MONITORING TRENDS IN DRUG-USE - STRATEGIES FOR THE 21ST-CENTURY

Since the 1970s the United States and other nations have conducted reg ular statistical monitoring of the prevalence and patterns of drug use in their populations. Given the importance of such surveys for policy making, their quality is a critical issue, and the biases that may aff ect their measurements become a major concern. An increasing volume of empirical evidence shows that the mode of administration of a survey can strongly influence the validity of respondents' reports. Compared with interviewer-administered questionnaires, self-administered forms appear to elicit more complete reporting of drug use, but the challeng es they pose to the literacy skills of respondents may result in measu rement biases. In addition, processes of social change may confound tr ue shifts in drug use with changes in the willingness of respondents t o report such use. The authors propose several strategies to improve m onitoring of trends in drug use. Those approaches include 1) more freq uent use of a survey technology-audio computer-assisted self-interview ing-that ensures full privacy for all survey respondents but does not require literacy; 2) increased use of time-series of indicators of dru g use consequences built from blinded surveys of medical records; and 3) population-based surveys that collect biological specimens (e.g., h air samples). Data from the latter two sources are not subject to the same constellation of biases that afflict self-reports of drug use. Ti me-series of those data can be integrated with self-reports to provide a better understanding of changes over lime in the prevalence and pat terns of drug use.