How To Know If You Should Refuse To Take A Drug

Transcription

1 WHY PEOPLE DON'T USE ILLICIT DRUGS January, 1990 The Texas Commission on Alcohol and Drug Abuse Austin, Texas

2 1990, Texas Commission on Alcohol and Drug Abuse (TCADA), Austin, Texas. TCADA grants full permission to reproduce and distribute any part of this document for noncommercial use. Appropriate credit is appreciated. TCADA is a state agency headed by six commissioners appointed by the governor. TCADA provides educational materials on substance use, develops prevention, intervention, and treatment programs, and conducts studies on the problems of substance use in Texas. Texas Commission on Alcohol and Drug Abuse 9001 North IH-35, Suite 105 Austin, Texas (512) (800) Web site: C This document was printed on recycled paper.

3 TEXAS COMMISSION ON ALCOHOL AND DRUG ABUSE WHY PEOPLE DON T USE ILLICIT DRUGS 1. Introduction Many studies have explored the reasons why people use illicit drugs, but little attention has been given to reasons people have for not doing so. Yet, only a minority of Americans have ever used illicit drugs, and even fewer have used them within the past year. Also, it appears that most illicit drug users discriminate with respect to the kinds of drugs they consider acceptable. It follows that most people probably have reasons for not using illicit drugs. The purpose of this report is to investigate the reasons adults give for refusing illicit drugs, and whether some refusal reasons appear to provide more protection against illicit drug use than others. These reasons may indicate the nature and extent of values, attitudes, practices and beliefs which prevent the spread of illicit drug use in the general population. If these barriers exist they could be useful as models for effective drug prevention and intervention programming. 2. Methodology In 1988, a random telephone survey of alcohol and illicit drug use was conducted among adult Texans by the Texas A&M Public Policy Resources Laboratory (PPRL) for the Texas Commission on Alcohol and Drug Abuse (TCADA). The survey yielded responses from 5,156 adult Texans, 18 years of age and older. An additional face-to-face survey was administered by PPRL to 1,056 inmates entering the Texas prison system in late 1988 and early Questionnaires for these projects were based on a National Institute of Drug Abuse (NIDA) incidence and prevalence questionnaire model. Many questions were added to the NIDA instrument, including a set about reasons for not using drugs. Figure 1 shows the general procedure for asking respondents about the availability and their use of illicit drugs, as well as their reasons for refusing to use illicit drugs. All respondents, except those reporting use of a given drug within the past 30 days, were asked if they would use the drug if it were offered to them. This procedure was repeated for each of 8 illicit or classes of illicit substances (marijuana, cocaine, crack, stimulants, sedatives and tranquillizers, heroin, other opiates and psychedelics). Respondents who said that they would refuse any of the eight illicits were then asked why. The answer was recorded verbatim by the interviewer, who then asked if there was another reason for refusing. The question was asked a third time, thus providing respondents three opportunities to express reasons for refusal. Interviewers were instructed to record the entire answer as offered by the respondent. 1

4 Fig. 1 Respondents were given 8 chances to offer refusal reasons, one for each drug questioned. This chart outlines the procedure for questioning the availability and use of one substance. About how old were you when you first had a chance to try {name of substance}if you wanted to? If you are not sure how old you were, try to estimate your approximate age at that time. Gives Age, Doesn't Know or Refuses to Answer NEVER About how old were you the first time you actually tried {name of substance}? NEVER Gives Age, Doesn't Know or Refuses to Answer Have used, but not within past month Additional questions about usage of {name of substance}. Have used in past month If {name of substance} were offered to you, would you probably accept it? YES, Doesn't Know or Refuses to Answer NO What is the main reason for that decision? Answers to the refusal questions were field coded by trained questionnaire editors. Editors were supplied with a preliminary list of codes and definitions for reasons, and instructed to assign as many additional codes as needed to classify the central idea of the verbatim responses. This approach to data collection is particularly useful for investigating topics about which relatively little prior information is available. 2

5 3. Results 3.1 Reasons Given For Not Using Drugs Respondents provided 65 separate refusal reasons (Table 1). Although adults give many different reasons for refusing illicit drugs, a limited number of responses account for most answers: six responses account for about half of all answers to these questions, and twenty-four responses account for 90 percent of the total. The most frequent response recorded in the adult survey was don t know (about 24 percent of answers in the three question series); only a minority of respondents offered three separate reasons for not using drugs. About 7 percent of responses fell into the category not interested in illicit drugs, which means either that a person has not used illicit drugs and is not interested in using them, or has used illicit drugs but is no longer interested in using them. Other frequent answers include don t need illicit drugs, it s bad for you, and generic health reasons. About 4 percent of responses were characterized as religious. This response group includes statements such as it s against my religion and people in my church don t believe in using. Other relatively frequent reasons include illicit drugs are contrary to family teaching/upbringing; illicit drugs are detrimental to health; I ve seen the negative results of illicit drug use; and I don t want to try illicit drugs. 3.2 Classes of Drug Refusal Response In order to present an overview of these complex results, responses were categorized by content into ten classes: 1. Health-related reasons contain the word health, or make reference to a physician or to some physical consequence of illicit drug use. 2. Social reasons indicate social pressure, socialization, or social stigma as a reason for not using drugs. 3. Psychological reasons make specific reference to fear (for example, fear of what would happen if I took it/them ), concerns about psychological effects, and mental stability. 4. Legal reasons pertain to legal status or legal sanctions against illicit drug-taking behavior. 5. Economic reasons mention occupational barriers, expense of buying illicit drugs, etc. 6. Personal choice reasons mention not liking, not needing, or not wanting illicit drugs; these reasons incorporate low order value judgments about illicit drugs. 3

6 Table 1 ID TYPE N % CUM NO ABSTRACT RESPONSE RANK REASON Responses Responses % 98 Don't know 1 DON'T KNOW % 24.37% 55 Not interested/lost interest 2 PERSONAL CHOICE % 30.93% 58 Don't need 3 PERSONAL CHOICE % 37.12% 66 Bad for you 4 ETHICAL % 41.88% 0 Generic health 5 HEALTH % 45.83% 51 Religion (long term) 6 ETHICAL % 49.57% 59 Family teaching, upbringing 7 SOCIAL % 53.05% 6 Detrimental to health 8 HEALTH % 56.53% 27 Seen (negative results) 9 OBSERVATIONAL % 59.83% 64 Don't want to try 10 PERSONAL CHOICE % 62.90% 50 Generic personal 11 PERSONAL CHOICE % 65.68% 4 Addiction/getting hooked 12 HEALTH % 68.31% 28 Fear what will happen 13 PSYCHOLOGICAL % 70.87% 56 Don't like PERSONAL CHOICE % 73.32% 63 They are wrong-stupid 15 ETHICAL % 75.69% 57 Don't believe in ETHICAL % 78.01% 69 Heard about on TV,read about it 17 OBSERVATIONAL % 80.10% 70 Know better, learned better 18 OBSERVATIONAL % 82.18% 67 Dangerous 19 PERSONAL CHOICE % 84.01% 31 Illegal 20 LEGAL % 85.69% 74 Does nothing for you 21 PERSONAL CHOICE % 87.30% 25 Fear "loss of control" 22 PSYCHOLOGICAL % 88.54% 60 Non-classifiable 23 NON-CLASSIFIABLE % 89.49% 20 Generic Psychological 24 PSYCHOLOGICAL % 90.45% 68 See friends or their kids doing it 25 OBSERVATIONAL % 91.27% 12 Socially Unacceptable 26 SOCIAL % 92.04% 29 Fear dying 27 PSYCHOLOGICAL % 92.69% 73 Self respect 28 PSYCHOLOGICAL % 93.32% 11 Pressure from relative/friend 29 SOCIAL % 93.91% 23 Mental instability 30 PSYCHOLOGICAL % 94.49% 53 Personal abuse history 31 OBSERVATIONAL % 95.04% 75 Not appropriate for occupation 32 ECONOMIC % 95.60% 54 Family abuse history 33 OBSERVATIONAL % 96.13% 3 Long term physical effects 34 HEALTH % 96.57% 62 Substance not available 35 NON-CLASSIFIABLE % 96.89% 41 Too expensive 36 ECONOMIC % 97.19% 10 Generic social 37 SOCIAL % 97.49% 43 Job security 38 ECONOMIC % 97.78% 42 Can't afford 39 ECONOMIC % 97.95% 2 Short term physical effects 40 HEALTH % 98.09% 7 Physically unable to continue 41 HEALTH % 98.23% 24 Psychological dependence 42 PSYCHOLOGICAL % 98.35% 97 Other 43 NON-CLASSIFIABLE % 98.48% 14 Change family structure 44 SOCIAL % 98.60% 65 Athletics 45 HEALTH % 98.72% 46 Wastes money 46 ECONOMIC % 98.83% 40 Generic economic 47 ECONOMIC % 98.94% 15 Never heard of it 48 NON-CLASSIFIABLE % 99.04% 30 Generic law 49 LEGAL % 99.15% 26 Fear "needles" 50 PSYCHOLOGICAL % 99.24% 22 Cognitive change, confusion 51 PSYCHOLOGICAL % 99.34% 8 Tolerance increased/decreased 52 HEALTH % 99.42% 61 Little bit every thing 53 NON-CLASSIFIABLE % 99.51% 33 Fear of arrest 54 LEGAL % 99.60% 1 Doctor's suggestion 55 HEALTH % 99.69% 71 Penalties you pay 56 LEGAL % 99.77% 21 Affective state change 57 PSYCHOLOGICAL % 99.85% 44 Alcohol/drug testing 58 ECONOMIC % 99.90% 45 Loss productivity 59 ECONOMIC % 99.93% 13 Changed friends, lifestyle 60 SOCIAL % 99.95% 76 Suicidal 61 PSYCHOLOGICAL % 99.96% 5 Need to decrease habit 62 HEALTH % 99.98% 52 Religion (short term) 63 ETHICAL % 99.99% 99 Refuse 64 DON'T KNOW % 99.99% 72 Had to go 65 NON-CLASSIFIABLE % % 4

7 7. Ethical reasons mention belief or moral judgments regarding illicit drugs; the statement it s against my religion is an example of the former, it s wrong of the latter. These reasons incorporate a higher order value judgment than the personal choice reasons. 8. Observational reasons mention having seen the effect of substance use on one s self, family, neighborhood, or in the news media. 9. Unclassified reasons are those which did not fit into one of the above general categories. 10. Don t know indicates that a respondent is unable to supply an additional reason for not using illicit drugs. When drug refusal reasons are examined by class of response (Figure 2), three separate patterns become clear. First, the number of don t know/refuse answers increased the second time the question was asked, and increased again for the third repetition. This indicates that while almost all respondents have at least one reason for refusing an illicit drug, relatively few have as many as three reasons. Second, five classes of reasons markedly decrease with subsequent questioning: health reasons, economic reasons, personal choice reasons, ethical reasons, and observational reasons. Since these classes appear more frequently on the first response than on subsequent queries, they are considered primary responses. Four classes of response tend to be as or more frequent on subsequent repetitions of questioning than on the first round of questioning: social reasons, psychological reasons, legal reasons, and unclassified reasons. These classes can be regarded as secondary responses, in the sense that they become more likely after a primary response has been given. Fig. 2 Reasons for Refusing Drugs: First, Second, and Third Response Don't Know/Refuse Unclassified Observations Ethical Personal Choice Economic Legal Psychological Social Health 0% 10% 20% 30% 40% 50% 60% 70% First Second Third 5

8 3.3 Overview of Drug Refusal Reasons by Category of Use Terminology Category of use is a measurement of the extent of a person s involvement with illicit drugs. Two general and four specific categories of use are utilized in this paper: Non-users are persons not reporting use of any illicit drug during their lifetime. (a) Non-exposed non-users are persons reporting that they had never had the chance to try any of the eight illicit drugs queried on the questionnaire. (b) Exposed non-users are persons that had an opportunity to try illicit drugs but had never used them. Users are persons reporting use of one or more categories of eight illicit drugs at some time during their lifetime. (a) Past users are persons reporting use of illicit drugs, but not as recently as the past year. (b) Recent users are persons that had used illicit drugs within the past year Observations In order to examine the relationship between the respondents experience with illicit drugs and their tendency to provide a given kind of answer to the drug refusal question, the ten classes of refusal reasons are broken out by category of use for the first, second and third response (Figures 3 to 5). The don t know/refuse class was excluded from these presentations in order to more clearly define differences in refusal reasons. Some observations were: Personal choice reasons for non-use are the most important type of reasons for all four groups, especially for past and recent users. Recent users are more likely than other groups to report personal choice reasons as a primary response (Figure 3), while past users appear to be more likely to report such reasons on the second (Figure 4) and third response (Figure 5). Ethical reasons are most likely to be reported by non-exposed non-users. The higher the level of involvement with drugs, the less likely respondents were to report ethical reasons for non-use. This distribution is consistent for both primary and secondary responses. Health-related concerns are important for all four groups, particularly for non-exposed non-users and as a secondary reason for recent users. Recent users are more likely than other groups to report psychological and observational reasons in all three responses, and to report economic reasons more often than others on first and second responses. Social reasons tend to be reported more by exposed non-users and past users than other groups. Exposed non-users are more likely to cite legal reasons for illicit drug refusal than other groups. 6

9 Fig. 3 Reasons for Refusing Drugs by Category of Use: First Response Unclassified Observations Ethical Personal Choice Economic Legal Psychological Social Health 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% Non-Exposed Exposed Past Users Recent Users Fig. 4 Reasons for Refusing Drugs by Category of Use: Second Response Unclassified Observations Ethical Personal Choice Economic Legal Psychological Social Health 0% 5% 10% 15% 20% 25% 30% 35% Non-Exposed Exposed Past Users Recent Users 7

10 Fig. 5 Reasons for Refusing Drugs by Category of Use: Third Response Unclassified Observations Ethical Personal Choice Economic Legal Psychological Social Health 0% 5% 10% 15% 20% 25% 30% Non-Exposed Exposed Past Users Recent Users 3.4 Drug Refusal Reasons by Category of Use Positive and Negative Association A measure was taken within categories of the difference between the number of responses expected by chance and those actually recorded. A positive association indicates that the number of refusal reasons given in a certain category is greater than what could be attributed to chance. A negative association indicates that fewer observations than expected by chance are actually observed. Using this method of positive and negative associations shows the distribution of refusal reasons which cannot be explained by chance, and organizes separate reasons into patterns of association that can be indentified within the four categories of use. This procedure permits an analysis of the relationships that may exist between level of drug involvement and specific types of reasons given for non-use. Readers desiring a more in-depth explanation of the determination of positive and negative association can consult the Appendix for additional information. 8

11 3.4.2 Non-exposed non-users Non-exposed non-users tend to report ethical reasons and reasons which display negative attitudes about drugs. In fact, of the four categories of use, only non-exposed non-users cite ethical refusal reasons at rates higher than expected by chance (Table 2). Four ethical drug refusal reasons are positively associated with non-exposed non-users ( long term religion, don t believe in illicit drugs, illicit drugs are wrong/stupid, and illicit drugs are bad/bad for you ). This group also provides a health reason - illicit drugs are detrimental to health - at rates higher than expected by chance. Non-exposed non-users tend respond with don t know more often than would be expected by chance as compared to other groups, suggesting that non-exposed non-users have fewer reasons for refusing illicit drugs than do other respondents. Non-exposed non-users tend not to report several common observational reasons for refusing to use drugs, including: seen negative results, see friends or kids doing it, and family abuse history. In comparison to other groups, this group would seem to have relatively little first-hand experience with illicit drug use. Non-exposed non-users also tend not to provide one legal reasons ( [illicit drugs] are illegal ), one psychological reason ( fear of what would happen if I used illicit drugs ), two economic reasons ( not appropriate for occupation and illicit drug use would endanger job security ), two personal opinions ( don t like illicit drugs and don t need illicit drugs ), one social reason ( family teaching or upbringing ) and one health-related reason ( addictive properties of illicit drugs ). Table 2 Reasons positively and negatively associated with NON-EXPOSED NON-USERS Cell Chi Square Type Non- Exp. Past Recent Response N Reason P Phi Exp. Non- Users Users Non- Users POSITIVE ASSOCIATION Users 51 Religion (long term) 514 ETHICAL (+)26.35 (-)1.23 (-)6.84 (-) Don't believe in ETHICAL (+)17.62 (+)0.29 (-)15.04 (-) Detrimental to health 477 HEALTH (+)13.00 (-)2.66 (-)1.29 (-) They are wrong/stupid 325 ETHICAL (+)10.62 (+)0.00 (-)7.03 (-) Bad for you 653 ETHICAL (+)9.08 (-)0.59 (-)1.02 (-) Substance not available 45 NON-CLASSIFIABLE (+)7.66 (-)0.25 (-)8.96 (-) Don't know 3342 DON'T KNOW (+)1.16 (-)0.78 (-)0.98 (+)0.74 NEGATIVE ASSOCIATION 53 Personal abuse history 76 OBSERVATIONAL (-)28.13 (-)11.05 (+)23.22 (+) Family abuse history 73 OBSERVATIONAL (-)15.75 (+)1.89 (+)1.64 (+) See friends/kids doing it 113 OBSERVATIONAL (-)9.80 (+)2.50 (+)2.18 (+) Illegal 231 LEGAL (-)9.43 (+)15.83 (+)0.69 (-) Know better 285 OBSERVATIONAL (-)9.09 (-)5.50 (+)15.99 (+) Fear what will happen 351 PSYCHOLOGICAL (-)6.85 (+)0.03 (+)1.01 (+) Not approp. for occupation 76 ECONOMIC (-)5.29 (+)4.29 (+)2.41 (-) Seen (negative results) 452 OBSERVATIONAL (-)4.84 (+)10.01 (+)0.07 (-) Job security 39 ECONOMIC (-)4.32 (+)1.46 (+)3.31 (-) Don't like PERSONAL CHOICE (-)3.20 (+)0.05 (+)0.50 (+) Don't need 848 PERSONAL CHOICE (-)3.08 (+)0.12 (+)8.29 (-) Family teaching,upbringing 477 SOCIAL (-)2.17 (+)4.96 (+)1.42 (-) Addiction/getting hooked 360 HEALTH (-)1.41 (-)0.15 (+)0.29 (+)6.38 9

12 Table 3 Reasons positively and negatively associated with EXPOSED NON-USERS Cell Chi Square Type Non- Exp. Past Recent Response N Reason P Phi Exp. Non- Users Users Non- Users POSITIVE ASSOCIATION Users 31 Illegal 231 LEGAL (-)9.43 (+)15.83 (+)0.69 (-) Seen (negative results) 452 OBSERVATIONAL (-)4.84 (+)10.01 (+)0.07 (-) Family teaching,upbringing 477 SOCIAL (-)2.17 (+)4.96 (+)1.42 (-) Not approp. for occupation 76 ECONOMIC (-)5.29 (+)4.29 (+)2.41 (-) Self respect 87 PSYCHOLOGICAL (-)0.87 (+)3.08 (+)0.43 (-) See friends/kids doing it 113 OBSERVATIONAL (-)9.80 (+)2.50 (+)2.18 (+) Family abuse history 73 OBSERVATIONAL (-)15.75 (+)1.89 (+)1.64 (+) Job security 39 ECONOMIC (-)4.32 (+)1.46 (+)3.31 (-)0.33 NEGATIVE ASSOCIATION 53 Personal abuse history 76 OBSERVATIONAL (-)28.13 (-)11.05 (+)23.22 (+) Know better 285 OBSERVATIONAL (-)9.09 (-)5.50 (+)15.99 (+) Does nothing for you 220 PERSONAL CHOICE (-)0.23 (-)4.08 (+)6.70 (+) Detrimental to health 477 HEALTH (+)13.00 (-)2.66 (-)1.29 (-) Religion (long term) 514 ETHICAL (+)26.35 (-)1.23 (-)6.84 (-) Exposed non-users Exposed non-users display a more pragmatic mind-set for not using drugs, citing such reasons as the legal and economic consequences of illicit drug use. Exposed non-users tend to report three observational reasons at rates higher than non-exposed non-users, and ethical reasons more rarely. For exposed non-users, the legal status of illicit drugs, economic consequences, socialization aspects, self-concept and some first-hand observation of the negative consequences of illicit drug use appear to have a role in refusing illicit drugs. The reason drugs are illegal is most strongly positively associated with exposed non-users (Table 3). This difference, as compared to non-exposed non-users, might suggest that the legal status of a substance becomes an issue when people are faced with the opportunity to try drugs. Three observational reasons ( seen negative results of illicit drug use, seen friends/kids doing it and family abuse history ), two economic reasons ( not appropriate for occupation and illicit drug use would endanger job security ), one social reason ( family teaching/upbringing ), and one psychological reason ( self respect ) tend to be provided as drug refusal reasons by exposed non-users. This response pattern suggests that when given the opportunity to try drugs, exposed non-users formulate practical reasons for not doing so. And overall, exposed non-users tend to have more reasons for not using illicit drugs than do non-exposed non-users. Responses negatively associated with this group include two observational reasons ( personal abuse history and know better ), a personal opinion ( does nothing for you ), a health reason ( detrimental to health ), and an ethical reason ( long term religion ). 10

13 3.4.4 Past Users Economic reasons and personal choice seem to play important roles in the responses of past drug users, whereas health and psychological reasons distinguish recent users as a group. However, response patterns of these two groups are more similar than those observed for the two groups of nonusers described above. For example, both past and recent users tend to give observational reasons for refusing illicit drugs, and not to give ethical reasons for refusal. Past users show positive associations (Table 4) in four observational reasons ( personal abuse history, seen friends/kid using illicit drugs, family abuse history, and know better ), two personal opinions ( don t need illicit drugs and illicit drugs do nothing for you ), two economic reasons ( [illicit drugs] would endanger job security and illicit drugs are not appropriate for occupation ), and one social reason ( family teaching/upbringing ). Of the above, personal opinions and social reasons may be important for many past users in the decision to discontinue illicit drug use; this hypothesis is discussed in more detail below. Past users tended not to cite ethical reasons ( don t believe in, illicit drugs are wrong/stupid, religion long term, and illicit drugs are bad/bad for you ) or two health reasons ( long term physical effects of illicit drugs and illicit drugs are detrimental to health ). Past users also tend not to report unavailability of drugs as a reason for not using illicit substances as compared to some other groups Recent Users Table 4 Reasons positively and negatively associated with PAST USERS Cell Chi Square Type Non- Exp. Past Recent Response N Reason P Phi Exp. Non- Users Users Non- Users POSITIVE ASSOCIATION Users 53 Personal abuse history 76 OBSERVATIONAL (-)28.13 (-)11.05 (+)23.22 (+) Know better 285 OBSERVATIONAL (-)9.09 (-)5.50 (+)15.99 (+) Don't need 848 PERSONAL CHOICE (-)3.08 (+)0.12 (+)8.29 (-) Does nothing for you 220 PERSONAL CHOICE (-)0.23 (-)4.08 (+)6.70 (+) Job security 39 ECONOMIC (-)4.32 (+)1.46 (+)3.31 (-) Not approp. for occupation 76 ECONOMIC (-)5.29 (+)4.29 (+)2.41 (-) See friends/kids doing it 113 OBSERVATIONAL (-)9.80 (+)2.50 (+)2.18 (+) Family abuse history 73 OBSERVATIONAL (-)15.75 (+)1.89 (+)1.64 (+) Family teaching,upbringing 477 SOCIAL (-)2.17 (+)4.96 (+)1.42 (-)7.61 NEGATIVE ASSOCIATION 57 Don't believe in ETHICAL (+)17.62 (+)0.29 (-)15.04 (-) Substance not available 45 NON-CLASSIFIABLE (+)7.66 (-)0.25 (-)8.96 (-) They are wrong/stupid 325 ETHICAL (+)10.62 (+)0.00 (-)7.03 (-) Religion (long term) 514 ETHICAL (+)26.35 (-)1.23 (-)6.84 (-) Long term physical effects 60 HEALTH (-)0.20 (+)0.12 (-)2.08 (+) Detrimental to health 477 HEALTH (+)13.00 (-)2.66 (-)1.29 (-) Bad for you 653 ETHICAL (+)9.08 (-)0.59 (-)1.02 (-)

14 Table 5 Reasons positively and negatively associated with RECENT USERS Cell Chi Square Type Non- Exp. Past Recent Response N Reason P Phi Exp. Non- Users Users Non- Users POSITIVE ASSOCIATION Users 53 Personal abuse history 76 OBSERVATIONAL (-)28.13 (-)11.05 (+)23.22 (+) Know better 285 OBSERVATIONAL (-)9.09 (-)5.50 (+)15.99 (+) Fear what will happen 351 PSYCHOLOGICAL (-)6.85 (+)0.03 (+)1.01 (+) Long term physical effects 60 HEALTH (-)0.20 (+)0.12 (-)2.08 (+) Don't like PERSONAL CHOICE (-)3.20 (+)0.05 (+)0.50 (+) addiction/getting hooked 360 HEALTH (-)1.41 (-)0.15 (+)0.29 (+) Family abuse history 73 OBSERVATIONAL (-)15.75 (+)1.89 (+)1.64 (+) See friends/kids doing it 113 OBSERVATIONAL (-)9.80 (+)2.50 (+)2.18 (+)3.23 NEGATIVE ASSOCIATION 51 Religion (long term) 514 ETHICAL (+)26.35 (-)1.23 (-)6.84 (-) Don't believe in ETHICAL (+)17.62 (+)0.29 (-)15.04 (-) Bad for you 653 ETHICAL (+)9.08 (-)0.59 (-)1.02 (-) Detrimental to health 477 HEALTH (+)13.00 (-)2.66 (-)1.29 (-) They are wrong/stupid 325 ETHICAL (+)10.62 (+)0.00 (-)7.03 (-) Family teaching,upbringing 477 SOCIAL (-)2.17 (+)4.96 (+)1.42 (-) Self respect 87 PSYCHOLOGICAL (-)0.87 (+)3.08 (+)0.43 (-) Don't need 848 PERSONAL CHOICE (-)3.08 (+)0.12 (+)8.29 (-) Illegal 231 LEGAL (-)9.43 (+)15.83 (+)0.69 (-) Not approp. for occupation 76 ECONOMIC (-)5.29 (+)4.29 (+)2.41 (-) Seen (negative results) 452 OBSERVATIONAL (-)4.84 (+)10.01 (+)0.07 (-)1.33 Most refusal reasons given by recent users emphasize concern over the personal consequences of illicit drug use. Several response patterns are distinctively associated with recent users, including: concern over long term physical effects, don t like illicit drugs, and concern about addiction/ getting hooked. Since respondents in this group used at least one illicit drug within the past year, one might conclude that these reasons tend to be associated with drug-specific rather than general preventive effects of illicit drug use. Recent users cite observational reasons ( personal abuse history, family abuse history, seen friends/kids doing it, and know better ), a psychological reason ( fear of what might happen ), two health reasons ( long-term physical effects of illicit drugs and concern about addiction ), and a personal opinion ( don t like drugs ) as refusal reasons more often than other groups (Table 5). Recent users tended not to cite four ethical reasons ( religion long term, don t believe in illicit drugs, illicit drugs are bad/bad for you, illicit drugs are wrong/stupid ), a health reason ( illicit drugs are detrimental to health ), a social reason ( family teaching/upbringing ), a psychological reason ( self respect ), a personal opinion ( don t need illicit drug(s) ), a legal reason ( illicit drugs are illegal ), an economic reason ( illicit drug use is not appropriate for occupation ), and an observational reason ( seen negative results of illicit drug use ) as compared to other groups Random Answers 12

15 Some answers are random with respect to category of use. Such answers include, by descending frequency of response: not interested/lost interest in illicit drugs, generic health, don t want to try illicit drug(s), heard about it on TV, read about it, and the observation that drugs are dangerous. These reasons do not appear to be associated with any particular pattern of use; that is, recent users are about as likely to offer such refusal reasons as persons who have never used illicit drugs. Another way of looking at these refusal reasons is that they do not seem to provide any measurable protection against use of illicit drugs. 4. Discussion Ethical reasons for drug refusal such as "drugs are evil," a response offered most often by nonexposed non-users, may be difficult to maintain in circumstances where illicit drugs are more readily available. For example, if one s friends, neighbors, and family are involved to differing degrees with illicit drug use, then the issue is no longer theoretical and involves personal interactions with people one may not consider evil. An implication is that whereas a moral/ethical approach might be effective in preventing and delaying the onset of drug use in general, such an approach might not be expected to be effective with those who have been exposed to or become involved with drugs. Patterns of answers among exposed non-users are particularly important for drug prevention policy. In a society where illicit drugs are easily available, it is important to be aware of barriers that stand between the current use and a more widespread outbreak of illicit drug use. Given current discussions about whether or not to legalize certain drugs, it is interesting to note that exposed non-users cite legal status as a reason for refusing illicit substances. One possible implication is that relaxation of legal sanctions may result in additional users. Exposed non-users, on one hand, view the consequences of using drugs as significant; on the other hand, they report that the role of family, positive self-concept, and social integration are important factors in their decision not to use. One implication for prevention programming is that a balanced approach, which emphasizes both the sociological issues, such as enhancement of individual, family and social strengths, as well as the negative consequences of illicit drug use, may best foster attitudes associated with long-term refusal of illicit drugs. Response patterns of past users are more like those of exposed non-users than any other group, which suggests that many of the same attitudes associated with refusing to try illicit drugs when given the opportunity may also be associated with abandoning drugs after a period of experimentation. One implication may be that prevention programming that fosters attitudes of refusal to experiment with illicit drugs may later be important for helping those who have experimented with drugs to learn to abstain. 13

16 Technical Appendix A Method For Summarizing Categorical Data and Chi-Square Statistical Tests Standard categorical statistical techniques were used to summarize patterns of response to the drug refusal questions. Shown on Table A-1 is a cross-tabulation of category of use broken out by respondents who did and who did not offer religion as an explanation for not using drugs. Notice that a total of 514 respondents provided this explanation; 292 non-exposed non-users, 121 exposed non-users, 95 past users and 6 recent users; 4,579 respondents did not give this response. This appendix will explain the procedure of ascertaining whether there is evidence that specific refusal responses are associated with any particular group of respondents. The number of respondents in each category of use expected to give this answer by chance depends on the number of respondents who give each answer and the number of respondents in each category of use. Since about 10 percent of respondents offer religion as a refusal reason, and about 8 percent of the respondents are recent users, one would expect that by chance about.8 percent of respondents (approximately 40) should be recent users who also offer religion as a refusal reason. However, in this case only 6 recent users gave this refusal reason, 34 fewer than expected by chance. The cell chi-square is defined as: C= Cell Chi-Square E= Number expected O= Number observed C=(O-E) 2 /E Where: As the difference between observations expected by chance and those actually observed increases, the cell chi-square becomes larger; in other words, the cell chi-square is a measure of how much a cell departs from what is expected by chance. A cell chi-square is always positive because the numerator of the expression on the right side of the equation is squared. Thus the cell chi-square does not indicate if there are more or fewer observations than are expected by chance, only whether the distribution is different than what is expected by chance. The total chi-square statistic of a table is equal to the sum of cell chi-squares in the table. This statistic is a measure of the extent to which cells in the table as a whole are distributed differently than would be expected by chance. Notice that for Table A-1, the total chi-square statistic has a value of about 70. This indicates that there is a relationship between category of use and providing religion as a reason for refusing drug. Notice that the probability of achieving this total chi-square statistic by chance on a table with eight cells is This means that there is less than 1 chance in 10,000 that the distribution in this cross-tabulation can be explained by chance alone: it is highly probable that category of use is associated with whether or not respondents cite religious reasons for not using illegal drugs. 14

17 Table A-1 Category of Use by the Refusal Reason "Religion" Frequency Expected Cell Chi-Square Percent Did Not Answered Row Pct Answer Religion TOTAL Col Pct Religion Non-exposed Non-users Exposed Non-Users Past Users Recent Users TOTAL Frequency Missing = 3 STATISTICS FOR TABLE A-1 Statistic DF Value Prob Chi-Square Likelihood Ratio Chi-Square Mantel-Haenszel Chi-Square Phi Coefficient Contingency Coefficient Cramer's V Effective Sample Size = 5093 Frequency Missing = 3 15

18 Respondents offered 65 different reasons for not using drugs. It was not feasible to present crosstabulation tables and statistics separately for each of these reasons, but a method for summarizing results of these cross-tabulations was devised. Shown in Table A-2 are summary statistics drawn from the information previously presented on Table A-1. Table A-2 Summary Statistics for Refusal Reason "Religion" Cell Chi Square Type Non- Response N Reason P Phi Exposed Exposed Past Recent Non-Users Non-Users Users Users Religion (long term) 514 ETHICAL (+) (-)1.23 (-)6.84 (-)28.47 Some 514 respondents cited religious reasons for refusing drugs (col 2). There are significant differences among groups with respect to the rates at which religious reasons are offered (col 4). Phi (col 5) is a measure of association for the table as a whole which is derived from the chi-square statistic. The larger the value of phi, the more different than expected by chance is the observed distribution in the table. For exposed non-users, the cell chi-square is represented as (-) 1.23 (Table A-2; col 7). On Table A-1 it can be seen that 121 exposed non-users reported religion as a drug refusal reason, while about 134 were expected to do so by chance. The minus sign has been added to the cell chi- square to indicate that fewer than expected exposed non-users reported this refusal reason. The relatively small cell chi- square shows that this difference is relatively small, on the order of 10 percent. On Table A-2 the cell chi-square for non-exposed non-users is represented as (+)26.35 (col. 6). This measure indicates that many more non-exposed non-users than expected cite religious reasons for refusing illicit drugs. By examining the cell chi-squares associated with each category of use on Table A-2, it can be seen that non-exposed non-users are much more likely than expected by chance to cite religious refusal reasons, and that each subsequent category of use is increasingly less likely to cite this reason. This method of summarizing results is also useful for comparing distributions among reasons (for an example, see Table 2 in main text). The highlighted cell chi-squares on the top table are all positive, and arranged in descending order of magnitude. While exposed non-users are more likely than is expected by chance to cite each of these reasons, differences are more subtle with each subsequent reason. When a cell chi-square is between (+)1 and (-)1, the number of respondents who cite a given refusal reason is very close to what would be expected by chance. 16

19 A Test of the Model Late in 1988, a sample of 1,027 inmates entering the Texas prison system was surveyed using an instrument similar to that previously described for free-world adults. Among topics queried were reasons for refusing illicit drugs. The protocols for gathering this information were the same as were used for the general population. The prison data set offers a medium to test the hypothesis that drug refusal reasons are associated with categories of use. For example, it has been observed that in the free-world population, those offering religion as a reason for refusing drugs, are most likely never to have had an opportunity use illicit drugs. If this association is not accidental, one would also expect that inmates who volunteer religion as a refusal reason would also tend not to have an opportunity to use illicits. In other words, the associations between refusal reasons and categories of use observed in the free-world population should enable one to predict category of use from refusal reason in the inmate population. This test was implemented by first assigning the probability of membership of an inmate to a given category of use on the basis of the association between a given response and a given category of use, and repeating this process for up to three responses. Presented in Table A-3 are three refusal reasons reported by a respondent in the inmate survey. Two reasons, fear what will happen and family abuse history, are most closely associated with recent users in the general population. One reason, detrimental to health is most associated with non-exposed non-users in the general population. Assignment weight for this respondent is computed by adding associations in each category of use. In this case, this pattern of response is most closely associated with recent users and, on the basis of these responses, the best guess is that this inmate is a recent user. Some drug refusal reasons such as not interested in drugs and health are not significantly associated with any particular pattern of use in the general population. Other refusal reason are provided by fewer than 25 free-world respondents, and it is not possible to determine if these reasons are randomly or non-randomly distributed with respect to category of use. The refusal reason don t know offers another special case. While in the general population non-exposed non-users are just slightly more likely to volunteer this reason, most respondents do not have as many as three reasons for refusing drugs and offer 'don t know' as a refusal reason in addition to any other refusal reason they might have. However, when inmates offer at least one refusal reason other than don t know Table A-3 Probability of Assignment by Category of Use Non-Exposed Exposed Past Recent Reason Non-User Non-User User User Fear what will happen (-)6.85 (+)0.003 (+)1.01 (+)16.3 Detrimental to health (+)13 (-)2.66 (-)1.29 (-)11.69 Family abuse history (-)15.75 (+)1.89 (+)1.64 (+)3.42 Assignment Weight

20 which is non-randomly distributed in the free-world population, it is possible to make a guess about their category of use (Table A-4). Notice that in Table A-3, 211 inmate recent users volunteered a complex of refusal reasons most associated with recent use in the general population, while only 179 recent users would be expected to offer such a complex of refusal reasons by chance. Knowledge of refusal reasons volunteered by inmates also enables prediction of each other category of use at rates higher than expected by chance. While the additional ability to predict category of use from refusal reason among inmates is statistically significant (p=.000), differences are subtle (Phi=.223). Inmates tend to come from different social and economic backgrounds, have had different opportunities to use drugs, and have very different patterns of drug use than persons in the general population. The fact that a model developed on the general population has utility for making verifiable predictions among inmates is remarkable and suggests that the observed associations between refusal reasons and category of use could be widely distributed throughout the general population. 18

21 Table A-4 Anticipated Category of Use By Actual Category of Use ANTICIPATED CATEGORY OF USE ACTUAL CATEGORY OF USE Frequency Expected Cell Chi-Square Non- Percent Exposed Exposed Row Pct Non- Non- Past Recent TOTAL Col Pct Users Users Users Users Non-Exposed Non-Users Exposed Non-Users Past Users Recent Users Total Frequency Missing = 289 STATISTICS FOR TABLE A-4 Statistic DF Value Prob Chi-Square Likelihood Ratio Chi-Square Mantel-Haenszel Chi-Square Phi Coefficient Contingency Coefficient Cramer's V Effective Sample Size = 725 Frequency Missing = 289 WARNING: 29% of the data are missing. 19