Drug War Distortions: Cannabis and Drug Treatment Part II

The Substance Abuse and Mental Health Services Administration (SAMHSA) in March 2005 released a report on the number of marijuana users referred to drug treatment from 1992 through 2002. According to SAMHSA, "Admission rates for primary marijuana increased nationally by 162 percent between 1992 and 2002 (Figure 1). Rates were calculated per 100,000 persons aged 12 or older. The number of marijuana admissions per year more than tripled in this time period. In the same period, the proportion of marijuana admissions increased from 6 percent of all admissions to 15 percent of all admissions."

The data comes as no surprise. The FBI reports in its Uniform Crime Report that in 2002, there were 697,082 marijuana arrests in the US, compared with 342,314 marijuana arrests in 1992.

In addition to mounting arrests, the number of cases referred through the criminal justice system has increased greatly since 1992. The TEDS data shows that in 2002, 58.1% of those reporting marijuana as their primary substance were referred to treatment by the criminal justice system directly; only 35.8% of all those referred to treatment that year were referred by the criminal justice system. In 1992, only 47.9% of those reporting marijuana as their primary substance had been referred through the criminal justice system; 33.3% of all those entering treatment that year were referred in that manner. Altogether from 1992-2002, 53.6% of those reporting marijuana as their primary substance were referred through the criminal justice system; 34% of all those entering treatment in that period were referred in that manner.

Also in that time, the criminal justice system has enthusiastically embraced the treatment-alternative-to-incarceration/drug court approach to handling drug using offenders. The US Office of Justice Programs Drug Court Clearinghouse at American University reported in its Drug Court Activity Update of Jan. 1, 2005 that in 1992, there were a total of ten drug courts operating in the US; by 2002, that number had grown to 1,086. At the beginning of 2005, there were a total of 1,262 drug courts. In addition, in 2000 California voters approved Prop 36, a law which "allows people convicted of 1st and 2nd time nonviolent, simple drug possession to receive drug treatment instead of incarceration." Efforts are ongoing in other states to enact similar legislation.

The question is begged, is treatment appropriate for these offenders, or are they seeking treatment because they see it as a preferred alternative to a criminal record along with a fine and/or imcarceration or an extended probation? One bit of data that should help get a handle on this are the diagnoses of these offenders. The treatment data reported by SAMHSA in its report deals only with the primary substance of abuse, which is "the main substance reported at the time of admission." The data for its report came from the Treatment Episode Data Set. According to SAMHSA, "The Treatment Episode Data Set (TEDS) is a compilation of data on the demographic and substance abuse characteristics of admissions to substance abuse treatment. Information on treatment admissions are routinely collected by State administrative systems and then submitted to SAMHSA in a standard format."

Data from the TEDS series are available for analysis at the Substance Abuse and Mental Health Data Archive at the University of Michigan's Inter-University Consortium for Political and Social Research (ICPSR). Though the data are incomplete for DSM diagnoses, the available figures show that of those reporting cannabis as their primary substance of abuse in 1992, 24.9% were diagnosed with cannabis dependence, and an additional 19.4% were diagnosed with cannabis abuse. By 2002, the figures had climbed somewhat: 37.6% of those reporting marijuana as their primary substance at admission were actually diagnosed with cannabis dependence and 24.8% were diagnosed with cannabis abuse. Over the period studied, 1992-2002, of all those reporting marijuana as their primary substance of abuse only 35.4% were diagnosed with cannabis dependence and 24.7% were diagnosed with cannabis abuse. Again, the data is quite incomplete -- only 24.6% of the cases from 1992-2002 could be examined. This does show improvement in data quality -- 21.5% of these cases in the datafile in 1992 had valid codes compared with 29.4% in 2002.

Finally, the data regarding self-referral and referrals through drug and alcohol abuse or other health care providers should be compared. In 1992, 22.5% of those with marijuana as their primary drug were 'individual' referrals, which include self-referrals; 7.4% were referred through alcohol/drug abuse care providers, and 6.3% were referred through other health care providers. In 2002, 16.6% were individual referrals, 5.4% were referred by alcohol/drug abuse care providers, and 4.7% were referred by other health care providers. So we do see somewhat of a decline in referrals from these other non-court-related sources.

Distortion 17: Cannabis and Drug Treatment Part II