuse Prevention Coordinator, 1989, Des Moines: Iowa Department
                                                              -
of Public Health, Division of Substance Abuse, 1989.

Lilienfeld, A. M., and D. E. Lilienfeld. Foundations of Epidemiology, 2nd
ed. New York: Oxford University Press, 1980.

Montana. “Drug Strategy.” Department of Institutions, Helena, n.d.a.

Montana. Montana Adolescent Health Status. Helena: Montana Coalition,
the Montana Office of Public Instruction, and the Montana Department
of Health and Environmental Sciences, March 1990a.

Montana. Montana Comprehensive Chemical Dependency Plan. Helena:
Department of Institutions, Treatment Services Division, Chemical
Dependency Bureau, n.d.b.

Montana. “Progress Report on FY 1989 Goals and Objectives.” Depart-
ment of Institutions, Treatment Services Division, Chemical Dependency
Bureau, Helena, 1989.

Montana. Unpublished data. Montana State Prison, Chemical Depen-
dency Program, Deer Lodge, June 19,199Ob.

National Association of State Alcohol and Drug Abuse Directors,
Research and Technical Assistance Committee. State Alcohol and Drug
Abuse Research. Washington, D.C.: 1990a.




Page 68                                      GAO/PEMD-90-24   Rural Drug Abuse
Bibliography




National Association of State Alcohol and Drug Abuse Directors. Treat-
ment Works: The Tragic Cost of Undervaluing Treatment in the “Drug
War.” Washington, DC.: 1990b.

North Dakota. The 1986 Alcohol and Drug Survey of North Dakota
Junior and Senior High Students. Bismarck: Department of Human Ser-
vices, Division of Alcoholism and Drug Abuse, November 1986.

North Dakota. North Dakota 1989 Statewide Drug and Violent Crime
Strategy. Bismarck: Office of the Attorney General, February 1989.

North Dakota. North Dakota Alcohol and Drug Abuse and Mental Health
Services Block Grant Application. Bismarck: Department of Human Ser-
vices, Division of Alcoholism and Drug Abuse, n.d.

Rahdert, E. R., and J. Grabowski, eds. Adolescent Drug Abuse: Analyses
of Treatment Research. NIDA Research Monograph 77. Washington, D.C.:
U.S. Government Printing Office, 1988.

Rouse, B. A., N. J. Kozel, and L. G. Richards. Self-Report Methods of
Estimating Drug Use. NIDA Research Monograph 57. Washington, D.C.:
U.S. Government Printing Office, 1985.

Sarvela, P. D., and E. J. McClendon. “An Impact Evaluation of a Rural
Youth Drug Education Program.” Journal of Drug Education, 17 (1987),
217-31.

Scheurich, J. “Evaluation of Alcohol and Drug Prevention Programs in
Kansas Secondary Schools, 1987-1988.” DCCCA Center, Lawrence,
Kansas, n.d.

Scheurich, J., and L. Hou. “Evaluation of the Department of Corrections’
Alcohol and Drug Treatment Programs.” DCCCA Center, Lawrence,
Kansas, January, 1990.

Shinn, R. Drug Abuse and Control: National Public Opinion Polls. Wash-
ington, DC.: Congressional Research Service, February 23, 1990.

Speckart, G., and M. D. Anglin. “Narcotics and Crime: An Analysis of
Existing Evidence for a Causal Relationship.” Behavioral Sciences and
the Law, 3:3 (1985), 259-82.




Page 69                                      GAO/PEMD-90-24   Rural Drug Abuse
                                                                     D

                                                                         I



Bibliography




Tims, F. M., and J. P. Ludford, eds. Drug Abuse Treatment Evaluation:
Strategies, Progress, and Prospects. NIDA Research Monograph 5 1. Wash-
ington, DC.: U.S. Government Printing Office, 1984.

U.S. Congress. Fighting Drug Abuse: A National Strategy. Report pre-
pared by the majority staffs of the Senate Judiciary Committee and the
International Narcotics Control Caucus. Washington, D.C.: January,
199oc.

U.S. Congress. Administering Antidrug Programs in Iowa: Federal, State,
and Local Coordination. Senate Hearing Before the Committee on Appro-
priations, 1Olst Cong., 2nd sess., S. Hrg. 101-505. Washington, DC.: U.S.
Government Printing Office, 1990a.

US. Congress. Hard-Core Cocaine Addicts: Measuring and Fighting the
Epidemic. Staff report prepared for the use of the Committee on the
Judiciary, US. Senate, 1Olst Cong., 2nd sess. Washington, D.C.: May 10,
1990b.

U.S. Department of Health, Education, and Welfare. “An Investigation
of Selected Rural Drug Abuse Programs,” Services research report.
Alcohol, Drug Abuse, and Mental Health Administration, National Insti-
tute on Drug Abuse, Washington, D.C., March 1977.

US. Department of Health, Education, and Welfare. “Nonurban Drug
Abuse Programs: A Descriptive Study.” Services research report.
Alcohol, Drug Abuse, and Mental Health Administration, National Insti-
tute on Drug Abuse, Washington, D.C., January 1978.

U.S. Department of Health and Human Services. “Block Grant Technical
Assistance Plan and Status Report.” Alcohol, Drug Abuse, and Mental
Health Administration, Office for Treatment Improvement, Washington,
DC., June 1990a.

U.S. Department of Health and Human Services. Drug Abuse in Rural
America. Treatment research report. Washington, D.C.: Alcohol, Drug
Abuse, and Mental Health Administration, National Institute on Drug
Abuse, 1981.

US. Department of Health and Human Services. National Household
Survey on Drug Abuse: Highlights 1988. Washington, DC.: Alcohol,
Drug Abuse, and Mental Health Administration, National Institute on
Drug Abuse, 199Oc


Page 70                                      GAO/PEMD-90-24   Rural Drug Abuse
Bibliography




U.S. Department of Health and Human Services. National Household
Survey on Drug Abuse: Population Estimates, 1988. Washington, D.C.:
Alcohol, Drug Abuse, and Mental Health Administration, National Insti-
tute on Drug Abuse, 1989.

U.S. Department of Health and Human Services. Prevention Research
Findings: 1988. Proceedings of the First National Conference on Preven-
tion Research Findings: Implications for Alcohol and Other Drug Abuse
Program Planning. OSAP Prevention Monograph 3. Washington, DC.:
Alcohol, Drug Abuse, and Mental Health Administration, 1988.

U.S. Department of Health and Human Services. “Substance .Abuse Ser-
vices Plan.” Draft report. Alcohol, Drug Abuse, and Mental Health
Administration, Office of Treatment Improvement, Washington, DC.,
1990b.

U.S. Department of Justice. “Attachment A, Narcotics Control Program,
Fiscal Year 90 Funds.” Bureau of Justice Assistance, Washington, D.C.,
1990a.

U.S. Department of Justice, Federal Bureau of Investigation. Crime in
the United States, 1988. Washington, D.C.: U.S. Government Printing
Office, 1989a.

U.S. Department of Justice. Evaluating Drug Control and Svstem
           A                          ”     ”                    ”


Improvement Projects: Guidelines for Projects Supported by the Bureau
of Justice Assistance. Washington, D.C.: National Institute of Justice,
Office of Justice Programs, August 1989b.

US. Department of Justice. “Evaluating Drug Control Initiatives Confer-
ence Agenda.” National Institute of Justice, Office of Justice Programs,
Washington, D.C., 1990b.

U.S. Department of Justice. 1988 Drug Use Forecasting Annual Report.
Washington, DC.: National Institute of Justice, Office of Justice Pro-
grams, March 199Oc.

US. Department of Justice. “Panel Briefs.” National Institute of Justice,
Office of Justice Programs, Washington, D.C., 1990d.

U.S. Department of Justice. “A Report of the Findings of a Survey of the
Nation’s Jails Regarding Jail Drug Treatment Programs.” Draft report.



Page 71                                         GAO/PEMD-90-24       Rural Drug Abuse
           Bibliography




           Office of Justice Programs, Bureau of Justice Assistance, Washington,
           D.C., May 1990e.

           U.S. Department of Justice. Uniform Crime Reporting, National Incident-
           Based Reporting System, Vol. 1. Data Collection Guidelines. Washington,
           DC.: Federal Bureau of Investigation, July 1988.
           U.S. Department of Justice. Unpublished data. Federal Bureau of Inves-
           tigation, Washington, D.C., 1990f.

           U.S. General Accounting Office, “Comprehensive Drug Education for
           Young Adolescents.” Program Evaluation and Methodology Division,
           Washington, D.C., forthcoming.

           U.S. General Accounting Office. “The Department of Justice’s Efforts to
           Compile State Crime Statistics.” GAO/T-GGD-90-33. Statement of Lowell
           Dodge, Director, Administration of Justice Issues, General Government
           Division, before the Subcommittee on Criminal Justice, Committee on
           the Judiciary, U.S. House of Representatives, Washington, D.C., April
           19, 1990.

           U.S. General Accounting Office. “Impact of Drug Free Schools Program
           on Combating Drug Abuse.” Human Resources Division, Washington,
           DC., forthcoming.

           Utah. “Main Findings Utah Household Survey on Substance Abuse.”
           Prepared for the Utah Department of Social Services, Division of Sub-
           stance Abuse by Dan Jones & Associates, Salt Lake City, 1989.

           White House. National Drug Control Strategy. Washington, D.C.: U.S.
           Government Printing Office, September 1989.

           White House. National Drug Control Strategy. Washington, D.C.: US.
           Government Printing Office, January 1990.

           Wish, E. D., and B. D. Johnson. “The Impact of Substance Abuse on
           Criminal Careers,” pp. 52-88. In Criminal Careers and “Career
           Criminals,” A. Blumstein et al., eds. Washington, DC.: National
           Academy Press, 1986.




(978818)   Page 72                                     GAO/PEMD90-24   Rural Drug Abuse
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