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Objectives. This study examined differences between the visibility of drugs and drug use in more than 2100 neighborhoods, challenging an assumption about drug use in poor, minority, and urban communities.
Methods. A telephone survey assessed substance use and attitudes across 41 communities in an evaluation of a national community-based demand reduction program. Three waves of data were collected from more than 42 000 respondents.
Results. Measures of neighborhood disadvantage, population density, and proportion of minority residents explained more than 57% of the variance between census tracts in visibility of drug sales but less than 10% of tract-to-tract variance in drug use. Visible drug sales were 6.3 times more likely to be reported in the most disadvantaged neighborhoods than in the least disadvantaged, while illicit drug use was only 1.3 times more likely.
Conclusions. The most disadvantaged neighborhoods have the most visible drug problems, but drug use is nearly equally distributed across all communities.Thus, efforts to address drug-related problems in poorer areas need to take into account the broader drug market served by these neighborhoods. (Am J Public Health. 2001;91:1987-1994)
Illicit drugs are associated with a panoply of social, economic, and health problems, and efforts to reduce use have met with mixed success. Despite strict penalties for illicit drug use and sale-part of a "war" against drugs involving an annual cost of $40 billion1-use of illicit drugs remains widespread and continues to be a serious health and social problem. Multiple reasons explain the limited effectiveness of substance abuse programs. One is that programs focus on visible manifestations of substance use. In particular, in the framework of prevention efforts, programs focus on illicit drug use in poor and minority communities where drug markets are most visible. Yet visibility of drugs in particular communities does not necessarily imply drug use among residents of those communities. As a result of the conflation of visible drug use with presumed drug use, community-based demand reduction strategies may fall short of their desired impact.
To deal more effectively with illicit substance use, public policy has increasingly emphasized demand reduction. National policy remains heavily focused on law enforcement approaches, but there has been a steady increase in investment in prevention, treatment, and research.2 A key thrust of these activities has been to...