The Chicago Tribune; Friday, December 12, 1997
Naftali Bendavid, Washington Bureau.

The finding appears to confirm what many experts have long believed, that traditional methods substantially undercount hard-core addicts. The undercount, if it is found elsewhere in the country, could affect how resources are allocated to fight drug abuse.

As many as 333,000 Cook County residents are hard-core users of powder cocaine, crack, or heroin, according to the in-depth study, which is scheduled for release next year but was obtained by the Tribune.

In contrast, a recent, more traditional federal survey showed only 117,000 users of illegal drugs other than marijuana in Cook County, and that included casual as well as hard-core users.

The number of hard-core drug users across the country usually is estimated at 2 million. The new study raises the possibility that the estimate is significantly low.

Peter Reuter, a drug expert who teaches at the University of Maryland, said the new Cook County figures are "troublingly high."

"If the number of serious heroin and cocaine users is so much larger than we thought, then the size of the markets and the revenues generated are likely to be as well," he said. "There are more people out there committing crimes related to drug use, and not in treatment, than had previously been expected."

The study was conducted for the Office of National Drug Control Policy, often called the drug czar's office, by Abt Associates Inc., a respected research firm in Cambridge, Mass.

Mayor Richard Daley was notified of the study's results in September. The findings bolster Daley's frequent assertion that the federal government needs to do more to help cities fight crime, his aides said.

"They chose Chicago to demonstrate the breadth of the problem," said Tom Needham, assistant to the mayor. "This would be a great place to start with more drug treatment and more resources for the schools."

The findings also could influence the debate over whether to concentrate treatment resources on hard-core addicts or more casual users.

"The findings are probably closer to the real picture than what is normally recorded," said Joseph Califano, a former U.S. health secretary who now heads the Center on Alcoholism and Substance Abuse in New York City.

"If these numbers are true, we have to look at providing a lot more treatment to hard-core drug users than is currently available," Califano said.

The Office of National Drug Control Policy, which coordinates the nation's drug-fighting efforts, declined comment on the study.

The study does not suggest that hard-core drug use has gone up, only that it is more widespread than many thought. That in itself causes consternation among drug experts.

The Chicago study was designed to address a longtime problem: Because the most serious drug abusers often live on the fringes of society, the usual ways of tracking them may be inadequate.

Studies of drug use, such as an annual survey conducted by the Health and Human Services Department, generally rely on phone calls or household visits. That is the least expensive approach.

It is also a flawed one, many believe. A high percentage of hard-core addicts are largely inaccessible--sleeping on the streets, residing in homeless shelters, living in flophouses, staying with friends.

To get a more accurate count, the drug office decided several years ago to conduct an in-depth examination of one specific metropolitan area. Cook County was chosen because of its diverse population, including Chicago's gritty urban neighborhoods and an array of suburbs.

From March to November of 1995, researchers fanned out to the Cook County Jail, homeless shelters and drug-treatment centers.

By extrapolating those findings to the entire county, the researchers concluded that the number of hard-core cocaine and heroin users is not 117,000, but ranges from 318,000 to 333,000. Hard-core users are defined as those who have used drugs on eight or more days during at least one of the preceding two months.

The new estimate "is much higher than conventional surveys would suggest," the study says.

"But it is certainly not implausible."

The new findings do not necessarily mean the number of hard-core users is three times higher nationwide than previously thought.

"The results of this feasibility study cannot be extrapolated to the nation," the report cautions. "The next steps will be to apply the approach to an entire region of the country and then, assuming that results are favorable, to the nation."

Still, there is no reason to believe that other urban areas have been undercounted any less than Cook County. Indeed, that is why it was selected.

"Probably in any area of the United States that they conducted a study of this sort, they would find that the number is greater than anyone had expected," said Daley spokeswoman Jacquelyn Heard. "So I don't think that Chicago or Cook County is in any way unusual in that respect."

One of the study's most striking figures relates to the African-American population. The report finds that about 240,000 Cook County blacks are hard-core drug users. That is between one-fifth and one-sixth of the county's 1.3 million African-Americans.

In addition to refocusing attention on the drug problem, these findings could affect the nation's drug policy debate.

Some drug experts, for example, have long favored targeting hard-core users. Severe addicts are responsible for much of the drug trade and the attendant crime, the thinking goes, so it makes sense to focus on them. Others respond that hard-core users are the hardest to treat, and it is much more efficient to target casual users.

If the hard-core faction is much bigger than previously estimated, that may lend force to the argument for spending more on that part of the population.

The federal government spends about $15 billion a year on anti-drug efforts. No breakdown exists regarding how much of that goes to either hard-core or casual users.

CAPTION: PHOTOS (color): In a City of Chicago and privately funded effort to reduce HIV transmission among drug users, old syringes are exchanged in a trailer at 47th Street and Vincennes Avenue. PHOTO (color): Drug users trade old needles for new ones Thursday in a trailer at 47th Street and Vincennes Avenue. The Chicago Recovery Alliance runs the site aimed at reducing AIDS among users. Tribune photos by Milbert Orlando Brown. GRAPHIC (color): Cook County drug use. - How the drug czar's survey breaks down: Gender, Race, Age. Chicago Tribune. - See microfilm for complete graphic.

Copyright 1997/The Chicago Tribune. Reproduced with permission. Reproduction of this article (other than one copy for personal reference) must be cleared through the Permissions Desk, The Chicago Tribune, 435 North Michigan Avenue, Chicago, IL 60611.
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