------------------------------------------------------------------- Transcript - Arrestee Drug Abuse Monitoring Program, Part 1 Of 2 (National Institute Of Justice News Conference On NIJ's New Arrestee Drug Abuse Monitoring Program - ADAM) Date: Fri, 2 Jan 1998 00:16:47 -0800 To: email@example.com From: Majordomo@mapinc.org Subject: DND: US: Transcript: Arrestee Drug Abuse Monitoring Program [Part 1 of 2] -- ] Subj: US: Transcript: Arrestee Drug Abuse Monitoring Program [Part 1 of 2] ] From: Ethan Nadelmann ] Date: Thu, 01 Jan 1998 13:48:28 -0500 Source: News Conference, Tuesday, 23 December, 1997 Speakers: Jeremy Travis, Director, National Institute Of Justice; Sally Hillsman, Deputy Director, National Institute of Justice; K. Jack Riley, Director, Adam Program, National Institute Of Justice [Part 1 of 2] NATIONAL INSTITUTE OF JUSTICE OFFICIALS HOLD NEWS BRIEFING ON EXPANSION OF ARRESTEE DRUG ABUSE MONITORING (ADAM) PROGRAM TRAVIS: Good morning. My name is Jeremy Travis. I am the director of the National Institute of Justice, and I am very pleased to welcome all of you to this morning's announcement regarding the institute's new arrestee drug abuse monitoring, or ADAM -- A-D-A-M -- program. And I am joined today by Sally Hillsman on my far left, who is the deputy director of the National Institute of Justice and heads up our research and evaluation office. And to my immediate left is Dr. Jack Riley, who is the director of the institute's ADAM program. In a moment, I will ask Dr. Riley to describe to ADAM program in some detail. But I would like to first take a few minutes to set a broader context for today's announcement. At both the national level and at the local level there is a strong desire to develop a greater understanding of the drug problems facing our communities. As a nation, we have implemented a number of surveys that document the changing nature of drug abuse. The Monitoring the Future Survey recently released focuses on high school students. The Household Survey, as its name implies, focuses on households. And the Drug Abuse Warning Network, or the DAWN Survey, captures data on drug abuse from emergency room admissions. For the past 10 years, the National Institute of Justice has administered another survey that helps to create a national composite. This has been called the Drug Use Forecasting, or DUF program, under which we conduct anonymous confidential interviews with randomly selected arrestees who are in police facilities awaiting their first court appearance. The standard interview consists of questions about drug abuse, about criminal involvement, as well as social history information. We also take urine samples to determine recent drug use so that the data reported from the DUF program does not rely upon self reports. Over the past decade, the DUF program has provided powerful corroboration of the relationship between crime and drug use. Consistently, in city after city, over the entire 10 year period, we have found that between half and three quarters of all arrestees test positive for drugs at the time of their interview. The DUF program has also documented changes in drug use patterns, including, for example, the upward and then downward trends in crack use; the rise, fall and apparent rise again in methamphetamine use; and the rise in marijuana use among juveniles. Most importantly, from our point of view, the DUF program has provided a powerful window into the world of criminal behavior that has allowed (ph) researchers and policy-makers to learn in a timely fashion about important, street-level changes in that world of criminal behavior. For example, using the DUF program, the National Institute of Justice has conducted research on access to illegal handguns, research on variations in drug markets, and we have constructed profiles of methamphetamine users. All of these research studies, we believe, have contributed to understanding of the world of criminal behavior and drug abuse. For the same period of time, the DUF program has also, however, experienced limitations. Most significantly, it has been limited to 23 cities for the past 10 years. And as a result, the DUF program has not captured drug abuse patterns in most American urban centers nor has it documented drug abuse patterns in rural America or suburban jurisdictions at all. These limitations have become particularly acute as the nation has witnessed a sharp surge in methamphetamine use, which, as we know now, is a particular Western and rural phenomenon. About 18 months ago, Attorney General Reno asked the National Institute of Justice to develop a plan to expand the DUF program to provide tools for a much broader understanding of drug use patterns around the country. With her very strong encouragement and with the active support of General Barry McCaffrey, who is the director of the Office of National Drug Control Policy, and Tom Contantine, who is the administrator of the Drug Enforcement Administration, and Dr. Al Leshner, who is the director of the National Institute of Drug Abuse, with their strong support, NIJ has now developed ADAM, the Arrestee Drug Abuse Monitoring program. As the successor of the DUF program, ADAM is projected to grow over the next three years from the current 23 cities to 75 cities and have a presence in every city in the United States over 200,000 in population. TRAVIS: President Clinton's budget for fiscal year '98 contained a request to the Congress to fund the first phase of that three-year expansion, that expansion to 35 cities. And Congress has now provided the funding in the recently enacted budget. So today, we are formally announcing the creation of the ADAM program and the selection of the next 12 ADAM sites. This is an important towards creation of a known national system for monitoring drug abuse within the criminal population, which is a very important group in terms of our broader interest in breaking the linkages between drug abuse and crime. When fully operational, the national ADAM program will cover the 75 largest cities in the country -- these cities account for almost half of our homicides -- and will include annual surveys in rural, suburban and travel jurisdictions. Although this national coverage is important, the structure of ADAM recognizes the drug abuse problems are highly localized in nature. The ADAM protocols that we're announcing today call for the creation of local coordinating committees to use the ADAM survey to ask research questions of local policy relevance. So we think that this balance between national coverage and local focus makes ADAM a powerful tool for practitioners and researchers alike who are interested in developing more effective responses to challenges in drug abuse. So I now (ph) turn the presentation over to Dr. Jack Riley, and we'll both be available, as will Dr. Sally Hillsman, for any questions. RILEY: Thank you, Jeremy. I'd like to start with a brief description of the ADAM system and what the program means in terms research and policy relevance both at the local and national level with respect to substance abuse issues. As Jeremy mentioned, the program is relatively simple in concept. It's a base interview, approximately 15 to 20 minutes in length, combined with a drug test that confirms or validates reports of recent drug use. In that sense, the program is designed to provide basic prevalence information on drug use among arrestees. And that's the context in which the predecessor program, the drug use forecasting program, has primarily been used. The key new feature of the ADAM system is to transform this program into a system that not only facilitates research, but facilitates local policy adjustments and local policy approaches to substance abuse, criminal justice and other social issues. To that extent, the ADAM program makes frequent and extensive use of special topic studies. These are supplemental questionnaires that are added to our base interview and are used to address issues that are of either local, regional or national importance. At the publications table, over to my right, there are examples of a number of different special topic studies that we have done and administered through special questionnaires over the course of the past two years -- including a study on methamphetamine use; arrestee attitudes and use of firearms as well as access to firearms; crack's decline and changes in crack consumption; a preview of a study of drug market participation in six ADAM sites. In addition, we're in the process of developing national addenda, as we call these supplemental questionnaires, on gang activity, substance abuse, alcohol use and domestic violence, and a variety of other topics relating to policing practices. All of these subjects are designed to provide local policy-makers and local researchers, as well as national policy-makers and national researchers, direct policy relevant information on subjects that are of interest to them in their communities. It's also important to note that this system can be used to conduct longitudinal studies. We provide direct access to the arrestee population, a population that is involved in a variety of different socially harmful and socially costly activities. We are currently using a site in Birmingham, Alabama, to conduct a longitudinal evaluation of a community intervention called "Breaking the Cycle." This is a program of universal needs assessment for substance abuse services at the time of arrest, followed by the development of a tailored program addressing substance abuse needs. The ADAM system serves as the platform by which that program will be evaluated over the course of the next two years. RILEY: In addition to the special studies feature of the program, ADAM represents important new distinctions from the drug use forecasting program. Perhaps the most important is the geographic expansion of the program. The addition of 12 new sites -- which are listed to my right, your left -- provides important eyes and ears on subjects as substance abuse, in this case in the western United States, which is where we started the expansion of the program. An equally important component of the program however is the outreach component of the program. This is the rotating supplemental data collection that Director Travis mentioned through which each of the communities where we routinely and consistently collect data will have the opportunity in conjunction with NIJ and in conjunction with their own coordinating council at the local level to select a supplemental population - -- it may be rural; it may be tribal lands; it may be juveniles; it may be the general arrestee population from surrounding counties -- to study with respect to substance abuse issues. These are populations that, until this component of the program was developed, we were not routinely able to develop information on and provide information to national, state and local policy-makers. A second important distinction between the ADAM and the DUF program is the Department of Local Coordinating Councils. These are local bodies constituted by NIJ and charged with three primary responsibilities. The first is scanning for those outreach ideas that I just mentioned. We believe very strongly that state and local policy- makers should develop the ideas for the outreach data collection. They are the people who know or have a sense for where the problems with respect to substance abuse, in their communities and their states, are developing. And we will be reliant on these coordinating councils to scan for those outreach opportunities. Second, the local coordinating councils will be charged with developing ideas for special topic studies. Again, as we've seen with substance abuse issues over the course of the last decade and the drug use forecasting program, there is no one single drug problem when you get down to the community level. Community needs vary tremendously depending on local circumstances. We expect that local circumstances will help dictate the types of special studies that are undertaken in these communities. And then finally, the coordinating councils will have responsibility for local dissemination and integration of this data in a policy context. We will collect the data. We will assist them in the dissemination. But ultimately, the process of making use of these data in the local community context will fall upon the local coordinating councils. It's also important to note that the ADAM system provides each community with the opportunity to collect data among both adult and juvenile detainees. The former drug use forecasting system collects the data from adults in 23 sites, and from juveniles in 12 sites. We're very pleased to have the opportunity to extend the data collection in all 35 sites to include both adult and juvenile detainees where it's possible. I'd like to say a few words on the significant cooperation that this program has experienced with other local, state and federal organizations as a part of developing the platform. Director Travis mentioned the Office of National Drug Control Policy, which has played an important role in supporting us as we moved from the drug use forecasting system to the arrestee drug abuse monitoring system. In addition, we have developed important collaborations with other federal organizations, such as the Center for Substance Abuse Treatment, on the issue of developing state-level estimates of the need for treatment among arrestees; the Centers for Disease Control on testing a sub-population of the arrestees for the prevalence of certain sexually transmitted diseases; and international audiences on the possibility of developing an international platform, taking ADAM to foreign sites in some context in the coming years. This program is a staged ramp-up. Today, marks the move from 23 to 35 sites. We hope next year to be able to take the program to an additional 15 locations, an additional 25, bringing us up to 75 in FY 2000, and have a fully functioning system in place with 75 routinely collected sites plus outreach operating at peak capacity in FY 2001. As I mentioned earlier, we started the process of expansion in the western United States in large part because of the concern about our lack of information on methamphetamines use, but also because generally that was an area of the United States where the DUF program lacked geographic coverage. To my right, the four sites that are listed in blue -- Minneapolis, Sacramento, Albuquerque and Tucson -- are the first sites that we expect to begin collecting data some time in January or February. RILEY: In other words, in the first quarter of the new calendar year. The remaining sites that are listed -- Anchorage, Seattle, Spokane, Salt Lake City, Las Vegas, Des Moines, Oklahoma City and Laredo -- we will roll out in terms of data collection over the course of the next several months in the new calendar year. It is important to understand what the communities put into the process of becoming an ADAM site, and we asked when we sent out a request for proposals and concept papers to these communities that they address several interests or several issues in their application. We want to see the demonstration of what the community interest in the program was -- what context they did use the data; what were their local needs with respect to substance abuse issues, particularly among arrestees; and how would this program fit in that context. We asked about their capacity to collect the data. Would they be able to guarantee our access to their facilities and to collect the data according to a prescribed national protocol? We asked for their ideas about special studies. What are the community's needs with respect to special topical issues? We got a wide variety of responses from these communities. Perhaps the most important and the most consistent across all these sites was the interest in gang activity, and that's why we have undertaken the development of a national addendum on gang activity that we expect to start fielding sometime in 1998. And then finally, we asked these communities to give us some of their ideas about outreach for all the parts in their states or in their surrounding communities where they lacked data on substance abuse trends and substance abuse issues and where implementation of data collection would provide high-value added or high leverage toward understanding substance abuse issues in their community and in their state. So the result of the process is the 12 communities, as I indicated at my right. And if you take a look to my left, you will see a chart that shows what the national system looks like. In this case, the newest sites are listed in red, and the existing sites -- carryovers from the drug use forecasting program -- are noted in blue. We are very pleased to be here today announcing the expansion of the program and look forward to your questions. Thank you. QUESTION: Does this now mean that there will be a continuing physical presence of some additional people at these various locations to collect the -- to do the interviews, to do the drug tests, to analyze the data? TRAVIS: We conduct these surveys on a quarterly basis. So every quarter there will be a random selection of arrestees who will then be administered the survey questionnaire and from whom we will take urine samples. So it's not continuous, but it's pretty frequent. So it's on a quarterly basis. QUESTION: Now these will be people who go from Washington or from where? TRAVIS: We have established relationships at the local level with typically universities or some of the research entities, sometimes governmentally based, and they are the ones who actually conduct the interviews. So the relationship between NIJ and the local site is a -- an -- ongoing relationship that helps support the actual interview activity. So they collect the data, and then that gets aggregated up to a national level. But we are particularly interested in local variation, because the drug problems are really quite different from community to community. [continued in Part 2]
------------------------------------------------------------------- Transcript - Arrestee Drug Abuse Monitoring Program, Part 2 Of 2 Subj: US: Transcript: Arrestee Drug Abuse Monitoring Program [Part 2 of 2] From: Ethan Nadelmann Source: News Conference, Tuesday, 23 December, 1997 Speakers: Jeremy Travis, Director, National Institute Of Justice; Sally Hillsman, Deputy Director, National Instituteof Justice; K. Jack Riley, Director, Adam Program, National Institute Of Justice [Part 2 of 2] QUESTION: Do you follow examples of how these surveys have been used practically, you know, in the past? TRAVIS: Well, it's a real important question. One of the powers of the ADAM program is that it is a collection of data at the local level where a lot of policy is made on responses to the drug use problem, and where we are working to increase the timeliness of the data coming back to the local community. So we view -- the institute -- the local policy level relevance of the ADAM program is one of the primary strengths of this particular approach. So what are the types of questions that some of the local policy coordinating councils might be looking at? Jack Riley mentioned some. The profile of methamphetamine users that we published has particular interest to people who are interested in public health issues on who is coming into the criminal justice system that has a methamphetamine problem. How do you think about treatment availability for this particular group of individuals? Another one that would be more on the enforcement side, the publication that we have a preview of here that we are about to release next month looks at the variations in local drug markets. We've asked arrestees, how do you access your drug supply? TRAVIS: How often do you have to go into drug markets to be able to buy drugs? Do you buy from the same user -- from the same seller all the time? To what extent do police and their enforcement activities tend to impinge upon the availability of drugs? So these questions have particular relevance at the local level to those who are interested in enforcement questions. So the variation of the variety of drug policy questions from treatment to enforcement all have sort of purchase in terms of how the ADAM program can help inform the local policy discussions. QUESTION: (OFF-MIKE) in studying the link between drug abuse and violent crime, do you find that one -- are they co-equal partners or does one drive the other? Your 10 years of DUF data -- what comes first, or can you say that it's something like that? RILEY: I think it's important to recognize that... (UNKNOWN): I'll stand so I can see you. (LAUGHTER) RILEY: There are high levels of substance abuse across all crime categories. A median across sites of probably 60 percent or more of the arrestees test positive for at least one drug at the time of arrest, almost regardless of crime categories. Now there are certain -- certain charge categories where you're even more likely to find an individual who tests positive for drugs. Prostitution and possession cases are instances. With respect to the link between violent crime, I urge you to pick up a copy of the large report on the table to my right on homicide in eight U.S. cities. Six of those cities were drug use forecasting cities, and there's a very clear link between homicide trends in those communities and the level of drug use -- cocaine use measured among the arrestee population. I think a lot of what is driving that relationship is differences in terms of the risk of participating in cocaine markets, particularly in crack markets, in those communities. QUESTION: But which comes first? Did most people start at one violent crime versus drug abuse? RILEY: That isn't information that at this point we routinely gather, although I will say in part of developing our revised interview instrument we're looking at what amount that is -- that is information we should be asking about -- the development of criminal careers and how drug use affected the development of criminal careers. QUESTION: Did the incident (ph) study differentiate in that division you were talking about, about cocaine use and the link with homicide. Did it differentiate between crack and power cocaine? RILEY: We, in terms of drug testing, cannot distinguish between crack and powdered cocaine. The testing process only tells you whether or not the person recently used cocaine. But we can then corroborate the cocaine test with self-report, so that we know what the majority in those communities -- the vast majority in some cases -- of what we're talking about with respect to recent measured cocaine use is in fact crack cocaine and not powdered cocaine. QUESTION: How much was the funding that you got to spend on this? TRAVIS: Congress appropriated $4.4 million -- additional dollars this year to the NIJ budget to fund the expansion to the 12 sites that we're announcing today. QUESTION: I think you said you do these interviews and drug tests quarterly. What is the sample size? You mean you just do everybody in the jail at that point or a certain number of people? Or... RILEY: Well, it in part depends on the size of the community. But as a general rule, we end up interviewing about 225 to 250 adult males. For practical considerations because of the lower arrest rates for females, we almost always end up interviewing all the females that come through the facility during our two- to three-week window of data collection. And then, in the juvenile situation, it again depends largely on the arrest rate as to whether or not we interview everyone or a fraction that comes through. QUESTION: And are these drug tests mandatory or voluntary? RILEY: No, the data collection is all voluntary, and we make clear at the time of the interviewing that their participation in the program has nothing to do with their current arrest charges. QUESTION: What is the rate of consent? Just curious. RILEY: We get about 90 percent, 85 percent, depending on the location of the people approached who agree to be interviewed. And of those, 85 to 90 percent will agree to give a urine sample. RILEY: We don't consider an interview complete unless we have both the completed interview and a drug test. QUESTION: Have you failed to monitor or assess the extent to which the local policy councils have implemented or made action conclusions based on the data that they've got so far? RILEY: The local policy councils are being created now with the creation of ADAM. So what we have asked to the sites that do both new sites and all sites, both the DUF sites and the new ADAM sites, is to constitute a local policy coordinating council. We asked the new sites in submitting their application or their concept paper to identify policy questions that they want answers to. So once, you know, they're up and running, we expect that they'll start adding the addendum, the added questions to the survey of interest to them. So in a year, we'll come back and talk again. But I think one of the important, very important objectives here is to provide local communities with a better empirically based understanding of their drug problem and answer questions that are of interest to them so that they can then take policy action. QUESTION: Was there no systematic way that the communities looked at the (OFF-MIKE) and then...? RILEY: Sally, did you want to say something to it? HILLSMAN: There is no systematic way, although obviously, both the law enforcement and the research community that were involved in the DUF program at the local level had a variety of mechanisms that they used in order to bring the information to the attention of local policymakers, and to also initiate some of the research addenda that we added to the DUF program. But what we're trying to do here is to regularize that process and also to ensure that, to the extent possible, it's inclusive of all of the various parties at the local community who might have important ways to use this information. One of the things I also wanted to add was that in the urinalysis test, it's a panel of 10 different drugs that are tested. So one of the important things in the ADAM samples will be the capacity to look at different -- not just the level of drug use -- but the different kinds of drugs that are being used at the local level. And in the ADAM program, we are going to have some flexibility with respect to what's in that panel of drugs so that we'll have a core panel that we will test across all of the sites. But then sites may have some concern about a different drug or a new drug and we'll have the capacity to adjust the panel in order to see if we can pick up either leading edge new drugs that may be coming on the market. TRAVIS: If I just might add -- one thing I neglected to mention is that we are examining the technology to add new drugs to the panel. There are some drugs that until recently, the ability to detect them in the urine specimen was relatively limited. So we expect that that panel of 10, that menu that we can choose from, the test for will grow -- in addition to the addition of several sexually transmitted diseases, through collaboration with CDC to the panel. QUESTION: This drug testing as well is contracting through some local public or private agency or... TRAVIS: Yes. QUESTION: And is it typically a public or private agency that does this? TRAVIS: The drug testing -- just to answer your question. The drug testing portion is handled through a national contractor so the current set-up is that the site administrator, the local person responsible for managing the interview team and providing quarterly access to the facility, at the end of the data collection run will ship the specimens to a national laboratory contractor. So the testing is not done on-site. And that's to ensure that we have uniform testing methodology, comparable testing procedures across all the participating sites. QUESTION: (OFF-MIKE) TRAVIS: Well, there are certain classes of inhalants, (OFF-MIKE) to organic compounds that we expect to be able to add to the panel, not the universe of inhalants. LSD is difficult to test for, but that's clearly a drug that would be of importance to the juvenile population. Some of the more exotics, we've had the ability to test for, but the relatively expensive. So we need to determine a methodology for sort of best determining how to feel that expensive testing technology. This would be things like ecstasy, GHB, and other drugs that are probably relatively low prevalence, but there may be isolated pockets where testing for them might be important. TRAVIS: Signal communities for example. QUESTION: How well do you test for methamphetamines right now? TRAVIS: I'm sorry. QUESTION: How well do you test for methamphetamines now? TRAVIS: Well, methamphetamine is tested -- that's one of the core 10 drugs, so we test for that in all 23 existing sites. QUESTION: With all 10 -- 12 new sites west of the Mississippi, it seems to be a powerful statement about the growing problem of methamphetamines. Right? TRAVIS: That is correct. Almost every one of the applications that was submitted from the western United States indicated, either through their own local initiatives on collecting data and drug testing, that they were experiencing problems with methamphetamine. QUESTION: Including California? TRAVIS: Exactly. That they wanted routine collection of the data and -- I'm not aware of a single community that applied that did not think that it had a problem that was relatively severe with methamphetamine. QUESTION: Is the primary objective of this program to give a helping hand to local communities? Or to gather data that allows you to look at national trends and patterns? TRAVIS: Do you want to chose between those two? We're trying to do both, and I think one of the -- some underlying -- some principles of the ADAM program is that the national drug program has a significant local dimension to it. Just to give a quick example of that, speaking of methamphetamine, the test - -- the positive rate for methamphetamine tests in San Diego either exceeds or comes very close to cocaine levels. If you test for methamphetamine, which we do on the eastern seaboard, you can barely find it. If you look at heroine use in Baltimore, that is the drug problem in Baltimore, whereas in Washington, D.C. it's a crack cocaine problem. So there is significant local variation toward the drug problem. So the ADAM program has the benefit because it is locally rooted, of being able to provide a picture, which is composite of pictures, of the drug problem by looking at it's local variation. At the same time, the -- because this is a research platform, the access to this population, the criminal (ph) of our population, allows us to look at a number of national -- issues of national importance -- the gang research that Dr. Riley mentioned. Obviously there's a lot of concern about gang prevalence in cities. There's also a lot of concern about gang migration. Where do gangs come from, go to? How do they sprout up in places that are unexpected? So having a national research platform that allows us on a quarterly basis to talk to people in police custody about their criminal involvement, drug involvement, and gang involvement and weapon involvement, gives us the capability at the national level to be able to understand some very important phenomenon, particularly in their regional variation and as some of these activities move across the nation. So it is both -- a national research program that is distinguished by its access at the local level. QUESTION: Are gangs yet in and methamphetamine much yet? RILEY: I don't think we've developed any information on that. We are in the process of completing a study in six western sites that is analogous to the market study -- the market participation study that you'll find a preview of here. There are some important differences, at least from preliminary data, in terms of differences of participation in those markets. But beyond that, it's a little early to speculate. QUESTION: Is there one particular drug that you see as a kind of an up-and-coming problem? TRAVIS: Well, we've discussed methamphetamine a lot this morning. That is... QUESTION: Something that maybe is not as well known, that you're finding the more use of and could be something of the future to worry about? TRAVIS: I'll ask Jack to talk about trends that we've observed recently. But let me just comment upon the methamphetamine question again. There's a little concern about the rise of methamphetamine use, and concern that we don't know enough about it's movement across the country. And the decision by the institute to focus our expansion activity on the western part of the United States reflects a very serious concern about methamphetamine use, and a desire to know much more about the users, the markets, the access to markets, the movement from jurisdiction to jurisdiction. So if you were to ask what is the drug that's on the scene right that we are most concerned about, both for its law enforcement purposes and for its public health purposes, I think methamphetamine would be the number one concern at the moment. And the ADAM will help us development much better understanding. If you want to talk, Jack, about some trends that we're seeing at all? RILEY: I think two significant trends, one of which is available in report form over on the publication tables, are worthy of note. RILEY: The one that is reported on is the plateauing or the gradual decline in powder cocaine and crack use in most of the existing 23 sites in the system. Andy Gaul (ph) and Bruce Johnson (ph) have very carefully analyzed those trends and reported that there is stabilization of crack and powder cocaine use, ultimately leading toward a long-term decline if those trends hold up in many communities across the United States. The other major trend that we have observed over the course of the past couple of years is the sharp increase in marijuana use. That's no surprise to those of you that have been paying attention to drug use statistics, but the rapid expansion of the use of that drug among the arrestee population was very stark over the course of the past two years. TRAVIS: Anything else? Thank you. END Copyright 1997 Federal Document Clearing House, Inc.
------------------------------------------------------------------- Homeless For The Holidays (Report On Massachusetts' Defunding Of Services, From 'The NewsHour With Jim Lehrer,' PBS) Subj: US: NewsHour Transcript: Homeless For The Holidays From: Marcus/Mermelstein
Date: Fri, 02 Jan 1998 22:07:44 -0500 Newshawk: Marcus/Mermelstein Source: The NewsHour with Jim Lehrer, PBS Contact: firstname.lastname@example.org Pubdate: 23 Dec 1997 HOMELESS FOR THE HOLIDAYS - NewsHour Transcript During the holiday season, many donate time and money to homeless causes. But dealing with the basic causes of homelessness is more problematic. According to most estimates, between 75 and 90 percent of homeless are either mentally ill, substance abusers or both. Paul Solman, of WBGH-Boston, has been following what Massachusetts is doing to address the issue. PAUL SOLMAN: A mock funeral on Boston Common in 1996 for the 175 homeless people who died in Boston the previous year. ACTIVIST: Today we speak the names of those who died in the war against homelessness, some as soldiers and all as victims: Paul F.; Timothy G.-- PRIVATIZING MENTAL HEALTH CARE. PAUL SOLMAN: To these activists death from homelessness in Boston is not just a matter of too little housing but also too little care for the acutely mentally ill who make up so much of the chronically homeless population. By most estimates some 75 to 90 percent of those who live on the streets are either poor mentally ill, poor substance abusers, or both, in Massachusetts, people for whom the Department of Mental Health is responsible. According to an internal department study deaths of this population rose 79 percent from 1990 to 1994. The significance of that, says the department, is that in this period it began keeping better records. But to the critics who staged this event these were the years when the state was closing its mental hospitals and switching to private, managed care. Macy DeLong. MACY DELONG, Activist: As the medical system that is supposed to serve people with mental illnesses has become privatized, I have watched people not be able to get into hospitals anymore, and I've watched those people harm themselves and come to a point where they could harm other people within 24 hours after that. PAUL SOLMAN: Macy DeLong is an activist who spent time on the street, herself, in the 1980's, after repeated hospitalizations for manic depressive psychosis. Before that, she supervised a lab at Harvard University, as she tried to explain to us. MACY DELONG: Going from someone that can run a lab of 30 people to someone that can't teach a dishwasher how to wash a test tube in six weeks is just devastating. David-- PAUL SOLMAN: Could you let me talk to her. Let me talk to her. No, no, I understand, but-- MACY DELONG: (Talking to Ill Man) David, we can't understand what you're saying. PAUL SOLMAN: We show this encounter with one of the chronically homeless, mentally ill, in this case also a substance abuser of alcohol, to give you some idea of the enormous difficulty of dealing with people who have such problems. MACY DELONG: Let me wheel you back over here and let me talk to these guys, okay? Please. MASSACHUSETTS' PLAN. PAUL SOLMAN: We've been on this story for two years now, following managed care of mental health for the poor here in Massachusetts, because this state's been in the forefront of the national move to private public services. It began in earnest in response to the taxpayer pressure of the 1980's, and by 1991, Massachusetts had begun to economize on its mental health care costs in several ways: by shutting down half of the state's eight public mental hospitals; by contracting with private hospitals, clinics, and day centers to assume a lot of its work, by giving one company the job of managing all the private contractors. As a results, costs have been held down but at a huge price, says psychiatrist Matthew Dumont, who we first interviewed in the fall of 1995. DR. MATTHEW DUMONT, Psychiatrist: What we're having essentially is the devastation of a service system for very disorganized and chaotic people. PAUL SOLMAN: Dr. Dumont, a former assistant commissioner of mental health for Massachusetts, took us to a hospital he used to work at--Metropolitan State--former home to 500 patients, the kinds of people, he said, who had had nowhere else to go. DR. MATTHEW DUMONT: People who were sent to a state hospital like this were acutely psychotic; they were suicidal; they were generally people who were poor--you go to a state hospital when you don't have any insurance, or when your insurance runs out--or because they were the kinds of patients who were unacceptable to a private environment because they were too violent or because they were too messy. PAUL SOLMAN: Dr. Dumont now works at one of the state's last poor public mental hospitals, places, he insists that, since the reforms of the 60's, have been providing better care than you get with managed care. DR. MATTHEW DUMONT: I have never been told that I can only have four sessions with an abused child, or that this depressed person should be put on a drug and seen only three times. And I have never been told at a hospital I'm working in now that I'm sorry, this patient's insurance has run out; the patient has to be discharged. PAUL SOLMAN: We took Dr. Dumont's complaint to the state's current commissioner of mental health, Marylou Sudders. Outside this big building she works in, an uncomfortable reminder of the problem, a homeless person sleeping. Commissioner Sudders was Dr. Dumont's boss back in 1990, when she ran Met State and oversaw its closing. MARYLOU SUDDERS, Commissioner of Mental Health: Closing that hospital was absolutely the right thing to do. Half of the people who were in Metropolitan State Hospital transferred to other state hospitals. The other half moved to new community residential services, with case management in the community. That physical plant was rotted. It never could have met national accreditation standards. PAUL SOLMAN: Now, Remember, this was when the taxpayer revolt was in full swing. Bringing hospitals up to code would have been very expensive. Just running them as is cost a bundle. As to Dr. Dumont's charge that privatization meant stinting on important services, the state's Michael Bailitt countered that without cost controls, the state might encourage too much medical care. MICHAEL BAILITT, Division of Medical Assistance: Supply drives demand in health care. The more doctors you have, the more therapists you have, the more hospitals you have, generally the more care is delivered. Now, sometimes that care is appropriate to the patient's need, but not always. The case of Mr. M. PAUL SOLMAN: All right, then, according to the state, privatization was helping more than it hurt. But at the private Deaconess Hospital, now treating state patients, the doctors thought care was being cut to the bone. We weren't allowed to tape patients but could listen in as the staff fretted over sending them back out into the world, patients like Mr. M.. STAFF MEMBER: Mr. M. continues to be on razor restriction, and people were wondering if we could get some clarification around that. PAUL SOLMAN: Although not to be trusted with a razor, Mr. M. was to be discharged in just a few days. SECOND STAFF MEMBER: He's got a hotel that takes weekly--it's, you know, done in weekly rates--and he set this up himself, and so he'll be doing that. He's also set up Social Security to be getting back payments that he was do, so-- DR. MARYANN BADARACCO, Deaconess Hospital: And he has a doctor following him on the outside? SECOND STAFF MEMBER: He does, yes, so--he'll follow him--maybe. It depends. PAUL SOLMAN: Mr. M. will be followed up maybe. It depends. The hospital was reluctant to release people with no resources, like Mr. M., but, in fact, the financial pressure to do so was increasing. That had the head of this private unit, Dr. Maryann Badaracco, worried about the future. DR. MARYANN BADARACCO: Anybody who works with people with major mental illness knows that the treatment of the acute illness is important, but what makes a big difference is how much continuity of care the person can have over time and, yes, we all are worried that over time the resources that we have available now for shelter, free medication, availability of nurses, doctors, to treat the patients outside of here, good social work, that we're worried about whether that's still going to be available. THE ROLE OF THE PARTNERSHIP. PAUL SOLMAN: In July of 1996, Massachusetts went further into privatization, contracting much its budget for the care of the indigent mentally ill to this man, Richard Sheola, whose private company, the Partnership, would manage the program by sending the business to places like the Deaconess. PERSON ON PHONE: And she sees a psychiatrist? PAUL SOLMAN: The emphasis would be on efficiency, Sheola insisted, not arbitrary cost-cutting. RICHARD SHEOLA Massachusetts Behavioral Health Partnership: Less than a third of any earnings that can occur in this contract occur because of cost savings. Fully 2/3 of any potential earnings in the contract occur because we will hit performance standards, and there are 10 of them that have been established by the commonwealth. If we hit all of those performance standards, we will earn a reasonable return on the investment. PAUL SOLMAN: Managing the state's mental health care contracts, Sheola's performance standards were explicit. RICHARD SHEOLA: Timely admission to an out-patient setting within three days of a discharge. Timely decision making in a crisis. Within two hours of getting a call, we have to make a disposition on the case and arrange for admission. SPOKESMAN: I had a case as a matter of fact that I put in yesterday, and I just got an answer a couple of hours ago. PAUL SOLMAN: Now this is the essential argument for privatization--a level of efficiency that in theory only private firms have enough incentive to provide. In addition, Sheola put the squeeze on health care providers, doctors and hospitals, because that's now managed care saves most of its money. RICHARD SHEOLA: Less psychotherapy, shorter hospital stays, fewer admissions, fewer trips to the emergency room, better opportunities to live in community settings that are less expensive, more responsive, and generally what consumers want. Consumers don't want to be in hospitals. PAUL SOLMAN: Okay. It's now been more than a year since Sheola took over. What's happened? Well, the state has been saving money--almost $8 million this year--that's gone back into community care services, like this so-called clubhouse, a day rehab program in Boston. But Center House has been around for years. New community settings, a key promise of the partnership, have yet to be established. Partly as a result perhaps, Boston's chronic homeless population hasn't dropped, which suggests the mental health system hasn't got its clients off the streets. In fact, on any given night, more of the poor mentally ill and/or substance abusers are now at Boston's main homeless shelter, the Pine Street Inn, than in all the state hospitals combined. There's also evidence that an increasing portion of the commonwealth's prison population is made up of the mentally ill. Finally, there is that controversial study with which this piece began--that death rates have risen by 79 percent since the advent of managed care. DR. MATTHEW DUMONT: Do we want to save money at a time of unprecedented wealth by allowing people to perish? They are perishing! PAUL SOLMAN: Dr. Dumont says that things have gotten worse and replacing public institutions with free market privatization is to blame. Even at one of the remaining state hospitals, Westborough, where Dumont now works, he emphasizes that a former halfway house for patients re-entering the community has just been turned into a lock-up facility for juvenile offenders. The commonwealth now rents out his former hospital, Met State, as a movie set. DR. MATTHEW DUMONT: I think the market has caused the mentally ill to be treated as if they were items of no importance. Their livelihood; their life; and by the way, the life of the community in a very profound way has been seriously compromised. PAUL SOLMAN: Dr. Maryann Badaracco also sees her earlier fears coming true; that the state would cut back its services, hoping that private hospitals and clinics would simply pick up the slack. DR. MARYANN BADARACCO: And I think the state may also be thinking that this isn't going to become--isn't going to be very interesting to people because a group of people who are not going to be served have no advocates. PAUL SOLMAN: Well, in fact, the poor mentally ill do have some supporters, like Advocates for Quality Care. This group's recent survey of 100 providers found that more than half claimed at least one of their patients was put in life-threatening danger due to premature hospital discharge since the partnership took over. But when we asked advocates early on to help us come up with an example to dramatically document their case, they couldn't. There were issues of privacy, of course, and the worst off may simply have been too disorganized, too far gone to interview, like David, our interrupter at the mock funeral last year. He died on the street during the course of our research. But, in fact, when we called an advocacy group made up primarily of parents, the Alliance for the Mentally Ill, they told us that for them, things had improved. A SUCCESS STORY. JOHN BOVE, Alliance for the Mentally Ill: In one year we had less than five telephone calls, complaints against the Partnership. PAUL SOLMAN: According to former Alliance President John Bove, that's a big change from the days when the state's Department of Mental Health ran the entire show. JOHN BOVE: They were the enemy and they were doing everything wrong, and we tried to--you have to clean up your hospitals. You have to clean up your houses. You need more beds. Don't you do anything right? Don't you hire good people? PAUL SOLMAN: And now it's not like that? JOHN BOVE: Not anymore. No way, that system is long gone. PAUL SOLMAN: And these guys, the private guys, are doing a better job? JOHN BOVE: The private guys are doing a very good job. PAUL SOLMAN: A very good job of responding to at least one portion of its clientele. KATHRYN WOLFE, Former State Hospital Patient: I can give you a freshly-made cup of coffee or a diet soda. PAUL SOLMAN: Kathryn Wolfe was hospitalized for 13 years with a psychotic disorder--de-institutionalized when privatization swept in. She's also John Bove's step-daughter. He credits new medications but also the new managed care firm with Kathryn's improvement. JOHN BOVE: She hasn't been in the hospital. There's the proof right there. She's--this is her apartment. She works 15 hours a week. KATHRYN WOLFE: Eight hours. JOHN BOVE: Eight hours a week. She gets a paycheck. She does her own grocery shopping. She has a TV. She has music. She can have friends over. I don't see her back in the hospital. That's success to me. PAUL SOLMAN: Success? KATHRYN WOLFE: I get to see my parents on the weekend, and it's really nice. It's a lot of fun. I just wish I had a car; I could get up to Plymouth by myself. PAUL SOLMAN: To critics, though, the problem is that those without family support like this fall through the cracks. And Kathryn's mother, Jean Bove, agrees that those with only the state and Partnership to rely on are still in trouble. JEAN BOVE, Alliance for the Mentally Ill: Many of the people who are in the program are going into emergency services; they're getting their few days of stabilization; they're being put out; they're going back; they're being put out; they're going back; they're being put out. Not everyone that I have known in my experience has been as fortunate as Kathryn to state out continuously. PAUL SOLMAN: So you're one of the lucky cases here? KATHRYN WOLFE: Yes. I'm a lucky case. PAUL SOLMAN: But what about the unlucky cases, those who don't have families like this, the indigent mentally ill and substance abusers who make up such a disproportionate share of the homeless? We put that last question to the Partnership's Richard Sheola. RICHARD SHEOLA: In the final analysis it's a public policy issue. It's not a managed care phenomenon. PAUL SOLMAN: Forget managed care. Whose responsibility is it? RICHARD SHEOLA: The responsibility for responding to the needs of the seriously mentally ill who are homeless. I view it as a responsibility of the state ultimately that this is a population that requires care and treatment and should not be languishing in the absence of same. PAUL SOLMAN: But the state budget keeps getting cut for these kinds of services? RICHARD SHEOLA: Tough choices are being made, and that's not a population that has a great voice and a great constituency. PAUL SOLMAN: Okay. After all this time where are we? Well, there isn't a clean answer perhaps because there are no clean answers to the problems of the indigent mentally ill, especially once you include substance abusers. Yes, taxpayer money has been saved but mainly by paying less to mental health care providers. Yes, the system is more efficient, but the real beneficiaries seem to be those who have family or other support to help them take advantage of it. The fact is the number of homeless mentally ill has remained constant since privatization began in the early 90's, making the question of managed care's ability to care for them as urgent as ever.
------------------------------------------------------------------- Italy's Drug Fighter (USA's National Public Radio Interviews Pino Arlacchi Of The UN Drug Control Program) Date: Fri, 2 Jan 1998 00:16:43 -0800 From: Majordomo@mapinc.org ] Subj: US: NPR: Italy's Drug Fighter ] From: Ethan Nadelmann ] Date: Wed, 31 Dec 1997 21:22:37 -0500 Newshawk: Ethan Nadelmann Source: National Public Radio Show: Morning Edition Pubdate: December 23, 1997 ITALY'S DRUG FIGHTER NPR's Tom Gjelten profiles Pino Arlacchi, who took charge of the United Nations Drug Control Program in September and says he intends to stop worldwide production of illegal cocaine and opium within 10 years. He wants to begin in Afghanistan, where the Taliban relies on cultivation of coca plants and poppies for much of its revenue. Arlacchi's goal is considered overly ambitious, but he says it can be attained. He earned his crimefighting reputation as director of a special anti-Mafia task force in Italy. BOB EDWARDS, HOST: One of Italy's top anti-Mafia fighters is making a new name for himself in the battle against international drug trafficking. Pino Arlacchi previously directed a special police unit in Italy that focused on the Mafia. In September, he took charge of the United Nations Drug Control Program based in Vienna. Within weeks, Arlacchi announced his intention to end coca and opium production around the world within 10 years. NPR's Tom Gjelten reports on Arlacchi's bold start and the skepticism he's encountering. TOM GJELTEN, NPR REPORTER: The United Nations General Assembly is meeting in special session next June to discuss drug trafficking around the world. Pino Arlacchi says he wants to make the session, in his words, "a milestone event." PINO ARLACCHI, HEAD OF UNITED NATIONS DRUG CONTROL PROGRAM: We want to present a set of proposals for each of the points of the agenda. And one of these proposals is the global plan for the elimination of the opium and the coca cultivation worldwide. GJELTEN: Eliminating opium and coca would end the production of heroin and cocaine. And Pino Arlacchi thinks he can do it in 10 years at a cost of just $25 million a year. Arlacchi's boldness has impressed UN member governments, the United States in particular. Jonathan Winer, deputy assistant secretary of state for international narcotics, says some people wonder whether Arlacchi is aiming too high. JONATHAN WINER, U.S. DEPUTY ASSISTANT SECRETARY OF STATE FOR INTERNATIONAL NARCOTICS: It's like a batter who steps up to the plate ready to hit one out of the park. Now, if you decide you want to try and hit the home run first time out, if you hit the home run, you're gonna get everybody applauding and thrilled and excited and you're gonna be a superstar. Of course, you run a larger risk that you may strike out and get nothing. GJELTEN: Arlacchi has encountered skepticism before. As a government investigator 15 years ago with just a few Italian colleagues, Arlacchi took on the Sicilian Mafia. By the time they'd finished, the team had exposed a collusion that had long existed between the Mafia and major political parties in Italy. Arlacchi's belief in the power to do good might strike some as naive were it not for his own record. ARLACCHI: When I started to attack, with very few people, the Sicilian Mafia, nobody thought that we could be successful. But we did. Because, after all, we have on our side the law, the values, that are superior to that of our enemies. GJELTEN: Arlacchi's strategy in taking on the Mafia was to find the weak points of the organization and focus law enforcement efforts there. He takes the same approach in fighting drug trafficking, identifying where the trade is most vulnerable. In Arlacchi's judgment, it is in the growing of opium poppies and coca plants, the first step in heroin and cocaine production. ARLACCHI: We need the very small amount of resources, because when you go to the point of the production of narcotics you will find very small figures. GJELTEN: Of the billions of dollars earned every year in the heroin and cocaine trade, Arlacchi says, less than 1 percent goes to the farmers who grow coca and opium poppies. So, relatively modest financial incentives could lure farmers out of the narcotics business. Arlacchi wants to focus first on Afghanistan, where half of the world's opium is produced. Last month he traveled there to meet with leaders of the Taliban, the Islamic fundamentalist movement that controls most of the country. After just three hours of negotiating, Arlacchi had a deal. ARLACCHI: The agreement is very simple. They should destroy all the poppy cultivation in the province of Kandahar. And we will in exchange of that provide opportunities, jobs, for the peasants of that province. GJELTEN: Some diplomats question Arlacchi's willingness to take the Taliban leaders at their word. The movement financed its guerrilla uprising partly with profits earned in the drug trade, according to Western governments. Once in power, they brutally repressed their opposition and stripped Afghan women of basic civil rights. Jonathan Winer of the State Department wonders whether the Taliban can be trusted now to help end drug trafficking in Afghanistan. WINER: There have been areas of Taliban control where there has been a substantial amount of crop grown. So, the Taliban is responsible for that. It may not be their crop, but they have facilitated it or have failed to discourage it in the past. GJELTEN: The United States has already pledged in principle to support Pino Arlacchi's campaign to eradicate opium and coca cultivation. But Jonathan Winer says the State Department has not yet endorsed the idea of UN money being distributed in Afghanistan. WINER: In the case of the Taliban there are additional problems associated with their treatment of women and human rights abuses in the past. And we have to make sure that we have assurances that we can rely on before we're going to be in a position to do very much. GJELTEN: Pino Arlacchi is the first to admit that the Taliban may prove to be unreliable allies. But he notes it's just a one-year experiment. "If it doesn't work," he says, "we won't have lost anything. We'll just have spent money for the benefit of the people of Afghanistan." Tom Gjelten, NPR News, Washington. Copyright (c) 1997 National Public Radio, Inc -------------------------------------------------------------------
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