Differential contributions of family and peer factors to the etiology of narcotic addiction.

This retrospective study investigated relationships among early family circumstances, peer associations, and narcotic addiction in a sample of 601 urban males. Results of logistic regression analyses indicated that the extent of deviant behavior among close friends at ages 12-14 and disruption in family structure (parental divorce/separation) prior to age 11 were significantly associated with narcotic addiction. Additional regression analyses indicated that deviant behavior among family members, as well as family disruption, experienced prior to age 11, also increased the probability of association with deviant peers and a negative home atmosphere at ages 12-14. Implications of these findings for preventive interventions and for future research are presented.

The early emergence of narcotic addict types.

Providing retrospective self-reports of their activities, perceptions, and experiences during their early adolescent years (ages 12 to 14), 255 narcotic addicts were classified into four distinct types on the basis of a clustering technique applied to risk factor information derived from five major descriptive domains: family; peer deviance; personal deviance; psychological status; and protective factors. Differentiations among the types largely involved the extent of early drug and other behavioral deviance and family dysfunction. The predictive utility of the typology was examined in terms of outcome over the first ten years of the addiction career, including age at first narcotic addiction, amount of time incarcerated, and percentage of time addicted while in the community. The implications of the typology for both substance abuse prevention and treatment are discussed.

Early family adversity as a precursor to narcotic addiction.

This retrospective study examined differences among three groups of urban males in the prevalence of various family risk factors occurring before age 11 and their independent contributions to subsequent deviance. The groups included: narcotic addicts; never-addicted peer controls who were associates of the addicts at age 11; and never-addicted community controls not associated with the addicts. Sixty-four percent of the addicts, compared to slightly under 40% of both control groups, reportedly experienced one or more family risk factors involving deviant behavior among family members and family disruption before age 11. While community controls differed from addicts on both family deviance and disruption in family structure, peer controls differed from addicts only on disruption of family structure. For the total sample, both family deviance and family disruption experienced before age 11 were significantly associated with crime severity level at age 11. Implications of these findings for future substance abuse research and intervention are discussed.

Drug abuse treatment in the context of correctional surveillance.

Evaluating drug abuse treatment within a correctional framework presents unique issues and challenges. Given their respective emphases on rehabilitation and incapacitation, treatment and corrections approaches to incarcerated drug abusers often differ in methods aimed at reducing deviant behavior. Although this results in problems in planning integrative drug abuse intervention strategies, the two approaches are not always incompatible. Corrections can help identify those individuals in need of treatment, and for some of these, treatment can lessen the need for incapacitation. Understandably, gaining a drug-abusing offender's cooperation in monitoring routines and engendering trust in the confidentiality of treatment conducted in criminal justice systems settings, while still ensuring public safety, are not easy tasks. Nevertheless, there are decided advantages, in terms of compliance and retention, to the increased surveillance exercised by the criminal justice system in community-based treatment efforts. In these efforts, therapy coupled with urine monitoring appears particularly promising. Along with the presentation of descriptive and preliminary outcome information, this report provides a discussion of treatment/corrections issues within the framework of an ongoing treatment evaluation study involving drug-abusing parolees in Baltimore City.

The nature and status of drug abuse treatment.

This article focuses on the effectiveness of the major drug abuse treatment modalities (methadone maintenance, therapeutic communities, outpatient drug-free programs, and short-term detoxification) in the United States. It includes findings specific to individual clients and to particular modalities. Methadone maintenance, therapeutic communities, and outpatient drug-free treatment are generally effective in reducing illicit narcotic use and the criminal activity that often accompanies narcotic addiction. These effects are usually short-term, however, and more than one treatment episode is often required for long-term recovery. Longer time in treatment, pretreatment employment, and lack of pretreatment criminality are generally associated with favorable outcome regardless of modality. Issues needing further study, such as treatment for nonnarcotic (mainly cocaine) use, matching clients to treatments, and evaluating the cumulative effects of multiple treatment episodes, are discussed, along with the authors' research on the relationship between drug abuse, crime, and treatment in Maryland.

Trends in criminal activity and drug use over an addiction career.

The present study, involving 132 narcotic addicts with multiple periods of addiction, examines trends in criminal activity and drug use over successive periods of addiction and successive periods of nonaddiction during an average 15-year addiction career. Significant decreases over successive addiction periods were found for four (of five) categories of crime: theft, violence, drug distribution, and "other" crime (primarily gambling). These results appear to be accounted for by a disproportionately high level of crime during the first addiction period. Criminal activity, most notably theft and violence, decreased over successive periods of nonaddiction, though not significantly. Although more evidence is needed, a particularly large addiction vs nonaddiction disparity in crime rates for Hispanic addicts revealing a low propensity for crime when not addicted suggests that crime reduction may be a reasonable objective in the treatment of these individuals. With regard to drug use over the addiction career, the most dramatic increases over time were found for illicit methadone and cocaine. Rates of heroin and marijuana use declined. Generally, nonnarcotic drug use, other than use of cocaine and Valium, tended to decrease progressively over time regardless of addiction status. These results, along with findings relevant to the "maturing out of addiction," are discussed.

The consistency of types of criminal behavior over preaddiction, addiction, and nonaddiction status periods.

Using self-report information provided by 250 male admissions to methadone maintenance/detoxification clinics in Baltimore and New York City, separate criminal typologies were derived for prior periods of addiction and nonaddiction in the community. Although far more crime was committed during periods of addiction, comparison of the typologies indicated highly consistent individual patterns regarding the kinds of crime that were committed over periods of addiction and nonaddiction. The association between early deviant behavior and later criminal involvement over an addiction career was determined by relating preaddiction characteristics to both the addiction and nonaddiction typologies. It was found that crime patterns established before addiction, although intensified by addiction, tended to persist throughout the addiction career. Correspondence between the present typology results and those found in an earlier Baltimore sample of 354 addicts was high with respect to both the number and descriptive characteristics of the types derived. Implications of this research with regard to the early identification of the most criminally prone individuals are discussed.

Differences among treatment clinic types in attitudes toward narcotic addiction.

Factor analysis of data from a general survey of attitudes and opinions concerning narcotic addiction and its treatment revealed 10 major dimensions, five of which were likely to have significant implications for drug abuse intervention strategies. For these latter dimensions, differences were determined among clients and staff according to type of treatment clinic (three types involving the provision of methadone maintenance in various combinations with other treatments and one involving the use of abstinence only). The most pronounced differences were between the methadone clinics and those offering abstinence only. Both the clients and staff of abstinence clinics were more skeptical concerning treatment effectiveness, were more negative regarding the use of narcotic drugs, and were more disposed to the use of ex-addict counselors and group procedures in treatment.

Nonnarcotic drug use over an addiction career--a study of heroin addicts in Baltimore and New York City.

Detailed interview data from 250 male narcotic addicts attending methadone maintenance treatment centers in Baltimore and New York City were used to confirm and extend previous findings regarding the frequency of nonnarcotic drug abuse among relevant addict subgroups. Consistent with earlier results, abuse of nonnarcotic drugs in general, and particularly cocaine, was higher during periods of addiction than during periods of nonaddiction. Overall, marijuana and cocaine were the two main drugs of abuse, but variations were present according to addiction status period, city, and ethnic group membership. Relationships between cocaine use and specific types of criminal activity were also examined. It was found that there were high associations between cocaine use and several different kinds of crime.

MMPI-168 profiles of male narcotic addicts by ethnic group and city.

MMPI-168 profiles were obtained on 225 male narcotic addicts who were attending methadone maintenance clinics in Baltimore and New York City during 1983 and 1984. Data were collected on Black and White (Anglo, other than Hispanic) addicts in Baltimore and on Black, Hispanic, and White addicts in New York City. In general, the profiles indicated high levels of psychopathology, with particularly high elevations on the F, D, PD, PT, and Sc scales. Consistent across cities and in agreement with earlier findings, profiles of Whites indicated somewhat more maladjustment than those for Blacks, while the profiles of Hispanics displayed essentially the same levels of disturbance as those for Whites. Comparisons by city revealed greater deviance for New York City subjects, a finding more evident among Whites than among Blacks.

Attitudes toward narcotic addiction.

In an effort to isolate the major dimensions of attitude and expectation regarding narcotic addiction and its treatment and to compare different groups of addict/clients and agency staff on these factors, a comprehensive questionnaire was administered to 900 addict/clients and 237 agency personnel in 25 drug treatment clinics in six states. Results of a factor analysis, which used questionnaire data from all of the 1137 subjects so that direct group comparisons could be made, indicated the presence of 10 major dimensions of attitude and expectation. Results also suggested considerable variation, particularly by status (client vs. staff) and ethnic group, on these dimensions. An additional analysis of staff attitudes and expectations revealed correlations with years of education, ex-addict status, and years of work experience. Such findings suggest the need to consider client/staff characteristics and attitudes in the planning of treatment services for narcotic addicts. An abbreviated (53-item) attitude and expectation questionnaire was developed for this purpose.

The relationship of preaddiction characteristics to the types and amounts of crime committed by narcotic addicts.

Postaddiction crime rates among narcotic (principally heroin) addicts in five different areas (theft, violence, dealing, confidence games, and other crime) were found to be substantially related to a number of preaddiction characteristics, especially criminal activity and drug and alcohol use prior to addiction to narcotics. Early family influences such as lack of religious training, history of parents' arrest, and use of drugs and alcohol by other family members also appear to play an important role. Early identification of extremely crime-prone individuals followed by intensive intervention efforts might reduce the amounts of crime such persons might otherwise commit.

A comparison by ethnic group and city of the criminal activities of narcotic addicts.

In an effort to update the results of earlier studies concerning the amounts and types of crimes committed by urban, male narcotic addicts, confidential interviews were conducted with addicts attending methadone maintenance clinics in Baltimore and New York. Samples were stratified by ethnic group (black and white in Baltimore; black, white, and Hispanic in New York), and the amounts and types of crimes committed were compared across groups, cities, and narcotic addiction status (actively addicted/not actively addicted) using six different measures all based on the concept of crime-days per year at risk. Consistent with previous findings, addicts were found to engage in a great deal of criminal activity, especially during periods of active addiction to narcotics. Differences in the amounts and types of crimes committed were found among ethnic groups and, to a lesser extent, between cities as well. For the Baltimore sample, comparison of findings with those derived from an earlier (1973-78) data base suggests that the amount of crime committed by addicts has increased in several categories as well as overall. However, minor differences in data collection procedures render this finding suggestive rather than conclusive.

A comparison by race/ethnicity of narcotic addict crime rates in Baltimore, New York, and Philadelphia.

In an effort to provide timely information concerning the criminal activities of narcotic addicts in three different metropolitan areas, male narcotic addicts attending methadone maintenance/detoxification centers in Baltimore, Philadelphia, and New York City participated in extensive, confidential interviews conducted between May 1983 and April 1984. The information obtained focused on the amounts and types of crimes committed during the addict's longest period of active addiction to opiates, their derivatives and synthetics, as well as his first period of nonaddiction. Crimes committed were placed in one of five categories as follows: Theft, Violence, Drug Sales, Deception/Forgery, and Other. Several different measures of criminal activity were utilized, all embodying the concept of crime-days per year at risk. Such crime-days measures involve annualizing, i.e., the number of crime-days accumulated by each subject in each category during a specified time at large in the community is expressed as crime-days per year at risk by taking the ratio of crime-days to total days at large and multiplying by 365. Addicts were compared by race/ethnicity (Black, White, and Hispanic) within cities as well as by race/ethnicity across cities using one-way analysis of variance procedures. Addict crime rates were also compared for the period of active addiction and nonaddiction. Several mean differences by race/ethnicity within city, as well as by race across cities, were noted. Moreover, crime rates tended to be higher during the period of active addiction. In this sense, then, drugs may be said to "drive" crime.

Trends in the commission of crime among narcotic addicts over successive periods of addiction and nonaddiction.

Although several studies have documented high levels of criminal activity among narcotic addicts, especially during periods of active addiction, few studies have delineated the types of criminal activities involved or have attempted to uncover trends in such activities over successive periods of addiction and nonaddiction in addicts' careers. In the present series of analyses, the criminal activities of 354 male narcotic addicts were categorized and traced individually over time using five, standardized, crime-days-per-year-at-risk measures in the areas of theft, violence, drug sales, deception/forgery, and other crimes. In addition, a sixth composite measure was also employed. Although large differences among addicts in patterns of criminal activity over time were much in evidence and may be useful as a basis for a criminal typology, this same heterogeneity tends to preclude definitive statements concerning addicts as a group. This caveat notwithstanding, there does appear to be a general tendency for criminal activity to diminish over successive periods of nonaddiction and to increase irregularly over successive periods of addiction. The agreement of these findings with those of earlier group analyses by the authors is discussed.

An empirical typology of narcotic addicts.

On the basis of structured interview data concerning their life-styles, behaviors, circumstances, and activities during their most recent periods of addiction, 460 male narcotic addicts (230 Black and 230 White) were empirically classified, or "typed," using factor and cluster analytic techniques in a multistage process. Mean factor score profiles for each of the eight types derived are presented, along with provisional labels and verbal descriptions. It is believed that this classification is descriptive of the major addict types to be encountered in a large urban population.

Factor structure of the MMPI-168 in male narcotic addicts.

Factor analyses of abbreviated clinical and validating scales derived from the MMPI-168 yielded essentially the same solutions reported for full-length versions of the inventory. However, previously derived item-level factor scales did not emerge as distinct factors. Although the factor structures associated with black and white narcotic addict samples (N = 460) were highly similar, significant mean differences between the racial groups on many of the scales suggested the presence of greater psychopathology among white addicts.