Drug Use Measurement:

Strengths, Limitations, and Recommendations for Improvement

PEMD-93-18: Published: Jun 25, 1993. Publicly Released: Aug 2, 1993.

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Pursuant to a congressional request, GAO evaluated three prominent drug prevalence studies currently sponsored by the federal government, focusing on the: (1) degree of data concordance; and (2) strengths and limitations of each study.

GAO found that: (1) the rate of cocaine use among arrestees in 1990 was 22 times higher than the rate for high school seniors and 53 times higher than the rate for households; (2) arrestees' cocaine use remained stable from 1987 to 1990; (3) all groups showed a decrease in the use of marijuana; (4) between 1979 and 1990, general household drug use decreased by 60 percent and high school senior drug use decreased by 62 percent; (5) between 1987 and 1990, arrestee marijuana use decreased by 48 percent; (6) the National Household Survey on Drug Abuse (NHSDA) employs a highly developed research design that emphasizes a national multistage probability sampling procedure; (7) the High School Senior Survey (HSSS) uses a national multistage probability sampling procedure for collecting drug use data on approximately 15,000 to 19,000 high school seniors each year; (8) arrestees underreported cocaine use by more than 50 percent in 20 sites, raising questions about the utility of the self-report procedure for this population group; (9) survey findings do not support the annual collection of data on the various forms of substance abuse among high school students and the general population; (10) adequate state-level drug use data are necessary to assist local policymakers in the planning and evaluation process; and (11) proposals to expand NHSDA to the state level are costly and potentially duplicative of other funded studies.

Matter for Congressional Consideration

  1. Status: Closed - Not Implemented

    Comments: Congressional interest in annual reporting of drug use estimates was reiterated in the Crime Control Act of 1994. Congress has not subsequently taken action on the issue.

    Matter: To reduce costs with no meaningful loss of information, Congress should amend part A of title V of the Public Health Service Act to provide that the Secretary of Health and Human Services collect survey data only biennially, rather than each year, on the national prevalence of the various forms of substance abuse among high school students and among the general population. But if local or regional indicators portend an increase in drug use, then the Secretary should have the authority to initiate new or augment current studies to determine the nature and degree of the problem.

Recommendations for Executive Action

  1. Status: Closed - Implemented

    Comments: The Department concurred. New training procedures and methodological guidelines have been instituted to support standardization.

    Recommendation: The Director, National Institute of Justice, should review the practicality of improving the Drug Use Forecasting (DUF) design, such as by using a standardized methodology across sites.

    Agency Affected: Department of Justice: Office of Justice Programs: National Institute of Justice

  2. Status: Closed - Implemented

    Comments: The Department concurred with this recommendation and does not intend to change the current design of this instrument.

    Recommendation: The Secretary of Health and Human Services should retain the current design of NHSDA to provide national estimates only, and not expand the design to provide state-level estimates of drug use.

    Agency Affected: Department of Health and Human Services

  3. Status: Closed - Not Implemented

    Comments: The Department concurred. However, the Department argues that HSSS is performed under a grant that has been approved through 1997 and that the principal investigator has jurisdiction over the survey. Any modifications in sample design would have to be proposed by the principal investigator, would take at least 1 school year to incorporate, and would require additional funding.

    Recommendation: The Secretary of Health and Human Services should incorporate methodological design changes into HSSS so that nonwhite individuals are adequately sampled.

    Agency Affected: Department of Health and Human Services

  4. Status: Closed - Implemented

    Comments: The Department concurred. The National Institute of Drug Abuse has begun to investigate methods to improve the validity of self-reported data, including the use of objective techniques. NIDA conducted a technical review of alternative methods to address validity and reliability issues on September 8 and 9, 1994, as part of an overall review of this issue. A national health and pregnancy survey collected hair and urine samples to validate self-reports. Further studies on the validity of self-reports are being solicited, along with a SBIR project on collecting self-report data through interactive computers.

    Recommendation: The Secretary of Health and Human Services should give high priority to validating self-reports of the use of illicit drugs, particularly focusing on objective techniques such as hair testing.

    Agency Affected: Department of Health and Human Services

  5. Status: Closed - Implemented

    Comments: The Department concurred. The Public Health Service conducted studies of drug use prevalence rates among various hard-to-reach populations, including a 3-year study of drug use in a large metropolitan area. NIDA has solicited research on high-risk groups, including the homeless, AIDS populations, border populations, Native Americans, rural populations, and Mexican-Americans.

    Recommendation: The Secretary of Health and Human Services should design and conduct a systematic program for the study of drug use prevalence rates among underrepresented, high-risk groups.

    Agency Affected: Department of Health and Human Services

  6. Status: Closed - Implemented

    Comments: The Department concurred. Analyses and evaluations of available data are being planned to study issues related to underreporting undercoverage and overlaps between data. The development of supplemental surveys is intended. The Office of Applied Studies, SAMHSA, is continuing to work on drug prevalence measurement, using ratio estimation methods. NIDA has solicited grants for small area analysis covering heroin and cocaine. These efforts are ongoing.

    Recommendation: The Secretary of Health and Human Services should develop or improve supplementary data sources to more appropriately determine heroin and cocaine prevalence patterns and trends.

    Agency Affected: Department of Health and Human Services

  7. Status: Closed - Implemented

    Comments: The Department concurred. A new director has been appointed and the program moved to the Office of Research and Evaluation. Catchment areas and arrest categories have been clarified to permit greater generalization. Representativeness of past samples is being checked. Other improvements are planned.

    Recommendation: The Director, National Institute of Justice, should give priority to creating a DUF arrestee database that can be generalized to booked arrestees in the geographic areas surveyed.

    Agency Affected: Department of Justice: Office of Justice Programs: National Institute of Justice

 

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