Addiction (2001) 96, 809–813

EDITORIAL

Recent developments in drug-testing arresteesfor research purposes: an English perspectiveon an international phenomenon

In July 1999, a new programme of drug usemonitoring was launched in England and Walesunder the title of the New English and WelshArrestee Drug Abuse Monitoring programme(NEW-ADAM). The programme has its originsin the United States in the Drug Use Forecasting(DUF) program and more recently in the up-graded version known as the Arrestee DrugAbuse Monitoring (ADAM) program. Similarprogrammes have also recently been established,or piloted, in Australia, Chile, Malaysia, theNetherlands, Scotland, South Africa and Tai-wan. These and other countries have recentlyformed into an international consortium of coun-tries engaged in arrestee monitoring known as theI-ADAM (International-Arrestee Drug AbuseMonitoring) programme.

The aim of the I-ADAM programme is togenerate data on trends in drug abuse usingstandardized measures with the explicit purposeof making international comparisons of drug mis-use prevalence and other issues. The � rst inter-national comparison using standardized data waspublished recently under the title Comparing DrugUse Rates of Detained Arrestees in the United Statesand England (Taylor & Bennett, 1999). Thereport provided, for the � rst time,an authoritative indicator of differences in druguse prevalence among arrestees in England andthe United States using similar data collectionmethods.

In this short paper, I shall describe brie� y thekey characteristics of the NEW-ADAM and thenconsider international developments in ADAM-type programmes and some of the advantagesand disadvantages of this type of research.

The NEW-ADAM programmeThe NEW-ADAM programme (covering Eng-land and Wales) was launched in 1999 after 3years of developmental work which sought,among other things, to devise and test the re-search methods. The results of this developmen-tal research and a description of the methodsused have recently been published in the HomeOf� ce Research Studies series (Bennett 1998,2000).

The NEW-ADAM programme is based onrandom surveys of arrestees currently held inpolicy custody suites. The research is conductedin 16 locations in England and Wales with eightsites visited each year. The survey locations arerevisited every 2 years (eight in one year and eightin the next) in order to provide both cross-sectional and trend data on drug misuse preva-lence and other issues. Arrestees are selectedfrom among all eligible arrestees processed over24 hours a day and 7 days a week for the durationof the survey period (typically about 30 days).

The NEW-ADAM programme differs slightlyfrom some other I-ADAM programmes in that itaims to tackle a broad range of issues beyonddrug use prevalence. This is re� ected in thelength of the questionnaire, which is one of thelongest I-ADAM questionnaires, and covers arange of issues relating to health, treatment,criminal behaviour, living arrangement, lifestyles,weapons and guns and use of drug markets. It isalso notable in its close links with governmentdrugs policy and its particular emphasis on ex-ploring the links between drug use and crime(discussed in more detail below) and monitoringtreatment and health issues.

ISSN 0965–2140 print/ISSN 1360–0443 online/01/060809–05 Ó Society for the Study of Addiction to Alcohol and Other Drugs

Carfax Publishing, Taylor & Francis Limited

DOI: 10.1080/09652140020050933

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I-ADAM programmes in other countriesAll I-ADAM programmes are based to someextent on the methods used in the North Ameri-can programmes. The early DUF surveys in theUnited States were based on convenience sam-pling and covered just a few hours of the day.The more recent ADAM surveys use probabilitysampling covering 8 hours a day based on a‘stock’ and ‘� ow’ method of sampling followedby statistical modelling in order to achieve 24-hour-a-day population estimates. The Scottishpilot surveys were based on probability samplingof all eligible arrestees over 18 hours a day and 7days a week. The Australia DUMA (Drug UseMonitoring in Australia) programme uses conve-nience sampling over varying times of the daydepending on the local conditions.

All ADAM-type programmes use urinalysis asthe main method of drug testing. There arevarious advantages to urinalysis, including thespeci� c time scale over which drugs consumedcan be detected, the accuracy of the results andthe ease of collection. The programmes arebased typically on ‘chain of custody’ proceduressimilar to those used in the United States tominimize the risk of contamination and degra-dation of the samples. There is some variationacross countries in the type of test used. Allcountries include screening tests (typically im-munoassays) and some countries (notably Aus-tralia and the United States) use con� rmatorytests for some of the drugs tested (typically gaschromatography). There is also some variationacross countries in the cut-off levels used (al-though the I-ADAM consortium is currently de-vising a method to enable drug testingcomparisons across surveys with different cut-offlevels).

All countries also include an interview sectionas part of the data collection and participatingI-ADAM countries have agreed to include cer-tain core questions that are comparable across allinterview schedules. However, there is somevariation in the length and content of the re-mainder of the questionnaire. The US question-naire is relatively short and (apart fromoccasional use of addendum questionnaires onspeci� c topics) focuses mainly on recent drugconsumption. The Australian questionnaire isalso quite short and matches closely the USapproach. The Scottish questionnaire is quitelong and matches more closely the English andWelsh questionnaire.

Advantages of NEW-ADAM and I-ADAMprogrammesThere are many advantages to the developmentof ADAM-type programmes. The most obviousadvantage is that the research can provide anobjective indicator of drug use prevalence amongthe arrestee population. This data can be supple-mented with information from the self-reportsection of the interview to estimate more pre-cisely the types of drugs used (e.g. whetherheroin in relation to positive tests for opiates orcrack in relation to positive tests for cocaine).Arrestees may be regarded as the ‘high-risk’ or‘extreme end’ of drug misusers in the populationand information about this group can usefullysupplement prevalence estimates derived fromother sources (for example, national householdsurveys which tend to miss those at highest riskand treatment-oriented surveys which tend tomiss those who choose not to seek treatment).

ADAM-type programmes can also help ident-ify links between drug use and crime. The NEW-ADAM research, for example, includes anumber of measures of drug use (urinalysis re-sults, self-reported drug use over various periodsof time and recent expenditure on drugs) and anumber of measures of crime (current charge,number of arrests, self-reported crime and illegalincome). These measures can be used to deter-mine the general level of association betweendrug use and crime and speci� c associationsbetween types of drug use, types of crime anduser characteristics. It is also possible to generatemodels of the links between drug use and crimefrom the cross-sectional data and to test theseagainst the trend data. It is not really possible touse the research to tackle in any authoritativeway the issue of causality as it cannot deal effec-tively with the issue of temporal order. Neverthe-less, some insight into causality can be achievedby asking arrestees about the nature of the linkbetween drug use and crime in their own par-ticular case.

ADAM-type data can also be used to generateand monitor government policy. The � ndings ofthe NEW-ADAM programme have already beenbuilt into government performance targets. Oneof the current targets is a reduction of 3 percent-age points in the proportion of arrestees testingpositive for heroin (opiates) and cocaine/crack(cocaine) from the 1999/2000 ‘half baseline’ (theresults of the � rst eight surveys of the NEW-ADAM programme) (HMG, 2000). The re-

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search � ndings will also be used as one of themeasures of the government’s key performancetarget to reduce levels of repeat offending amongdrug misusing offenders by 25% by 2005. Thiswill be operationalized by identifying those ar-restees who report recent consumption of heroinor crack/cocaine and who also report high levelsof acquisitive crime. The latest annual report ofthe ADAM programme in the United States alsodescribes the programme as a research platformfor local and national policy analysis (NationalInstitute of Justice, 1999).

Disadvantages of NEW-ADAM and I-ADAM programmesIn parallel with the many advantages of ADAM-type programmes, there are a number of prob-lems facing this type of research. In manyrespects, the research is hard to conduct and isfraught with legal, ethical, methodological andpractical problems. Many of these problems arecommon to social science � eld research. How-ever, they are especially problematic in the tenseand often chaotic setting of police custody suites.Most countries conducting this kind of researchexperience the same kinds of problems and someof the key issues raised in England and Wales inparticular are discussed brie� y below.

Legal issuesArrestees in England and Wales are processed inpolice custody suites under the terms of thePolice and Criminal Evidence Act, 1984, andlater amendments. Research in police custodysuites is similarly directed and constrained. Inrelation to interviewing and drug testing, theresearch must take note of the requirements ofSection 1.1 of Code C of the new Codes ofPractice which state that all persons in custodymust be dealt with expeditiously and released assoon as the need for detention has ceased toapply (HMSO, 1995, p. 26). The key issue forthe research is whether interviewing and collect-ing voluntary urine specimens from arrestees de-lays of� cial processing. The main method usedto avoid delaying proceedings is to approacharrestees at a point shortly after their arrival atthe police station and before police interrogation.This period is typically taken up by police ad-ministrative work relating to the case and shouldnot delay processing. However, in order to separ-ate the research from the legal process, it re-mains necessary for the researcher to ensure that

nothing relating to the current arrest is dis-cussed.

A second legal issue concerns disclosure. Thelaw relating to disclosure requires that the pros-ecution makes available to the defence any evi-dence on which they intend to rely in makingtheir case. The main research issue is whetherthe material collected during the interview andwhether the urine specimen and the urinalysisresults could be used as evidence in court. Thiscould be problematic for a number of reasons,including the issue of con� dentiality and anon-ymity, as well as the cost and inconvenience ofresearchers repeatedly being asked to attendcourt. In the United States this problem hasbeen solved by legislation in the form of Codesof Federal Regulation which grants that infor-mation generated by the ADAM programmeshall be immune from legal process. In Englandand Wales the problem has been solved to dateby obtaining an agreement from the CrownProsecution Service that the material collectedwould not be called upon as evidence. However,this provision does not constrain the defencefrom requesting these materials. The extent towhich this might become a problem for theresearch will be discovered in due course.

Ethical issuesOne of the key ethical issues concerns ‘informedconsent’. This is an issue for all human subjectresearch. However, it is especially important inrelation to arrestees as their co-operation issought under conditions of captivity, in the hec-tic conditions of a police custody suite, withinperhaps just one or two hours of their arrest.

Nevertheless, it is important that arrestees en-ter into an agreement to take part in the researchon a voluntary and informed basis. This meansthat potential respondents must be givensuf� cient information about the research to allowthem to make a rational decision about compli-ance. This decision should also be made freefrom undue pressure on the part of the re-searcher. In practice, the researcher is instructedto read out a statement which identi� es theinterested bodies and which explains the ar-restees’ rights. This must also be done in aresearch setting which does not lend itself tolengthy introductions and in which the re-searcher must achieve target numbers of inter-views and specimens. Nevertheless, a properbalance must be struck which ensures both the

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rights of the individual and the successful com-pletion of the research. In reality, it has beenshown that most arrestees (over 90% of arresteesinterviewed in the � rst eight surveys of the NEW-ADAM programme) are willing to be interviewedand provide a urine specimen (albeit with thesmall inducement of a hot drink or cigarette).

The researchers have also been faced with awide range of moral dilemmas. Many of these arebased on potential breaches of trust. What hap-pens if the arrestee indicates to the interviewerthat he or she is in possession of a weapon, drugsor some other banned item? What happens if theinterviewer discovers that the arrestee has a con-tagious disease or has committed a serious crimeunknown to the police or intends to commit one?If the interviewer reports this information to thepolice, then it might be construed as a breach oftrust between the interviewer and the arresteeand a breach of the promise of anonymity andcon� dentiality. If the interviewer fails to reportthis information to the police, then some graveharm could done. This problem has been tackledin the current research by explaining to the ar-restee prior to interview that the promise ofanonymity and con� dentiality relates only towhat is said in response to the questionnaire. Ifthe arrestee offers unsolicited information unre-lated to the questionnaire, then the promise ofcon� dentiality and anonymity cannot be guaran-teed.

Methods issuesPerhaps the major methods (or measurement)issue concerns the accuracy of drug testing andinterviewing (self-report) methods. There is aconsiderable body of literature on the advantagesand disadvantages of each. Some research sug-gests that self-report methods underestimatedrug use when compared with drug testing(Fendrich & Yanchun, 1994), and some researchsuggests that drug-testing underestimates druguse when compared with self-reports (Edgar &O’Donnell, 1998). It was decided during thedevelopmental stages of the NEW-ADAM pro-gramme to use both methods in order to obtainthe unique advantages of each and also to providea comparison across the two data collectionmethods.

Employment issuesThe � eldwork for the NEW-ADAM programmeis conducted by researchers who are trained to

interview arrestees in police custody suites and tocollect urine specimens using agreed ‘chain ofcustody’ procedures. One research issue con-cerns the ‘duty of care’ that the University asemployer has over the researcher. In particular,the researchers should not be put into a situationthat might cause them harm. This requirement iscommon to all � eld research involving employedinterviewers. However, it is especially problem-atic in relation to high-risk research.

The issue of interviewer safety has been tackledin the NEW-ADAM programme by developingrigorous procedures and by the use of guidelinesfor methods of dealing with potentially dangerousevents. This problem is also tackled to someextent by fact that the research is conducted inthe vicinity of trained police of� cers and in ex-tremely controlled conditions. However, it isdif� cult, if not impossible, to remove every po-tential harm when conducting research on ar-restees in the cramped and occasionally stressfulconditions of police custody suites.

ConclusionsThere are one or two conclusions which can bedrawn from this brief overview. In recent years,there has been an unprecedented and inter-national growth in arrestee drug-abuse monitor-ing using ADAM-type methods of interviewingand drug testing. This has recently resulted in theestablishment of an international consortium ofparticipating countries under the acronym I-ADAM.

I-ADAM countries tend to identify similarbene� ts as the main reasons for implementing theprogramme. At the general level, the programmesare seen as powerful research tools which can beused for monitoring and understanding drug mis-use and for devising, monitoring, and evaluatingdrugs policies. At a speci� c level, they are viewedas providing insight into the links between druguse and crime and identifying drug use, health,lifestyle and behavioural problems among rep-resentative samples of arrestees.

It is also widely believed (with some supportingevidence) that the majority of problem drug usersin any particular country will be found in thepopulation of arrestees. Regardless of the actualpercentage, the population of arrestees is seen asan important and possibly unique point of con-tact for tackling the problems of both currentlyactive offenders and problem drug misusers.

The drawbacks of the research are also widely

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recognized. There are many legal, ethical, meth-ods, employment and human subject issues thatneed to be tackled before programmes of thiskind can begin to provide results.

Despite these problems and the considerableeffort involved in conducting the research,ADAM-type programmes have produced import-ant national and international � ndings. The re-sults are relevant to a wide range of audiences andare particularly relevant to academics researchingdrug misuse and crime, members of professionalhealth and criminal justice organizations andpolicy makers responsible for implementing na-tional and international drugs strategies. Thefuture success of the I-ADAM programme andthe national ADAM programmes will depend onthe extent to which they can show that theycan maximise the advantages and minimise thedisadvantages of conducting this type of research.

TREVOR BENNETT

Institute of Criminology, University of Cambridge,7 West Road, Cambridge CB3 9DT, UK

ReferencesBENNETT, T. H. (1998) Drugs and Crime: the results of

research on drug testing and interviewing arrestees,Home Of� ce Research Study 183 (London, HomeOf� ce).

BENNETT, T. H. (2000) Drugs and Crime: the results ofthe second developmental stage of the NEW-ADAMprogramme, Home Of� ce Research Study 205 (Lon-don, Home Of� ce).

EDGAR, K. & O’DONNELL, I. (1998) Mandatory DrugTesting in Prisons: the relationship between MDT andthe level and nature of drug misuse, Home Of� ceResearch Study 189 (London, Home Of� ce).

FENDRICH, M. & YANCHUN, X. (1994) The validity ofdrug use reports from juvenile arrestees, InternationalJournal of the Addictions, 29, 971–1985.

HER MAJESTY’S GOVERNMENT (HMG) (2000) TacklingDrugs to Build a Better Britain: United Kingdom anti-drug co-ordinator’s National Plan 2000/2001 (London,Stationery Of� ce).

HMSO (1995) Police and Criminal Evidence Act 1984(s.60(1)(a) and s.66): codes of practice (London,HMSO).

TAYLOR, B. & BENNETT, T. H. (1999) Comparing DrugUse Rates of Detained Arrestees in the United Statesand England (Washington, DC, US Department ofJustice).